Diagnosis … What kind of diagnosis was that!
Zheng Ren looked at Su Yun on the stage and began to recall the medical history he had told him before.
"Here are the other data and copies of the existing cases," Su Yun said with a smile. Su Yun smiled and said, "Because it happened so suddenly, this case discussion is just a rehearsal. The effect seems to be pretty good. Chang Yue, do you think I'm handsome? "
Su Yun asked as he walked past Chang Yue, one by one.
"If you spend half of your time acting handsome on surgery …" Chang Yue took the medical record and said half a sentence.
"I'm starting to regret giving you the medical record." Su Yun did not care about Chang Yue's words and said with a smile, "Because you don't understand it at all."
"Abdominal pain. What's so difficult about diagnosis?" Chang Yue said disdainfully. She adjusted her glasses and began to carefully read the medical record.
After Zheng Ren got the medical record, he also began to read it.
Su Yun picked the key points. The information in the medical record was more detailed.
Nausea, vomiting, abdominal pain, no bacterial or viral infection. What was there to consider?
His eyebrows furrowed. His mind was filled with countless cases in the literature he had read during this period of time.
"How is it, Chang Yue? Tell me your opinion." Su Yun waited for a few minutes and said with a smile when he saw that everyone had almost finished reading the medical record.
"Consider kidney stones." Chang Yue gave her answer. "Nausea, vomiting, left lower abdomen pain, these all meet the diagnostic criteria for kidney stones."
"What a beautiful diagnosis. I can't bear to deny this fairy-tale diagnosis," Su Yun said with a smile. "However, this is the medical team's first case discussion. Chief Luo is also here, so you still have to be more serious."
Chang Yue put her hand on her glasses, her eyes shining with a sharp light.
"The pain caused by kidney stones can be very serious, and when the stones are located in certain locations, there will be symptoms similar to acute abdominal pain.
When stones cause obstruction and hydronephrosis, urinary sepsis may occur, and vomiting may be a prominent manifestation of serious kidney stones.
"The patient's several symptoms suggest this diagnosis. I guess you looked at the urine routine test sheet. The red blood cells inside give you a clear hint that this is caused by kidney stones. "
Chang Yue's hand paused.
Su Yun was like a roundworm in her stomach. What he said was completely the logic of her diagnosis without the slightest deviation.
How great would it be if this guy's mouth wasn't so sharp and unkind?
"Unfortunately, these are all wrong!" Su Yun smiled and said, "You must have forgotten that I specifically mentioned the menstrual period. The red blood cells in the urine are considered to be caused by menstrual blood, not by the rupture of the ureteral intimal cells caused by the urinary tract stones."
"How did you know?" Chang Yue asked coldly.
"Doctor Chang, I don't think you understand the enhanced CT image of the patient's abdomen. The calculus is in the kidney, and the ureter is smooth, so your diagnosis is 99.9% wrong. "Su Yun blew a breath, and the black hair on his forehead fluttered.
"The reason why I didn't say 100% is because I have to take care of your pitiful self-esteem," Su Yun said disdainfully.
Zheng Ren felt very helpless. Su Yun had a sharp tongue. It was a miracle that he had survived until now without being beaten to death.
"Brother Yun, there's a problem with your ECG." Lao He was still a little kinder, at this time, he interrupted Su Yun's words, and also killed Chang Yue's anger.
There was an ECG image in the medical record, but Su Yun did not list it.
Some heart diseases manifested in the gastrointestinal tract, resulting in nausea and vomiting. Because Su Yun had previously denied all gastrointestinal diseases, Lao He saw the abnormality on the ECG at a glance.
The 12-lead ECG recorded during this visit showed supraventricular tachycardia. The ECG also showed that the RP interval was prolonged.
The cardiogram recorded after adenosine administration showed that the supraventricular tachycardia stopped.
The patient had sinus tachycardia after a ventricular ectopic beat and a brief atrial ectopic beat. The 12-lead ECG confirmed that there was continuous sinus tachycardia.
This was the most likely place, Lao He thought to himself.
He had to perform, he had to perform! As a senior anesthesiologist, Lao He was quite sensitive to the heart and breathing.
As soon as he looked at it, he felt that there was something wrong with the ECG.
"No." Without waiting for Su Yun to speak, Zheng Ren suddenly shook his head and said, "The patient's cardiogram shows tachycardia and the QRS wave group is narrowed. This discovery is consistent with supraventricular tachycardia.
The patient's heart rhythm is regular, so atrial fibrillation and multifocal atrial tachycardia are unlikely. The patient had a sudden tachycardia, so sinus tachycardia is unlikely.
Sinus tachycardia will have a gradual increase in heart rate, not a sudden increase in heart rate to more than 200 beats per minute.
Therefore, I suspect that the patient's regular supraventricular tachycardia is one of the following three types: atrioventricular reentrant tachycardia; atrioventricular reentrant tachycardia caused by retrograde conduction through an additional pathway; or focal atrial tachycardia.
But no matter which one it is, the ECG has changed after using adenosine, but the symptoms have not changed. For the time being, we will not consider abdominal pain caused by heart disease. "
Zheng Ren lowered his head. His clear and rigorous logical analysis overturned Lao He's diagnosis.
Su Yun smiled. For Lao He to be able to think of this, he could already be considered an old doctor with rich clinical experience.
However, this was still not enough. The patient's condition was very strange. Until now, Su Yun only had a preliminary diagnosis.
However, he did not say it.
He did not want the boss to deny it. If that was the case, the entire stage effect would be gone. It would be very disappointing.
"Chief Luo, do you have any considerations?" Su Yun's tone softened as he asked Chief Luo.
"The patient has taken opioids orally," Chief Luo said unhurriedly. Chief Luo said unhurriedly, "Opioid withdrawal can explain tachycardia, agitation, nausea, vomiting, and abdominal pain. However, the patient does not show signs of opioid withdrawal such as sweating, yawning, goosebumps, or dilated pupils. "
"So, I'm more suspicious that the patient has serotonin syndrome."
Su Yun smiled.
He was also considering serotonin syndrome.
Serotonin syndrome was a group of symptoms caused by taking serotonergic drugs or a combination of serotonergic drugs and monoamine oxidase inhibitors.
Clinically, typical cases were rare.
Changes in mental state and behavior, such as mild mania, agitation, and changes in motor system function.
Autonomic nervous dysfunction caused fever, nausea, diarrhea, headache, trembling, flushing, sweating, tachycardia, shortness of breath, changes in blood pressure, dilation of pupils, and other symptoms.
The patient's various symptoms were highly consistent with serotonin syndrome.
With Chief Luo's judgment, Su Yun's confidence increased greatly. The boss, that guy, could only think of this level at most.
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