Sun Lien was a little ashamed. Body temperature is the basic value of the human body, and like heart rate, blood pressure, and blood oxygen, doctors need to pay attention to the first focus. Due to the special way of maintaining the body temperature of homeothermic animals, this measured value often lags behind the actual situation of the body. When he was "" several times before, Sun Lien did use body temperature as the reason for the patient's symptoms. The usual invincible explanation of the reasons has been forgotten when it can really come in handy.

It must be said that Dr. Pascal's gaze was very sophisticated and vicious, and he could see at a glance the root cause of the difference between the results of the examination and the facts that should reflect the situation.

"Your excellent diagnostic skills and the position you are in today are a deep misfortune. Dr. Pascal patted Sun Lien on the shoulder with some sympathy, "Other young doctors, at your age, are still making mistakes and learning. And you are not like them, it doesn't matter if they make mistakes, after all, no hospital will let them take care of the life and death of patients. But you're different. You're now leading a lot of doctors, including me, and you're going to be responsible for complex cases that other senior doctors can't handle, and if you can't handle them, you're going to have to transfer them to a higher level hospital. ”

Listening to Dr. Pascal's words, Sun Lien suddenly felt that he was under a lot of pressure.

"So, you can't make mistakes. Dr. Pascal's eyes sharpened. "Other young doctors can make mistakes, other senior doctors can make mistakes, even I can make mistakes. But you can't. The patients who need to be taken over by our treatment group are patients who have no other way to seek medical care, and the conditions are often very serious. If someone else makes a mistake, you can put the patient in your hands, but if you make a mistake, the price may be the patient's life. ”

Sun Lien was silent for a long time, then raised his head and said, "I can't guarantee that I will never make a mistake, but I promise that I will do my best to avoid mistakes." ”

"In the future, you have to pay attention not only to whether you make mistakes, but also to pay attention to the position of the perspective. Dr. Pascal nodded in satisfaction, then continued, "You're not just a solo person, you're the leader of a therapy group. In addition to doing it yourself, you should also rely on the professional ability of the team members. ”

Sun Lien nodded honestly, anyway, Lao Pa was not so much his subordinate, but rather the supervising teacher that Xu Yourong invited for him. Experienced, with a wealth of teaching experience, and most importantly – with a straightforward personality. If you change to another doctor, you may have a lot of concerns because of the relationship between the team leader or because you are not familiar with the so-called "working atmosphere".

Although it is always unpleasant to be clearly pointed out that mistakes, Sun Lien is also well aware that these are valuable experiences that cannot be bought. For Pascal, who would rather give up his life in the United States and come to China to carry out research and cure diseases and save people, Sun Lien did not have a trace of resentment, but admired this half-bald old man with ginger red hair in his heart.

"Then, knowing that his blood clotting condition is abnormal, we can know that there are some serious problems with his body. Sun Lien reorganized his mood and began his own diagnosis. "First of all, it is certain that the blood clot has affected his brain and small intestine. In addition, the deep veins of his lower limbs also developed blood clots, although we have removed large blood clots through interventional treatment, but if the blood clotting problem is not solved, he will still continue to face the risk of embolism. ”

"It affects both organs at the same time, but it has not yet affected the most vulnerable lungs and heart. Dr. Pascal nodded, "I think he's lucky. ”

"Then the next question is how bad the blood clotting function is and why the blood clotting disorder is occurring. Sun Lien frowned and thought for a moment, then suddenly picked up the phone, "Doctor Yuan, prescribe a urine routine for Xia Hongyuan to check his kidney condition." ”

"It's been checked. Yuan Ping'an's voice on the other end of the phone sounded very serious, "The situation is not good, he is a cast-type urine." ”

Casts are cylindrical proteogmers formed by the condensation of proteins, cells, cell debris, etc. in renal tubules and collecting ducts. Casts are an important component of urine sediment, and their presence indicates that the patient has renal parenchymal damage, which means that the patient has damage to the glomeruli or renal tubules.

"When did you take the sample?" Sun Lien immediately got up from his seat and walked briskly towards the rescue room. Renal parenchymal injury has not previously appeared in the patient's status bar. This is an emerging symptom.

"When Lao Pa entered the emergency room, I took a sample. Yuan Ping'an replied, "Probably less than five minutes?"

Sun Lien bypassed the busy medical staff in the emergency room and rushed to Xia Hongyuan's side.

Xia Hongyuan, male, 26 years old, left tibial anterior blood blister (74.26.28), avascular necrosis of the small intestine (53.58.41), ischemic acute kidney injury (00.14.36). Xia Hongyuan's status bar has changed dramatically, and the most striking thing is the new kidney injury indication and the two sets of numbers that have changed.

Sun Lien was stunned for a while, and then he saw Yuan Ping'an who hurriedly ran back to the rescue room.

"It's not a coordinate...... Although Sun Lien's eyes saw Yuan Ping'an, his attention was on the changes he had just discovered. "Those numbers are not coordinates, they are time!"

Yuan Ping'an looked at Sun Lien, who was starless, and patted his arm with some worry, "Doctor Sun, you ......" He was about to ask Sun Lien if he was uncomfortable, but this action suddenly made Sun Lien come back to his senses.

"Follow me!" Sun Lien seemed to have suddenly changed into an electric doll with a fully charged battery, full of energy, and rushed into the small conference room with Yuan Ping'an with neat movements. He didn't even have time to say anything more to Dr. Pascal, but rushed to the whiteboard in the small conference room and began to note the symptoms.

First appeared, the left common iliac vein thrombosis, then the popliteal vein, and soon, blood blisters appeared, followed by avascular necrosis of the small intestine. Until the onset of stroke, and now acute kidney injury. A timetable appears on the whiteboard.

"He first developed a thrombus in his left common iliac vein, which caused the entire left lower extremity to return blood to a slower rate and a popliteal vein thrombosis. Sun told the doctors who were present about his findings, "We already know that the blood blisters appeared at least three days ago. In other words, the blood clot in the veins of the lower extremities must have appeared three days ago - the venous return of the lower extremities is impaired, which is the cause of the appearance of blood blisters. ”

Sun Lien's explanation was convincing, and both Dr. Pascal and Yuan Ping'an nodded.

"And even without a CT scan, I'm sure that the length of the patient's avascular necrosis of the small intestine is not too long. After all, he can still continue to go to work more than two days after the onset of abdominal symptoms. Sun Lien continued, "From this point, it can also be proved that the cause of avascular necrosis of the small intestine is not due to insufficient blood supply to the small intestinal artery, or the passage between the small intestinal vein and the hepatic portal vein is blocked, it must be a capillary blockage." ”

"Until the patient has symptoms of stroke. We have solved this through interventional surgery. Sun Lien drew two circles on the whiteboard, encircling the two symptoms of avascular necrosis of the small intestine and stroke. Then a pen was used to draw a triangle behind two deep vein thrombosis.

"I don't know if you have noticed that the abnormal blood clotting that occurred before the patient was admitted to the hospital included both large and small blood vessels?" Sun Lien said of his findings. "Just now, we confirmed that the patient had casts in urine, which means that even after surgery to remove two deep vein thromblots and anticoagulation, the patient's kidneys were still acutely damaged. ”

Yuan Ping'an's eyes lit up, "You want to say that kidney damage is also ischemic?"

"If yes. Sun Lien did not answer the question directly, but continued according to Yuan Ping'an's assumption, "That is, the third case of abnormal coagulation of small blood vessels occurred in two days, and the third organ was involved. ”

Dr. Pascal stood up, grim, "This is CAPS, Catastrophic antiphospholipid-antibody?syndrome."