MTL - I Can See Health-Chapter 46 Li Yao's invitation letter

   Chapter 46 Li Yao's Invitation Letter

   Lu Chen's heart moved.

  Buy night shifts, it doesn't matter if you have money or not.

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

   If you only stay in the general ward, the efficiency of getting thank you points will be slower.

   However, Lu Chen decided to hold his ground. First, he had to figure out what the system's gratitude value was for, and then make his next plan.

  …

   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 is somewhat familiar, but what it is and what its significance is, further research is needed.

   Find your long-cherished copy of the Advanced Manual of Electrocardiography.

  Lu Chen began to play around in the sea of ​​books and read similar electrocardiograms.

  Ventricular arrhythmia, supraventricular arrhythmia, atrial arrhythmia, coronary ischemic ECG…

   Looking through most of the manual, Lu Chen racked his brains, but still couldn't find any clue.

   The time unknowingly reached one o'clock in the afternoon, and there was still an hour before work.

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

   came to the eight districts of the heart.

  Because Sun Guoguo worked the night shift yesterday, she will rest this afternoon.

If there was something that could not be handled in the group, Sun Guoguo explained to the attending physician of the other group and asked Lu Chen and others to find him to solve it.

   In the morning, Lu Chen and others have filled all the hospital beds, so no new patients will come in the afternoon.

  Lu Chen began to sort out the medical records of the four-bed patients under his charge.

  10 beds, an old man who suffered two consecutive illnesses this morning. He was diagnosed with coronary heart disease, ischemic cardiomyopathy, and heart failure. He is now in critical condition and is at risk of sudden death at any time.

   11 beds, a mother-in-law in her 70s, diagnosed with grade 3 hypertension (very high risk group). Recently, because of the large blood pressure fluctuations, she came to hospital this time to lower blood pressure. At present, the blood pressure is still unstable.

   12 beds, a woman who was admitted in the morning. The cause of arrhythmia was diagnosed to be undetermined, and the electrocardiogram was abnormal. No cause was found for the time being.

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

   Four patients, except for the 12th bed received in the morning, the condition of other hospital beds is relatively stable.

During the    period, Lu Chen took time to see the old man with ten beds.

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

   And the color on his head is always red, which means 10 beds are not completely out of danger.

   The aunt on the 12th bed, Lu Chen asked her to have a heart ultrasound and a chest CT in the afternoon, and there were no obvious abnormalities in the results.

  Lu Chen also reviewed her electrocardiogram, which did not change much from the electrocardiogram when she was first admitted to the hospital in the morning.

  Her auxiliary examinations have been completed, and no problems have been found in blood tests and imaging examinations.

   "Doctor, when will 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 12-bed woman couldn't sit still in the ward, and ran to the doctor's office in less than an hour.

   The color of the patient's head is yellow, which means that his life is not in danger for the time being.

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

  …

   Until about to get off work, a nurse suddenly walked into the office.

   "Is the doctor in the director's team there? The 10-bed patient has hematuria, go and see."

  Lu Chen was extremely sensitive to his 10 beds, so he quickly said:

   "Someone's here, I'll see right away."

  Lu Chen saved the medical record he was writing, took the stethoscope, and walked quickly towards the 10th bed.

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

   "Hello Mr. Li."

   "You are Lu... Lu Chen? Did you just enter the department today?"

  Li Yao's memory is not bad, she recognized Lu Chen right away.

   "Well, yes." Lu Chen smiled.

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

  Lu Chen said: "Just 10 beds suddenly hematuria, I'll go take a look."

   "10 beds...is that the old man with heart failure?" Li Yao pondered for a moment.

"Yes."

   "Then let's go see it together."

After   , Li Yao turned around and walked towards the 10th bed.

  Lu Chen was stunned for a moment and followed closely behind.

   came to the ward.

   The family members 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 beside the bed.

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

   is indeed blood red.

   Normal urine should be clear and pale yellow.

   "Have hematuria started today?" Li Yao said.

  The old woman nodded and said, "It was fine the other day. He urinated once 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 began to examine the patient.

   After auscultation of the chest, Li Yao lifted the patient's sheet and looked at his limbs and torso.

   Inspection completed.

   "Director Li, is my old man alright." The old woman said nervously.

  Li Yao didn't reply, but turned around and asked Lu Chen, "Lu Chen, what is hematuria?"

   Lu Chen was taken aback by the sudden question.

   But he reacted quickly.

   "There are two types of hematuria, one is gross hematuria and the other is microscopic hematuria."

"Urine containing a certain amount of red blood cells is called hematuria. 1000ml of urine contains more than 1ml of blood, and the appearance of red urine is called gross hematuria. There is no abnormality in the appearance of urine, and the fresh urine centrifugation sediment is checked for 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 while, then carefully observed the patient's urine bag.

   "According to normal thinking, the first thing to consider is the hematuria caused by the injury of the urinary catheter to the urethral mucosa. However, the patient has been intubating the urinary catheter for several days, and without external force pulling the urinary catheter, it will not suddenly cause hematuria."

  Li Yao nodded: "Since it's not urethral mucosal damage, what's the reason?"

  Lu Chen thought of the blood clot in the patient's throat this morning, and then continued.

   "The patient coughed up **** sputum this morning, and a blood clot was sucked out of the throat. In connection with all these conditions, abnormal coagulation or bleeding caused by drugs should be considered!"

"I read all the doctor's orders of the patient, because the patient is currently diagnosed with coronary heart disease and needs to use antiplatelet drugs routinely, and also has atrial fibrillation. According to the CHA2DS2-VASC score of atrial fibrillation anticoagulation, anticoagulant drugs should be used in combination. All right."

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

   After listening to Lu Chen's analysis, Li Yao showed admiration on her face.

   "Yes, well-organized and well-founded."

   It is rare to have such an excellent little guy, and Li Yao is very pleased.

   And Lu Chen breathed a sigh of relief, he finally knew why Senior Sister Sun Guoguo likes to ask questions so much!

   It turns out that this is the tradition of the group, and it is in the same line!

   At some point, Ke Yue and Jiang Qingyan also came to the ward.

  Li Yao glanced at them.

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

   Ke Yue's face became bitter.

   You really shouldn't have followed me to the ward.

   Now this is getting burned!

   "First stop the drug..."

   Ke Yue glanced at Lu Chen after saying that.

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

  Ke Yue immediately shook his head: "Ah, no, you can't stop the drug first."

  Li Yao frowned, "What measures are you using?"

   Ke Yue grimaced and pursed her lips.

   "Teacher, I, I forgot."

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

   "Jiang Qingyan, what's your opinion?"

Jiang Qingyan raised her brows and said slowly: "The blood routine and coagulation should be reviewed immediately. If these indicators are OK, then replace aspirin with indobufen, and Xarelto with intravenous low molecular weight heparin. If the blood routine, coagulation and other indicators are abnormal, the drug can be stopped first, and the 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 similar to Jiang Qingyan's," Lu Chen said, "but there is one thing to add. In fact, patients with coronary heart disease and atrial fibrillation in the long-term stable period can use anticoagulant drugs alone and stop antiplatelet drugs, especially for the elderly, Patients at high risk of bleeding."

  Jiang Qingyan frowned, in her impression, this kind of treatment method was not written in the internal medicine book.

  Lu Chen seemed to see through her thoughts, and added in a low voice.

   "This is mentioned in the latest atrial fibrillation guideline, not written in the book."

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

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

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

   "The two of you need to improve your knowledge level. Now it is no better than the undergraduate period. You should not only be familiar with the knowledge in internal medicine books, but also frequently browse the relevant guides of cardiology."

"You have to remember one thing, treat diseases according to the guidelines, we will be invincible in the event of medical disputes! But if everyone believes in treating diseases, no matter how well you treat them, if there is any error, If you cause bad consequences, then you are fully responsible!"

   "Got it, teacher."

   Ke Yue and Jiang Qingyan nodded.

   "This patient will be handled according to the method that Jiang Qingyan and Lu Chen said." 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.

  …

   walked into the director's office.

   This is the second time that Lu Chen came to this office, and the first time was when he adjusted.

  The office is furnished as usual.

   A desk and a welcome pine.

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

   "It's very good. There are many patients. In the morning, I encountered two rescues."

  Li Yao smiled, "I heard Guoguo say that the patient in bed 10 had two heart failures in the morning, and the second time was thanks to you for helping to **** phlegm."

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

   "Do you have any plans for the next three years as a graduate student?" Li Yao went straight to the point.

  Lu Chen pondered for a while before saying:

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

   When talking about your goals.

   is very simple, that is to be the best cardiologist in the world.

   But this goal is too lofty and illusory.

   Say it, the credibility is not high.

   Such an ambitious goal needs to be accomplished in stages.

   The goal of graduate school is to be familiar with diseases in various departments.

   An excellent cardiologist must first be an excellent major physician!

"What about future career planning?" Li Yao said, "If you want to go far in medicine, a master's degree and a doctorate are just the beginning, and there is still more room for you to explore in the future. If you just want to find a good job Work, maybe get a master’s degree or a doctorate, and post a few articles, you can enter most hospitals in China.”

  Lu Chen said decisively: "Teacher, I want to be 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 independent scientific research ability!"

   "In the past three years, in addition to mastering clinical knowledge and skills, you must not fall behind in scientific research!"

   "Just being able to do clinical work will not go far in the hospital system, and you can't even be promoted to deputy director."

   At present, the promotion of senior titles in domestic medicine requires the support of papers.

   In some cases, the importance of scientific research ability even far outweighs clinical ability.

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

   Can write papers, which 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 circle and vice versa.

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

   "But don't be too impatient to engage in scientific research." Li Yao continued, "You can come to the laboratory building at the back door of the hospital when you have time. I currently have a few experimental projects. When the time comes, I will let your brothers and sisters 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 want to remind you that the school has various scholarships and grants every year, and these scholarships are evaluated through papers."

   "For example, the national scholarship is 10,000 yuan, and the essay evaluation accounts for the vast majority of the proportion. Whether you can get these scholarships depends entirely on your own efforts."

   "Thank you teacher for the reminder."

   From the current point of view, Li Yao's mentor is very good.

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

  Li Yao asked Lu Chen a few 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 back door laboratory building.

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

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

  This is an electronic invitation.

   (end of this chapter)