I Can See Health

Lu Chen's heart moved.

When buying a night shift, it doesn't matter if you have money or not.

The key is to work the night shift and deal with various emergencies. This is one of the ways to quickly improve the system completion and gratitude value.

If you just stay in a general ward, the efficiency of obtaining gratitude points will be slower.

However, Lu Chen decided not to do anything. He first wanted to find out what the gratitude value of this system was for, and then make the next step.

…

After lunch, there is a two-hour break at noon.

As soon as Lu Chen returned to the dormitory, he began to check the relevant electrocardiogram data.

The electrocardiogram he encountered this morning seemed somewhat familiar, but what it was exactly and what its significance was required further research.

Find your long-cherished "Advanced Electrocardiogram Manual".

Lu Chen began to wander through the sea of ​​books and read similar electrocardiograms.

Ventricular arrhythmias, supraventricular arrhythmias, atrial arrhythmias, coronary ischemic electrocardiogram...

After reading through most of the manual, Lu Chen racked his brains and still couldn't find any clues.

It was one o'clock in the afternoon before I knew it, and there was still an hour left before going to work.

Lu Chen felt a little sleepy, so he leaned on the desk and squinted for half an hour before going out to work.

Come to the eighth district of the heart.

Because Sun Guoguo worked the night shift yesterday, she would have a day off this afternoon.

If there was something that the team could not handle, Sun Guoguo told the attending physician of the other team and asked Lu Chen and others to find him to resolve it.

In the morning, Lu Chen and others had filled all the hospital beds, and no new patients would come in the afternoon.

Lu Chen began to sort out the medical records of the patients in the four beds under his care.

Bed 10 is an old man who fell ill twice in a row this morning. He was diagnosed with coronary heart disease, ischemic cardiomyopathy, and heart failure. He is now critically ill and is at risk of sudden death at any time.

Bed 11 is a mother-in-law in her 70s who was diagnosed with grade 3 hypertension (very high-risk group). Recently, her blood pressure has fluctuated greatly, so she came to the hospital to reduce her blood pressure. Her blood pressure is still unstable.

Bed 12, a woman was just admitted in the morning. The cause of the diagnosis of arrhythmia is yet to be investigated. The electrocardiogram is abnormal. No cause has been found yet.

Bed 13 is a patient with chest pain who is going to undergo elective coronary angiography to rule out coronary heart disease.

Among the four patients, except for the 12th bed admitted in the morning, the conditions of the other beds were relatively stable.

During this period, Lu Chen took the time to look at the old man in bed 10.

He is still sitting upright and has intermittent breathing difficulties. However, compared with when he fell ill in the morning, his condition has improved significantly and he is able to have energy to chat with others.

The color on his head is always red, which means that bed 10 is not completely out of danger.

The aunt in bed 12, Lu Chen asked her to do a heart ultrasound and chest CT in the afternoon, and the results showed no obvious abnormalities.

Lu Chen also rechecked her electrocardiogram, which showed no major changes from the electrocardiogram when she was first admitted to the hospital in the morning.

All her auxiliary examinations have been completed, and no problems were found in blood tests and imaging examinations.

"Doctor, when can I be discharged from the hospital?"

"Doctor, have you found out what's wrong with me?"

"Doctor, what injection are you giving me now?"

The woman in bed 12 couldn't sit still in the ward and ran to the doctor's office in less than an hour.

The color of this patient's head is yellow, which means that there is no immediate danger to his life.

Lu Chen could only explain to her patiently, then comfort her, and wait for Sun Guoguo to deal with this difficult problem tomorrow.

…

Until it was almost time to get off work, a nurse suddenly walked into the office.

"Is the doctor from the director's team here? The patient in bed 10 has hematuria. Go and have a look."

Lu Chen was extremely sensitive to his 10th bed and said quickly:

"Someone is here, I'll go check it out right away."

Lu Chen kept the medical record he was writing, picked up the stethoscope, and walked quickly towards bed 10.

As soon as he walked out of the ward, Lu Chen ran into Li Yao who was returning from the outpatient building.

"Hello, Teacher Li."

"Are you Lu...Lu Chen? You just entered the department today, right?"

Li Yao's memory was pretty good and she recognized Lu Chen immediately.

"Well, yes." Lu Chen smiled.

"What are you planning to do when you run out in such a hurry?" Li Yao asked with a smile.

Lu Chen said: "There was blood in bed 10 just now. I'll go over and have a look."

"Bed 10...are you still the old man with heart failure?" Li Yao pondered for a moment and said.

"yes."

"Then let's go and see it together."

After saying that, Li Yao turned around and walked in the direction of bed 10.

Lu Chen was stunned for a moment and followed closely.

Come to the ward.

The family member of the 10-bed patient, the old woman, saw Li Yao at a glance.

"Director Li, you are here."

The old woman smiled and stood up from the chair next to the bed.

Li Yao nodded and looked down at the urine bag next to the bed.

It is indeed blood red.

Normal urine should be clear and light yellow.

"Have you had hematuria since today?" Li Yao asked.

The old woman nodded and said, "Everything was fine for the past few days. He peed just now. I saw that the urine tube was all red. I thought it was abnormal, so I told the nurse."

"Yes." Li Yao responded, and then began to examine the patient.

After auscultating the chest, Li Yao lifted the patient's sheets and looked at his limbs and torso.

Check completed.

"Director Li, is my old man okay?" the old woman said nervously.

Li Yao did not reply. Instead, she turned back to Lu Chen and asked, "Lu Chen, what is hematuria?"

Lu Chen was stunned by the sudden question.

But he reacted quickly.

"Hematuria is divided into two types, one is gross hematuria and the other is microscopic hematuria."

"Urine containing a certain amount of red blood cells is called hematuria. The amount of blood in 1000ml of urine exceeds 1ml, and the appearance of the urine is red is called gross hematuria. There is no abnormality in the appearance of the urine, and the centrifugal sediment examination of fresh urine has more than 3 red blood cells per high-power field This is called microscopic hematuria."

Li Yao nodded slightly, "Then what do you think is the cause of this patient's gross hematuria?"

Lu Chen pondered for a long time and then carefully observed the patient's urine bag.

"According to normal thinking, we should first consider the hematuria caused by the damage of the urinary catheter to the urethral mucosa. However, the patient has had a urinary catheter for a few days, and hematuria will not suddenly occur when no one is pulling the urethra."

Li Yao nodded: "Since it's not urethral mucosal injury, what other reasons are there?"

Lu Chen thought about the blood clot in the patient's throat this morning, and continued after thinking about it.

"The patient coughed up bloody sputum this morning, and also aspirated blood clots in his throat. Combined with all these circumstances, abnormal coagulation or bleeding caused by drugs should be considered!"

"I looked through all the patient's medical orders. Because the patient is currently diagnosed with coronary heart disease and requires routine use of antiplatelet drugs, he also has atrial fibrillation. According to the CHA2DS2-VASC score of atrial fibrillation anticoagulation, anticoagulant drugs must be used in combination. Bai Rui OK."

"With antiplatelet combined with anticoagulation, the patient is older and has an increased risk of bleeding. It is currently considered that the bleeding may be caused by the drug."

After listening to Lu Chen's analysis, Li Yao showed a look of appreciation on her face.

"Not bad, clear and well-founded."

It was rare to have such an outstanding little guy, and Li Yao was very pleased.

Lu Chen breathed a sigh of relief. He finally knew why Senior Sister Sun Guoguo liked to ask questions so much!

It turns out that this is a tradition in the group, passed down from generation to generation!

I don't know when, Ke Yue and Jiang Qingyan also came to the ward.

Li Yaochao glanced at them.

"Ke Yue, please tell me how to deal with this kind of bleeding, bleeding caused by anticoagulant and antiplatelet drugs."

Ke Yue looked bitter.

I really shouldn't have followed him to the ward.

Now this is setting yourself on fire!

"First we should stop taking the medicine..."

After Ke Yue finished speaking, she glanced at Lu Chen.

When Lu Chen saw her looking at him, he immediately understood and shook his head gently.

Ke Yue immediately shook his head: "Ah, no, we can't stop taking the medicine first."

Li Yao frowned, "What measures should be taken?"

Ke Yue grimaced and pursed her lips.

"Teacher, I, I forgot."

Li Yao shook her head slightly, sighed, and looked back at Jiang Qingyan.

"Jiang Qingyan, what's your opinion?"

Jiang Qingyan raised her brows and said slowly: "The blood routine and coagulation parameters should be reviewed immediately. If these indicators are OK, then aspirin should be replaced with indobufen, and Xarelto should be replaced with intravenous low-molecular-weight heparin. . If blood routine, coagulation and other indicators are abnormal, the medication can be stopped first, and then antiplatelet and anticoagulant drugs can be started after the bleeding stops."

"Lu Chen, what's your opinion?" Li Yao looked at Lu Chen.

"It's almost the same as Jiang Qingyan's." Lu Chen said, "But there is one more thing to add. In fact, patients with long-term stable coronary heart disease and atrial fibrillation can use anticoagulant drugs alone and stop antiplatelet drugs, especially for older people and those with atrial fibrillation. Patients at high risk of bleeding.”

Jiang Qingyan frowned. In her impression, there seemed to be no such treatment method written in internal medicine books.

Lu Chen seemed to have seen through her thoughts and added something in a low voice.

"This is mentioned in the latest atrial fibrillation guidelines, but not in the book."

Jiang Qingyan nodded slightly and said, "Well, thank you."

Ke Yue was already holding a pen and recording Jiang Qingyan and Lu Chen's treatment opinions in his notebook.

Li Yao on the side looked at Lu Chen with satisfaction, and at the same time turned back to Jiang Qingyan and Ke Yue and said.

"You two need to improve your knowledge level. Now, no more than when you were undergraduates, you not only need to be familiar with the knowledge in internal medicine books, but also frequently browse the related guides of cardiology."

"You have to remember one thing: if you treat diseases according to the guidelines and regulations, we will be invincible when a medical dispute occurs! But if everyone believes in treating diseases on the fly, no matter how good you are in treating diseases, if anything goes wrong, you will be invincible. If it causes adverse consequences, you are fully responsible!"

"I understand, teacher."

Ke Yue and Jiang Qingyan nodded.

"This patient will be treated according to the method mentioned by Jiang Qingyan and Lu Chen." Li Yao said, "Also, Lu Chen, come to the office with me."

"Okay." Lu Chen nodded.

Li Yao walked out of the ward, and Lu Chen followed closely behind her.

…

Enter the director's office.

This is the second time Lu Chen has come to this office. The first time was when he was transferred.

The office furnishings are as usual.

A desk and a welcoming pine.

"How do you feel about your first day in the department?" Li Yao said with a smile.

"It's pretty good. There are a lot of patients. I just came here in the morning and I had two rescues."

Li Yao smiled and said, "I heard from Guoguo that the patient in bed 10 had heart failure twice this morning. The second time, it was thanks to your help in suctioning sputum."

Lu Chen smiled and touched the back of his head sheepishly.

"Do you have any plans for your graduate career in the next three years?" Li Yao got straight to the point.

Lu Chen pondered for a long time before saying:

"Work hard, learn clinical knowledge, and become a qualified doctor."

If you talk about your goals.

It's very simple, just be the most awesome cardiologist in the world.

However, this goal is too ambitious and too illusory.

Speaking of which, the credibility is not high.

Such an ambitious goal needs to be completed in stages.

The goal during the postgraduate period is to become familiar with the diseases in various departments.

An excellent cardiologist must first be an excellent general internist!

"What about future career plans?" Li Yao said, "If you want to go far in medicine, a master's degree or a doctorate is just the beginning. There will be more space for you to explore in the future. If you just want to find a good job To work, maybe get a master's degree or a doctorate, publish a few articles and you can get a job in most hospitals in the country."

Lu Chen said categorically: "Teacher, I want to do the best!"

Li Yao smiled and understood what Lu Chen meant.

"According to the current domestic medical environment, if you want to be an excellent doctor, you can't just learn clinical theoretical knowledge. You also need to have independent scientific research capabilities!"

"In the past three years, in addition to mastering clinical knowledge and skills, you can't lag behind in scientific research!"

"Just being able to do clinical work won't make you far in the hospital system. You won't even be promoted to deputy director."

At present, promotions to senior professional titles in domestic medicine require the support of papers.

In some cases, the importance of scientific research capabilities even far exceeds clinical capabilities.

For example, a PhD graduate in general surgery may not even be able to perform an operation for appendicitis or gallbladder stones!

Being able to write papers means that you can apply for various projects and funds.

With money, the hospital can develop, publish more articles, and apply for larger projects.

This is the result of a virtuous cycle and vice versa.

Lu Chen somewhat understood what Li Yao meant. She wanted him to participate in scientific research experiments.

"But you don't have to be too impatient when doing scientific research." Li Yao continued, "If you have time, you can come to the experimental building at the back door of the hospital. I have several experimental projects at the moment. When the time comes, your senior brother and senior sister will take you to study."

Lu Chen nodded and said, "Thank you, teacher. I will definitely study when I have time."

Li Yao said: "In addition, I would like to remind you that the school has various scholarships and grants every year. These scholarships are evaluated through essays."

"For example, if the national scholarship is 10,000 yuan, thesis evaluation takes up the vast majority. Whether you can get these scholarships depends entirely on your own efforts."

"Thank you teacher for the reminder."

From the current point of view, instructor Li Yao is a very good person.

For the sake of students, help Lu Chen make career plans.

Li Yao asked Lu Chen a few more questions about the department and life.

Lu Chen answered one by one, and the conversation ended.

Before leaving, Li Yao also handed Lu Chen a card, which was the access card for the backdoor laboratory building.

In addition, Li Yao asked Lu Chen to leave his email address.

As soon as Lu Chen returned to the doctor's office, he received the email from Li Yao.

This is an electronic invitation.