I Can See Health

   Chapter 742 Subdued

   After this episode of ward rounds, Jin Miao, the 10,000-year-old chief physician, immediately realized that Lu Chen was not as bad at seeing a doctor as a scientific researcher in everyone's stereotype.

   Today, the patient with elevated "myocardial enzymes" stayed in his bed for several days. Director Yan Wanfeng also saw the patient, but no one thought it would be myocarditis caused by "immune checkpoint inhibitors".

  This not only requires careful clinical thinking, but also requires a large amount of literature reading.

  Otherwise, even if you encounter the drug "immune checkpoint inhibitor", you don't know its use and principle, and it is unlikely to diagnose the "myocarditis" it induces.

  Jin Miao was still sighing at Lu Chen's greatness, "As expected of a specially introduced talent!"

   What he didn't expect was that he was about to usher in a storm.

   Back to the doctor's office.

Lu Chen changed his silence in the ward, opened the patient's medical record, and slowly said to Jin Miao: "Before the ward round, I briefly looked over the medical record, and then during the round, I asked the patient some questions. According to the actual situation, I found that the diagnosis and treatment plan for some patients still has some flaws."

   "Director Lu, you said, I'll listen." Jin Miao's posture was extremely low.

   Now he wants to curry favor with Lu Chen, and after the ward round just now, he found that Lu Chen really didn't come here to hang out clinically.

"Let's start with a simple one." Lu Chen's expression was extremely serious, "First of all, let's take a look at this 5-bed patient, a thirty-four-year-old female patient, without any symptoms of chest pain and chest tightness, just relying on the T wave of the electrocardiogram As a result, you let the patient do coronary angiography?"

   "Director Lu, this is the consent of the patient." Jin Miao defended.

"Hehe, the patient agreed?" Lu Chen shook his head, "I'm not a clinical rookie, communicating with patients about their condition, whether to do coronary CTA or coronary angiography, depends on your inductiveness. If the disease is too serious, or coronary angiography must be done, will the patient refuse it?"

  Jin Miao's face was not very good-looking, his posture was already very low, but Lu Chen was still so aggressive.

   "Director Lu, the patient is willing to do it and has already signed it. Is it wrong for us to do it for her?"

  Lu Chen laughed dumbly when he saw that Jin Miao was still pretending to be confused.

   "Okay, let's not discuss the patient's willingness or not. Tell yourself, does this patient need coronary angiography?" Lu Chen's tone became very serious.

  Jin Miao remained silent for a long while before slowly saying: "The electrocardiogram has the possibility of myocardial ischemia, and coronary heart disease must be ruled out."

   "Don't change the concept." Lu Chen's eyes were shining brightly, "To rule out coronary heart disease, an angiography must be done? Isn't it good to do coronary CTA?"

  Coronary angiography, no matter how non-invasive and small the wound is, it is also an operation!

   When the catheter enters the blood vessel, it will cause certain damage to the human vascular endothelium and even the nerve.

  Once the operation is wrong, there will be many side effects.

   Such as ruptured blood vessels, bleeding, hematoma, and even the possibility of infection.

   And coronary CTA, the diagnosis of coronary heart disease also has an accuracy of more than 95%.

   "Even, have you ever thought that the patient is a cardiac neurosis? Autonomic disorder?" Lu Chen continued.

   Hearing what Lu Chen said, Jin Miao lowered her head and stopped talking.

  Who said that people who are engaged in scientific research are not proficient in clinical practice.

   This Lu Chen, despite his young age, is quite rich in clinical experience.

"Director Lu, everyone is basically doing angiography now. If we don't do it, others will do it." Jin Miao said helplessly, "Now the hospital encourages one-day angiography, and many patients treat coronary angiography as a routine examination. "

  One-day coronary angiography, in simple terms, is to do coronary angiography in the outpatient clinic, do it in the morning, observe it in the afternoon, and then you can leave the hospital.

   "Hey." Lu Chen shook his head slightly, "I didn't say boycotting surgery, I am a surgeon myself. But the better the doctor, the one who does more surgeries, but the one who knows which surgeries cannot be performed!"

   Jin Miao was startled when she heard the words.

   He never thought that this sentence came from the mouth of a junior.

   Once upon a time, his teacher told him the same.

  A good doctor does not perform many operations, but knows which operations cannot be performed!

  The better the technology and the richer the experience, the more you will have a heart of reverence for life.

   Instead of being a novice, you have to intervene in everything, and you have to recommend surgery for any kind of patient.

   "Director Lu, what you said is true, I wrote it down." Jin Miao nodded earnestly.

   "I hope you can really understand." Lu Chen sighed slightly, "Although many surgeries can generate income, the harm to patients is irreparable."

   "Yeah." Jin Miao replied in a low voice.

  Lu Chen knew that if he said this, he would definitely offend some people and even involve the interests of others.

   He may not be able to take care of others, but in his own medical team, he must take care of it when he sees it.

   When you wear this white coat, you need to take the initiative to take on many responsibilities.

"Let's not talk about this for now." Lu Chen felt that the topic was a little heavy, "Let's take a look at this eight-bed patient. In the test on admission, D-dimer was elevated, and it was more than ten times higher, why is the ward round? No one mentioned this indicator? There are abnormal indicators in the blood test, do you leave it alone and do not re-examine it?"

   "This... The patient should not have pulmonary embolism." Jin Miao hesitated, "There is no thrombus elsewhere, and he is using anticoagulant drugs, so I left it out for the time being."

   "Then you plan to use anticoagulants all the time?" Lu Chen frowned, "Is it even after you leave the hospital?"

   "Stop it after a few days." Jin Miao replied in a very unconfident manner.

   "Hey, let's talk about the common causes of elevated D-dimer." Lu Chen sighed.

  Jin Miao was taken aback for a moment, but he usually asks students questions.

  It was my turn to be asked today, but the question is simple, just said: "The increase of D-dimer indicates that the patient is in a hypercoagulable state, or the patient has a tumor, and the content of D-dimer in the body will also increase."

   "Can't you be more specific?" Lu Chen frowned.

  Jin Miao quickly said: "For example, pulmonary embolism, myocardial infarction, atrial fibrillation, and even aortic dissection, D-dimer will increase."

   "It's still not perfect." Lu Chen shook his head, "First of all, you have to distinguish between pathological and physiological. With age, D-dimer can increase physiologically, and pregnancy can also cause it to increase."

   "Secondly, as you said, the patient is in a hypercoagulable state, which is more general, or in other words, many diseases will put the human body in a hypercoagulable state."

"The most common is deep vein thrombosis, followed by tumors, infections, autoimmune diseases, DIC, burns, trauma, most cardiovascular diseases, and hemolysis, blood transfusion reactions, and thrombolytic therapy can cause D-dimers Elevated..."

  Jin Miao stood beside Lu Chen and looked at him talking eloquently. He really admired this kind of clinical knowledge.

   Don't look at the very simple basics, but most people don't care about these details.

   Next, Lu Chen asked a few more questions and found out the loopholes in Jinmiao's diagnosis and treatment.

   This time, Jin Miao really had to accept it!

   It's no wonder that Lu Chen could be promoted to deputy chief physician just after graduation. It makes sense.

  Jin Miao felt that when facing Lu Chen, it was like facing Director Cen Shangwei of the Cardiology Department!

   And it only took Lu Chen one morning to be completely convinced by this ten thousand year old doctor in the department.

   (end of this chapter)