Come on, Dr. Wu

Chapter 364 Progress
“Does this surgery have a good chance?”

The four of them looked at Xun Qi's outpatient clinic. Lin Dongping frowned and asked, and Jiang Yuankai shook his head when he heard it.

"It's not easy to treat. If it's just lymph node metastasis, it's okay. If there is distant metastasis, it can only be palliative surgery. It's difficult to cure it.

Especially since the tumor is so large, the risk of removing it is high. The child is only thirteen years old, and there is a high possibility of cardiopulmonary failure during the operation.

But we can’t just not do it.”

It is indeed not possible. The patient is so young. If we don’t do radical surgery, how can we talk about the prognosis and quality of life?

Now I just hope it doesn't spread far away.

The more difficult and serious the disease is, the more it tests the doctor's ability. Just like this, whether it is case analysis or diagnosis and treatment communication, it is very challenging.

There are many possibilities for mediastinal tumors. How should Xun Qi explain it to the patient? If he explains it as a minor case, what if the patient's family does not take it seriously? If he explains it as a serious case, what if it turns out not to be that serious?

Therefore, you must first make a judgment in your mind before you can proceed to the next step.

But don't think that once the examination is done, you can just look at the examination sheet and directly diagnose and start treatment based on the results on the sheet.

"Okay, Xun Qi is doing well, let's take a look at Pan Ying. Although high blood pressure is common, it is not easy to treat."

Miao Qingyan interrupted their discussion and spoke, and everyone looked towards Pan Ying's clinic.

To be honest, Pan Ying's performance during this period was not so ideal, especially in the first week. He was too pretentious and too artificial. This is what some patients said privately.

If you play up your identity, you won't be able to get close to the patients. If you pretend to be too pretentious, people will dislike you, especially Pan Ying, who easily forces explanations when he clearly doesn't know how to do it.

This is even worse.

Most of the patients in the cardiology department are old patients, the kind who have become doctors through long-term illness. If you give any inappropriate explanation, it will be noticed.

Therefore, communication between Pan Ying and patients has always been a problem. Habits are hard to change. In fact, this problem is not only in Pan Ying, but most doctors who have just entered the hospital have this problem.

Because they don't want the patients to feel that they are unreliable, so even if they don't know everything about the problem, they still force themselves to explain it.

But this can easily lead to problems.

Fortunately, Pan Ying gradually realized that this was not a good idea and has made many changes this week.

Especially last week's poor results have forced Pan Ying into a corner. Pan Ying has aspirations and wants to stay, so he must work hard this week.

Forced changes must be made.

Look, this week Pan Ying is obviously more pragmatic. Not only is he more active in his work, but he is also much more low-key. If patients have any questions they don't know, they just ask the teacher directly, or he says he will answer them later. Compared with the first week, Pan Ying is obviously more popular with patients.

They are all doctoral students from prestigious universities and have a good foundation. Once their attitudes change, the progress will be obvious.

Miao Qingyan also went from frowning at the beginning to feeling relieved now.

Therefore, I am still very much looking forward to Pan Ying’s performance this time.

In Pan Ying's clinic, a young male patient came in. Pan Ying took a look at the registration record and found that he was only 31 years old.

The patient was accompanied by his wife. Pan Ying stood up and pointed to the stool next to him and said, "Please sit down."

If you go to the outpatient clinic normally, you will basically not see this scene. However, this is an assessment. Although the doctors are real doctors and the patients are real patients, they will not lack any necessary humanistic care, including this step.

Not only Pan Ying, but also Fu Yuanhang and Xun Qi.

"Why did you come here this time?"

"He's been dizzy for a few days now, but he's been holding it in without telling me. I think he's dying. Bring him here right away."

Without waiting for the patient to speak, the patient's wife had already spoken. Looking at her husband, it was obvious that the wife loved and hated him. She hated that he did not actively seek treatment. Most people felt the same way. If they were sick, they could delay treatment and see how things got. However, they had to see a doctor as soon as possible for their loved ones, for fear that something might happen to them.

This may also be an important meaning of the company of family members.

"It's been a few days. What happened then?"

As the conversation progressed, the medical consultation went smoothly. However, the patient basically remained silent, and it was the patient's wife who helped answer the questions. However, every time Pan Ying got an answer, he would look at the patient, and only confirm it when he saw the patient nod.

Admitted to hospital due to dizziness for 7 days.

Seven days ago, the patient suddenly felt dizzy with no obvious cause, without obvious headache, blurred vision, nausea, vomiting, vertigo, limb movement disorder, syncope or blackout. He measured his blood pressure at 7/190 mmHg on his own. He did not take it seriously and it was relieved after rest. Over the past seven days, the symptoms progressively worsened.

hypertension!
so tall!
The high blood pressure is 190, which is already stage three hypertension, or severe hypertension. Judging from Pan Ying's condition, this type of hypertension occurs in young people and is generally secondary. Primary hypertension is really rare, especially when it is so high right from the start. Of course, it may also be due to bad living habits and not paying attention.

However, Pan Ying asked about the patient's occupation, and found out that he was a civil servant. Although he occasionally stayed up late and drank alcohol, he was no different from other young people, and should not have caused such serious consequences.

I'm afraid there are other reasons.

Pan Ying measured the patient's blood pressure on the spot. Normally, people use electronic sphygmomanometers to measure, which may have some errors, so outpatient clinics usually have mercury sphygmomanometers available for more accurate measurements.

Normally, Pan Ying and Zhong Beibei also use mercury sphygmomanometers in their work in the cardiology department to measure the blood pressure of patients who need to pay special attention to their blood pressure. Because they need to control their blood pressure precisely, electronic sphygmomanometers are still somewhat inappropriate.

200/120mmHg!

Wow, it’s taller.

"Does he have any other diseases?" "No, he had a physical examination two months ago. By the way, this is his physical examination report. I brought it here specially. Doctor, please take a look."

There is a checklist!

Pan Ying was relieved when he heard this. Although it had been two months, at least there was a reference. Hypertension is a chronic disease and it cannot be formed all at once. Even if the cause cannot be found accurately, it can be ruled out.

There are actually only a few diseases that can cause hypertension.

First look at the electrocardiogram, sinus rhythm, V4-V6 slightly decreased by 0.05mv.

This is actually not a big deal. Although there are some problems with V4-V6, when the patient was asked if he had any heart discomfort, he said no, so it should not be closely related to the heart. However, for this electrocardiogram, the patient should still consider rechecking the heart examination to eliminate hidden dangers.

Of course, long-term high blood pressure may also lead to this situation. However, when the patient was examined, his blood pressure was normal, 140/80 mmHg, normal high blood pressure. In other words, the patient's blood pressure rose so much within two months.

Renal function: Creatinine 122.1mmol/L.

Creatinine is high!
Seeing this, Pan Ying was also cheered up. Renal hypertension is still very common in the normal population. However, although the creatinine is high, it is actually not too high. The normal level is about 100. If it is more than 20, it may be due to staying up late in the past few days, taking some medicine, or eating too many calories.

Other findings showed that blood amylase and lipase were normal, and color Doppler ultrasound of the heart, abdomen, abdominal aorta and renal vessels showed no obvious abnormalities. There was no definite abnormality in the head CT scan, and no obvious abnormality in the upper abdominal CT scan.

This!
To be honest, Pan Ying felt that he had met a tough guy.

There is no other way but to hope for a physical examination. After all, his outpatient time is limited, and it is impossible for him to ask the patient to go for another examination. Moreover, the results of the examination cannot be obtained as soon as possible. It is best to lock in a target first and then check.

Pan Ying could only quickly conduct another physical examination.

The body temperature, heart rate and pulse are all normal. The patient is just dizzy, but his mind is clear and he can answer any questions clearly.

There was no yellowing of the sclera, no obvious bruises or ecchymoses on the skin and mucous membranes of the whole body, soft neck, neutral trachea, clear breath sounds in both lungs, no dry or wet rales. The heart sounds were strong, A2=P2, the heart rhythm was regular, the heart rate was 78 beats/min, and no pathological murmurs were heard in the valve areas. The abdomen was full, without tenderness, rebound pain, or muscle tension, no masses were palpated, and the liver and spleen were not palpated below the ribs.

Everything is normal. Everything is normal.

No, Pan Ying touched the patient's lower limbs and found mild pitting edema in both lower limbs.

Thinking of the creatinine level of the patient during the physical examination, suspicion of renal hypertension came to my mind again. Of course, hypertension caused by heart reasons can also cause edema in both lower limbs, so the main suspects are still cardiac and renal causes.

Outside, Wu Xiaofu and the others looked at the patient and felt worried for Pan Ying.

The treatment process for patients with chronic diseases has become a habit, so the treatment, although cumbersome, is not troublesome. However, finding the cause is not so easy.

"This patient's heart rhythm is actually fine, so it's probably not cardiac in origin."

Some doctors from various departments also came along to watch the assessment today. When they looked at this patient, they all started discussing. They had nothing to do anyway, so they might as well use their brains.

"No atrial fibrillation was found during this physical examination, but V4-V6 was slightly reduced by 0.05mv, which actually cannot rule out the possibility of paroxysmal atrial fibrillation. After all, our electrocardiogram can only detect the condition of the heart at that time, which cannot be ignored. If you are hospitalized, you still need to check a -hour electrocardiogram.

In addition, although the color Doppler ultrasound did not show an atrial septal defect, it does not rule out the possibility that the atrial septum was too small to be missed. It is best to repeat the transesophageal ultrasound to confirm it, and you can also check if there is any thrombus in the left atrium. "

This is a chief physician in cardiac surgery. He mainly expressed his opinions based on cardiogenic factors. After all, for such a young patient with such high hypertension, cardiogenic factors cannot be ignored. When it comes to cardiogenic factors, we have to consider some congenital heart diseases.

"If I were Pan Ying, I would do an electrocardiogram on the patient on the spot. Who knows, there might be a surprise."

Wu Xiaofu suddenly spoke, and everyone nodded. Only then did they notice that this clinic was equipped with an electrocardiogram machine. Well, it might be Miao Qingyan, as she had considered this before.

"I think it's more likely to be renal. The patient's creatinine was high two months ago, over 120, and there was no follow-up examination. Maybe two months later, the patient's creatinine is even higher. In fact, he should have been further examined at the time. After all, it is not impossible that he has renal insufficiency."

"That being said, even if we see that the patient's creatinine level is only slightly elevated in the outpatient clinic, we will not ask the patient to undergo a renal scan or anything like that. We can only ask the patient to eat a healthy diet and exercise to see if the patient can recover after the follow-up examination. The patient also said that he drank and ate barbecue with his colleagues the day before the physical examination. In fact, it is normal for the creatinine level to be slightly elevated."

"It's a pity that it takes at least an hour for creatinine to come out. Otherwise, it would be appropriate to check the creatinine now."

The discussion gradually became heated. This was actually a habit that doctors developed. The results obtained through one's own thinking would never be as good as those obtained through discussion. The collision of everyone's knowledge and inspiration would help to produce the correct answer. Even the director would not refuse people from discussing together.

"What does Director Jiang think?"

Wu Xiaofu suddenly looked at Jiang Yuankai and asked, "Cardiovascular and cardiovascular are actually very different. However, Jiang Yuankai is more professional than the doctors in other departments after all. As for Miao Qingyan, the results will have to be given in the end to judge whether Pan Ying's performance is good or bad, so just keep it for now."

Jiang Yuankai pondered for a moment and said slowly, "As for the cause of the disease, considering the patient's young age, we should first consider secondary hypertension.

The most common types of secondary hypertension are renal hypertension and renal vascular hypertension. If the patient has mild abnormalities in renal function, the possibility of renal hypertension is high.

Another thing to consider is endocrine hypertension, such as primary aldosteronism, pheochromocytoma and Cushing's syndrome, and the relevant hormones should be screened.

There are also sleep apnea-hypopnea syndrome and aortic coarctation, but there is not much support for these at present, so let's not consider them for now.

If it's cardiac, I don't think it's likely."

Jiang Yuankai basically summarized the causes of hypertension in adolescents, but it can be heard that Jiang Yuankai is more inclined to believe that it is caused by kidney factors.

"Well, this patient has a very prominent feature - acute onset of hypertension, and severe hypertension. This level of blood pressure is rare. Based on this feature, we can actually narrow down the scope a lot."

Lin Dongping also spoke up, "Acute onset of severe hypertension is rare. The causes are mostly acute renal failure, acute left heart failure, pheochromocytoma, and acute renal artery embolism. Based on the patient's clinical manifestations and the current examinations, pheochromocytoma cannot be ruled out. Acute renal artery embolism cannot be easily ruled out. After all, renal vascular color Doppler ultrasound sometimes has a certain false negative rate. So I think it is necessary to improve renal artery CTA if conditions permit."

After all, Pan Ying’s outpatient clinic still has the step of admitting patients. In fact, Pan Ying now only defines the diagnosis as hypertension, and then lists the necessary tests step by step. If the subsequent patient admission is good, the score will not be too low.

Everyone was talking about this, and actually, at this point, the cause of the patient's hypertension was already very narrow, with only a few possibilities.

"Look, Camp Pan is going to do an EKG."

(End of this chapter)