Chapter 983 Please stop pulling, I'm scared!
"Key points?"
Hearing this, not only Shi Lian, Yang Yuen and others, but even the invigilator cast his eyes.
However, the latter did not make any obvious movements. He glanced at it lightly and then put his attention back on the record sheet in his hand.
"What do you mean?" Jiang Mai rubbed his hands and asked.
For internal discussions, the more different opinions, the better.
Not everyone has Xu Qiu's diagnostic ability. For them, after arguing, the real answer may surface.
Shi Lian pointed to several data on the screen and said:
"Here, the blood concentration of tacrolimus in the patient's blood has increased by three times when he was admitted to the hospital.
And the blood routine test shows that the proportion of lymphocytes in the patient is very low!"
This...
Jiang Mai and Yang Yuen and others looked at each other. They were not particularly clear about what the two indicators appeared at the same time.
Shi Lian did not keep them in suspense and said bluntly: "It means that the patient is already in an over-immunosuppressed state!"
Over-immunosuppressed?
Why did he suddenly overdose again?
After hearing this conclusion, everyone had new doubts in their hearts.
From the postoperative period to the infection admission, the patient's dosage has been adjusted all the time, and there is no sudden increase in dosage.
How can the same or even less dosage lead to excessive immune status?
Shi Lian said silently: "Have you all forgotten that the patient has diarrhea more than ten times a day for more than twenty days."
At this moment, the conference room was silent.
Jiang Mai and others looked at each other... They actually ignored this!
Very frequent diarrhea leads to blood concentration, which in turn causes a significant increase in the concentration of immunosuppressive drugs, and finally causes an over-immunosuppressive state!
The patient's diarrhea is actually quite characteristic. After all, more than ten times a day, no one can ignore it.
But this time the assessment pit is here. The patient's information is only played once, and the information that can be viewed at any time is only this page on the screen.
"I said that this assessment is not so simple. It seems to be examining the balance between immunosuppressants and infections, but in fact it also hides a very low lymphocyte, and the diarrhea mentioned before..." Jiang Mai exhaled with some fear.
As expected of a student taught by an idol... Yang Yuen smiled with satisfaction.
Shi Lian touched his chin and said while thinking:
"At present, the patient must have widespread infection, and the functions of multiple organs have been damaged, so that even blood pressure cannot be maintained.
If immunosuppressive drugs are used at this juncture, the scope and degree of the patient's infection will be greatly aggravated. It is definitely not the so-called "recovering a little immune ability, but no obvious help in fighting infection."
After that, Shi Lian led everyone to readjust the diagnosis and treatment plan.
Stick to the last time point and submit their answers.
Then, a new round of information appeared on the screen, and the diagnosis and treatment came to the next stage.
At this time, a new batch of test results came out.
The stool routine did not report possible etiology.
On the second day of hospitalization, blood culture results indicated Gram-positive coccal infection.
Blood test and chest CT simultaneously indicated fungal infection.
This series of results is not difficult for any doctor with experience in infectious diseases. Just add amphotericin B and tigecycline.
There is no meaning of any investigation.
Therefore, this measure appeared directly in the information given on the screen.
Next, after five days of rescue and treatment, the patient's diarrhea gradually eased. On the fourth day, the diarrhea stopped completely, and the body temperature was gradually dropping.
On the fifth day, the condition seemed to have stabilized, all indicators were out of critical values, and the patient's condition continued to improve.
However, on the night after the ventilator was removed and transferred to the general ward, the patient suddenly had severe watery diarrhea again.
That night, the cleaning lady set up a stepladder, wearing a doctor's surgical cap, mask, and goggles, while wiping the filth on the ceiling and cursing.
Their eyes almost popped out... They had never seen such a fierce patient in their lives.
Moreover, who turned the patient over? Why not just let him launch to the ground?
What's the matter, are you afraid that he will succeed in landing on the moon?
...
After watching, many contestants were all stunned.
"This description... is it necessary to be so detailed?"
"Oh my god, are you sure it's the hospital's medical record? It's not the examiners' bad taste?"
"It's outrageous. I just finished my meal!"
"Fortunately there is no picture. No, I'm worried that the next PPT will be a picture..."
"Smelly question!"
Complaints aside.
Treatment should be given.
At this time, everyone took it seriously again and took measures based on the only information.
First of all, blood pressure.
In the previous few questions, not many people paid attention to the patient's blood pressure. However, with the emergence of explosive watery diarrhea, the patient's blood pressure also fluctuated sharply and was listed as a key observation object by everyone.
However, genius doctors such as Liu Si and Shi Feng all contracted their pupils.
Why is the patient's blood pressure so fragile...
In theory, under the premise of sufficient blood volume support, even if the patient has watery diarrhea, the blood pressure will not change much in a short period of time.
Unless... the blood volume itself is very low.
What causes low blood volume?
"It's screwed. In the previous question, we ignored the blood concentration caused by diarrhea!" Liu Si reacted immediately.
The other people's faces also changed slightly.
Blood concentration...
They immediately recalled the examination report at that time, and then their expressions became ugly.
"The immunosuppressants should be stopped. In the state of blood concentration, the immunosuppressants in the patient's body are completely excessive. Stopping half is too much, and they must be completely withdrawn."
After Liu Si said this, he looked at Chen Qiao with a complicated expression.
The eyes of others also fell on Chen Qiao...During the previous discussion, only Chen Qiao insisted on withdrawing all the drugs.
However, everyone stood on Liu Si's side.
No one expected that they would be slapped in the face just a few minutes later...
"It's meaningless to consider the previous diagnosis. Let's solve this explosive watery stool first." Liu Si retracted his gaze and brought the topic back.
Only this time, he looked at Chen Qiao first and asked, "What do you think?"
Chen Qiao had a blank expression on her face, glanced at the screen indifferently, and then said, "The blood pressure fluctuated violently, the oxygenation index dropped to about 180, the inflammatory index was also increasing, and the liver function index was abnormal... It is likely to be drug-induced liver injury."
Others followed Chen Qiao's train of thought and felt that their thoughts were extremely smooth.
The examiner looked at Chen Qiao for a second time, with surprise in his eyes.
What a clear clinical thinking...
In just a few seconds, all kinds of disturbances were eliminated, and all the key points were directly grasped, and drug-induced liver injury was inferred!
This is indeed the problem that must be solved first at the moment.
As for explosive watery diarrhea, of course it also needs to be dealt with, but at least it is not something that should be considered at present.
Are Dr. Xu's students so outstanding... The biggest dark horse in this famous knife competition will not be his students...
Thinking of this, the examiner suddenly felt a little sympathetic to Liu Si and Shi Feng.
"What about explosive watery stools, how to explain this?" Someone in the Union Medical College team suddenly asked.
