Chapter 213 Incomplete description
"The patient's coronary artery is fine." The surgeon paused slightly, a little impatient.
"Hello, I am Dr. Luo from Xiehe." Luo Hao introduced himself softly.
Concord?
Concord!
The doctor's expression immediately changed. Although he was not too expressive, he still gave Luo Hao enough respect.
"The patient has no history of Kawasaki disease, rheumatic diseases, syphilis and other diseases. The cardiac color ultrasound does not show the apical spherical changes of Takotsubo cardiomyopathy and the prolongation of the QT interval of the electrocardiogram. There is no diffuse systolic dysfunction of virus-related myocarditis. .”
A series of professional words made the doctor serious.
"You think it's time for surgery. Don't withdraw the tube yet, but do a drug challenge test?"
"Are you suspicious?"
"Non-obstructive coronary myocardial infarction needs to be ruled out. The angiography has been done. Let's do an acetylcholine challenge test. What do you think?"
The surgeon pondered.
Luo Hao also knew that if he had to do the surgery himself, he would hate it when someone was gesticulating.
"The patient still has pain in the precordial area, which is hard to explain. After all, he is a graduate student in the Department of Medicine at Teito University. If the diagnosis is not clear, he still has to go back to one of the affiliated hospitals."
Luo Hao spoke very vaguely, but his meaning was quite clear.
Although the patient is just a student, there are countless teachers behind him, and he may not be sure which one of the experts in the Teito University Department will give him the correct diagnosis at a glance.
If the examination is incomplete or hasty, the Department of Circulation Medicine at the Aviation General Hospital will be looked down upon and reduced to rubbish.
The chain of contempt within the medical system exists, and the chain is quite clear.
The Department of Cardiovascular Medicine at Union Medical College is slightly weaker. In some rankings, it is even on the edge of the top ten, slightly lower than the First Hospital of the Medical University.
Luo Hao firmly refuses to admit this kind of ranking.
"Okay." The surgeon compromised directly, but still insisted on defending, "I guess it will be fine."
"Recent guidelines believe that since MINOCA is a temporary diagnosis, the standard is coronary angiography. No obvious stenosis was found, but at this time it is necessary to determine whether the myocardial injury is caused by ischemic or non-ischemic causes."
"Are you also a circulatory physician?"
"Some understanding. A little. "
The surgeon was a little embarrassed. Luo Hao brought out the latest guide. He didn't know how to deal with it.
After listening to a few words, the surgeon solemnly agreed and went over to continue the operation.
"Luo Hao, do you think it really has nothing to do with me?" Chen Yong asked Luo Hao in a low voice.
"Of course, didn't I say that I believe you." Luo Hao smiled, "Besides, you don't know how capable you are?"
"Didn't I just become stronger? Not at all, I don’t have good control, I’m afraid that just a joke will..."
Chen Yong was worried. Even if Luo Hao ridiculed him and laughed at him, he was still worried.
This thing is indeed a coincidence, a very coincidence, and the other party is a strong young man, so there shouldn't be any problems.
In addition, the coronary angiography was normal, which further made Chen Yong feel uneasy.
Luo Hao patted Chen Yong on the shoulder to express comfort.
Chen Yong didn't hide either, but sighed worriedly.
"Zhuang Yan!" Luo Hao shouted.
"Senior brother, I'm here." Zhuang Yan stood up and came to Luo Hao.
"Ask Wang Yang's classmates in the same dormitory about his recent situation." Luo Hao felt that the medical history was not enough, "The more detailed the information, the better, yes."
"Yes! Brother, don't worry."
Looking at Zhuang Yan going to "ask for medical history," Chen Yong sighed again.
"Chen Yong really has nothing to do with you." Luo Hao said.
"Oh, don't comfort me." Chen Yong was very frustrated, "It's all my fault."
"..."
Luo Hao looked at Chen Yong, this idiot, and was speechless. Speechless. He didn't believe that Chen Yong could give a young man a heart attack with just a snap of his fingers.
It’s not that I don’t believe that Chen Yong doesn’t have this ability. After all, the luck value of 101+5 is clearly displayed on the system panel.
Luo Hao mainly believed that Chen Yong was kind and had no reason to do this.
If he could do this accidentally, Luo Hao considered sending Chen Yong back to Qingcheng Mountain or Longhu Mountain, Laoshan, or Wudang Mountain to cultivate his mind.
"It was fine, but suddenly it stopped working. I didn't see any problems during the angiography." Chen Yong didn't listen to what Luo Hao said at all, and murmured in frustration, "It must be my fault. "
"Idiot." Luo Hao cursed.
"What did you say?"
"It should...it must have nothing to do with you, don't worry." Luo Hao glared at Chen Yong, "The examination has not been completed yet. Just because there is no problem with the angiography does not mean it is true. No problem.”
"But..."
"Except for Union Medical College, students from other medical schools have poor foundations." Luo Hao scolded with disdain.
After a few curses, Chen Yong finally became more energetic.
“Senior Brother!”
Zhuang Yan ran back.
"What's going on?"
"Wang Yang had a gastrointestinal cold yesterday and had diarrhea." Zhuang Yanhui reported, "But can this cause myocardial infarction?"
"What medicine did you take?"
“Montmorillonite powder + levofloxacin + clarithromycin.”
Zhuang Yan’s level is still good, and she doesn’t ask questions one after another.
Got it!
A comfortable smile appeared on Luo Hao's face, "It's about clarithromycin."
"???"
"???"
Chen Yong immediately took out his mobile phone and searched for instructions for clarithromycin.
"1. Mainly include oral odor (3%), gastrointestinal reactions such as abdominal pain, diarrhea, nausea, and vomiting (2% to 3%), headache (2%), and transient elevation of serum aminotransferase.
< br>2. Allergic reactions may occur, ranging from drug rash and urticaria to severe allergies and Stevens-Johnson disease.
3. Occasionally, hepatotoxicity and pseudomembranous enteritis caused by Clostridium difficile.
4. There have been reports of transient central nervous system adverse reactions, including anxiety, dizziness, insomnia, hallucinations, nightmares, or confusion, but the relationship between the cause and the drug is still unclear. ”< br>
"Luo Hao, there is no side effect of causing myocardial infarction." Chen Yong said doubtfully after reading it.
"The description is incomplete."
"Fuck!"
"Let's wait for the results of the provocation test." Luo Hao didn't explain, and returned to the chair to sit down, stretching his legs and holding his hands. Make a circle in front of you and move your thumbs around.
"What is going on? I see it is written in the contraindications below - certain heart diseases, including arrhythmia, bradycardia, Q-T interval prolongation, ischemic heart disease, congestion It is prohibited for patients with heart failure and other conditions." Chen Yong came over with his mobile phone.
"A very rare situation." Luo Hao said seriously.
Chen Yong knew what the next sentence would be. But this time it involves him, and Chen Yong can't hide even if he wants to.
"But it is rare in other hospitals and cannot be diagnosed. It is a common disease in my family, Xiehe." Luo Hao said.
“!!!”
Sure enough, Chen Yong’s guess was not wrong at all!
Luo Hao really said that.
This piece of shit!
"Does your Xiehe cleaning aunt know about it?" Chen Yong asked disdainfully.
“I can’t say everything, but the circulatory and emergency room hygienists will definitely know.” Luo Hao said firmly, “When the provocation test results are obtained, don’t worry, it’s a drug allergic reaction and it has nothing to do with you.”
“ Please explain in detail.”
“There’s nothing to say. Simply put, the allergic reaction to clarithromycin causes the activation of mast cells, macrophages and T lymphocytes, and the synthesis and release of inflammatory mediators.
< br>
A syndrome of peripheral vasodilation, lowered blood pressure, decreased coronary blood flow, arrhythmia, coronary spasm, coronary atheromatous plaque erosion, rupture or coronary stent thrombosis, also known as allergic myocardial insufficiency. blood syndrome. ”
“The scientific name is Kounis syndrome. "
"..."
"..."
Both Chen Yong and Zhuang Yan looked confused.
Luo Hao sighed, the diagnostic assistant AI is really useful, and I feel good after using it.
And inseparable.
Now the diagnostic assistant AI is being upgraded, and I don’t know what to integrate it with. If the diagnostic assistant AI hadn't been working, I would have been able to "see" that Wang Yang had a myocardial infarction at the airport.
Although nothing serious happened, it was still a bit dangerous.
The facts were pretty much what Luo Hao had "expected". The surgeon came out half an hour later and the acetylcholine challenge test was positive!
Luo Hao told the surgeon his judgment.
Clindamycin was discontinued and combined treatment with nitrates and calcium channel blockers was given.
A few hours later, Wang Yang's symptoms were significantly relieved, and Luo Haobian left with Wang Jiani, Chen Yong, and Zhuang Yan.
With a correct diagnosis, the subsequent treatment is not important.
As long as there are no allergens, "myocardial infarction" will be cured even without medication.
"Luo Hao, it really has nothing to do with me." Chen Yong's expression was very complicated, with relief mixed with a little bit of disappointment.
Luo Hao understands Chen Yong's mentality very well. He is afraid that his brother will have a hard time, and he is also afraid that his brother will drive a Land Rover.
Humans are always confused.
“It’s okay, isn’t it?”
“Clindamycin has such side effects, why isn’t it written in the instructions?!” Chen Yong began to become active, and his tone of voice became clearer. changes.
"There are many similar situations, not just about clarithromycin." Luo Hao said, "It's not a side effect, it's an allergy. Some people are even allergic to water, so you can't give pure water an instruction manual to explain the situation."
"What else happened?" Chen Yong asked.
"Disease factors, such as angioedema, asthma, vasculitis, hay fever, etc.; environmental factors, insect bites, plant cuts, latex, diesel, etc.; food factors, shellfish, tuna, kiwi fruit, etc. ;Drug factors, antibiotics, contrast agents, anti-tumor drugs, non-steroidal drugs, glucocorticoids, proton pump inhibitors, etc.
The most common cause is antibiotics, followed by insect bites. ”< br>
“Occasionally, patients will have a similar situation during chemotherapy. I once arranged a table for Teacher Pan to perform embolization surgery at Xiehe University. The patient was allergic to chemotherapy drugs and had ST-segment changes. Teacher Pan told me.”
"..."
Chen Yong was a little disappointed.
Every time Luo Hao "showed off" how awesome Union College was, he would wonder at a loss whether his life would be any different if he had worked harder in high school and was admitted to Union College.
Although there is a high probability that I will still have to go abroad and go to Qingcheng Mountain, it is still much better to tell people that I graduated from Xiehe University.
Alas.
Chen Yong sighed deeply in his heart.
"Chen Yong." Luo Hao asked in a low voice. "What?"
"If you have the will, can you do it?" Luo Hao asked a confused question.
“I don’t know.” Chen Yong shook his head, “I can’t do it even if I want to harmonize the society and eradicate gangs. Do you want me to become a gangster? Or do you want to open a private hospital? Everyone is sick, but I can rejuvenate them?”
"You are so dark. I just asked you casually, and you actually thought of that."
Luo Hao said, suddenly his heart moved.
“Any of you do this?”
“Of course, there are many evil ways.” Chen Yong said, “But I am different. I am a disciple of a famous sect from Qingcheng Mountain.”
"Disciple of the Houchu."
"That's also a disciple! Which branch of the People's Liberation Army is the strongest? It's not the cooking soldiers. It's the same in Qingcheng Mountain in my family. The disciples in the back kitchen are the strongest, even those from the outer sect."
Seeing Chen Yong return to normal, Luo Hao breathed a sigh of relief .
“Let’s go, I’ll treat you to some bean juice.”
“No!”
“No!”
"Okay."
Only Wang Jiani said yes happily.
"Da Nizi, are you stupid! You will regret it after drinking that Douzhier thing!"
"Luo Hao shouldn't give me something bad to drink." Wang Jiani suddenly flashed Said with big eyes.
"emmmm." Luo Hao thought for a moment, "Then let's go eat hot pot. There is a good hot pot restaurant under Sanyan Bridge. Director Qin likes to go there."
A hearty meal.
Luo Hao was also very hungry in India. Together with Chen Yong and Technician No. 66, the three of them ate 20 plates of meat in one go, leaving Wang Jiani and Zhuang Yan stunned.
In the poor land of India, Luo Hao didn't even dare to touch unfamiliar water, let alone eat hand cakes and other meat foods.
Now that he is back and has cooked the mutton, Luo Hao feels extremely happy.
This kind of happiness is as real as it is, and it is so thick that it cannot be dissolved.
"Are you being treated so harshly like this in India? It's so miserable. I feel like you are just asking for food." Wang Jiani was surprised.
Luo Hao was a little helpless, and Wang Jiani was very glad that she did not go to India with Luo Hao.
Eat and drink enough, go back and rest.
Luo Hao took Wang Jiani to visit the two bosses early the next morning, left a message for Principal Wang, and then got on the plane home.
While the plane was taxiing, Luo Hao turned on his mobile phone and saw a series of missed calls.
Uh, what's going on?
The call was from Geng Qiang.
Luo Hao quickly replied.
There must be something urgent when Geng Qiang comes to see him.
“Brother Geng, I’m on a plane and just landed. What’s wrong?”
"An investor is sick. He may be acclimatized. I'm thinking of having a look at you." Geng Qiang's words were calm, but Luo Hao could hear some urgency.
Thinking about it, if he was not in a hurry, Geng Qiang would definitely not call him alone, and there would be a series of missed calls.
"Okay, I'm going to take a look. Where is he?"
"The ICU of the First Hospital of Medical University."
Fuck!
We are already in the ICU, so why don't we worry?
"I'll be there soon." Luo Hao hung up the phone, "Da Nizi, help me get my luggage. I'll go to the ICU when I get off the plane."
"Chen Yong, you come with me Let’s go together.”
“Lao Liu, help Da Nizi deliver things”
Luo Hao made arrangements immediately.
Seeing Luo Hao's serious face, the others knew that there must be a difficult patient.
After getting off the plane, Luo Hao hugged Wang Jiani gently and said, "I'll see you when I'm done."
"Yes!"
Luo Hao left quickly.
“What patient?”
"I don't know the specific illness, but I guess the investor suddenly fell ill and is now in the ICU."
"Foreigners are very fragile," Chen Yong said.
“???”
“I feel that they are not fully evolved and have numerous allergies.” Chen Yong went through the gossip, “I know a girl in the UK. She has severe allergies. I was lactose intolerant and had diarrhea after drinking milk, and I went straight to the hospital one time.”
Uh.
Luo Hao's mind flew to the other side of the sky.
I already know that I am lactose intolerant, but I still want to be exposed to it. Is it because of the small lactose content?
It seems possible, otherwise why would Chen Yong add the three words "serious" before lactose intolerance when describing his little girlfriend.
This sentence exposes many problems.
"What are you thinking!" Chen Yong saw Luo Hao's expression and understood instantly.
"The lactose content is just that, isn't it?" Luo Hao asked.
“That’s a little bit?”
“0.62 mg per milliliter. Calculated according to the general standard upper limit of 5 ml, it’s only 3 mg. Will I be allergic? Do I still need to go to the hospital? The ambulance will go there ? Or you took me there on a broomstick! ”
“In fact, we don’t know much about allergies in the past few decades. ." Luo Hao said, "Otherwise, if you can't even eat enough, why would you have so many allergies?"
Chen Yong was shocked by Luo Hao's previous calculation. He was calculating carefully and didn't hear clearly what Luo Hao was saying.
"I have been in contact with a patient who is allergic to garlic. He only needs to take garlic orally..."
"Just take garlic. If you say oral administration, I always feel weird." Chen Yong said seriously Putting his lactose allergy aside, he corrected.
“Well, abdominal pain will occur less than 10 minutes after eating garlic, and the pain will subside after about 20 minutes.”
“How did you cure it later?”
"Just don't eat it." Luo Hao smiled, "But what you said is similar to what a senior brother said. He went to Canada to study and said that people there have various allergies. Peanut allergies are the most common, and some even The murder case took advantage of peanut allergies."
"I have seen people with egg allergies!" Chen Yong said.
"That's really unfortunate. It's okay if you don't eat peanuts. If you don't eat eggs, you always feel like you're missing something."
The two entered the parking lot while chatting.
Before going abroad, Luo Hao drove the sign 307 and parked it in the parking lot of the airport, and he just drove away at this time.
"There are many medical records of egg allergy in Xiehe's case library, but one thing is strange."
"What's strange."
"Those patients are allergic to eating ordinary eggs, but they are allergic to tea." Eggs are fine. So when it is found that the allergen is eggs, most patients will deny it after all. Not many, many families make tea eggs.”
“Why are tea eggs not allergic? Is there anything in tea that can neutralize allergens?”
“I don’t know. , I have no interest in this research. If you are interested, you can think about it carefully.”
Tea eggs are not allergic, but ordinary eggs are. Is it related to tea?
Chen Yong began to think about it.
"By the way, a foreign nutritionist came to China to give a lecture a few years ago, and I just happened to listen to one." Luo Hao started 307, and Daniel's voice was still so nice.
"He said that peanut allergies are rare in our country because of insufficient medical conditions and the genes for peanut allergies have been naturally eliminated."
"Bullshit!" Chen Yong said scornfully, "Those foreign devils will tell you that our genes are not good if they turn around."
Luo Hao smiled. He always felt that Chen Yong was bullied when he was in school in the UK, or discrimination would be a more accurate description.
Otherwise he wouldn't behave in such an extreme way.
The words he just said sounded a little uncomfortable to Luo Hao, but as if he had touched Chen Yong's inverse scales, the guy immediately started to scold him.
"It is said that during the Ming Dynasty, peanuts were grown on a large scale and used as food rations, and then the allergenic genes were gradually eliminated." Luo Hao repeated the words of the nutritionist.
Chen Yong was extremely disbelieving and could not express his disbelief.
Luo Hao felt refreshed when he drove the car. It may be because he returned to China. He didn't have to be as vigilant as he was in India and he felt relaxed.
Even Luo Hao felt that there was a sweet smell in the air.
When will I come to see Boss Ding from Piyang, or go home to see my mother and uncle?
Luo Hao stopped talking to Chen Yong about allergies, and did not guess in advance what kind of disease the people admitted to the ICU had. He drove all the way back to the First Hospital of the Medical University.
Go back to the department to change clothes.
He saw Shen Zizai face to face. Shen Zizai had just come out of the ward in white clothes with his hands behind his back.
"Xiao Luo, you are back!" Shen Zizai grinned, "I said it was time for you to come back."
"Hello, Director Shen." Luo Hao stepped forward and said respectfully Bow respectfully.
"Hai, don't be so polite." Shen Zizai smiled and said, "I took a look at the film. The tumors planted by Chen Jiao's seeds have shrunk significantly, and the effect is particularly good. The pain caused by bone metastasis has almost disappeared, no need to After taking painkillers and taking painkillers, the quality of life has improved significantly, which is pretty good.”
“Well, the effect of internal radiation therapy is pretty good, and the side effects are relatively small. I’ll evaluate it later. Let’s take a look. Where to plant particles and how many particles to plant?”
Luo Hao said and came to the duty room to change clothes.
Shen Zizai was about to say something when he suddenly remembered what Luo Hao said for a while, and he was a little surprised, "Then what are you doing now?"
"ICU, it is said that a foreigner is seriously ill. , let me take a look."
A strange expression appeared on Shen Zizai's face.
Luo Hao could see clearly, "Director Shen, what's wrong?"
"It's bad, I suggest you don't go." Shen Zizai said, "That foreigner was accompanied by a health doctor from the Mayo Clinic, and the results became worse and worse. I think the doctor from the Mayo Clinic seems to be blaming us. The First Hospital of the Medical University."
"..."
"The recent rumor is that our medical equipment is not good enough, so there is no clear diagnosis, which makes the foreign devils become more and more serious. Don’t say he’s not good enough.”
“Director Shen, what disease does he suspect?” Luo Hao asked.
"It seems to be carcinoid syndrome, but it doesn't get better after giving corresponding treatment. The foreign devils are so difficult to take care of, and you didn't even see it." Shen Zizai said angrily.
"I'd better take a look." Luo Hao smiled and glanced at his lucky value.
101+5, it is possible to know it at a glance.
Shen Zizai didn't stop him either. He just told Luo Hao the relevant situation. When Luo Hao insisted, he followed Luo Hao upstairs.
"Don't worry, if the foreign devils scold you, I will scold you back." Chen Yong patted his chest, "What I learned when I was in school were all ancient proverbs. And I joined several clubs in London. I know all about their broken rules."
"Oh? A club?"
"Get out!"
(End of this chapter)