Rebirth of Medicine Practices the World

"Let me treat this discussion as a teaching round. There are so many graduate students and interns, as well as new faces from several departments. I ask questions and everyone answers. Of course, it must be done with Director Dong and Zi

Doctors are the main ones.”

"Okay, that's good." Ye Xiu, who is studious, was the first to say yes.

"Let's start with the undergraduate disease. This patient has been ill for more than three weeks now. My physical examination just now found that the patient's right limb muscle strength is level 2, the muscle tone is low, the tendon reflexes are absent, and the pyramidal tract sign is positive.

.”

"Why would a patient with brain damage and a patient with central nervous system damage have such contradictory signs? Dr. Zi said first." Lin Lin named her directly.

"Uh..." Zi Xuan prepared thousands of times, all focusing on the issue of body temperature. He never expected that Lin Lin would start with neurology issues.

"I didn't pay attention to this question before, and I don't understand it now." Zi Xuan already fully understood the characteristics of Lin Lin's ward rounds and the characteristics of her work, so she didn't dare to answer randomly.

"Here comes Director Dong." Lin Lin kept her promise and started with the doctor in charge.

"This kind of situation is more common when the central nervous system is severely damaged, and it lasts about a month. The more serious the damage, the longer it lasts. Damage in the brain is called cerebral shock, and damage in the spinal cord is called spinal shock."

"At this time, in addition to positive pathological signs, the patient's other signs are very similar to peripheral nerve damage. If you don't understand, you will be easily confused."

"Although I understand this situation, to be honest, if it hadn't been for Dean Lin's physical examination today, I wouldn't have noticed it. Therefore, there is no reflection of this in the disease records. After a while, I will ask Dr. Zi to make up for this.

Go up."

After hearing this, Zi Xuan glanced at Lin Lin.

"Okay, Director Dong said it very comprehensively, which shows that Director Dong has a very deep foundation in neurology. Well, next question." At this point, Lin Lin paused.

In the office, it was extremely quiet. Some people were nervous, while others were excited and eager.

"The treatment method for this patient is very correct. If ventricular drainage is not done in time, this patient will not survive the acute hydrocephalus. The question is, how long should the ventricular drainage tube be left in place for? How long can it not be longer?

After saying that, Lin Lin looked at Zi Xuan.

Zi Xuan's face turned red and purple, looking very embarrassed. Such knowledge seemed very profound to him, and he had never looked up the information.

"I...I...I'm sorry, Dean Lin, I don't understand."

"For the first question, you don't understand. I forgive you. Although it involves basic skills, it has little impact on the patient's treatment. For this question, you don't understand, so I will criticize you."

"As the doctor in charge, you should figure it out, you must figure it out, and you can figure it out. Because it is related to the life and death of the patient."

"Director Dong will not answer this question for the time being. I hope other young doctors will take the initiative to answer this question."

"Let me answer." Liu Yulan started.

"Under normal circumstances, the indwelling time does not exceed one week to ten days. In special circumstances, it can be extended to two weeks. If it is longer, it will not work and it can easily lead to secondary infection in the ventricle."

"Okay, very good. Director Ding, how long has it been since you did any business studies in the department?"

"It's been a long time, ever since you and I left our jobs, and we haven't recovered yet." Ding Feng didn't care how Zi Xuan felt, she had always been aggrieved by what happened to Lin Lin, and naturally she didn't have a good impression of Zi Xuan.

"Next month, recovery will begin next month. It will still be the same as before. There will be exams, and the results will be related to promotion and use."

"This patient's drainage tube has been left in place for far more than two weeks. I just tried it and the intracranial pressure is not high. Director Dong, don't worry about gains and losses, just remove it."

"Okay, I'm really worried about gains and losses. After a while of discussion, I will unplug it." Dong Huayu said.

"Now, let's get to today's core issue. Why does the patient's fever not go away? Just now, Dean Ye put forward her opinion. This kind of thinking is worth learning from. I also

Let’s do it in the form of questions, so that everyone’s attention can be more focused.”

"Haha, Dean Lin, you have made us all nervous." Ling Xiaoyun said with a smile.

"Really, okay, it's better to be nervous. When you study, you have to be nervous. When you play, you can relax."

"When Dr. Zi was reporting the medical history, I looked through your examination application forms. There was an application form for blood culture, which was issued last Thursday. I would like to ask, is it usually too much to do blood culture?

How long does it take to see bacterial growth?"

Lin Lin's question is extremely tricky.

Silence, a silent silence.

"Let me answer." Ye Xiu is indeed extraordinary, no wonder Lu Han thinks so highly of her.

"Generally speaking, with bacterial blood culture, you can see whether there is any growth of pathogenic bacteria within a week. Of course, the laboratory will not issue a report immediately after a week. They will continue to observe it for another week."

"Perfecton!" Lin Lin suddenly said something in English.

"Has Dean Ye done this?"

"Yes, I did it when I was in graduate school. If you add a drug sensitivity test, it will take two weeks."

"Okay, great, you have answered the second question I wanted to ask. Do you think this discussion is good?"

"Okay." A neat voice suddenly burst out in the silent office.

"What is the current daily intake of this patient? Remember, it includes the amount of fluid replacement and the amount of oral food."

"The statistics from the patient's family are not very accurate, but it is roughly estimated to be around 2,000 milliliters." Zi Xuan rushed to answer this time.

"For a patient with fever, is 2000 ml enough?"

"Not enough." Zi Xuan knew that this was another big problem.

"Let me ask again, what is this patient's daily output?"

"The urine output is more than 2,700 milliliters." Yu Ling knew this very well and answered immediately.

"Look, the medical orders you write are not as clear as the head nurse. I have emphasized many times before that any doctor's medical orders must have his purpose. After they are issued, they must be followed up to the end. Very

Obviously, you failed to do this."

"Comparing the input and output, you should know why the patient's sputum is so thick, right?"

"This can also explain part of the reason why the patient's white blood cells, red blood cells, and hemoglobin are increased."...

"Just now, Dean Ye asked whether it is central fever. This can be considered. However, generally speaking, central fever usually appears at the peak of the disease, and the temperature will be relatively high. At the same time, most patients are accompanied by delirium and

Disorder of consciousness. This patient does not meet the criteria."