Chapter 522 I'm not a doctor, I'm a killer

Xu Qiu glanced at Yang Yuen.

Yang Yuen's eyes widened, and her expression was very surprised.

Is my idol testing me?

She quickly stood up, "The key is right heart failure. The cause of congested liver is the obstruction of blood return in the hepatic vein, and right heart failure just causes this."

"But it's not that serious, and why did it get better so quickly..."

Just after he finished speaking, the neurologist suddenly paused, and then showed a happy expression.

He also figured it out!

Sibutramine!

Because of long-term use of sibutramine, the patient does have chronic liver function damage.

In addition, heart failure caused congested liver, which led to the patient's liver function indicators being so serious.

As for why he recovered within half an hour-

Congested liver, the patient's liver itself is not too serious as the underlying disease of chronic liver damage. As long as the congestion is relieved and the hepatic vein return is restored, it will naturally get better quickly.

...

The conference room was silent.

Everyone was thinking about this medical record.

The tortuous diagnosis process, the thrilling rescues, and Xu Qiu's incredible direct attack on the key points...

Just based on this patient, it is enough to write a fine article, at least it can be published in Chinese core!

Moreover, Wei Ding's condition is too classic, with repeated life-and-death crises and frequent twists and turns, which can definitely become a demonstration diagnosis and treatment case.

After the morning handover, everyone followed Xu Qiu to make rounds tacitly.

Only Wang Ping, who was teaching rounds, was left with a confused look on his face.

Wang Fan walked up to Wang Ping with his hands behind his back: "Director, we are really wanderers in the world. I am the most bullied among the attendings, and you are the most miserable among the directors."

"Stop talking nonsense to me, let's go, go to the rounds with me."

"I... I want to go to Xu..."

"Xu what Xu, you haven't taken care of enough patients this month, do you want me to deduct your bonus?"

"What are you talking about, Director Wang, hurry up and make rounds, I'm still waiting to learn more!"

"Yeah." Wang Ping nodded with satisfaction.

They were right, it felt really good to bully Wang Fan.

…

After finishing the ward rounds, Xu Qiu developed a further treatment plan.

At the same time, he also received a joint request from the directors of the emergency department, neurology, neurosurgery, hepatology and cardiac surgery, hoping that he could supplement and improve this case and use it as a standard textbook for clinical diagnosis and treatment.

After finishing half a day of outpatient treatment, Xu Qiu returned to the office at noon. While eating, he completed Wei Ding's medical records.

Blood gas analysis indicated respiratory alkalosis + metabolic acidosis.

The hemoglobin in the blood routine indicated extremely severe anemia, and later he also analyzed malnutrition.

In fact, this step can also be done by examination. Checking serum ferritin can lock in iron deficiency anemia and then confirm malnutrition...

It is also because of anemia that the patient cannot supply enough oxygen. After the body loses compensation, glucose can only be anaerobicly glycogenized to produce lactic acid, resulting in a rapid increase in lactic acid. The subsequent confusion and coma are likely to be manifestations of brain hypoxia.

In addition.

Liver function indicates liver damage, but all doctors are misled by this indicator and focus on finding the cause of acute liver damage.

In fact, the patient has chronic liver damage, which is caused by congestion in the liver due to heart failure.

Xu Qiu should have discovered this earlier.

The patient's bilirubin is not high, only the alanine aminotransferase rises sharply. At that time, all the rescue doctors were frightened by the transaminase before the operation, and all their attention was focused on this.

In addition, the patient's coagulation function is extremely poor, which makes doctors including Xu Qiu lean towards acute liver damage at the first time.

But looking back at the past, Xu Qiu noticed some details.

For example, bilirubin is not high!

This indicator actually indicates that there is no problem with the liver's decomposition and metabolism function.

Poor coagulation is not necessarily due to impaired liver synthesis function. It may also be due to long-term malnutrition, which leads to imbalance of gastrointestinal flora, and ultimately causes insufficient raw materials for partial coagulation - without raw materials, how can coagulation be good?

And the key to the final rescue is the rapid transfusion of red blood cells in large quantities.

This step corrected the anemia and also saved the congested liver caused by reflux obstruction, so lactic acid dropped rapidly and liver function improved in a very short time.

The next plan is to treat the symptoms.

At the same time, correct the electrolyte disorder as soon as possible.

Nutritional support is not so urgent. For Wei Ding, whose gastrointestinal function may be impaired, this process must be cautious and slow.

"Otherwise, refeeding syndrome is likely to occur."

As the name suggests, this is a long-term hunger and malnutrition. After oral feeding or enteral and intravenous nutritional support, the patient has long been accustomed to the low nutritional state. The body suddenly receives a large amount of nutrition, blood sugar will rise rapidly, insulin secretion will increase rapidly, and potassium ions, magnesium ions, phosphorus ions, etc. will be transferred into cells, causing hypophosphatemia, hypokalemia, hypomagnesemia...

The consequence is that the heart, brain, liver, lungs and other cells are damaged, and may even lead to organ failure and death.

These experiences are all exchanged for blood and tears.

Daxia had experienced several major earthquakes, and countless victims had not eaten for several days. After being rescued, they began to eat, and as soon as they were full, they immediately developed symptoms such as arrhythmia and dyspnea.

These were still considered mild.

The symptoms of the victims who received nutritional support were even more serious. Some people were rescued from the collapsed houses, but because of the emergency infusion of sugar-containing preparations, they induced acute heart failure, etc., many people died.

…

After summarizing the report of the medical record, Xu Qiu approved it together with the new treatment plan.

Soon, this case spread all over Linyi.

It immediately caused a wave of discussion.

"Damn, after reading it, I feel like I am not a doctor, but a killer. Ten out of ten patients like this will die in my hands!"

"My scalp is numb! If Dr. Xu becomes a criminal policeman, I feel that he can also become a leader, and it will definitely not be worse than being a doctor!"

"From lupus brain to heart failure, many of them are things I never thought of. It's so annoying to compare with others. Dr. Xu is too strong!"

"The cases under Dr. Xu's hands remind me that I am a loser all the time..."

The Linyi group was crazy about the screen.

There were also many emoticons of Xu Qiu mixed in.

A photo of Xu Qiu holding a scalpel, with the text: Lie down on it yourself.

A photo of Xu Qiu listening to his stethoscope, with the caption: Let me hear if you have any problem.

There is also a photo of Xu Qiu staring into the distance in a daze, actually simulating a brainstorm in the operating room, with the caption: Tired, destroy it...

In the office.

Xu Qiu held his mobile phone far away, which was a habit developed by the elderly in his previous life, and he has not changed it until today.

Others thought Xu Qiu wanted to protect his eyesight. After all, as long as he is a genius, others will always find a reasonable explanation for any abnormal behavior of his.

If they really can't find it, then it's the quirk of a genius.

Xu Qiu originally wanted to share the electronic version of the medical record with the group, but he saw these emoticons...

Suddenly, he was silent.

After hesitating for a while, he typed a few words: "Who made the emoticon package?"