Since 1981 Health School

Professor Tong took the medical report handed over by Chen Qi, put on reading glasses and looked at it for a while, then pursed his mouth.

The other doctors from Xijing Hospital next to him didn't dare to say anything after seeing it. Everyone knew that Mr. Tong's mouth was shrugged, and it was often because of a problem.

Professor Tong handed the medical records to the students behind him:

"Look at it too, everyone talks about their opinions."

Several colleagues of Cui Tongzhi saw it and began to discuss, because these doctors are obviously foreigners, why did they suddenly intervene in the patients of the People's Hospital?

Intellectuals are more or less particular about "right to privacy".

One of the staff knew Chen Qi, so he asked softly, "Dean Chen, who are these..."

Chen Qi laughed and joked:

"You guys don't know Mount Tai with your eyes. This is a great professor of Xijing Hospital. You can see that the doctors behind him are almost at the level of professors and directors. With the number of this Professor Tong, you don't have to wait for seven days to go to Xijing Hospital. Qiye's team can't get in at all."

The staff member was taken aback: "Xijing Hospital? The one in Xi'an? This hospital is amazing."

"That's right, so the big professors are helping you see a doctor for free today. Do you think that old Cui has gotten lucky?"

Several staff members of the post office nodded again and again, and then looked expectantly at these great professors from the Northwest.

As a result, the doctors from the northwest had a headache.

Everyone gathered together to study the medical records first, and then took out all the inspection reports, and even many doctors took the initiative to do physical examinations and auscultate the heart and lungs of the patients.

It turned out to be nothing.

Doctors generally believe in the results of auxiliary examinations.

Diagnoses came out of their mouths one by one, and then they were overturned by their colleagues one by one. Everyone's eyebrows were furrowed.

Some people are already complaining: "This Yuezhong is really evil, why are there all these intractable diseases."

"Organic diseases can be ruled out. The stomach, pancreas, gallbladder, liver, and spleen seem to have no problems so far, and the test results do not support that there are lesions in these parts. So is the problem still in the intestines?"

"Could this also be epileptic abdominal pain?"

Just now, Chen Qi's performance was amazing. The gastroenterology department of the entire Xijing Hospital couldn't find out the problem. He solved a few details, which made people have to admire.

Professor Tong also looked at Chen Qi: "Xiao Chen, I see that you are confident, do you have any ideas for diagnosis and treatment?"

Experts just ask if they don’t know how to speak, do you know what is wrong with him?

This is too difficult, the doctor can only say that it is doubtful...

Just like when Chen Qi diagnosed Yu Sisi's epileptic abdominal pain before, he didn't identify it at the beginning, but verified his own diagnosis and treatment ideas based on reasoning.

For example, when he saw the corner of the girl's mother's mouth twitching, he wondered if it might be epilepsy?

If the mother has epilepsy, can the disease be passed on to the children?

If it can be passed on to girls, will epilepsy cause abdominal pain?

If you guess that the abdominal pain is caused by epilepsy, what tests should be done to verify it? What medicines are taken for treatment?

After this set of diagnosis and treatment ideas, it is like doing a math problem, listing the steps one by one, and finally getting a result.

Medicine is the same as mathematics, the result is very important, but the process is also very important. During the medical examination, the way of solving problems is the same as mathematics. There are also step scores.

Explain the process, or the importance of ideas.

This problem-solving process is the "clinical approach". As long as the diagnosis and treatment ideas are correct, it can provide other doctors with a brand-new clinical approach, which is the embodiment of the characteristics of empirical medicine.

Chen Qi asked back, "Professor Tong, what do you think?"

"Now we can only do exclusion. Trauma can be ruled out because there is no relevant record in the medical history. Inflammatory causes such as acute gastroenteritis, appendicitis, various perforations, and peritonitis can also be ruled out according to the inspection report. of."

Chen Qi nodded slightly, and continued to listen to Professor Tong's analysis:

"Then is it possible that it is secondary pain? The patient's abdominal pain is just an appearance, that is to say, the real cause is not in the abdomen, but in other surrounding parts. This is also something that is ignored by everyone."

"Oh, it seems that Professor Tong has the same idea as me."

At this moment, the old urchin lost his temper: "Then Xiao Chen, let's take a bet and see who can guess which part is wrong."

Chen Qi's personality is not prudent, and he became interested as soon as he heard about the bet:

"Okay, let's compare with Professor Tong today. Let's write down the parts we guessed on the paper, and then light it up to see who is more accurate."

"Okay, it's a deal, bring a pen and paper."

Both Professor Tong and Chen Qi were mostly joking. Of course, there is also a factor of "not admitting defeat" to their peers in their bones.

Although Professor Tong Shanggao wants to stimulate and teach his disciples and grandchildren more and more, but as Liang Pingjian said, should Xijing Hospital still have its cards?

For Yu Sisi, Xijing Hospital lost face this time, even though the trip to Vietnam was a good thing for the patient, because the cause of the disease was found out for her.

But in terms of face, the gastroenterology department of Xijing Hospital became a laughing stock of the national health system when the news got out.

So Professor Tong wanted to win the round through this kind of joke.

Cui Tongzhi's medical record can be regarded as an intractable disease. If Chen Qi guessed wrong, Tong Shanggao guessed right based on his decades of experience, and it would be a one-to-one tie, right?

The face of Xijing Hospital has also been somewhat saved.

When they heard that their ancestors wanted to make a bet with Chen Qi, the doctors in Xijing Hospital all cheered secretly, and all of them blushed.

The medical staff at the People's Hospital looked calm. Their own director, Chen, was on the job, and there was still a bad disease?

Anyway, of the more than 1,300 employees of the People's Hospital, except for a certain deputy secretary, almost everyone else is Chen Qi's brainless fan.

After a while, the little nurse brought a pen and paper, Chen Qi and Professor Tong wrote a word at random, and handed in the paper.

The two put the white paper on the desk together, and the people next to it eagerly surrounded it, and then made a burst of "嗤~~~~" sounds.

I saw that Chen Qi and Professor Tong wrote a word together on the paper: heart

Chen Qi and Professor Tong looked at each other and smiled, everything was kept silent.

Yi Zewen is the head of the emergency department, and he was the first to ask:

"Teachers, why do you answer that there is a heart problem? This is obviously a patient with abdominal pain."

The doctors of Xijing Hospital also had doubts, except for the veteran directors Liang and Zhou who were thoughtful and seemed to be reasoning about this possibility.

Cui Tongzhi just had abdominal pain, not dead or comatose, he didn't care to be surprised when he heard this answer, instead he touched his left chest and was scared to death.

Good guy, what can I do if my stomach hurts? If there is a problem with this heart, it is really going to die.

"Doctor, help, help me~~~"

Other doctors are also eager to ask their own questions, especially the doctors at the Yuezhong People's Hospital. Chen Qi has always advocated this kind of open and enthusiastic academic atmosphere. Anyone can ask questions. Don't be afraid of any authority. authority.

"Dean Chen, what's going on?"

"Dean Chen, why do you think there is a heart problem?"

But Chen Qi waved his hand,

"Now is not the time to explain. If Professor Tong and I have the right idea of ​​diagnosis and treatment, the patient is already in great danger. Zhang Xing, you should do an electrocardiogram right away. Chen Li, you should go to the laboratory in person and ask them to expedite the examination immediately." Cardiac enzymes, and troponin, fast."

Everyone saw that Chen Qi's face became serious, and they started to act one after another.

Professor Tong saw Zhang Xing running over with the electrocardiogram in his arms, and grabbed it: "I will do this electrocardiogram myself."

Zhang Xing was still a little afraid: "Professor Tong, how can I let you do this kind of rough work..."

"Okay, there is no time, since we have guesses, let's race against time!"

After finishing speaking, Professor Tong had already started to install the lead wires on the patient himself, and the little doctors next to him were so frightened that they rushed to help.

The electrocardiograms of Yuezhong People's Hospital are all imported from the United States. Although they are second-hand, they are still very sensitive. When the switch is pressed, the electrocardiogram will be spit out.

Everyone, including Chen Qi, surrounded him, and many doctors even stood on stools, wanting to see the results of the electrocardiogram.

Suddenly the doctors at the front of the crowd exclaimed:

"Inferior myocardial infarction!"

Hearing the heart attack, everyone trembled. Cui Tongzhi almost fainted when he heard it, and the colleagues next to him were obviously anxious.

Myocardial infarction was almost a fatal emergency in the 1980s, and everyone avoided it.

In fact, even in 2023, when medical science is highly developed, the out-of-hospital mortality rate of myocardial infarction will reach more than 30%. Note that it is "above".

Because in many remote areas, many patients obviously died of myocardial infarction, but because there was no autopsy or timely help, the mortality rate was more than 70% or even higher.

Even in the "hospital infarction" with well-equipped medical equipment, the mortality rate has reached about 13%, which can be described as "notorious".

Chen Qi stared at the electrocardiogram, while introducing to the presbyopic Professor Tong:

"ST-segment elevation in leads II, III, and AVF, ST-segment depression in leads I, AVL, and ST-segment depression in leads v1~v3 greater than or equal to 0.1 millivolts, it is indeed an inferior wall myocardial infarction, and the infarct size is relatively large." Large, the posterolateral wall and the posterior 1/3 of the interventricular septum have been involved."

Professor Tong sighed: "Xiao Chen, you can deal with the patients in your hospital."

He understood that meeting a patient with myocardial infarction was a dead end, and the patient was already in danger.

Chen Qi immediately shouted to the surrounding doctors and nurses in the emergency department:

"Immediately perform thrombolytic therapy, and at the same time perform coronary angiography immediately, and if the situation permits, perform interventional surgery immediately. And several of your colleagues, please inform Cui Tongzhi's family as soon as possible."

Several employees of the post office have already lost their minds:

"Oh, okay, notify the family members, yes, notify the family members, but where are the family members?..."

At this time, Yi Zewen coughed a few times, and reminded in a low voice: "President Chen, our hospital has not yet carried out coronary angiography."

Chen Qi patted his forehead, thinking that he was patronizing endoscopy, and didn't take into account the specific operations being carried out in other departments.

In fact, he can't be blamed, Chen Qi has only been the dean for so long, and there are so many departments in the whole hospital, even a dean can't handle it.

"No Coronary Angiography... No Interventional Procedures..."

Chen Qi was stunned for a moment. As a rebirth doctor, he was very aware of the critical nature of myocardial infarction, and he also knew that coronary angiography is the gold standard for diagnosing heart disease, and intervention is the key to life and death for myocardial infarction.

Thrombolytic therapy alone is not safe, especially the efficacy of thrombolytic drugs in the 1980s was very poor.

This is why everyone's face changed when they heard about a heart attack, and even the doctors of Xijing Hospital were helpless.

Coronary angiography, this is not a rare thing, as early as 1958, a foreign hospital completed the first case of angiography.

It is the gold standard for diagnosing coronary artery disease and macrovascular lesions.

Coronary angiography can find out whether the coronary arteries are narrowed, which vessel is narrowed, and to what extent. According to the results of coronary angiography, it can be evaluated whether to perform stent implantation or coronary artery bypass surgery on the narrowed vessels.

If coronary angiography shows coronary artery stenosis, and the stenosis of a single diseased vessel is more than 75%, it is recommended to insert a stent.

If coronary angiography shows that more than two blood vessels are diseased, and the degree of stenosis exceeds 75%, coronary artery bypass surgery is recommended.

Therefore, this inspection is very important, and it is also the key to the success of follow-up rescue.

The so-called interventional procedure, originally percutaneous coronary angioplasty (PTCA), was invented by Swiss doctors in 1977.

The operation method is to send a balloon catheter to the vascular lesion through peripheral arterial infusion, relieve vascular stenosis through balloon expansion, restore coronary blood flow, and then remove the balloon.

However, in the subsequent clinical application, it was observed that PTCA had serious problems, including restenosis and acute vascular occlusion.

Therefore, medical researchers from all over the world have to make improvements. The most direct idea is to prop up a scaffold at the narrow blood vessel as a support, and the stent was born, thereby significantly reducing the restenosis rate of PTCA.

In 1986, French doctors performed the first coronary stent implantation.

The problem is that it is only 1989, people have just invented and developed abroad, and new clinical surgical techniques have just been introduced, so it is impossible to spread them to China all at once.

These days, Huaguo is half a beat behind developed countries, and this is something that can't be helped.

But Chen Qi can do radiography and interventional surgery that others can't do.

This thing has been popularized in almost all hospitals in later generations, not to mention third-level and second-level hospitals, even the awesome first-level hospitals, that is, the central town health center can do it.

But in Yuezhong Hospital in 1989, it was not so simple to play interventional therapy. One is whether the equipment is allowed?

This requires a set of special tools, a professional medical angiographic X-ray machine, and a dedicated catheter guide wire bracket.

This set of gadgets is available in Chen Qi's space operating room, but the problem is to use it out, and how to keep it secret has become a big trouble.