"It's actually quite simple. ”

Being watched by everyone, Zhang Tianyang behaved calmly.

Originally, he wrote this medical record, but now he is just stating his own thoughts.

He knows this himself, Lin Ke'an next to him knows, but the others don't know!

The only known neurology inpatient is always regardless of the ICU.

So in everyone's eyes, it is just a little intern who is ready to start speaking out without knowing the sky.

In an instant, the looks of a circle of white coats are different.

The white coats who were far away looked at Zhang Tianyang with good show and pity.

To get to the step of regular training, the time spent in the clinic is at least one year or more.

Instructors like the attending physician who like to ask questions, they have seen a lot.

For example, Zhang Tianyang is obviously just an intern, but he feels that he knows everything, is the first in the world, and dares to answer anything, and they have seen a lot.

When their eyes glanced over Zhang Tianyang's "pretending" face, they had already imagined how miserable this poor little intern would be taught a lesson by reality after a while.

The eyes of the white coats who were close were much sharper, with varying degrees of blame and even hatred.

They finally hid here, but because of this little intern who wanted to be in the limelight, they became the focus of everyone!

I don't dare to move, I don't dare to slip, and I have to pretend to be serious and hardworking.

Are they easy!

Hurry up and say it!

After saying that, hurry up and scold, scold!

Then after scolding, they can continue to fish happily!

After all, the three resident doctors were relatively calm, and the expressions on their faces were not leaking.

But he didn't show any seriousness.

Just stared at the screen silently.

Just an intern.

It is not certain whether the intern can have a clear idea when writing a medical record, and I want him to figure out the idea behind a great medical record?

Ten ** can't be answered.

And then the question has to be asked to them at the end.

It's better to prepare early.

Senior Brother Gui Pei also looked at Zhang Tianyang sweating profusely, his eyes full of gratitude.

Fortunately, there was an intern with a head iron to help him share the attention of the attending brother, so that even if he scolded later, the two of them scolded together.

Someone accompanied, grateful and comfortable!

The faces of the attending physician and Lin Ke'an were more strange.

A person who had heard of Zhang Tianyang's name could vaguely guess Zhang Tianyang's ability.

The other saw Zhang Tianyang write this medical record with his own eyes, and everyone was drunk and sober.

After taking in the faces of the white coats around them, the faces of the two became more and more strange.

Lin Ke'an was even holding back a smile.

Zhang Tianyang glared at her, straightened his expression, and began to state his thoughts when he wrote the medical record at that time.

"After a little drinking, he suddenly changed consciousness for 1 hour, and he was extremely excited, unable to control his words and behavior. This is a symptom of the patient. ”

The first sentence is decent, and everyone's eyes have not changed.

"I think there are many possible causes for this symptom, such as alcoholism, disulfiram-like reactions, poisoning with prohibited substances, intracranial infections, psychiatric disorders, hyperthyroidism, and so on. ”

The second sentence directly involves the possibility of disease, and the eyes of some experienced white coats have changed a little.

In this medical record, no diagnosis is given.

There is no word "exclude the possibility of xx", "consider the possibility of xx".

At most, there is only the main diagnosis given in the upper right corner: "meningitis".

Many interns and trainees are actually just tools to ask about medical history when they receive patients in the clinic.

They are only responsible for asking for a medical history, then writing it down, and then reporting it to their superiors.

The real diagnosis, differential diagnosis, and doctor's order are all the judgments of the senior doctors, who are only responsible for translating these judgments into practice.

They don't know exactly what diseases this patient may have, how to make a differential diagnosis, how to choose drugs, and how to consider the dosage.

But Zhang Tianyang opened his mouth and directly gave six possible diseases.

And if you think about it carefully, if you only look at the complaints, it seems that these diseases are indeed possible.

This is a differential diagnosis that really shows strength!

The eyes of good drama and pity changed, and many white coats stood up straight inexplicably, frowning slightly, and entered the thinking mode.

Zhang Tianyang paused and continued to state his thoughts.

"Painful countenance, pale and clammy skin, with fever, dizziness, vomiting, sweating, and a sense of resistance in the neck. These symptoms indicate a high likelihood of intracranial infection. ”

"I have recently suffered from a "cold" and have not taken medication. This again confirms the possibility of intracranial infection and excludes disulfiram-like reactions. ”

"The absence of weight loss, bulging eyes, hand tremors, etc., can help rule out hyperthyroidism. ”

"A good amount of alcohol and no history of bad habits or psychiatric illness can help rule out alcoholism, illicit poisoning, and psychiatric disorders. ”

Zhang Tianyang dismantled the entire course of the disease into a small paragraph for explanation, and the diagnostic idea of peeling off the cocoon was gradually revealed in front of everyone.

This kind of broken and crumpled thinking, all the white coats present understood it, and they also agreed with it from the bottom of their hearts.

"I see!"

"Looking at it this way, this order is really great, and the correlation can be connected together to rule out the corresponding diseases. ”

"Sure enough, we still need to learn, this kind of detail, if it wasn't explained like this, who would have thought of it!"

For a while, the ICU ward was quiet, and only the sound of countless pen tips brushing and recording on small notebooks remained.

That's dry goods!

Write it down well, and try to use it in practice in the future, and your ability and level will be greatly improved.

There were no more banter and pity in the eyes, not even hostility and resentment, and the eyes of the white coat gradually turned into surprise, but there was also a trace of hesitation.

After all, this is just an explanation given by Zhang Tianyang, an intern, and the chief boss has not spoken yet.

Although they didn't hear any problems when they heard it, maybe they didn't have enough ability?

The three resident doctors couldn't help but glance at Zhang Tianyang.

They have no shortage of ability, so naturally they know that Zhang Tianyang is not talking nonsense when they hear it.

They were just surprised that Zhang Tianyang was able to speak in such detail.

Although they can also see the idea of writing medical records, they may only be able to correspond to four or five of the six possibilities at a time.

This intern, there's something!

The doctor's face, which had been gloomy just a moment ago, was now fully unfolded like a flower.

This Xiao Zhang, as rumored, is a big baby!

Treasure found, treasure found!

I hold the right to use this big baby for two weeks in my hand, and now it is only the first hour of the first day, and I give myself such a comfortable feeling, how comfortable it is for two weeks!

In other words, do you want to think of a way to convert the two-week right of use into a freehold property?

He smiled and was about to exaggerate Tianyang, but Zhang Tianyang paused and continued to speak.

"Among the intracranial infections, there are encephalitis, meningitis, brain abscesses and other possibilities. ”

"Therefore, the first thing to consider after admission to the hospital, in addition to relieving the patient's hyperactive state, is the three possibilities of differential diagnosis. ”

"In addition to history and clinical symptoms, cerebrospinal fluid examination, CT of the brain, and neurological examination can help with the differential diagnosis. ”

In this paragraph, it is not only about the symptoms of admission, but also about the idea of differential diagnosis after admission.

It's clear and it's correct.

The attending physician listened happily and couldn't help but ask.

"Xiao Zhang, what you said is great! How can you see the diagnostic idea of this medical record so quickly?"

Just after talking, Zhang Tianyang, who was talking endlessly, suddenly stopped talking.

It's not that he has stage fright, but that the pale and cold sweat next to the attending doctor is really pitiful.

There's no need to chase after you, right......

He thought for two seconds, and was just about to open his mouth to be modest.

Lin Ke'an next to him couldn't hold it back any longer, and laughed out loud with a "poof".

"Senior brother, because this medical record was written by him last night!" 2k reading network