This Doctor is Great

It was completely torn apart.

Zhou Mo said that he was not free and had no chance to talk about buying papers.

And Huang Yiming, who turned out to be a native Tianlong, bought him with money? I'm afraid it's not enough for other people's monthly pocket money.

"what to do?"

"I want to wait for another paper, but I don't know how long it will take."

After thinking about it, Zhou Quan came up with a solution that was not a solution.

Squatting Zhou Mo, you must meet and talk with Zhou Mo. According to what he learned from his friends in the cardiology department, Zhou Mo is in financial difficulties, and his only breakthrough lies in Zhou Mo.

At this moment,

A student under him came over: "Teacher, I have a patient here, I can't figure it out, can you take a look?"

Zhou Quan suddenly became impatient: "I don't understand? Don't you know how to read a lot? I usually let you charge more after work in your free time, otherwise, if you want to be like this now, you don't understand anything and just ask the teacher. Are you useless?"

I was in a bad mood and scolded.

student:"………………"

On the surface, he dared not speak out, but he had already scolded Zhouquan a dozen times in his heart: "If you hadn't arranged so many beds for us, and you had asked us to help you with your papers, how could we be so busy? Free time? I have to be able to do it, I have been in the hospital for half a year, and I am busy every day until night, and when I go home, I fall on the bed exhausted, studying ass!"

"Also, after I graduated from undergraduate, I have been in this hospital for 3 years of regular training, 3 years of professional companionship, and 6 years of work. The hospital still refuses to hire me. It's nothing compared to... When the company is over, the hospital still doesn't want me, and I have to go out to find a job... I'm not even a human right now!"

The resentment in his heart has already made him have zero favorability for this hospital.

Zhou Quan didn't know what the students thought, and even if he knew, he would be full of disdain.

17:00,

Zhou Quan got off work and sat on the iron chair outside the Cardiology Department early, waiting to see when Zhou Mo would leave.

...

At this time,

Zhou Mo finished writing the information of the last patient and the admission information of the current patient.

Leaving the duty room, came to the ward.

In his heart, he stroked the patient again.

Myocardial infarction was ruled out first, because just now, the patient's troponin blood test results came out, and there was no problem.

came to the ward,

Just about to step in the door,

beep beep beep~~~

The wife of patient Zheng Zhengquan rang the call bell at the nurse's station.

When his wife saw Zhou Mo, she was overjoyed.

"Doctor Zhou, my husband seems to have something wrong, saying that his chest is getting more and more painful..."

Needless to say, Zhou Mo saw that the patient Zheng Zhengquan was clutching his chest at this time, his forehead was sweating in pain, and his breathing was even more slow, as if he was pressing.

"what happened?"

He glanced at the heart rate monitor.

The patient's vital signs are fine.

At this time, the nurse Kobayashi also ran over.

Zhou Mo quickly ordered: "Give him an electrocardiogram!"

Also think about it, what makes breathing hard?

Severe pneumonia, pulmonary embolism, heart failure, myasthenia gravis...etc.

First of all, with severe pneumonia, Zhou Mo listened to the patient's chest with a stethoscope.

There are no moist rales in the lungs.

Exclude severe pneumonia.

"Hey, wait..."

Zhou Mo noticed a problem. When his stethoscope was placed on the chest of the patient Zheng Zhengquan, the patient Zheng Zhengquan would frown and take a breath.

Zhou Mo was stunned.

Seriously asked: "Are you in pain?"

Gently pressed on the patient's chest.

Sure enough, the patient Zheng Zhengquan frowned fiercely again, and at the same time he still took a breath, as if taking a breath of cold air.

"pain?"

"(Patient nods)"

Zhou Mo was shocked and thought of a disease!

"Why didn't I think of it?"

Just now Zhou Mo pressed his finger on the patient's chest, but did not use force, but poked it slightly. With the hardness of the ribs of the human body, it is impossible to touch the heart and lungs below the ribs of the patient.

so!

The place of pain is the soft tissue in the chest!

Instead of the heart and lungs in the chest cavity!

The emergency department must have made a mistake. I only thought that there was a problem with my heart and lungs, but I couldn't find the cause, so I was sent to the cardiology department for admission.

"Why don't you say that you are these chest pains?"

Zhou Mo said to the patient Zheng Zhengquan dumbfounded.

Zheng Zhengquan cried bitterly: "I was a little confused at the time... You asked me to understand..."

Zhou Mo: "..."

However, since it was confirmed that the pain was caused by the soft tissue in his chest, Zhou Mo did not panic.

Not fatal!

Zhou Mo had enough time to take his time.

First use this cause, to stroke the patient's symptoms:

First, the patient has difficulty breathing, which may be due to inflammation of the chest wall (chest pain may be due to inflammation of the soft tissue of the chest wall after exercise.)

Because each breath will aggravate the pain, the patient dare not take a big breath, which creates the illusion of labored breathing.

"wrong!"

Zhou Mo suddenly thought of what the patient said about the left side, left hand and left foot, with little strength.

There is no way to explain the inflammation of the soft tissue in the chest alone.

"Rhabdomyolysis?"

Zhou Mo thought of a word.

The explanation of nouns is a bit complicated, and the literal meaning is almost the same.

Its etiology is very complex. Currently, there are more than 190 known etiologies, and more than 40 genetic related causes. Common causes include excessive exercise, muscle crush injury, ischemia...

The patient Zheng Zhengquan complained that he played volleyball and drank beer yesterday, so the possibility of rhabdomyolysis is not small.

But after all, he mostly sees cardiology now, and he is not very familiar with rhabdomyolysis.

"Forget it, call the nephrology doctor over for a consultation..."

Zhou Mo still didn't make a direct consultation call, but went to Senior Brother Chen Bing or Teacher Huang Li.

"That patient of yours is not a disease of the cardiology department?"

"Yes……"

"..."

Senior Brother Chen Bing was speechless. How many is this? Zhou Mo's luck, I don't know whether it is good or bad.

"Brother, I suspect it's rhabdomyolysis, so do you know any doctors in the department of nephrology?"

"Yes, there is. I'll make a phone call to ask, but I'm off work now, I'm afraid people won't come." Brother Chen Bing said while making the phone call.

Internal medicine is not surgery. Surgery performs well, but internal medicine does not.

Get through, chat a few words, hang up the phone.

Senior Brother Chen Bing spread his hands: "He's off work, you'd better find the on-duty consultation doctor of the Department of Nephrology."

Zhou Mo had no choice but to call the consulting doctor.

It is already 17:20, and the nephrology consultation doctor probably won't come, and it may be delayed until tomorrow to the doctor of the next consultation class.

really!

Zhou Mo waited all the way until 19:00,

The nephrology consultant has not arrived yet.

"Forget it, don't wait, I'll do it myself..."

What?

I don't understand in the kidney?

System, give me points! !

Zhou Mo first asked the nurse to draw blood from the patient, and sent it to do liver and kidney work.

Then start brushing books.

I searched for 2 guides and read them again.

"Ding...you read "2022 AAST Clinical Consensus: Rhabdomyolysis"..."

"Ding...you read the 2021 EAST Practice Guidelines: Management of Rhabdomyolysis..."

Took almost 2 hours.

Skill · get! !

At this time, Zhou Mo had become an expert in rhabdomyolysis syndrome.

Take a look:

What are the characteristics of rhabdomyolysis?

(Class representative boss, do you have a picture?)

First: the classic triad: myalgia, muscle weakness, tea-colored urine or cola urine (myoglobin, red blood cells).

Obviously, the patient Zheng Zhengquan had symptoms of muscle pain and muscle weakness.

As for the urine...