The answer to Sun Lien's question was Professor Zhu Minhua, who had been pricking up his ears and eavesdropping a little farther away.

"There is this equipment in the yard. He walked over to Sun Lien and asked with some curiosity, "Do you think it's necessary to use this method now?"

The full name of mNGS is "metagenomic next-generation sequencing technology", which is a relatively cheap, relatively mature, and fast detection technology for genetic testing. Unlike the first-generation technology, mNGS uses high-throughput testing technology, and although mNGS produces results much faster than traditional techniques, it still takes more than 24 hours to complete a thorough comparison test. And although this technology is "relatively cheap", the cost is still scary. If Lu Xuexin's cerebrospinal fluid sample is used for mNGS testing, the cost of the reagent set alone will be close to 20,000 yuan.

But there is a reason why people are expensive. The mNGS technology, which can detect nearly 7,000 viruses and bacteria in a sample at the same time, is indeed the most direct means to determine the cause of Lu Xuexin's disease - the smear did not detect the pathogen, which means that the infection of Lu Xuexin's brain is likely to be a harsh or uncultured bacterium. Traditionally, it is a luxury to expect bacterial culture of extracted cerebrospinal fluid (CSF) to identify pathogens. In the absence of broad-spectrum antimicrobials meropenem and ceftriaxone, mNGS has indeed become the only means of rapid detection.

"Even if a neurosurgeon were to be scheduled to perform a needle biopsy of an abscess in a patient's brain and then do a bacterial culture, it would take at least three days or more. Sun Lien calmly explained, "According to the medical history, the patient's brain infection should have been four days ago. Combined with the incubation period of bacteria, it is only five or six days. Over the course of a few days, the patient progressed from no infection to multiple brain abscesses, and meningitis. The patient's immune system is still suppressed, and if it drags on for another three days, who knows how far the brain abscess will progress. At that time, even if she can survive by chance, it is almost inevitable that she will have serious sequelae. ”

Speaking of this, Sun Lien glanced at Lu Xuexin on the bed with some regret, "She is still very young, it would be a pity if the family members could not afford the cost of the examination because of financial problems......

Zhu Minhua was silent for a while, and then suddenly laughed. "It's not for nothing that Lao Liu stuffed his successor into your team. He changed his previous coldness, and a gentle smile appeared on his white round face, "The young man's level is not bad." ”

Yuan Ping'an looked at his mentor, and then at Sun Lien, who was stunned. He laughed along.

"This patient's situation is indeed quite special. Zhu Minhua walked to Lu Xuexin's bed and gently patted the fence at the foot of the bed, "The symptoms of this encephalitis are also very unique. He glanced at his student Yuan Ping'an, and said with some dissatisfaction, "Xiao Yuan, I usually ask you to track down the papers published by others, you must not have read them, right?"

Yuan Ping'an was a little confused by Zhu Minhua's sudden criticism, but it is indeed true that he was lazy and didn't read the paper during this time. He lowered his head and said embarrassedly, "It's really a bit of a tight schedule." ”

"Time is tight, and you still have the time to go out on a date with your girlfriend. Zhu Minhua was happy, he looked at his student, a little helpless, and a little sad. "You kid wants to go to the gods, I'm afraid it's not just for the future, but also for Xiaohua, right? If you really want to be with her for a long time, then settle down and work in the emergency room. ”

Yuan Ping'an was startled at first, and then responded with a wry smile.

"And. Zhu Minhua nodded again, "You are only 31 years old this year, and you have become the general manager of our association." This resume is enough for you to become an associate chief physician in other places. ”

Sun Lien listened to Zhu Minhua's words and suddenly felt that something was wrong.

"You sent your resume to the Fourth Central Hospital last night, right?" asked Zhu Minhua with a smile.

Yuan Ping'an was really frightened now, "Teacher Zhu...... I ......"

"There's someone watching the network in our hospital. Zhu Minhua waved his hand and blocked his explanation. "You use the computer in the hospital to send your resume, and the people in the network department have already told me. He turned to Sun Lien and asked with a smile, "Doctor Sun, what do you think of me as a student?"

Sun Lien reacted at this time, he looked at Yuan Ping'an and was shocked, "The doctor who sent the resume is you?"

Yuan Ping'an nodded with a bitter face. He actually didn't want to work under Sun Lien at all, the purpose of sending his resume was actually just to let Sun Lien take the initiative to contact him, and then he would make a good show to be angry. Who would have thought that his lazy thing would be known by Zhu Minhua!

"I also listened to it just now, and Dr. Xiaosun's level is very good. You should learn more from others. Zhu Minhua didn't wait for Sun Lien's answer, Yuan Ping'an has been studying with him for more than eight years. The five-year clinical doctor of medicine plus the three-year double degree of scientific doctor of medicine has been obtained. Now is the perfect time for him to improve his clinical experience.

But there is one thing that Yuan Ping'an has always made Zhu Minhua a little dissatisfied, perhaps because Yuan Ping'an studied neurosurgery from undergraduate to graduate school. His ability to diagnose and deal with emergencies has always been relatively weak. In these problems, Sun Lien is stronger than Yuan Ping'an, I don't know how many times. With the same information and the same symptoms, Sun Lien can propose a more suitable diagnosis and treatment plan for the patient.

This shortcoming is even more obvious when encountering patients such as Lu Xuexin - in fact, it is more important to make an accurate diagnosis of Lu Xuexin than to use medication based on experience in advance. This is not because of Yuan Ping'an's poor professional level, but his diagnostic thinking still belongs to the category of specialists. In Zhu Minhua's view, what emergency doctors need to do is to quickly stabilize the patient's vital signs without any medical history, and then quickly diagnose the type of disease the patient may suffer from according to the symptoms the patient presents. Subsequently, with the assistance of a specialist, the patient is treated in a targeted manner. After the situation is basically under control, he will be transferred to a specialist ward for follow-up treatment. This is also the program advocated by the major emergency model of the Fourth Central Hospital.

It is a pity that under the big tree of Tongxie, Zhu Minhua knows better than anyone that it is impossible for Tongxie to change its policy of running a hospital, which has lasted for nearly a century, and has led Tongxie to a world-renowned hospital and medical university. With a large tree in your back, you can swim in the shade, but it is impossible to start a new one. The prestige of Tongxie and the achievements of Tongxie determine that Tongxie emergency can only be used as a "pretreatment" unit before other specialties. It is simply impossible to switch to a dominant hospital model.

Yuan Ping'an needs to change his diagnostic thinking, but Zhu Minhua himself has nothing to do about it. Let him teach professional knowledge and guide scientific research is no problem. But if he wants to transform the thinking mode of an adult, Zhu Minhua asked himself if he has this ability.

In this case, it is better to let him go to the pilot unit of the major emergency department to try it.

In fact, even if Yuan Ping'an didn't send the resume, Zhu Minhua planned to contact Liu Pingchuan. Let's see if we can send our disciples to study in the Fourth Central Hospital of Ningyuan. Perhaps under his own care, Yuan Ping'an's diagnostic defect will not be a big problem. But what if he goes to another hospital? What if he retires?

Yuan Ping'an is a good doctor, and he actually works very hard. And he's really a doctor. If something goes wrong in his future work because of this defect, Zhu Minhua himself can't forgive himself.

Sun Lien looked at the pair of masters and apprentices, and suddenly felt that he had become Liu Tangchun. After walking around the hospital and taking a shower, I poached a hospitalist, and when I returned to the hospital, Director Liu couldn't figure out how to give myself a bonus!

"Teacher Zhu......" Yuan Ping'an also tasted Zhu Minhua's meaning, and he asked in shock, "What do you mean ......?"

"You should go outside and take a look. Although Zhu Minhua was still smiling, there was some gloom in his eyes that could not be concealed. "The Fourth Central Hospital is one of the few pilot hospitals in China for major emergency treatment. It just so happens that there is still some unfinished fate between you and Liu Pingchuan, so it's not bad to give it a try. He patted Sun Lien on the shoulder, "Don't think that Xiao Sun is inferior to you because he is young." Zhu Minhua said solemnly, "Do you know where you are worse than others?"

Yuan Ping'an said, "I don't know......" Although he also knew that Sun Lien's diagnosis was stronger than his own, but as a doctor of Tongxie, he had worked many years longer than Sun Lien, and the pride in his heart would not be able to subside for a while.

"He's young, he's gifted in diagnostics, and his thinking hasn't become a set yet. Zhu Minhua sighed, "Being a doctor is different from other professions. We need experience, but we also reject it. Every patient's situation is different, and blindly relying on experience will only harm you and the patient in the end. ”

Sun Lien's face was about to turn red when he was praised.

"You have to have the ability to make careful logical inferences, you have to have the clearest view of the big picture, and you have to have enough professional knowledge to be a good emergency doctor. Zhu Minhua said earnestly to Yuan Ping'an, "Now you have enough professional knowledge, but the overall situation and logical reasoning ability are not strong enough." Let's go to the Fourth Central Hospital, and come back when you've learned something. ”

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Regarding Yuan Ping'an's personnel secondment and other professional issues, Zhu Minhua patted his chest and said that he could handle it himself. Subsequently, he left behind Sun Lien, who looked confused, and Yuan Ping'an, who was full of entanglement.

"Lu Xuexin's mNGS is already being done. It is estimated that the results will be available tomorrow. Before leaving, it seemed that Sun Lien did not worry, Zhu Minhua specially added. "When the time comes, I'll let Xiao Yuan tell you. ”

"So...... I'm going to follow you in the future?" Yuan Ping'an didn't actually have much resistance to being seconded to the Fourth Central Hospital, but it happened too suddenly, and he didn't come back to his senses.

Sun Lien patted him on the shoulder, "Doctor Yuan, believe me. I've been much more shocked than you have been in the past few days. ”8)