Chapter 384 Misdiagnosis for a Lifetime
“Lao Meng, thank you for your hard work, you haven’t gotten off work yet.” Luo Hao smiled and greeted Meng Liangren.
"Professor Luo, you are back. I told you that you have to come back and take a look at the patient."
"Definitely, the obsessive-compulsive disorder + severe persecution delusion has become serious again. If you don't look at the patient, you will Can’t sleep.”
“Director Fang hasn’t left yet. I’ve been waiting for you.”
"???" Luo Hao then remembered Fang Xiao.
It's not that Fang Xiao has no sense of presence, Luo Hao has a deep memory of Director Fang, who never kept his mouth shut.
Luo Hao also remembers that trip to Changnan City and what happened in Changnan a few days ago.
It’s just that this experimental surgery was of great significance, so great that Luo Hao ignored it.
Compared with surgery, Fang Xiao is almost transparent.
Although Boss Chai mobilized resources and Meng Liang and Feng Zixuan cooperated tacitly, the specific surgical work still had to be done by Luo Hao, and all the contents were new and needed to be mastered by Luo Hao himself.
He can be good at dancing and versatile, but when it comes to scoring.
"Director Fang hasn't left yet." Luo Hao passed by, patted Meng Liangren, and entered the office.
“Director Fang.”
“Professor Luo!”
Fang Xiao was competing with Er Hei and kept snapping his fingers, but Er Hei ignored him.
Hearing Luo Hao calling him, Fang Xiao jumped up from his chair.
"Professor Luo, you really consider the hospital your home, and you still come back to see the patients so late. I didn't believe it when I heard Lao Meng say that you will definitely come back."
"Haha "Wait a minute, I'm going to see Chen Jiao."
Fang Xiao followed Luo Hao quietly.
"Director Fang, what's going on?"
"It's nothing. I wanted to visit you and express my gratitude for what happened a few days ago. My old colleague is sorry and knows that you don't have time. , so I came here shamelessly."
"It's too polite. There is no need to keep it in mind."
"But..."
"Huh?" Luo Hao turned his head and looked at Fang Xiao.
"I had a splenectomy for a car accident a few days ago. The patient is living in the ICU of our People's Hospital, and his condition is getting worse and worse." Fang Xiao kept scratching his head.
The interface is so poor that I feel like digging my toes into the ground.
But Fang Xiao is thick-skinned and not afraid.
"Wait a moment." Luo Hao smiled, turned and entered the ward.
Chen Jiao was reading a book when she saw Luo Hao coming in. She smiled and said, "Hello, Teacher Luo."
"I haven't slept yet."
"I've been nervous all day today. I didn't expect the operation to be so quick, and I didn't feel anything at all. I don't feel sleepy now. I have nothing to do to read a book." Chen Jiao said with a smile. .
Luo Hao took a look and saw that Chen Jiao was holding a book of biochemistry.
“No reaction at all?”
“Well, no, okay. If Teacher Meng hadn’t told me not to go to the ground, I would have gone to the bathroom by myself. I don’t dare to drink water now. , afraid of trouble.”
"Be patient for one night and talk about it tomorrow. Although the trauma is small, we still need to pay attention to it." Luo Hao smiled.
After chatting with Chen Jiao for a few minutes, Luo Hao turned and left.
It’s best if nothing happens. Although Chen Jiao should be fine in theory, Luo Hao is still worried.
It feels better once I see it, and it cures my obsessive-compulsive disorder.
"Director Fang, is there a problem with the operation?" Luo Hao asked.
"No, there is no problem with the patient's surgery. I can confirm it. Moreover, he suffered from hyponatremia. He had convulsions and body stiffness after taking sodium supplement. I failed at the surgery and at most he suffered from hemorrhagic shock. It is not my fault."
Speaking of this, Fang Xiao suddenly realized that he had said the wrong thing and smiled sheepishly, "Professor Luo, I didn't mean that."
"Hyponatremia? Is there a gimbal?"< br>
“Yes, I want one.”
Fang Xiao originally just wanted to find an excuse and a rationale, but he didn’t expect Luo Hao to take it seriously.
This kind of patient occasionally encounters convulsions after trauma, which is generally considered clinically to be caused by excessive fright.
As for whether it is good or not, that is not necessarily the case. Some patients even never feel good because of convulsions and eventually die clinically.
There are different explanations for similar deaths, as well as various urban legends, monsters and the like, which Fang Xiao does not believe.
When he came to the office, Luo Hao sat down and snapped his fingers.
Erhei opened his eyes, walked to Luo Hao's side rustlingly, and put his shiny head close to let Luo Hao rub it.
Fang Xiao looked envious, but he still thought back and asked the other side for patient information and input it into the cloud platform.
Since you want to act, you have to put in some effort, otherwise it won’t look good.
Professor Luo should know the purpose of his coming, but he still needs to see the patient first, so he can't take it too seriously.
"Professor Luo, please take a look at the laboratory test report of the patient's hospitalization."
Fang Xiao handed the phone to Luo Hao.
The patient was comatose and dehydrated for 4 days, accompanied by intermittent vomiting and abdominal pain.
Laboratory tests: metabolic acidosis, hyperglycemia 37mmol/L, severe hyponatremia 89mmol/L, hyperlipidemia TG 223mmol/L, total cholesterol 41.4mmol/L, and sodium supplementation was given 2 hours after admission.
Luo Hao's brows furrowed, and he held Erhei in his left hand and fell into deep thought.
"Professor Luo, I'm sorry, this kind of thing happens very often. I think the patient suffered from convulsions due to the shock of the car accident." Fang Xiao scratched his head and explained sheepishly.
"Convulsions caused by fright?" Luo Hao suddenly asked after being silent for a few seconds.
"Uh..."
Fang Xiao suddenly didn't even dare to fart.
In the past, he must have thought that Luo Hao was too young, had insufficient clinical experience, and had never encountered similar patients, so he had such questions.
But now Fang Xiao roughly knows the gap between himself and Luo Hao, how dare he think so.
Professor Luo asked himself, his statement must be wrong.
But where did I go wrong? Similar patients are not uncommon. I have seen at least three or five similar patients.
"Professor Luo, what do you think?" Fang Xiao did not answer, but asked cautiously.
“First of all, it is not true to measure the blood sodium value in the state of hyperglycemia and chylemia. Secondly, the blood sodium rises too fast, causing nerve demyelination, and it is irreversible. This is already a major medical accident. ”
Fuck!
Fang Xiao was startled, it turned out to be a major medical accident? !
Are the several similar cases he has experienced in his life all major medical accidents? !
In an instant, Fang Xiao's back was soaked with cold sweat, and his hands and feet were cold.
He had no doubt whether what Luo Hao said was true or not. Although he could understand every word, Fang Xiao had no idea what it was about.
"I'm kidding, there are many things involved and it's quite complicated. Hyponatremia doesn't just require sodium supplementation, there are other things." Luo Hao smiled.
“For example?” Fang Xiao asked tentatively.
"Generally, the rise does not exceed 0.5mmol/L per hour, and the rise does not exceed 12mmol/24 hours.
But European guidelines recommend no more than 10mmol/24h.
There are literature reports of less than 10mmol/L 24h, demyelination also occurs. American guidelines recommend a daily upper limit of 10 if there is no high risk of demyelination, and a daily upper limit of 8 if there is a high risk of demyelination.
There are also more cautious expert recommendations of no demyelination. High risk, upper limit of 8 per day, and high risk of demyelination, upper limit of 6 per day.
In short, be increasingly cautious with demyelination due to malnutrition, alcoholism, liver insufficiency, and hypokalemia. High-risk patients are more cautious.”
"..."
Sodium supplementation actually carries the risk of demyelination. No wonder the patient has convulsions!
Fang Xiao’s body was clammy and cold, and there was a cold wind in his ears.
After Luo Hao explained carefully, he understood. The patient's convulsions were not the result of a car accident, but a nerve demyelination reaction caused by incorrect sodium supplementation.
Damn it!
Fortunately, I could find any reason to bring this patient out to talk about it, otherwise I would have been having convulsions, and it would be hard to tell whether the patient would survive after a few days.
“From the medical history, I have been comatose and dehydrated for 4 days, and I am also vomiting. All indicators are extremely high, consistent with concentration after dehydration, but the blood sodium is abnormally low.
Indicators appear If there is a reverse fluctuation, there must be something wrong.
The blood sodium is probably not low, and the osmotic pressure is probably hypertonic.
The occurrence of low sodium is a dilution phenomenon in the body to adjust the osmotic pressure. Or pseudohyponatremia caused by elevated triglycerides
Further identification is made by measuring osmotic pressure and blood gas analysis and ionization method to determine serum sodium. "
"Can your hospital do it? "Luo Hao turned his head and asked Fang Xiao.
"? ? ? "Fang Xiao was stunned. Luo Hao just said a lot of words, which sounded familiar to him. But now thinking about it, he seemed to have brain fog. What Professor Luo Haoluo just said, he didn't understand at all. I can’t remember.
Fang Xiao doesn’t even feel like he’s a doctor, he’s just an ordinary patient’s family member.
“Director Fang, here. "Meng Liangren handed over a piece of paper with a large paragraph written in cursive on it.
"Oh, I spoke too fast." Luo Hao smiled, took the paper Meng Liangren recorded, and began to explain to Fang Xiao word by word.
Everyone in Meng Liang was sweating.
When Professor Luo was explaining the disease to Director Fang, he was also checking whether his records were complete.
Assessment is everywhere.
Fortunately, if you are serious and work to a standard, there should be no problem.
Fang Xiao was dumbfounded when he saw all this, and his whole body was stunned.
Professor Luo said a few words to himself, and Meng Liangren remembered them all? In his previous life, he must have been a royal guard.
And the hand speed is too fast, shorthand?
But what really scares Fang Xiao is yet to come.
As Luo Hao analyzed the text recorded by Meng Liangren word by word, Fang Xiao felt as if he was watching a ghost movie, and the hair on his body stood up.
paralysis!
The content that had just been understood in a flash echoed in his mind. As Luo Hao talked about the treatment processes and clinical responses of several related patients, Fang Xiao realized one thing - he had encountered similar situations in his life. The patients were misdiagnosed!
When he thought of several patients who died in vain, Fang Xiao's heart froze, motionless, and even his breathing paused, as if the people were gone. (Note)
"Director Fang, the convulsions you mentioned happened by chance, right?" Luo Hao asked.
Fang Xiao nodded in confusion.
"The patient died later. Was there an autopsy?" Fang Xiao nodded first, then shook his head.
"Has anyone done a head CT after a convulsion?"
"Yes, yes." Fang Xiao replied repeatedly, "Cerebral hemorrhage! I guess it was Delayed cerebral hemorrhage. "
" Death from convulsions and cerebral hemorrhage after sodium supplementation may be caused by further increase in osmotic pressure, leading to dehydration and atrophy of the brain tissue, and bleeding due to vascular traction. However, excessive sodium supplementation will only cause death. Causes demyelination or heart failure, and generally does not cause cerebral hemorrhage. ”
"It's about like this."
Luo Hao finished seriously.
Fang Xiao suddenly became anxious, "Professor Luo, what should we do with the patient?"
"I didn't see the situation." Luo Hao spread his hands, "Well, you can find the director of your intensive care unit. , video consultation. I... I’ll say hello to Director Feng. It’s registered in the medical office of the first year of the Medical University. Do you think it’s okay?”
“Okay, okay.”
Fang Xiao couldn't care about his own face and anxiously began to contact the director of the ICU.
That side didn't really care, but he quickly gave in to Fang Xiao's constant roar of the evil dragon.
Fang Xiao quickly formed a group and started a video consultation.
He felt very unfamiliar with this consultation model. The doctor on duty in the ICU showed Luo Hao the patient's condition on his mobile phone and reported the current condition.
Luo Hao probably knew it well. He did not explain the principles to the little doctor like a good person, but directly gave him a treatment plan.
After ten minutes, the video consultation was hung up.
Fang Xiao was still uneasy and called the Intensive Care Unit of Changnan People's Hospital. He urged her to follow Professor Luo's consultation opinion.
If anything happens, you are responsible for it!
Fang Xiao, who has always been naughty, naturally said that he was responsible, without even realizing the subtle changes.
After repeated warnings, Fang Xiao put down his phone and walked back to the doctor's office.
Luo Hao was chatting with Erhei and Meng Liangren.
“Children are like this nowadays. My sister’s children live in Station B by themselves. This summer’s request is to go to Shanxi Jinci Temple, Yanqing Temple and Jinzhong Jianguo Temple. They have no interest in going abroad.” Meng Liang A smile appeared on the square face.
“What are you doing out there? I saw a few holes in the wall when I was abroad, and I thought, these are holes for nail guns. Is it some kind of decoration? But they told me that those are holes for nail guns. Some time ago, Liuzi went back to China for medical treatment, remember."
"Remember. "Yes, although Director Feng is mysterious, the news has spread throughout the hospital." Meng Liangren said, "Many people's children are studying abroad and they are extremely anxious. One of the couple has to watch."
“Haha, that’s not scary.”
"Yes!" Meng Liangren suddenly raised his voice and patted the chair, "Professor Luo, the child of Director Feng of the Endocrinology Department has changed his gender in the United States."
"Holy shit, really?!"
< br>"Really, Director Feng was about to jump off the building the day before yesterday, but he was stopped. I think that means he has bipolar disorder." Meng Liangren sighed, "You said, a good boy goes to study abroad and a girl comes back. What the hell is going on?”
“The day before yesterday?”
“You were doing research at the University of Technology, I don’t know. I was writing medical records that day, and I saw the hospital manager and the patient’s family members walking around. Go out and watch the fun.”
"..."
"I also took a look, and then after asking around, I found out that this was the case." Meng Liangren sighed, "Why bother with this."
"The eldest son of Lao Ma's family has been transgendered. Lao Ma must be strong enough. He doesn't even know that his child has been transgendered. It's really fucked up, but I'm still happy to see this kind of thing." Luo Hao smiled, "It's noisy Well, the more monsters and ghosts the better, and the fewer good families in the six counties the better."
Fang Xiao was a little confused after hearing this, and stood with his hands tied.
"Director Fang is back." Luo Hao smiled and greeted Erhei.
"Professor Luo, can the patient survive?" Fang Xiao was a little worried.
Although he is naughty and uninformed, he has still followed his true heart over the years, and he can still do the minimum of treating illnesses and saving people.
"It should be no problem." Luo Hao smiled, "I think the patient's condition is not very serious. The symptoms of demyelination are very mild. He will get better soon after corresponding treatment."
"I...I...I..." Fang Xiao stammered, feeling extremely complicated.
"It's harmful, you don't understand, there is no need to blame yourself." Luo Hao comforted.
Is this to comfort yourself? Or raise an army to accuse? Fang Xiao reacted for a moment, and then he roughly realized that Professor Luo was trying to comfort himself.
It’s just that the words are a bit like Yin Yang himself.
“It’s true, 99% of doctors across the country will give sodium in similar situations. The boss said that when he was young, he directly used concentrated salt mixed with physiological saline and pushed it directly into the patient.”
"!!!"
"At that time, there were no micropumps, so it was impossible to be precise. The vast majority of patients were cured, but a few patients would have accidents. What should I do if an accident occurs? With the current technology and understanding, With everyone’s level, what else can we do?”
"..." Fang Xiao was speechless.
"Go back and check the book, and try to be more precise when you knock it down in the future. There is no need to think too much." Luo Hao's smile was full of affinity.
Fang Xiao thought for a while. The limitations of history seemed a bit big for him, but it made sense.
No, it was a serious condition, so I just found an excuse to be as close as possible to Professor Ronaldinho, so why did I make myself uncomfortable?
Fang Xiao instantly broke free from the guilt.
Luo Hao felt happy when he saw Fang Xiao's expression change. Fang Xiao was indeed an interesting person.
"Professor Luo, okay, I will study hard when I go back. I will send you my study notes then, and you can help me guide you."
Okay, I climbed up the pole smoothly.
But Luo Hao didn't care what Fang Xiao said, as long as the patient was fine.
"Okay, I'll look at your study notes then." Luo Hao smiled, "Don't worry about the patient. By the way, have you had dinner tonight?"
"No..." Fang Xiao hesitated for a moment and then told the truth.
“Let’s go out to eat stewed noodles. The provincial capital is not as good as Donglian. If you were in Donglian, I would treat you to barbecue at the old restaurant in Feiyang. Boss Ding always goes to Changnan to get the meat, which is fresh. Very."
Luo Hao chattered with a smile.
“Lao Meng, have you eaten?”
“No.”
"Let's change clothes and eat together." Luo Hao thought for a while, "Remind me to write the surgical records tomorrow morning."
"Okay."
The three of them changed clothes and went downstairs.
It is late autumn and it is slightly cool outside.
"Professor Luo, what did you eat when you were at Xiehe?" Fang Xiao deliberately chose a topic to please.
"Ha, this is a long story. Who will score? Director Qian likes to eat, and I ate a lot when I was with him."
"???" Fang Xiao was startled, Office in Beijing? This rare term has not been mentioned in many years.
"Director Fang doesn't know?"
"I know a little bit, but I haven't eaten it."
"Then you must try it when you have time." Luo Hao walked away While explaining with his fingers, "Nanhe Beijing Office, their restaurant is a bit expensive, but the quality of their dishes is top-notch. You must order a bowl of spicy soup and mutton braised noodles at their restaurant. If you are interested, you can try their food." Kaifeng’s famous dish, baked carp noodles.”
"I'm not very interested in eating it, but the baked carp noodles taste delicious, and I'm still drooling just talking about it now."
"Don't say it, although I haven't eaten it, but just hearing you say that makes me salivate." I started drooling." Fang Xiao joked, "Anything else?"
Luo Hao smiled slightly, Fang Xiao was more conscious than Lao Meng.
"Su-Gan Liaison Office in Beijing, their hand-caught mutton is the best among all the Liaison Offices in Beijing." Luo Hao continued to explain, "When I think of hand-caught meat now, it is not Inner Mongolia, but Su-Gan. If you are interested, you can order some meat skewers, but the meat skewers in Piyang are better than those served by Sugan in Beijing, so I gradually forgot about them.”
“How to describe it? It’s tender and juicy.”
"By the way, you can also order Lanzhou beef noodles."
"Ah? Didn't you say that Lanzhou beef noodles didn't originate in Lanzhou?" Fang Xiao was surprised.
"Yes, but the Jiangsu-Gansu Liaison Office in Beijing is not willing to give up. It calls the name of my home, Lanzhou, so why can't I do it? It is said that Lanzhou Ramen originated in Huaiqing Mansion, Nanhe Province, but in Nanhe Province, I don’t see any Lanzhou Ramen in the Beijing Office.”
Luo Hao gossiped with a smile.
Fang Xiao felt a little emotional, Professor Luo Haolo has seen the world.
He spent eight years in the imperial capital, studying for a bachelor's degree, a master's degree, and a Ph.D., and all the major offices in Beijing have treasures in them.
“Then there is the Yibin Liaison Office in Beijing. The disadvantage is that there are too many people waiting for a table. The main reason is that it is delicious and cost-effective. The must-order items at every table at his restaurant are Yibin burning noodles and Li’s noodles. Just eat it with your eyes closed. "
"Speaking of Lizhuang white meat... Oh, I'm too busy now, even a guy like me who doesn't like eating is greedy. No, I still can’t forget it.”
Don’t like it?
Then all these things went into the dog’s belly? Fang Xiao cursed.
"Professor Luo, which is the best office in Beijing?" Meng Liangren asked.
“Changnan Liduan Office in Beijing, as long as you can eat spicy food, just go with your eyes closed.” Luo Hao said, “Fried noodles, beer duck, Jinggangshan tofu skin, radish ribs earthen pot soup, all are very good
But first, you must be able to eat spicy food.
Sichuan Si, Shancheng, and Nanhu are a bit inferior. Xijiang’s spicy food is so spicy that you can only eat it once. I’m going to get involved with the Anorectal Hospital.”
As he said that, Luo Hao’s expression changed slightly, as if he remembered something.
"Isn't there a saying recently that persuading people to eat spicy food is the same as persuading people to engage in sex." Meng Liangren chuckled and started driving.
This is the first time for Fang Xiao to see Meng Liangren driving.
He drives very naturally, with a hint of innocence.
This is a very strange feeling.
Especially Meng Liangren’s square face and generous smile give people a sense of decency.
It is also a skill to drive until you are not greasy at all.
“It’s delicious. Does your butt hurt after eating?” Luo Hao asked.
“Hahaha.” Meng Liangren laughed, “Professor Luo, you know this trick.”
“I just found out about it. When you said it, I followed your train of thought. I think I can probably guess it.”
Luo Hao didn’t care whether he was driving or not, he was gentle and calm.
"Professor Luo, it seems that you haven't been to Da Nizi's place for a long time." Meng Liangren reminded, "Women, you still need to spend more time with me."
"Well, I've been really busy these days. , after eating, I sent Director Fang to the hotel, and then went to see Da Nizi and Zhu Da.”
…
…
Note: After reading a discussion in Lilac Garden, I felt ashamed when I thought of several patients I met. I didn’t expect that there were so many things to do, sin after sin, just face the wall.
(End of this chapter)