Chapter 984 The final question! Impossible diagnosis!

To be precise, it is explosive watery diarrhea.

When this symptom was mentioned, Liu Si, Chen Qiao and others fell silent, and their minds were brainstorming wildly.

Explosive watery diarrhea is not the same as watery diarrhea.

The latter is common in gastroenterology, and is often seen in acute gastroenteritis, rotavirus infection and other causes.

But adding the word "explosive" is not that simple.

From the point of view of the ceiling, at least one thing is that the pressure in the abdominal cavity is very high.

"Chen Qiao?" Liu Si came back to his senses from his thoughts and glanced at Chen Qiao opposite.

Chen Qiao pondered for a moment and said: "Regardless of the cause of the disease, the most important things at present are three points, stopping medication, stopping diarrhea and protecting the liver."

Since the patient was admitted to the hospital, diarrhea has always existed.

However, until today, the hospital has not found the cause of diarrhea.

Compared with before, there is only one more explosive diarrhea. How can it be so easy to solve the problem?

Therefore, there is no need to waste time on this.

The primary task facing the medical staff should be to control the situation and consider other things after the patient's condition stabilizes.

...

"Stop all enteral nutrition drugs."

At the same time, in the clinical doctor's examination field, Shi Lian touched his chin and said firmly.

Jiang Mai nodded: "It may be gas accumulation in the intestine... It's hard to judge. The medical record does not mention whether there is a huge fart sound when spraying... Why are you looking at me?"

Jiang Mai raised his head... He just said the truth, why are the eyes of others full of disgust.

At this moment, he suddenly missed Dr. Wang Fan a little.

Dr. Wang is still willing to take risks. He has been changing clothes and pants for patients, catheterizing and removing feces for many years, and he has long been immune to it.

In comparison, Shi Lian and others are still a little too young. They are young people who have seen a lot of blood, but they are not as familiar with feces and farts as doctors in gastroenterology and anorectal medicine.

"This is the necessity of ward rounds." Shi Lian said.

What my teacher likes to do most is to check the wards when he is free. After checking eight or ten times, he can always find something that was previously overlooked, or find some symptoms that indicate the disease in advance.

In the medical industry, seeing is believing, and it must be seen in person.

As for video consultation or medical records... who dares to say that they can use video consultation or medical records to see a doctor? The other party is either a medical student who knows nothing but pretends to know, or a layman at all.

Even Xu Qiu is not capable of remote consultation through video.

At most, he can provide some superficial opinions, such as which department is more suitable for seeing.

Therefore, it is difficult to diagnose a patient's explosive watery diarrhea with just a medical record and a few simple pieces of information.

Jiang Mai added: "Of course, it may also be a change in intra-abdominal pressure? But it is impossible to judge at present, just do as Shi Lian said, and also stop diarrhea and protect the liver."

There are many contraindications to enteral nutrition, the most important of which is severe diarrhea.

Supplementing and defecating at the same time, the nutrients cannot be absorbed by the body and have been excreted.

What's more terrible is that, judging from the patient's condition, he is likely to have an intestinal/abdominal infection.

In this state, the nutrients rich in enteral nutrition will become a breeding ground for bacteria, which will aggravate the patient's condition.

"If you want to stop diarrhea, use berberine."

Shi Lian tapped her snow-white chin to herself, pretending to think seriously, and continued to add: "If there are liver-protecting drugs, use polyene phosphatidylcholine combined with magnesium isoglycyrrhizinate."

These are nothing special, and there is no need to discuss them.

"Antibiotic plan?" Yang Yuen asked.

At this point, everyone, including Jiang Mai, looked at Shi Lian at the same time.

In terms of antibiotic use, the leader in clinical medicine is Xu Qiu.

Director Xu can be said to be a master in this regard. Xu Qiu can't be absent from the gas gangrene back then and the antibiotic plan of the infection department now.

Shi Lian has been with Xu Qiu for so long, it is hard to say about other aspects, but the flexibility and targeting of medication are definitely far superior to geniuses like Jiang Mai.

"Well... anti-infection is still the main focus, but the antibiotic regimen needs to be slightly changed."

"In addition, the blood routine shows that the patient's lymphocyte count continues to rise, and the immune function has almost recovered. I think the use of immunosuppressants can be resumed."

Although the patient has explosive watery diarrhea, it has nothing to do with immunosuppression.

What we need to do now is to stop the diarrhea.

Next, we can focus on finding the source of the infection.

"We have not been able to confirm the cause of the infection in this patient, so it is reasonable that the condition recurs." Jiang Mai nodded.

After a brief consideration, Shi Lian recalled Xu Qiu's medication regimen while making minor adjustments based on the patient's condition, and soon gave a clear and organized combination:

"Switch to ceftazidime avibactam, the dose is 2.5g, q12h."

q12h means once every twelve hours.

Shi Lian continued: "There is also aztreonam, 1000mg, q8h. Voriconazole, 0.1g, q12h. Colistin sulfate, 750,000U, q12h."

After giving this plan, everyone breathed a sigh of relief.

After a long period of work, the diagnosis of this patient seemed to have returned to the beginning.

It still indicates diarrhea, and it is necessary to find out the cause of diarrhea and follow the clues to find the source of infection.

"Have you confirmed the answer?" At this time, the invigilator's voice sounded.

Shi Lian nodded: "Confirmed."

The invigilator wrote and drew on the record sheet for more than ten seconds.

At the same time, his earphone received instructions from the invigilation team.

After listening, the invigilator was refreshed and reminded: "There are only two questions left before the end of this assessment."

Hearing this, Shi Lian and others became nervous, and at the same time felt relieved.

It's finally over...

However, there are only two questions?

Judging from the information given in the questions, it is still a long way from making a diagnosis.

Moreover, since it is the second assessment of the famous sword competition, an independent assessment project, the difficulty cannot be low.

As a result, only two questions are needed to complete the diagnosis?

The first thing that can be ruled out is that the questions are not that difficult.

The famous sword competition is a competition for the national medical elite. Except for doctors like Xu Qiu, who are not human, no one else can easily answer them.

Even if the main judge on the field comes on stage, it is almost impossible to get full marks.

For example, the current case was extracted from the national database of difficult diseases. The diagnosis process of this patient went through multiple disciplinary consultations in top hospitals, and a large number of directors and experts discussed it. After many twists and turns, the diagnosis was finally made.

It is difficult for anyone to make a diagnosis based on just a few pieces of information on the screen.

Therefore, the difficulty of the questions must be beyond the scope.

Of course, there will be no way out.

In fact, although the test questions give little information, one thing is very clear... As long as it is given in the questions, it is basically useful information, and there are key clues that can lead to the final diagnosis.

In real clinical practice, doctors see a mixed person. All the information on the patient is thrown out at once. Which one is useful and which one is interference, the doctor has to rule it out.

But it is different in this assessment. What is given is useful, which is equivalent to reducing the difficulty by one level.

"It's still difficult." Jiang Mai shook his head with a bitter expression.

Shi Lian, who had been thinking, suddenly raised her head.

She thought of a very fatal problem... There is a huge loophole in this assessment!