White armor

Chapter 384 Misdiagnosis for a Lifetime
"Old Meng, you've worked hard. You haven't gotten off work yet." Luo Hao greeted Meng Liangren with a smile.

"Professor Luo, you're back now. I told you to come back and see the patient."

"Definitely. The obsessive-compulsive disorder and severe paranoia have worsened. The patient can't sleep without looking at his eyes."

"Director Fang has not left. He has been waiting for you."

“???” Luo Hao then remembered Fang Xiao.

It’s not that Fang Xiao has no presence. Luo Hao has a deep memory of Director Fang, who is not careful with his words.

Luo Hao also remembered the trip to Changnan City and what happened in Changnan a few days ago.

It’s just that this experimental surgery was of such great significance that Luo Hao overlooked it.

Compared to the surgery, Fang Xiao was almost transparent.

Although Boss Chai has mobilized resources and Meng Liangren and Feng Zixuan have worked well together, the specific surgical work still needs to be done by Luo Hao, and all the content is new and needs to be mastered by Luo Hao himself.

He can be good at dancing with long sleeves and is smooth in dealing with people, but he is not good at scoring.

"Director Fang hasn't left yet." Luo Hao passed by, patted Meng Liangren, and poked his head into the office.

"Director Fang."

"Professor Luo!"

Fang Xiao was competing with Erhei, snapping his fingers continuously, but Erhei ignored him.

When Fang Xiao heard Luo Hao calling him, he jumped up from his chair.

"Professor Luo, you really treat the hospital as your home. You come back to see patients so late at night. I didn't believe it when I heard Lao Meng say that you must have come back."

"Haha, wait a moment, I'm going to go see Chen Jiao."

Fang Xiao followed Luo Hao quietly.

"Director Fang, what's going on?"

"Nothing, I just wanted to visit you to express my gratitude for what happened a few days ago. My old colleague was embarrassed and knew you didn't have time, so I came here shamelessly."

"You're too polite. It's just a passing thing. There's no need to take it to heart."

"but……"

"Hmm?" Luo Hao turned his head and looked at Fang Xiao.

"I performed surgery on a patient who had a car accident a few days ago, requiring a spleen removal. The patient is now staying in the ICU of our People's Hospital, and his condition is getting worse and worse." Fang Xiaozhi scratched his head.

This interface is so poorly found that I want to dig the ground with my toes.

But Fang Xiao is thick-skinned and not afraid.

"Wait a moment." Luo Hao smiled and turned to enter the ward.

Chen Jiao was reading a book. When she saw Luo Hao coming in, she smiled and said, "Hello, Mr. Luo."

"have not sleep yet."

"I was very nervous all day today. I didn't expect the operation to be so quick, and I didn't feel anything at all. Now I don't feel sleepy anymore. I'll read a book when I have nothing to do." Chen Jiao said with a smile.

Luo Hao took a look and saw that Chen Jiao was holding a book on biochemistry.

"No reaction at all?"

"Well, no, I'm fine. If Teacher Meng hadn't told me not to go to the bathroom, I would have gone to the bathroom by myself. Now I don't even dare to drink water because I'm afraid of trouble."

"Just bear with it for one night and we'll talk about it tomorrow. Although the injury is minor, we still need to take it seriously." Luo Hao smiled.

After chatting with Chen Jiao for a few minutes, Luo Hao turned and left.

Nothing is the best thing. Although Chen Jiao should be fine theoretically, Luo Hao is still worried.

Just seeing it will make you feel better. It will cure your obsessive-compulsive disorder.

"Director Fang, is there any problem with the operation?" Luo Hao asked.

"No, the patient's surgery was fine, I can confirm that, and it was hyponatremia, and after sodium supplementation he had convulsions and body stiffness. I messed up the surgery, at most he had hemorrhagic shock, it can't be blamed on me."

At this point, Fang Xiao suddenly realized that he had said the wrong thing and smiled embarrassedly, "Professor Luo, that's not what I meant."

"Low sodium? Is there a cloud platform?"

"Yes, I want it."

Fang Xiao originally just wanted to find an excuse, but he didn't expect Luo Hao to take it seriously.

This type of patient is occasionally encountered, and convulsions occur after trauma, which is generally considered clinically to be caused by excessive fright.

As for whether it will get better or not, that is not certain. Some patients may even die clinically due to convulsions.

There are different accounts of similar deaths, as well as various urban legends, ghosts and monsters, etc. Fang Xiao doesn't believe them.

Arriving at the office, Luo Hao sat down and snapped his fingers.

Erhei opened his eyes, rustled to Luo Hao's side, and put his shiny head close to Luo Hao for rubbing.

Fang Xiao looked at it with envy, but he still collected his thoughts and asked for the patient's information and entered it into the PTZ.

If you want to act, you have to put some effort into it, otherwise it won’t look good.

Professor Luo should know the purpose of his coming, but he should still take a look at the patient first and not take it too lightly.

"Professor Luo, please take a look at the patient's hospital test results."

Fang Xiao handed the phone to Luo Hao.

The patient was in a coma and dehydrated for 4 days, with intermittent vomiting and abdominal pain.

Laboratory examination: metabolic acidosis, hyperglycemia 37mmol/L, severe hyponatremia 89mmol/L, hyperlipidemia TG 223mmol/L, total cholesterol 41.4mmol/L. Sodium supplementation was given 2 hours after admission.

Luo Hao frowned, holding Erhei in his left hand and fell into deep thought.

"Professor Luo, I'm sorry. This kind of thing happens very often. I think the patient is suffering from convulsions due to the shock caused by the car accident." Fang Xiao scratched his head and explained embarrassedly.

"Convulsion caused by fright?" Luo Hao was silent for a few seconds and suddenly asked.

"Uh……"

Fang Xiao suddenly didn't even dare to fart.

If it were in the past, he would definitely think that Luo Hao was too young, did not have enough clinical experience, and had never encountered similar patients, so he would have such doubts.

But now Fang Xiao roughly knew the gap between himself and Luo Hao, so he dared not think so.

Professor Luo asked himself, he must be wrong.

But what was wrong with me? Similar patients were not uncommon. I had seen at least three or five similar patients.

"Professor Luo, what do you think?" Fang Xiao did not answer, but asked cautiously.

"First, the blood sodium value measured under conditions of high blood sugar and chylomicronemia is not true. Second, the blood sodium level rises too quickly, causing nerve demyelination, which is irreversible. This is already a major medical accident."

I am!

Fang Xiao was stunned. It turned out to be a major medical accident? !

Could it be that the several similar cases I have experienced in my life were all major medical accidents? !
In an instant, Fang Xiao's back was covered in cold sweat and his hands and feet were cold.

He had no doubt whether what Luo Hao said was true or not. Although he could understand every word, Fang Xiao had no idea what the principle was.

"I'm just kidding. There are many things involved here and it's quite complicated. Hyponatremia cannot be treated by just replenishing sodium. There are other things involved." Luo Hao smiled.

"For example?" Fang Xiao asked tentatively.

"Generally, the increase is no more than 0.5mmol/L per hour, and no more than 24mmol in 12 hours.

However, European guidelines recommend not exceeding 10mmol/24h.

There are literature reports that demyelination can occur when the dose is lower than 10mmol/24h. The US guidelines recommend an upper limit of 10 mmol/8h for those without high risk of demyelination and mmol/h for those with high risk of demyelination.

Some more cautious experts also suggest that for those without high risk of demyelination, the daily upper limit is 8, while for those with high risk of demyelination, the daily upper limit is 6.

In short, we are becoming more cautious. We are even more cautious for patients at high risk of demyelination who are malnourished, alcoholic, have liver dysfunction, or have hypokalemia. "

"..."

Sodium supplementation actually poses a risk of demyelination, no wonder patients suffer from convulsions!

Fang Xiao felt cold and wet all over, with a chill wind blowing in his ears.

After Luo Hao explained it carefully, he understood. The patient's convulsion was not caused by the car accident, but by the demyelination reaction of the nerves caused by the incorrect sodium replenishment speed.

Oh shit!

Fortunately, I found a random reason to bring up this patient, otherwise the patient would have continued to have convulsions and it would be hard to say whether he could survive in a few days.

"From the medical history, he had been in a coma and dehydrated for four days, and he was vomiting. All the indicators were extremely high, consistent with concentration after dehydration, but the blood sodium was abnormally low.

If the indicator fluctuates in the opposite direction, there must be a problem.

The serum sodium is probably not low and the osmotic pressure is probably hypertonic.

The occurrence of hyponatremia is a dilution phenomenon caused by the body's attempt to regulate osmotic pressure, or it may be pseudo-hyponatremia caused by increased triglycerides.

Further identification is done by measuring osmotic pressure and blood sodium by blood gas analysis ionization method. "

"Can your hospital do it?" Luo Hao turned his head and asked Fang Xiao.

“???” Fang Xiao was stunned. Luo Hao had just said a lot of things, and they all sounded very familiar to him. But now thinking back, he felt like he had brain fog. He couldn’t remember anything about what Professor Luo Hao had just said.

Fang Xiao even felt that he was not a doctor, but just an ordinary patient's family member.

"Director Fang, here." Meng Liangren handed over a piece of paper with a long paragraph written in cursive on it.

"Oh, I spoke too fast." Luo Hao smiled, took the paper where Meng Liangren had written the words, and began to explain to Fang Xiao word by word.

Meng Liangren was sweating all over his forehead.

When Professor Luo was explaining the disease to Director Fang, he also checked whether his records were complete.

Assessment is truly everywhere.

Fortunately, I am serious and do it according to standard, so there should be no problem.

Fang Xiao was dumbfounded after witnessing all this, and was completely stunned.

Professor Luo said a few words to him, and Meng Liangren remembered everything? He must have been a member of the Imperial Guard in his previous life.

And the hand speed is too fast, shorthand?

But what really shocked Fang Xiao was yet to come.

As Luo Hao analyzed Meng Liangren's record word by word, Fang Xiao felt as if he was watching a horror movie, with his hair standing on end.

paralysis!

The content that he had just understood in a flash echoed in his mind. As Luo Hao talked about the treatment process and clinical reactions of several related patients, Fang Xiao realized one thing - all the similar patients he had met in his life were misdiagnosed!
When Fang Xiao thought of the unnecessary deaths of several patients, his heart froze and he could not move or breathe, as if the patients were already dead. (Note)
"Director Fang, the convulsion you mentioned must have happened accidentally, right?" Luo Hao asked.

Fang Xiao nodded in confusion.

"The patient died later. Was an autopsy performed?" Fang Xiao nodded first, then shook his head.

"Has anyone done a head CT scan after the seizure?"

"Yes, yes, yes." Fang Xiao answered repeatedly, "Cerebral hemorrhage! I think it's delayed cerebral hemorrhage."

"Convulsions and cerebral hemorrhages after sodium supplementation may lead to death due to further increase in osmotic pressure, which leads to dehydration and atrophy of brain tissue, and traction of blood vessels, resulting in death from bleeding. Supplementing sodium too quickly will only lead to demyelination or heart failure, and generally no cerebral hemorrhage will occur."

"Something like this."

Luo Hao finished speaking seriously.

Fang Xiao suddenly became anxious, "Professor Luo, what about the patient?"

"I didn't see the situation." Luo Hao spread his hands. "How about this, you find the director of your ICU and have a video consultation. I... I'll give Director Feng a call and register it with the Medical Affairs Office of the First Medical University. Do you think it's okay?"

"Good good."

Fang Xiao didn't care about his own face and began to contact the director of the ICU anxiously.

That side didn't care much, but soon succumbed to Fang Xiao's constant dragon roar.

Fang Xiao quickly created a group and started a video consultation.

He felt unfamiliar with this consultation mode. The doctor on duty at the ICU showed Luo Hao the patient's condition on his mobile phone and reported his current condition.

Luo Hao probably knew what was going on. He didn't talk too much and tried to explain the principle to the young doctor. Instead, he gave the treatment plan directly.

After more than ten minutes, the video consultation was hung up.

Fang Xiao was still worried, so he called the Intensive Care Unit of Changnan People's Hospital and repeatedly urged them to follow Professor Luo's advice.

Whatever happens, you are responsible for it!

Fang Xiao, who is always smooth-talking, said things like "I am responsible" very naturally, and he himself did not realize the subtle changes.

After repeated reminders, Fang Xiao put down his phone and walked back to the doctor's office.

Luo Hao was chatting with Erhei and Meng Liangren.

"Children nowadays are all like this. My sister's child hangs out on Bilibili. This summer he asked to go to Shanxi Jin Temple, Yanqing Temple and Jinzhong Jianguo Temple. He has no interest in traveling abroad." A smile appeared on Meng Liangren's square face.

"Why are you going out? I saw a few holes in the wall when I was abroad. I thought, are these holes for nail guns? Are they doing some kind of renovation? Then they told me that they were holes for guns. Some time ago, the students returned to China for medical treatment. Do you remember?"

"Remember, although Director Feng is mysterious, the news has spread all over the hospital." Meng Liangren said, "Many families have children studying abroad, and they are very anxious. One of the couples has to go and take care of them."

"Haha, that's not scary."

"Yes!" Meng Liangren suddenly raised his voice and slapped his chair, "Professor Luo, Director Feng's child from the Endocrinology Department has undergone sex reassignment surgery in the United States."

"Fuck, really?!"

"Really? Director Feng wanted to jump off the building the day before yesterday, but was stopped. I think that means he has bipolar disorder." Meng Liangren sighed, "You tell me, a good boy went abroad to study, and came back with a girl. What the hell is going on?"

"The day before yesterday?"

"You are doing research at Gongda, so I don't know. When I was writing medical records that day, I saw the hospital manager, patients, and their families running out to watch the fun."

"..."

"I took a look at it, and then I asked around and found out what was going on." Meng Liangren sighed, "Why bother?"

"The eldest son of the old Ma family had his sex changed. Old Ma is really strong, he didn't even know his child had his sex changed. It does sound shitty, but I'm still happy to see this kind of thing." Luo Hao smiled, "Go ahead, the more monsters the better, and the fewer good kids from the six counties the better."

Fang Xiao was a little confused after hearing this and stood there with his hands and feet tied.

"You're back, Director Fang." Luo Hao smiled and greeted Erhei while holding his arm around him.

"Professor Luo, I hope the patient can survive." Fang Xiao was a little nervous.

Although he is slick and erratic, he has always followed his heart over the years and is able to do the minimum necessary to cure diseases and save lives.

"It should be fine." Luo Hao smiled. "I think the patient's condition is not serious. The symptoms of demyelination are very mild. He will get better soon after appropriate treatment."

"I...I...I..." Fang Xiao stuttered, feeling extremely complicated.

"Oh, you don't understand, so there's no need to blame yourself." Luo Hao comforted.

Was this to comfort himself? Or was it to call for an explanation? Fang Xiao reacted for a moment before realizing that Professor Luo was comforting himself.

It's just that the way you said it sounds a bit like you are teasing yourself.

"It's true. In similar situations, 99% of doctors across the country will give sodium. The boss said that when he was young, he would just mix concentrated salt with saline and inject it directly into the patient."

"!!!"

"At that time, there were no micro pumps, so it was impossible to be precise. Most patients recovered, but a few had problems. What should we do if something went wrong? With the current technology and knowledge, we are at this level, so what can we do?"

"..." Fang Xiao was speechless.

"Go back and check the book. Next time you knock something over, just try to be more careful. There's no need to think too much." Luo Hao's smile was friendly.

Fang Xiao thought about it and felt that the limitations of history seemed a bit too much when applied to himself, but it made sense.

No, if it was a serious illness, I would just be looking for an excuse to get closer to Professor Xiao Luo. Why am I making myself uncomfortable?

Fang Xiao instantly freed himself from the guilt.

When Luo Hao saw Fang Xiao's expression change, he felt happy. Fang Xiao was indeed an interesting person.

"Professor Luo, OK, I will study hard when I get back. I will send you my study notes and you can help me with some guidance."

Okay, I climbed up the pole.

But Luo Hao didn't care what Fang Xiao said, as long as the patient was fine.

"Okay, I'll take a look at your study notes then." Luo Hao smiled, "Don't worry about the patient. By the way, have you had dinner tonight?"

"No..." Fang Xiao hesitated for a moment, but finally told the truth.

"Let's go out and have some noodles. The provincial capital is not like Donglian. If we were in Donglian, I would treat you to barbecue at the old restaurant in Dai'an. Boss Ding always buys the meat from Changnan, so it's very fresh."

Luo Hao chattered with a smile.

"Meng, have you eaten?"

"Nope."

"Let's go, change clothes and eat together." Luo Hao thought for a while, "Remind me to write the surgical record tomorrow morning."

"Okay."

The three of them changed their clothes and went downstairs.

It is already late autumn and it is slightly cool outside.

"Professor Luo, what did you eat when you were at Union Hospital?" Fang Xiao wanted to please him, so he picked up a random topic.

"Ha, this is a long story. It depends on who you are with. Director Qian likes to eat. I ate a lot of food at the Beijing Office when I was with him."

"???" Fang Xiao was startled. Beijing Office? This obscure word had not been mentioned for many years.

"Director Fang doesn't know?"

“I know a little bit, but I’ve never eaten it.”

"Then you must try it when you have time." Luo Hao explained while counting on his fingers as he walked, "Nanhe's Beijing office is a little expensive, but the quality of the dishes is online. You must order a bowl of spicy soup and mutton stewed noodles. If you are interested, you can also try their Kaifeng specialty, baked carp noodles."

"I'm not very interested in eating, but the carp baked noodles smell so good that I'm still drooling just talking about it now."

"Don't mention it. Although I haven't eaten it, I'm drooling just by hearing you say that." Fang Xiao said, "Anything else?"

Luo Hao smiled slightly. Fang Xiao was more aware of his role as the supporting actor than Lao Meng.

"The Sugansu and Gansu Liaison Office in Beijing has the best hand-pulled mutton among all the Liaison Offices in Beijing." Luo Hao continued to explain, "When I think of hand-pulled mutton now, it's not Inner Mongolia, but the Sugansu and Gansu Liaison Office in Beijing. If you're in the mood, you can order some skewers, but the skewers in Lei'an are better than those in the Sugansu and Gansu Liaison Office in Beijing, so I gradually forgot about it."

"How can I describe it? Fresh and juicy."

"By the way, you can also order Lanzhou beef noodles."

"Ah? Didn't they say that Lanzhou beef noodles didn't originate in Lanzhou?" Fang Xiao was surprised.

“Yes, but the Jiangsu and Gansu offices in Beijing are unwilling to give in. They call my hometown Lanzhou’s name, so why can’t I make it? It is said that Lanzhou ramen originated from Huaiqing Prefecture, Nanhe Province, but I haven’t seen any Lanzhou ramen in the Nanhe office in Beijing.”

Luo Hao gossiped while smiling.

Fang Xiao felt a little emotional. Professor Luo Haoluo was a man who had seen the world.

His eight years of undergraduate, master's and doctoral studies in the capital were not in vain, and he knows all the major offices in Beijing well.

"The other is the Yibin Liaison Office in Beijing. The downside is that there are too many people waiting for a table. But the food is delicious and very cost-effective. Every table here must order Yibin Yanmian and Lizhuang white meat. The rest can be ordered with your eyes closed. The average cost per person is about 100 yuan."

"Speaking of Li Zhuang white meat... Oh, I'm too busy now. Even though I don't like eating it, I was craving it so much that I still can't stop thinking about it."

do not like to eat?

So all these things went into the dogs' stomachs? Fang Xiao muttered inwardly.

"Professor Luo, which is the best Beijing office?" Meng Liangren asked.

"Changnan Liaison Office in Beijing, as long as you can eat spicy food, just go there with your eyes closed." Luo Hao said, "Fried noodles, beer duck, Jinggangshan bean curd, radish and pork ribs clay pot soup, all are very good choices.

But first, you have to be able to eat spicy food.

Sichuan Four, Shancheng, and Nanhu are all inferior. The spicy food in Xijiang is really spicy, dry and spicy. If you eat it once, you may have to go to the anorectal hospital. "

As he spoke, Luo Hao's expression changed slightly, as if he remembered something.

"There's a saying recently that persuading people to eat spicy food is the same as persuading them to have sex." Meng Liangren chuckled and started driving.

It was the first time Fang Xiao saw Meng Liangren driving.

He drove very naturally, with a hint of innocence.

It's a very strange feeling.

Especially Meng Liangren's square face and generous smile give people a sense of integrity.

Being able to drive a car without feeling greasy at all is a skill.

"It's delicious, but does your butt hurt a little after eating it?" Luo Hao asked.

"Hahaha." Meng Liangren laughed, "Professor Luo, you know this joke."

"I just found out about it. When you told me, I followed your train of thought and thought about it. I can roughly guess it."

Luo Hao didn't care whether he was driving or not, he was gentle and calm.

"Professor Luo, it seems like you haven't been to the girl's place for a long time." Meng Liangren reminded, "Women should be accompanied more often."

"Well, I've been really busy these past few days. After dinner, I'll send Director Fang to the hotel, and then go see Danizi and Zhuda."

……

……

Note: This is a discussion in Dingxiangyuan. After reading it, I recalled several patients I met. I was ashamed. I didn't expect there were so many things. It's a sin. I'm going to face the wall.

(End of this chapter)