Lin Ge was still full of hope for Boss Zheng, who came uninvited.
Boss Zheng was indeed awesome, but could he have any good ideas for such a clueless consultation? He hoped so.
Lin Ge looked at Boss Zheng expectantly.
"I agree with Professor Gu. It's systemic lupus erythematosus. The diagnosis is more clear," Zheng Ren said in a deep voice.
"Boss Zheng …" The gynecologist was stunned.
The doctors of the gynecology and obstetrics departments were all the same in smaller hospitals. Although they were different departments in the 912, the gynecology department had a deep understanding of obstetrics.
The intrauterine interventional surgery that Boss Zheng had just completed was no less than a fantasy for the gynecologists.
However, that was not a rumor. Boss Zheng was full of confidence and even dared to directly broadcast the surgery live.
He was a mighty figure. Even the gynecologist of the 912 had the deepest admiration and even awe for Boss Zheng.
Professor Gu said the same thing as an attitude. However, when it came from Boss Zheng's mouth, it became another attitude.
The gynecologist hesitated for a moment. She did not scold Boss Zheng condescendingly. Instead, she put on a posture of listening attentively.
"According to the records of my medical history, after the application of immunotherapy, the patient developed symptoms of shortness of breath.
Considering acute left heart dysfunction, after diuresis and cardiotonic treatment, the patient's shortness of breath improved, but the palpitations gradually worsened. The UCG showed that LVEF was
36%, pulmonary artery pressure 35
mmHg。”
Zheng Ren did not look at the medical record. He smiled and said, "So far, the diagnosis is still considered systemic lupus erythematosus. There is no evidence of heart valve, heart conduction system, and coronary artery involvement, so heart failure may be caused by systemic lupus erythematosus involving the heart muscle. "
"But the patient's condition has worsened according to the treatment of systemic lupus erythematosus," the gynecologist asked.
Lin Ge was also very puzzled. The doctors in the office were also very puzzled.
"I have a few considerations for the aggravation of heart function under the use of hormones and immunosuppressants.
First, the original treatment plan is not strong enough. I agree with Professor Gu's point of view. We can give shock treatment to save the function of important organs.
Second, similar symptoms may occur due to water and sodium retention and dysfunction of the center of gravity after the application of hormones.
Third, … "
Everyone in the room fell silent.
Rheumatic immune diseases were indeed very difficult to diagnose and treat. Even experienced clinicians might not even have access to rheumatic immune diseases.
Related diseases were complicated, and there were many treatments. This was also the reason why Su Yun said that if he encountered a disease he could not understand, he would go straight to the rheumatism immunization.
As for the doctors from the Department of Rheumatology and Immunology who were highly skilled, most of them would stand at the peak of medical technology and look down on other subjects. They would say in disdain, "Do they even know how to treat patients?"
Boss Zheng, a doctor from the Department of Interventional Medicine, sat there and spoke with fervor and assurance. He was firm and confident. It was really very dazzling.
"There seems to be something wrong with his lungs," someone whispered.
"The texture of the patient's lungs is obviously thickened. This is the manifestation of imaging," Zheng Ren said confidently after hearing the question.
"At this time, we need to determine whether the thickness of the pulmonary veins is a sign of a lung infection caused by steroid use or a sign of systemic lupus erythematosus in the lungs.
Of course, I just took a look at the patient.
The patient was placed on a nasogastric tube due to intestinal obstruction, but he still vomited and coughed. In addition, he was bedridden with steroid use and there were cases of aspiration. Therefore, aspiration lung infection cannot be excluded. "
This was the full statement, which was similar to what the respiratory medicine professor had said earlier. It was suspected that he was avoiding the important points and dwelling on the trivial.
However, Zheng Ren changed the topic and said, "However, fever, pulmonary symptoms, and aggravation of cardiac dysfunction appeared at the same time. Chest high-resolution CT did not indicate a clear focus of infection in the lungs. Anti-infection was ineffective, so it is more likely to be caused by systemic lupus erythematosus.
"The patient's medical record says that the patient is suspected to have Reynolds's phenomenon. I think this is one of the bases for Professor Gu's judgment.
"If you're worried …" Zheng Ren began to explore the rationality of the clinical diagnosis.
Under normal circumstances, the diagnosis of rheumatic immune diseases was more erratic. The patient's condition was best to do a cystoscopy for a tissue biopsy. However, the Department of Urology also said that the condition of the bladder wall was not suitable for a biopsy.
The best way was a puncture biopsy of the kidney tissue.
"I suggest we persuade the patient's family to do a puncture biopsy of the kidney," Zheng Ren said firmly. "After the biopsy, we will be able to determine the problem."
Lin Ge felt as if a big black pot had been thrown at him from all directions.
The reason for diagnostic treatment was that the patient's family believed that the nausea, vomiting, and diarrhea had nothing to do with the kidney, so they insisted that it was a gynecological problem.
Should they do a biopsy?
If someone else had said that a puncture biopsy was necessary, Lin Ge would not have believed it completely. This kind of operation could lead to the intensification of the conflict. If there was no positive result, it was hard to say how the patient's family would react.
However, if Boss Zheng said so, Lin Ge's mind began to think about how to explain it to the patient's family.
"If the patient's family agrees to the kidney biopsy and the result is positive, we can use a more radical treatment." Zheng Ren thought for a moment and said, "Methylprednisolone 1 mg, once-daily impact therapy + intravenous immunoglobulin 20
G, once-daily shock therapy + intravenous immunoglobulin 20
G, one treatment per day. Then cyclophosphamide is given.
1.0
G Impact, Hydrocortisone Succinate 300
This dosage …
A mistake in judgment was enough to cause death.
Lin Ge frowned at Boss Zheng. Did the dosage have to be so high?
Cyclophosphamide 0.2 g for a day was enough to cause serious damage to the patient's myocardium.
Cyclophosphamide 0.2 g was used for a day and the patient's myocardium was severely damaged. However, Boss Zheng actually used 1 g. This … This …
It was not easy to explain.
Lin Ge's mind raced. When he thought of the lethal dosage, he had to be more cautious.
He raised his head and glanced at Boss Zheng. His gentle and steady smile gave Lin Ge almost unlimited confidence.
There was silence in the office. Professor Gu looked at Zheng Ren in astonishment. This amount was the limit of what he had imagined.
Although he had just said that he would use a large dosage for impact therapy, Professor Gu knew that it was impossible for him to use such an extreme dosage on the patient.
Such a dosage was usually used after a puncture biopsy to confirm systemic lupus erythematosus. Before this, Boss Zheng had confidently said the dosage …
'This Little Zheng is too bold, isn't he?' After all, he was an interventional doctor and an expert in rheumatism and immunity.
After a moment of silence, Lin Ge closed his notebook and forced a smile. "How about this? Call the patient's family to the medical administration division. I'll discuss with them about the kidney puncture biopsy."
Lin Ge was forced into a corner.
There would probably be an arduous battle in the medical administration division.
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