Gou is practicing medicine in the clinic

If the enlargement of the heart is not resolved, the mitral valve will be found to be incompetent again just after repair.

This is a typical example of how high the Tao is and how high the devil is.

"Heart enlargement causes mitral regurgitation, and then heart failure causes respiratory failure, combined with chronic obstructive pulmonary emphysema?"

Lian Tao pondered his thoughts and asked.

"It should be this process. What causes the enlargement of the heart?"

It's impossible for the heart to swell for no reason, right?
Even rheumatic heart disease cannot appear for no reason.

There must be a reason.

"I have two tentative diagnosis directions here, one is rheumatic heart disease and the other is pulmonary heart disease. The patient's symptoms are consistent with both diseases, and these two diseases are as difficult to distinguish as the real and fake Monkey King. .”

Cor pulmonale generally refers to heart disease caused by pulmonary hypertension.

Also called pulmonary heart disease.

It is relatively common clinically.

Since Lian Tao suspects rheumatic heart disease and pulmonary heart disease, it means that he is not very sure that the idea of ​​inferring the course of the disease just mentioned is correct.

"Since you suspect cor pulmonale, why don't you check the pulmonary artery?"

"Aren't we trying to figure it out here? I even asked Professor Wang specifically, but even he couldn't make up his mind. And he also pointed out that there are some doubts about whether it is rheumatic heart disease or pulmonary heart disease. I originally planned to do a test for the patient. A cardiac catheterization test was performed, but the family and the patient disagreed."

Lian Tao said with some distress.

Sometimes, when doctors encounter such difficult cases, they not only have to find ways to fight the cunning disease, but also work hard to persuade patients to cooperate with examination and treatment.

Some stubborn patients have their own ideas and do not trust doctors and nurses at all.

Such patients often have eight hundred thoughts.

The doctor told him that he needed surgery to save his life. He would secretly think to himself, "Does the doctor want to make more money just because I dress well?"

Under normal circumstances, the cost of surgical treatment will definitely be much more expensive.

This patient was unwilling to cooperate with cardiac catheterization. In fact, there were other ways to diagnose the condition.

Such as auscultating heart sounds.

In patients with pulmonary hypertension, heart sounds are often accompanied by murmurs.

This patient's heart sound has a murmur, which fits this characteristic.

In addition, routine blood tests, arterial gas and blood analysis and other examinations can also diagnose pulmonary hypertension.

In addition, echocardiography, chest X-ray, chest CT, cardiac MRI and other examinations can also assist in the diagnosis of pulmonary hypertension.

However, these tests cannot fully confirm the diagnosis.

“Does the patient have a bulge in the precordium?”

Li Jingsheng has diagnosed many patients with pulmonary arterial hypertension, and they often have bulges in their precordium.

"Have."

Lian Tao answered very simply this time.

"The patient's chest X-ray also showed pulmonary hypertension. Therefore, I think the diagnosis can basically be confirmed."

he went on.

"No wonder you suspect he has cor pulmonale!"

Li Jingsheng finally understood why Lian Tao and Professor Wang Weiwei were undecided.

According to clinical experience, pulmonary arterial hypertension will almost certainly lead to cor pulmonale.

Textbooks only say that lesions in the lung tissue or the pulmonary artery and its branches increase pulmonary circulation resistance and increase the load on the right ventricle, resulting in enlargement of the right heart, with or without congestive heart failure, and is called pulmonary heart disease. .

But doctors like Li Jingsheng and Lian Tao simply do not copy the contents of textbooks when diagnosing diseases.

They have long accumulated rich clinical experience and have their own set of diagnostic methods.

This is why medical doctoral students will never see a doctor when they go to the hospital. When treating patients, even taking medicine may require reading books on the spot or searching online.

Because theoretical knowledge is just theory.

It differs greatly from practice.

There are very few medical students who can really learn and apply it, if not none.

Most people need to continuously refine the theoretical knowledge they have learned in clinical practice before they can finally transform it into clinical experience that can truly diagnose and treat diseases.

"That's why it's difficult to identify this patient's condition. Pulmonary arterial hypertension and COPD are all pulmonary heart diseases. But he also meets the characteristics of rheumatic heart disease. I have been diagnosing respiratory diseases for so many years, and I am really alive. This is the first time I have encountered such a strange case in a long time.”

Lian Tao was probably scratching his unkempt hair again.

"By the way, why did you just say that this patient cannot use diuresis?"

"I didn't say that diuresis is not possible, I just said that it is a double-edged sword. Based on the patient's current situation, you may be able to maintain normal blood circulation in the body if you don't give him diuresis. After diuresis, pulmonary hypertension itself will exist, and blood lipids will also be quite high. Yes, I am a little worried about pulmonary embolism."

This disease is fatal.

Li Jingsheng treats patients and always maintains a clinic mentality.

Before treating a patient, the first thing he has to consider is not how much money he will make, but whether the patient will be at great risk after treatment.
If a patient dies, the clinic is finished.

Precisely because there is zero chance of trial and error, his sense of crisis and sensitivity in diagnosis and treatment work are unmatched by other doctors.

Although Lian Tao has been to his clinic many times, his crisis awareness is not as good as that of his boss Li Jingsheng.

This is also the weakness of human nature.

If the clinic is opened by Lian Tao, I guarantee that his mentality will be different.

They are all matters that have nothing to do with themselves and are left high and dry.

"Oh, don't scare me! We have given the patient diuresis and cardiac stimulation. When we brought him in, he was already in a dying state. We can't do it without resuscitation!"

Lian Tao was really scared when he heard about pulmonary embolism.

Diuresis can quickly improve the patient's edema, which is conducive to the recovery of heart function.

The treatment idea is absolutely fine.

However, if you consider that diuresis may lead to the occurrence of blood clots and a decrease in total blood volume, you must be cautious.

"Just a reminder! If diuresis has been used, the patient's blood pressure must be monitored at all times. Also, diuresis should not be too strong and must be done slowly."

Li Jingsheng's current medicine has not yet had time to upgrade its efficacy and dosage, and he cannot give any advice on the use of medicine.

He has to work hard to save health points to increase his doctor level and proficiency in implantation surgery.

He promised Lian Tao that he would try to upgrade his colonoscopy skills within a month, and then help Lian Tao's 'girlfriend' do a colonoscopy.

At that time, it is likely that colonoscopy surgery will also be required.

If polyps or suspicious tumors are found, they must be removed.

Sometimes he couldn't understand why, with Lian Tao's excellent conditions, he wanted to find a girl with a serious illness as his girlfriend?

Love is something no one can explain.

He has now fallen into Ou Qinglan's love life.

……

Li Jingsheng pondered this difficult case over and over in his mind.

The patient's medical history stated that she had a chronic cough and felt short of breath when breathing.and the presence of prolonged heart failure.The patient's face is cyanotic and even he has a barrel chest, which are highly consistent with cor pulmonale.

In addition, it has been basically confirmed that the patient has pulmonary hypertension, and the possibility of supporting cor pulmonale is higher.

He asked Lian Tao to send over some test results that the patient would do later.

Based on the analysis of the patient's chest X-ray, chest CT, and electrocardiogram and other examination results, he believed that the patient not only had pulmonary hypertension, but also had high pulmonary venous pressure.

If this is the case, the evidence that patients have rheumatic heart disease will rise sharply.

Because according to his clinical diagnosis experience, cor pulmonale often has only simple pulmonary hypertension, without symptoms of both venous and arterial hypertension.

It is said that one thing cannot tell through a person, but one can underestimate a person.

After Li Jingsheng discovered that the patient might have both pulmonary artery and pulmonary venous double hypertension, he immediately downplayed the pulmonary heart disease.

Instead, he began to be optimistic about rheumatic heart disease.

However, there is another condition of cor pulmonale that can cause pulmonary venous hypertension, which is combined with left-sided heart failure.

This patient happened to have heart failure.

This also makes the doctor's diagnosis particularly difficult.

Lian Tao described the patient's disease as a real or fake Monkey King, which was so vivid.

"No, we can't just focus on the two causes of rheumatic heart disease and pulmonary heart disease. We have to change the direction and think differently."

Li Jingsheng also fell into the same quagmire as Professor Lian Tao and Wang Weiwei.

He realized that there was basically no solution for Ji Zhuisuo's two illnesses.

At that time, he will definitely start to doubt life like Lian Tao.

In fact, since the name of cor pulmonale appeared, doctors have been arguing endlessly about whether cor pulmonale is a disease of the whole heart or a left heart disease.

This case just fell into this strange circle.

In fact, cor pulmonale may be a complete heart disease or only a left heart disease.

There was once a very famous cardiac surgeon who performed autopsies on many patients who died of cor pulmonale in order to put an end to this topic that had been debated for many years.

The results showed that among the 40 patients who died from pulmonary heart disease, 17 had biventricular enlargement, and the rest had left ventricular enlargement.

In the end, the debate not only did not end, but the doctors argued even more fiercely.

At relevant academic exchange meetings, it was really not an ordinary bustle.

Everyone cited classics and classics one by one, and presented various clinical evidences to start a heated debate.

Li Jingsheng always felt that whether this patient had pulmonary heart disease or rheumatic heart disease, his heart disease was probably not simply caused by the lungs or the heart.There is probably a third party.It's just that this third party is currently hidden very deep and is not easy to find.

In the evening, after sending Ou Qinglan back, Li Jingsheng sat on the bed, still thinking about this mysterious case.

Diagnosing this extremely difficult case would also be of great benefit to him.

He was forced to review various clinical knowledge and rack his brains to find relevant clinical experiences in his memory.This is also a process of combining theoretical knowledge with practice.The next morning, he got up, washed up, and then prepared to go downstairs for breakfast.

I found that there were several unread messages on my phone.

Ou Qinglan sent him two messages.

"I had a nightmare just now. You were covered in blood and you didn't respond no matter how I called you. I was very scared."

This was sent at about three o'clock in the middle of the night.

At that time, Li Jingsheng was sleeping.

"My dear, I have never experienced falling in love with someone so unforgettable. You seem to be integrated into my life, and I can't imagine my life without you. Marry me soon, I want to marry you, I want to be you My wife, I want to have our little family, and I want to get along with you day and night."

She sent it around seven in the morning.

It seems that he must have woken up.

She usually gets up late in the morning and likes to sleep in.

I got up so early today, probably because I had something on my mind.

A gentle smile appeared on the corner of Li Jingsheng's mouth. This silly girl only now knows the power of love.

Not to mention, even if Li Jingsheng had been there, he still fell in love and couldn't extricate himself.

Ou Qinglan's status in his mind had quietly reached an unprecedented height.

It’s just that men’s feelings are deeper and they won’t be expressed easily.

"I have to send her a message back, or she'll scold me later."

Li Jingsheng held his mobile phone and pressed the voice button while going down the stairs.

"Give me a little more time, okay? I'll give you a warm little home next year at the latest."

Since she is getting married, she must have a decent wedding no matter what!
Now I haven't raised enough money to buy the clinic and the yard. How can I marry her in this case?

Girls tend to be more emotional. She must have been a little stimulated yesterday and was afraid that Li Jingsheng would leave her forever after being killed.That's why I couldn't wait to marry him and stay together forever.

"You idiot, come here for breakfast!"

Ou Qinglan has already bought breakfast.

And stood downstairs waiting for him.

If Li Jingsheng works in the clinic, Tang Ping usually brings him breakfast.

"Aren't you going to work today?"

Li Jingsheng was also very happy to see his sweetheart.

He quickly stepped forward and hugged her with his right hand.

"Your employees will see it soon."

She quickly broke away.

"You saw it, you saw it. What happened to me holding my girlfriend? Come on, let's go into the office and see what delicious food you bought me."

Li Jingsheng took her hand and entered the office.

"By the way, I have to tell Tang Ping not to bring me breakfast today."

He quickly sent a message to Tang Ping.

Otherwise, he would have had to eat two breakfasts.

Ou Qinglan bought him steamed buns, egg rolls, milk, angelica eggs...

"Qinglan, do you want me to open a breakfast shop?"

"Haha, it's good to open a breakfast shop! I see you are injured, so I want you to eat more so that the wound will heal faster."

She must have been confused about nutrition.

If Mu Yin from the People's Hospital were to match it, Li Jingsheng would be given at most two to three kinds of breakfast.

The body absorbs nutrients into two large parts.

One is the main nutrients, such as protein and fat, and the other is trace elements, vitamins, etc.

As for water, it is an essential substance for life.

"You haven't eaten yet, right? Let's eat together. We'll take a taxi there later. I won't be able to ride a bicycle to see you off these days."

Li Jingsheng pushed something with high nutritional value in front of her.

The two had breakfast together, and there was still a lot left.Ou Qinglan hurried to work.

Li Jingsheng naturally sent her outside the clinic.

I was lucky enough to catch a taxi.

He was also a driver who had been treated twice by Li Jingsheng.When he saw Li Jingsheng, he immediately greeted him warmly.

After watching Ou Qinglan get into the taxi and leave, Li Jingsheng turned back and walked towards the clinic.

There was no one in the guard room.

Xiang Cangsong is cleaning the yard.

According to the agreement, Xiang Cangsong did not need to do these tasks.But he cherishes this hard-won good job.

Although he has to work 24 hours a day, it is much easier than his motorcycle ride.

Moreover, it can protect you from wind and rain, have a stable income, and have five insurances and one housing fund.No more worries about being caught by city managers.

Li Jingsheng's heart moved slightly as he looked at Xiang Cangsong who was cleaning hard.

There is still most of the breakfast left.

They are all untouched.

He now has no shortage of food and clothing, and Xiang Cangsong's family is still living a tight life.

Immediately go into the office and pack the remaining breakfast bags.

"Lao Xiang, I bought too much breakfast. If you don't mind it, take it home for your wife and children."

"Oh, these are all expensive breakfasts. I usually wouldn't bear to buy them. Thank you, boss."

Xiang Cansong took it and looked at it, his face full of joy.

The bottom has bottom-level happiness.

And it's often simple.

The boss gave him the leftover breakfast, which was enough to make him happy for a long time.

"It's still hot, take it home and give it to your wife! If you have any difficulties at home, you can tell me."

Li Jingsheng knew that Xiang Cangsong lived not far away, and it was very convenient to go back and forth.

"Thank you, boss! Following you is my greatest blessing. Compared with before, my life now is full of hope."

"Haha, are you talking too much now? Work hard and your basic salary will be increased by 200 yuan/month for every year you work."

Packing in the warehouse could have allowed Xiang Cangsong to make extra money, but Li Jingsheng did not make this offer due to various considerations.

Human greed.

Lao Xiang's job is as a security guard. If he is involved in packaging and shipping, he can certainly earn some extra income.

But it can also easily affect your job.

When the time comes, Lao Xiang will definitely pack his bags in order to make more extra money.

It is easy to neglect your own job and even cause problems.

In the end, Li Jingsheng could only fire him.

After in-depth consideration, Li Jingsheng finally decided to let Lao Xiang do his job exclusively.

After he finished his breakfast, he turned and walked towards the reception hall.

A new day of work is about to begin again.

Who would have expected that before he sat down, someone would text him on WeChat.

Only by adding WeChat friends can you give him a voice message.

who is this?

He took out his phone and saw the voice connection from Lian Tao.

Well, who calls the two of them close buddies?

Li Jingsheng quickly connected.

"Jingsheng, at about 50:[-] this morning, the patient with heart murmur and edema had an emergency. You were right, he had pulmonary embolism. Fortunately, you warned me yesterday and I made some preparations. And specially sent people to keep an eye on it.

When he had a problem, my doctors noticed it right away.

I quickly led people to take the patient to rescue.

This time I took the opportunity to do an arteriogram and found out that there was stenosis in the pulmonary artery.After all the hard work, the person was finally rescued.I just sat down to have breakfast. What a miserable life. "

As soon as he answered the phone, Lian Tao couldn't wait to talk a lot.

"Send me his arteriogram. I always feel that this patient may have a third diseased organ besides the heart and lungs. That may be the real source of the disease."

Li Jingsheng was not surprised at all when he heard that the patient had pulmonary embolism.

He still has this confidence. (End of chapter)