It was already dawn, and there were many people in white coats or hospital gowns waiting in line at the entrance of the hospital cafeteria. On the other side of the cafeteria, more than a dozen tightly wrapped incubators are slowly entering the inpatient building under the impetus of the canteen staff. These are breakfasts that are delivered to patients who have ordered a meal.

As for the doctors...... They weren't treated so well. Either come and line up to eat, order your own takeout or go out to eat. Hospital canteens are also helpless, and their supply capacity is not enough to cover all hospital staff and inpatients. And now the stove equipment has reached its limit. Unless the canteen is dismantled and recovered, it will never be possible to meet the needs of everyone.

Xu Yourong and Zhou Ce were eating in the cafeteria, and the two looked around, but they didn't see Sun Lien's figure.

"Doctor Sun won't have gone back already, right?" Zhou Ce joked to Xu Yourong, "It is said that people should have gotten off work a long time ago, but you stopped me with a click, beware of the leader to give you small shoes to wear in the future." ”

Xu Yourong wiped the soy sauce marks on the corners of his mouth, and replied calmly, "If he can learn to put on small shoes for people, then I don't have to worry about this treatment group being dismantled." ”

Zhou Ce heard something else in Xu Yourong's words, and couldn't help but ask in a low voice, "What's the news?"

"Nothing special. Xu Yourong continued to eat rice rolls with his head down, and the Guangdong rice rolls that the Hunan chef learned from the Jiangxi boss tasted unexpectedly delicious. "Anyway, now that my boss is on top, the sky can't fall. ”

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"You're such a toss, sooner or later, you're going to have to collapse it. Zhou Jun looked at Sun Lien in front of him and was furious.

After pondering for hours in the small conference room, Sun Lien finally raised his hand and surrendered. He is just a regular doctor, not a professor and director specializing in nephrology. No matter how he thought about it, he couldn't make the connection between Staphylococcus aureus pneumonia and the rapid exacerbation of chronic glomerulonephritis.

However, the biggest advantage of being a front-line doctor is that you have a backer to rely on. If you don't understand the question, you can ask the senior brother!

Then Sun Lien was scolded by Zhou Jun.

"Streptococcal bacteria infect both lungs, causing acute glomerulonephritis. What's wrong with this diagnosis?" Zhou Jun knocked on the table at Sun Lien, "This is not tuberculosis, and it can also explain the patient's symptoms, isn't it a good diagnosis?"

"However, the imaging was wrong. Sun Lien took out the CT examination report that had just arrived with a bitter face. "The patient's lungs are ground-glass opacities, which do not fit the typical symptoms of pneumococcal pneumonia. ”

Zhou Jun took the CT report from Sun Lien's hand with a suspicious face, looked at it with a frown for a while, and muttered, "Inflammatory changes or the result of alveolar hemorrhage, right? Considering his coughing up blood, this is diffuse alveolar hemorrhage (DAH)." ”

"Then I couldn't figure it out. Sun Lien said with a bitter face, "It is impossible for pneumococcal pneumonia to cause diffuse alveolar hemorrhage, and the five infectious diseases admitted to the hospital are all negative, which can rule out Pneumocystis carinii pneumonia." No exposure to chemicals or toxic substances in the last month. The tumor markers are all good, and the coagulation function is normal......" Sun Lien sighed, "I really can't think of what is wrong with him." ”

Zhou Jun glared at Sun Lien, "Do you know that he is not tuberculosis?" In his words, he seemed to be a little dissatisfied with Sun Lien's attitude, "You Sun Lien can't just pour cold water on people, you have to find a way to find out what is wrong with this person." What's the use of just complaining? Can you tell you what kind of illness he has, or can he just cure someone?"

Sun Lien nodded with a bitter face to show that he had heard Zhou Jun's criticism. He sighed, and as if resigned to his fate, he picked up the checklist again and read it again.

"Brother Sun, the morning blood routine came out. While Sun Lien was struggling with the checklist, nurse Xiao Guo knocked on the door, held a piece of paper in his hand, and shook it towards Sun Lien. "It's your patient's test results. ”

Sun Lien took the checklist and thanked Xiao Guo. Then he looked down at the report.

"HB (hemoglobin) is only 80g/L?" Sun Lien frowned as he looked at the freshly released report. Holding the report in one hand, he began to rummage through the case records with the other. After digging through the table of sorted test reports, he found the first routine blood test report that the patient had done about six hours earlier when he was admitted to the hospital.

Hemoglobin content, 88 g/L. Within eight hours, the amount of hemoglobin in the patient's body decreased by 8 g/L.

"The patient coughed up blood twice after being admitted to the hospital, probably coughing up about 150 milliliters. Zhou Jun also came over, looked at the freshly released data, and said thoughtfully, "Even if I coughed up 200 ml of blood today, and it was all suspended red blood cells, this is only 1U, and it would be great to reduce it by 5g." The proportion of hemoglobin drop is also too large. ”

Generally speaking, the normal reference value of hemoglobin in the blood of normal adult men should be around 120~160g/L. Once it drops below 120g/L, it can be considered anemia. When the hemoglobin concentration drops to 90g/L, the patient will experience shortness of breath, fatigue and other hypoxia. When the hemoglobin concentration is reduced to 60~40g/L, the patient will have acidosis due to insufficient circulation. Once it falls below 40g/L, it is basically equivalent to the death of the patient.

According to Wang Lin's current rate of hemoglobin decline, his hemoglobin concentration will drop to the critical value of acidosis within about a day. After about 38 hours, his hemoglobin level would drop to the point of death.

"Replenish two units of suspension red blood cells. Sun Lien immediately reacted, Wang Lin's hemoglobin content could not be lowered, and it must be maintained at a minimum level of 70g/L. He called Xiao Guo in again and arranged, "Increase the oxygen concentration to 98%." ”

"The cause must be identified as soon as possible. Zhou Jun patted Sun Lien on the shoulder, "Communicate more with your team members." Brainstorming can help identify the true cause. ”

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"The rapid drop in hemoglobin concentrations is not a symptom of a streptococcal infection. Returning to the conference room from the cafeteria, Zhou Ce vetoed his diagnosis with some frustration. He was originally quite confident in his streptococcal diagnosis, but as soon as he went to eat, he was slapped in the face twice in succession by imaging and blood routine.

"Could it be an autoimmune disease? I think it could be SLE (systemic lupus erythematosus). "SLE first acted on the kidneys, causing chronic glomerulonephritis, and then then attacked his lungs, causing coughing and coughing up blood. ”

"The patient's WBC (white blood cell) count is elevated, suggesting an infection. Xu Yourong shook his head, "It must be a symptom caused by some kind of infection." This is not SLE. ”

Yuan Ping'an raised his head and asked in a low voice, "Could it be a tumor?" He himself had little faith in this inference.

"There is so little intelligence right now, and there is no point in discussing it here. Sun Lien made the decision, "Do a lung and kidney biopsy on the patient." ”