"Horse Place...... Dean Ma, I'm really sorry. When Director Song saw Ma Xiude coming in, he immediately stood up and said.

"It's okay, this is Director Zhou Guohui of the Department of Neurology of Imperial Capital Hospital. Matthew said.

"I know. Director Song hurriedly said, "Director Zhou, who held the academic meeting, gave a lecture. ”

Zhou Guohui nodded slightly, as a greeting. He doesn't really care about doctors in "grassroots" hospitals. They know themselves as they should, but they don't need to know them at all.

"Let's talk about the patient's condition, you were resuscitating just now. ”

"The patient is now diagnosed with upper gastrointestinal bleeding and has been given symptomatic treatment, and the condition is not very serious. Song Yabin said.

Upper gastrointestinal bleeding? This one is more bizarre than the other. The patient was a 21-year-old young man who had suffered a stroke and had a stomach hemorrhage.

Zhou Guohui sat down solemnly and asked, "I'll take a look at the medical records." ”

Immediately, a young doctor came over and brought up the patient's medical record page.

The patient, a 21-year-old man, presented with sudden dysarthria, mild left limb weakness, and ataxia with an NIHSS score of 6 on admission and no obvious vascular risk factors.

The patient had a history of psychotic depression and asthma and was treated with sertraline and risperidone for depression.

The patient was preliminarily diagnosed with posterior circulation stroke, and the right posterior cerebral artery was densely opagraphed on brain CT scan.

Ischemic stroke with cerebral infarction is well understood.

Zhou Guohui looked through the doctor's order again, and the doctor of the second hospital gave the patient a single dose of aspirin 300mg, and then gave clopidogrel 75mg orally once a day.

Because anticoagulant drugs were given, I was kept to see if there was a possibility of upper gastrointestinal bleeding during hospitalization.

Unexpectedly, the patient, who had been recovering well during the hospitalization, had an accident when he went through the discharge procedures.

Before the record of the course of the emergency rescue could be written, Zhou Guohui turned to the last page and asked, "How is the patient's current state?" ”

"Vital signs were stable and oxygen saturation was low, 92%. Director Song said, "The blood gas analysis report of the urgent investigation showed that the partial pressure of oxygen was 10.7, the partial pressure of carbon dioxide was 5.0, and the pH value was 7.38, confirming that the patient was hypoxic." ”

Zhou Guohui looked at the computer screen, pondering the specific situation in his mind.

After thinking for two minutes, Zhou Guohui said in a deep voice, "Let's take a look at the patient first." ”

"Director Zhou, this one, please. Song Yabin politely opened the door and bowed down to let Zhou Guohui go out first. Then she walked quickly to Zhou Guohui? Lead the way straight to the ward.

Zhou Guohui looked at the neurology ward of the Second Hospital of the Medical University? Looking at the layout, it should be a ward that can accommodate about 50 patients, and there are no extra beds in the corridor.

Does he know that there are no patients? Is it a tertiary hospital that does not allow extra beds? Many patients are waiting in line outside to be admitted.

The patient in front of him should actually be observed for another two days, but it involves assessment indicators such as bed turnover rate......

Are these non-medical factors? Zhou Guohui didn't care very much, but the habitual flash of thought passed.

Coming to the ward? Director Song pushed open the door? introduced Zhou Guohui, "This is a patient. ”

Subsequently, she and the patient's family said, "This is Director Zhou of the Department of Neurology of Imperial Capital Hospital?" We invite patients to come and consult. ”

Zhou Guohui glanced at the patient? His eyebrows furrowed.

The patient is eccentric.

His face was pale, presumably due to blood loss. Generally speaking, pale lips and pale eyelids after blood loss are normal.

But the patient's lips were "crawling" with a few capillaries, as if a few small worms were lying on his stomach.

"Does the patient have telangiectasia?" Zhou asked.

"Uh......" Director Song Yabin was stunned for a moment and nodded.

Zhou Guohui didn't say anything more in the ward? After all, I only came for consultation, and it was especially taboo to scold other doctors in the ward.

Not only that? Even in your own hospital, reprimanding a junior doctor in the ward? will have an extremely bad effect. This involves the level of trust that patients have in their junior doctors, which can have extremely negative effects.

Zhou Guohui asked about the medical history in detail? Subsequent physical examination? It took 20 minutes to get down to one set.

Back in the office? Zhou Guohui said a little sternly, "Why is telangiectasia not reflected in the medical records?

"......," Song Yabin concluded.

"I just asked the patient about the history of nosebleeds since childhood, which is not reflected in the medical record. Zhou Guohui talked about patients and medical records, and his aura was full of aura, "Director Song, I don't think the physical examination can be sloppy." ”

"Yes, yes. Song Yabin replied curtly.

"Imaging data for me. ”

Immediately, a little doctor brought the film, there was CT, there was an MRI.

Zhou Guohui watched the films one by one in front of the reader in chronological order. He watched it very carefully, and it took him thirty minutes to "pass" the film.

Director Song and his doctors waited for Zhou Guohui to give a conclusion, but they didn't expect him to pick up two of the films, insert them into the film reader, and look at them carefully.

It is a CT of the chest, and the two films are the lung window and the mediastinal window.

The little doctors all looked at Zhou Guohui in amazement, and did not understand why a patient with ischemic stroke should see lung CT if he did not look at the head film, the color Doppler of the neck blood vessels, and the blood supply image of the vertebral artery.

Zhou Guohui didn't explain, but reviewed the CT film of his lungs little by little, as if there was some treasure in it.

He watched the two films for 20 minutes.

The office was silent, and everyone seemed to feel a dark cloud hanging overhead, with increased humidity and difficulty breathing.

The silence was finally broken by Zhou Guohui.

"Ma Yuan, please ask when Teacher Wu is coming. ”

"Director Zhou, did you find anything?" asked Dean Ma.

"The lung CT is a bit wrong, my level is not enough, I think the patient has to do 64-row enhanced CT, or Mr. Wu will take a look at the film after he comes. Zhou Guohui casually admitted that his level was not enough, without a trace of embarrassment.

"Okay, I'll urge Mr. Wu again. Matthew said.

Although he couldn't understand why Zhou Guohui wanted to see a chest X-ray of an ischemic stroke patient, this was clearly a contrarian analysis. But Ma Xiude has already cultivated to perfection, so naturally he will not ask at this stall, Director Zhou must have his reason.

"Mr. Wu, hello, Director Zhou Guohui said that the patient's lung CT is a little problematic, and there is no diagnosis for the time being, so I would like you to take a look at the film. ”

"Okay, okay, I'll get in touch. ”

Hanging up the phone, Matthew said, "Mr. Wu still has about 1 hour to arrive, and he said that he will do a 64-slice three-dimensional CT of the chest for the patient." ”

"......" Song Yabin was dumbfounded, this is really simple and rude.