Come on, Dr. Wu

Chapter 365 Who taught you?
I saw that Pan Ying had already communicated with the patient and his family, obtained their consent, and started to do an electrocardiogram.

Yes, as a cardiologist, when I saw the electrocardiogram machine next to me, how could I not think of using it?

Miao Qingyan felt relieved when she saw this scene. She was really worried that Pan Ying wouldn't even do an electrocardiogram. Even if the electrocardiogram was done, there would still be no results. But you have to follow the necessary procedures.

"Paroxysmal atrial fibrillation!"

Looking at the electrocardiogram, everyone was excited. Paroxysmal atrial fibrillation, the electrocardiogram actually showed something.

Many times, some patients have paroxysmal atrial fibrillation without any symptoms, and most of them are discovered during an electrocardiogram. Moreover, it does not occur often, and it is usually not discovered until symptoms appear and the condition becomes serious, and a 24-hour electrocardiogram is done.

I have to say that Pan Ying is really lucky.

However, if the patient has paroxysmal atrial fibrillation, then the hypertension is probably of cardiac origin.

It can be said that before, people mostly tended to believe that hypertension was caused by renal factors, but now they have begun to change their mind and started to wonder whether it is caused by cardiogenic factors.

Even Pan Ying felt the balance in his heart tilted.

"He has to be hospitalized. At present, it seems that it is possible that he has renal hypertension or cardiac hypertension. The patient's electrocardiogram now shows paroxysmal atrial fibrillation. I am more inclined to believe that it is cardiac. After hospitalization, we will also need to check a 24-hour electrocardiogram to see the patient's heart condition.

However, although it tends to be cardiac, kidney problems cannot be ignored. Some exclusionary tests must be done immediately after hospitalization..."

Pan Ying gave instructions and started to issue hospital cards to patients, and also directly issued bills for various examinations.

Renal artery CTA, 24-hour electrocardiogram, etc. are all available.

Watching Pan Ying's operation, Miao Qingyan slowly asked Wu Xiaofu, "Director Wu, what do you think of Pan Ying's consultation?"

“In fact, there is nothing serious wrong with the patient. However, if it were me, I would directly admit the patient to the hospital for high blood pressure. As for the specific diagnosis, I would do follow-up tests and wait for the results to be determined. I would not be so decisive in telling the patient what the likely cause is.

Although paroxysmal atrial fibrillation was detected on the electrocardiogram, we should not forget that high blood pressure itself can cause atrial fibrillation. Who knows what the cause-effect relationship is?"

This!
Everyone nodded subconsciously when they heard this. Yes, it is still unclear whether it is atrial fibrillation that causes high blood pressure or high blood pressure that causes atrial fibrillation.

It's not just this patient. In clinical practice, many patients have both heart problems and blood pressure problems. Doctors also have difficulty distinguishing the cause and effect relationship between the two.

Those who know the sequence of their illness are fine, but those who don’t can only rely on the doctor to make a judgment after a series of examinations.

Pan Ying’s mentality is actually understandable. If he is not aggressive here to get high scores, it will be difficult for him to even maintain an average score, let alone surpass others.

If he really wants to stay, it will be even more impossible.

So, we have to fight.

However, at this time, the competition among the eight interns became interesting. It seemed that it had not been too obvious before, and only now did the cruelty of the competition appear.

"It's not easy to deal with the patients here, Jiang Bei."

Everyone landed in Jiang Bei's clinic. Hmm, isn't this easy to do?
Sitting next to Jiang Bei was an elderly male patient, 61 years old.

This time I came to see the doctor because of right lower abdominal pain for 2 days.

The patient had pain in the right lower abdomen. After everyone took a look at the patient, they were basically certain that it was appendicitis.

Jiang Bei performed a physical examination and found tenderness and rebound tenderness at McBurney's point, but other bowel sounds were normal. A digital rectal examination did not reveal any obvious abnormalities, and there was no blood when the rectal examination finger cuff was removed.

Aren't these just signs of appendicitis? After ruling out all the impossible, there's only one possibility left.

Wu Xiaofu actually said that Jiang Bei is difficult to deal with. Isn't this favoritism too obvious?

"I suspect it's appendicitis, but I'm not sure if it's the case or if there are other possibilities. My suggestion is to do an abdominal color Doppler ultrasound and then a CT scan of the abdomen."

Abdominal CT!

Before the patient said anything, the people watching frowned. It was obviously appendicitis. What kind of habit was this? It was not in line with the diagnosis and treatment process. If the medical insurance knew about it, it would be a sure thing. It was obviously over-medicalization.

Even if you suspect there is something else, you still have to check the color ultrasound and then check the CT scan if you find anything wrong.

"Who did you learn how to do a CT scan for appendicitis from? Really."

After saying this, the doctor also felt that he had spoken out of turn. This was an intern taught by Wu Xiaofu. Of course, this was definitely not taught by Wu Xiaofu. Wu Xiaofu almost didn't need to undergo examinations when seeing a patient, so how could it be possible for him to over-treat his patients?

It must be the bad habits I developed before that I brought here.

Wu Xiaofu supported his forehead and said, "Yes, that's right. He was the one who taught me that. After following Wu Xiaofu to the outpatient clinic these two times, the kid probably learned it. Appendicitis must be taken seriously and a CT scan should be done to be safe."

After all, every example Wu Xiaofu saw and every example he talked about were all cases of sudden onset appendicitis.

Although this patient appears to have appendicitis, there are indeed some suspicious points.

First I had tenesmus, then constipation. He said before that there was blood in his stool. I thought I had hemorrhoids, but the rectal examination just now didn't find anything.

Therefore, intestinal problems cannot be ruled out.

According to Wu Xiaofu's experience, there is most likely something wrong with the colon.

Then, whether the patient’s appendicitis is causally related to the disease is uncertain and cannot be ignored.

"Doctor, does appendicitis also require a CT scan?"

"It's not just about appendicitis, I suspect you also have a problem with your colon. Now we need to not only check whether you have appendicitis, but also check whether it is possible that the appendicitis was caused by the colon problem.

If so, simply removing the appendix surgically will not be enough. If the cause cannot be removed, it will be difficult to completely solve the problem."

It turned out to be the case.

The patient understood what was said and quickly agreed.

The crowd of onlookers didn't say anything after hearing this. This could be barely justified.

However, using CT scan to examine the colon is somewhat off topic. After all, the colon is usually located in the back of the abdomen and is blocked by the organs in front, so you can't see anything at all.

Unless there are some obvious problems, you won't see them at all.

Of course, since Jiang Bei wanted to do an exclusionary diagnosis and treatment, she did have her reasons.

However, most people are not optimistic about Jiang Bei's way of seeing a doctor. If there is no major problem with the later colon, then Jiang Bei's score, needless to say, must be pitifully low.

In fact, this is also the helplessness of clinical doctors. It is difficult to distinguish the line between over-medicalization and adequate diagnosis and treatment.

If you find out the problem, it is adequate diagnosis and treatment; if you cannot find out the problem, it is over-treatment.

Medical insurance and patients will not pay for a disease that does not exist. The cost of excessive medical treatment will only be borne by you, the doctor.

It is impossible for doctors to work for a fee, so some missed diagnoses and misdiagnoses are inevitable.

The same is true for Jiang Bei now. If there is a problem with the colon, it means adequate diagnosis and treatment, foresight, and high scores.

If there is no problem with the colon, it is over-medicalization. Well, I guess they will be at the bottom of the assessment this time. However, this result will not make them wait too long. Because of the assessment, the hospital has already put the eight people's examinations in the front, and as long as they order the examination, they can basically do it directly.

The ultrasound showed that there was no problem with appendicitis.

But when they saw the abdominal CT scan results, they were surprised. There really was a problem.

There is a shadow on the CT scan, but I am not sure what it is.

But there are only so many organs in the abdomen, and the liver, pancreas, and spleen are definitely not there.

Then I can only talk about the gastrointestinal tract.

Judging from its location, it is close to the appendix, so I'm afraid it is the colon.

They actually found the problem. Looking at the shadow, it looks like there is a mass on the colon.

Thinking of this, everyone couldn't help but sigh at Jiang Bei's luck for actually encountering this.

"Yes, this is a landmine patient. If there is no CT scan, and if the patient is operated on for appendicitis, everyone would be dumbfounded when the stomach is opened and see this situation.

Not only will it affect the patient's treatment, but I will also be unable to explain to the patient's family. Director Wu is a great leader of his students."

Lin Dongping suddenly laughed and said, "Moreover, Wu Xiaofu said that this patient was troublesome after seeing him just now. It was obvious that he could see many problems at a glance."

In fact, they all selected patients together before. It was not that they had seen the patient first. They just checked whether the patient was in critical condition and handed him over to the interns to see if there would be any problems with the patient due to time constraints.

In fact, they don't know exactly what disease each patient has.

Now Jiang Bei has the foresight to rule out the colon problem, and she will undoubtedly get a good score in the future.

Not to mention, Fu Yuanhang and Xun Qi mentioned above may not be as good as Jiang Bei.

But there are some problems with Pan Ying, as the inspection form issued by Pan Ying is also a direct inspection.

The patient's renal artery CTA was obtained.

very bad.

Most of the right kidney has been infarcted and is basically beyond saving, which means that the patient's right kidney has lost its function.

The patient came too late. In fact, if he had come for treatment as soon as he found his blood pressure was high, perhaps his right kidney could have been saved. After all, high blood pressure is a distress signal sent by the patient's kidney to the patient.

But it's too late now.

"I didn't expect it was hypertension caused by renal artery infarction. This case is indeed difficult. In fact, Pan Ying was admitted to the hospital with hypertension, and then further examinations were conducted. He was faced with such a difficult condition.

We will also consider the score as appropriate, this is a pity."

Jiang Yuankai spoke up, and the others nodded. To be honest, renal artery infarction was something they didn't pay much attention to, because even if it was kidney-related, it shouldn't be so urgent.

But it is like this.

"He's still too anxious. We don't dare to make a decision on our own about the patient's condition, but he dares? This should be considered a lesson for us."

Miao Qingyan shook her head and said.

“However, since this patient’s blood pressure was caused by renal artery infarction, it should not be difficult to control. The patient does not have scintillation pulmonary edema, severe renal insufficiency, etc., and there is no indication for arterial stent implantation.

After adding warfarin anticoagulation therapy to the patient, long-term oral antihypertensive drugs such as Bayxin will be enough.”

The renal artery has already been infarcted, and there is no influence of hormones. There are no other functional problems with other vascular conditions, kidneys and heart, so blood pressure is easier to control.

Miao Qingyan expressed her own judgment. If Pan Ying could follow this approach when he started to conduct assessments in the ward, the scores could still be salvaged.

"Never mind, next one."

Everyone looked around and their eyes were fixed on Song Tiantian's clinic.

Song Tiantian and Fu Yuanhang were considered the first and second at the time. Later, Fu Yuanhang was suppressed by Xun Qi, but among the female interns, Song Tiantian is still the first and is currently ranked third overall.

This is an intern who aspires to become the top female head of cardiac surgery like Lin Wei.

However, the patient that Lin Weinian was dealing with was not easy to treat. He was probably the most difficult one among her five patients.

It’s not easy to see it correctly.

"Hello, what are you here for this time?"

Song Tiantian looked at the patient next to her and asked. This was a young female patient with a slightly pale face and some acute illness signs. Song Tiantian felt at a glance that it was a heart or lung problem.

"I've been coughing up blood for a week. At first I thought it was just a sore throat, but when I saw it was getting worse, I panicked. I first did a chest CT scan at the district hospital. The doctor there suggested that I go to the cardiothoracic surgery department. I was worried, so I came here."

If we have the film, that would be easy to explain. However, since the doctor there asked the patient to go to the cardiothoracic surgery department, I'm afraid the disease is probably in the heart and lungs, and it still needs to be treated surgically.

To be honest, this information is enough.

Song Tiantian thought to herself that it shouldn’t be too difficult.

"There are hollows and nodular shadows!"

After taking a look at the CT scan, Song Tiantian found that the situation was serious. A young female with such features on the CT scan, tuberculosis?
"Does your temperature rise?"

“Not high.”

Not high. If tuberculosis progresses to this point, there should be a low fever, and the patient does not have other symptoms of tuberculosis such as coughing.

There is no incubation period. After all, the CT situation is not optimistic.

That's the other possibility!
"This patient's condition is quite interesting."

Wu Xiaofu suddenly spoke up. The others were still thinking about it. Seeing Wu Xiaofu's smile, they couldn't help but wonder, "Director Wu has already made a decision?"

"I encountered a special case before, and to be honest, I thought it was special enough, but I didn't expect to encounter an even more special one. My case was due to liver problems.

An examination revealed that endometriosis had spread to the liver."

Endometriosis!
Everyone was stunned when they heard this, and then they understood something. Wu Xiaofu was saying that the patient had endometriosis and that the endometriosis had spread to the chest?
No way!
He looked at Jiang Yuankai, hoping that Jiang Yuankai would give a conclusion.

Jiang Yuankai pondered for a moment and said, "The chest CT scan of the patient showed multiple cavities with halo signs in both lungs, as well as nodular shadows, and most of the cavities and nodular shadows were closely related to blood vessels.

Combined with its imaging characteristics, the following diseases are mainly considered: endometriosis, LAM, PLCH, BDH syndrome, LIP and infectious diseases.

Since LAM images are generally thin-walled cysts with a relatively diffuse distribution and no obvious correlation with blood vessels, they can be directly excluded.

Well, looking at it this way, endometriosis is the most likely cause."

(End of this chapter)