Rebirth of Medicine Practices the World

"After discussion, we conducted treatment according to acute Guillain-Barré syndrome. At the beginning of treatment, the condition seemed to improve, and the patient felt a slight improvement in strength."

"Three days ago, the patient suddenly developed respiratory muscle weakness and difficulty breathing. The condition progressed rapidly. Currently, the patient relies on a ventilator to maintain breathing."

"Because the treatment effect was not good, the condition suddenly worsened. At the handover meeting, Director Ding believed that the evolution of the patient's condition did not meet the characteristics of acute Guillain-Barré syndrome. Therefore, we asked Dean Lin to come back today to give us some guidance."

Ma Shuiyuan knew that Lin Lin was very strict, so he was fully prepared.

"Dr. Ma's report is good. Do you have anything to add?" Lin Lin became the host.

"The medical history and diagnosis and treatment process are as reported by Dr. Ma. There is nothing special to add." Seeing that no one said anything, Ding Feng said.

"Dr. Ma, you just said that the patient's tendon reflexes are symmetrically weakened in both upper limbs and symmetrically active in both lower limbs, right?"

"right."

"Okay, very good, let's go see the patient." Lin Lin said and stood up. Ding Feng followed Lin Lin with a set of examination tools.

Lin Lin's tools are kept in the office of his hospital and used when going out to the clinic. Ding Feng once proposed to get an extra set for him, but Lin Lin refused.

A set of tools isn't worth much, but Lin Lin can't get started with it.

For any patient, Lin Lin believed more in what she asked, saw, and checked. The information provided by others only accounted for about 20% of the information Lin Lin used to analyze the condition.

It's not that Lin Lin doesn't want to trust others, but clinical medicine is about knowledge, knowledge structure, basic skills, experience, thinking ability, and physical examination findings that are consistent with these.

No one can replace these things, and no one has the ability to replace them. If she could, there would be no need for Lin Lin to come back to participate in the discussion.

Everyone followed Lin Lin to the patient's bed. The patient was very conscious. Because he was on a ventilator, he could not speak. His eyes were full of the desire to survive.

Lin Lin told the patient that he could use his hands that could barely move to express what he meant and answer his questions with gestures.

"How long have you been ill?"

The patient held out two fingers. Lin Lin said to the patient: "If what I say is right, give me a thumbs up. If I'm wrong, don't move. Do you agree?"

The patient immediately raised his thumb and pointed his finger to express agreement.

"Two weeks?" Lin Lin asked, but the patient did not respond.

"2 months?"

The patient still didn't respond.

"2 years?"

The patient immediately gave a thumbs up to express his approval. The doctors present were shocked. Two years of medical history? Why did we only ask about more than one month?

Lin Lin was also secretly surprised. The two-year medical history meant that this patient's diagnosis of "acute Gran-Barre syndrome" could be denied. For "chronic Gran-Barre syndrome", the treatment with hormones was

Sensitive and effective, this was not reflected in this patient.

"Can you tell me where your illness first started? I will continue to ask, and you will continue to answer, okay?"

The patient gave a thumbs up again.

"Did it start with the hands?"

The patient did not respond.

"Does it start with the feet?"

The patient immediately gave a thumbs up.

"Does it start with the right foot?"

The patient gave a thumbs up again.

At this moment, Lin Lin already had a direction in her heart.

“Did it start with numbness on the soles of the feet and work its way up?”

The patient gives a thumbs up to express approval.

"Are you having difficulty defecating?"

The patient gives a thumbs up.

"Have you had difficulty defecating for more than a year?"

The patient gave a thumbs up again.

As Lin Lin questioned step by step, the doctors around her felt more and more something was wrong. What are the characteristics of Guillain-Barre syndrome in such a development of the disease?

"Are there any sexual dysfunctions? If so, did they appear before and after difficulty in defecation?"

The patient looked embarrassed, but firmly gave a thumbs up in affirmation.

Although the communication was difficult, it was indeed effective. Lin Lin got a lot of useful information from the consultation. Such consultation could not last too long for such a patient. Lin Lin stopped when it was appropriate and immediately began to examine the patient's physical examination.

The muscles of the patient's limbs have been atrophied to varying degrees, but it is more obvious in the upper limbs, which can also well explain the patient's current respiratory muscle weakness.

The patient's tendon reflexes in all four limbs were hyperactive and his pathological signs were positive. These signs were very consistent with Lin Lin's idea, but they made Ma Shuiyuan and the others feel very embarrassed.

"Well, we have to see if the patient has sensory impairment. If so, it will be of great help to the diagnosis." Thinking of this, Lin Lin started another "verbal" communication with the patient.

Lin Lin raised the "pin" in her hand and said to the patient: "I will use the needle to prick your skin starting from the feet. If you feel any obvious change in pain, please tell me."

After Lin Lin finished speaking, she patiently and carefully started from the feet and used the sharp tip of the "pin" to prick the neck bit by bit. When the tip of the needle passed above the areola and reached the sternal manubrium, the patient stretched out his thumb.

It means that there is a change in feeling.

"Do you feel the pain starting from this place?"

The patient raised his thumb to express his agreement.

At this point, Lin Lin breathed a sigh of relief. The patient's symptoms and signs already had a clear direction of diagnosis. Once the positioning was clear, qualitative diagnosis was not far away.

This is the diagnostic technique for neurological diseases. It seems simple, but in fact it is not easy. To achieve this goal, you must be able to think of it and then do it, so that you can obtain information useful for positioning and qualitative diagnosis.

When everyone saw Lin Lin asking about medical history and doing a physical examination, they were not only embarrassed but also admired her from the bottom of their hearts.

This is what Lin Lin once said to Ling Xiaoyun. He would never be humble in medical treatment. If a doctor is humble, the patient will suffer.

In fact, Lin Lin has always believed that these so-called "humble" doctors do not want to be humble, but are not strong enough and must use "humility" as a fig leaf.

Yes, when facing patients, every doctor must show his strongest strength. In the face of strong strength, all "humility" and all rhetoric have nowhere to hide.

After examining the patient, the other doctors returned to the doctor's office to wait. Lin Lin went to wash her hands before returning to the office.

"Let's discuss it," Lin Lin said to all the doctors present after sitting down.

The doctors looked at each other, but no one dared to say anything. There was a silent silence in the doctor's office.