On Wednesday morning, as usual, there is a daily computer round.

Professor Liu sat in front of the computer, followed by a group of white coats, one by one with half of his buttocks next to the chair, stretching his neck to read the words on the screen.

Zhang Tianyang sat in the farthest place and unexpectedly felt the benefits of "eyesight +1".

If you can go back to the third year of high school, your current eyesight should be able to increase your college entrance examination score by two or three points, right?

"Okay, next, 40 beds. ”

Professor Liu's words brought back Zhang's attention.

"There is nothing special about the 40 beds, the vital signs are stable, the chest x-ray and electrocardiogram have no obvious abnormalities, and there are many other results that have not yet come out. ”

Zhang Tianyang opened his own small notebook and reported according to the words written on it.

Every doctor has one of these little books.

Record the patient's vital signs during ward rounds, record important data when reviewing test results, and occasionally appear on the instructions of senior doctors, and the daily task can be seen at a glance as long as you open it.

Zhang Tianyang's eyes were fixed on the red circle, and he raised his head to ask Professor Liu for instructions.

"This patient needs to make an appointment for dialysis downstairs tomorrow, and this needs to be contacted by the professor. ”

"When was the last time you had dialysis?"

Professor Liu has many patients and outpatients, and often cannot remember the specific situation of each patient.

At this time, the doctor in charge of the bed cannot drop the chain.

"The last time I distilled dialysis was on Monday night, and this patient used to be on regular dialysis twice a week, but the patient had high blood pressure......"

Zhang Tianyang reported the basic conditions of some patients, and Professor Liu quickly remembered.

"Is this the one on emergency dialysis that night?"

"That's right. ”

"I'll take a look. ”

Professor Liu called up the data of 40 beds and looked at it for a long time, then suddenly turned his head to look behind him.

Senior Brother Wang happened to be sandwiched between Professor Liu and Zhang Tianyang, and in an instant, the shirt inside the white coat was soaked with sweat.

"What do you think needs to be done with this patient's treatment and medication?"

This sentence was asked to Zhang Tianyang.

Senior Brother Wang quietly breathed a sigh of relief, and moved his ass with the chair.

Little by little, little by little, it was finally out of Professor Liu's line of sight......

Professor Liu suddenly glared at Senior Brother Wang.

"Move, give me a good seat!"

Senior Brother Wang's face was instantly filled with a flattering smile, "That, professor, I'll make room for you and my junior brother." Aren't you asking questions from your junior brother~"

"That's a lot of nonsense. ”

Professor Liu's face was full of disgust, "Why don't you want to think about it, why don't I ask you questions?"

Why don't you ask me questions......

Because I'm a dish......

Senior Brother Wang curled up on the chair, wanting to cry without tears.

"I've tried so hard to lower my presence, but I still won't let me go.

Do you know how hard I worked?

Boom!"

Zhang Tianyang didn't expect that he would become "someone else's child" again, so he could only hand Senior Brother Wang a sympathetic look.

Dude, you're so hard!

Except for Senior Brother Wang's interruption, Zhang Tianyang became serious again.

The 40-bed eldest brother is the first patient he manages in the real sense, and Zhang Tianyang has also seriously thought about the eldest brother's condition. 、

So he thought about it a little, opened his mouth cautiously, and first summarized the patient's situation.

"Bed 40 is a 36-year-old man with a five-year history of dialysis and long-term blood pressure of 170-200/100-110mmHg.

The patient had been on dialysis twice a week, and each time he underwent low-sodium dialysis, he gained about 2 kg of weight between dialysis.

At present, patients are taking long-term drugs such as Baixintong 2/day, Ambrevy 2/day, Nitran 2-3/day, terazosin 2/day, and betalux 1-2/day.

But blood pressure remains high. ”

Hearing this, Professor Liu couldn't help but nodded, "It's a good summary, continue." ”

Behind Professor Liu, the three senior sisters were all listening attentively, only Senior Brother Wang's expression was a little subtle.

God knows how many times he used to be interrupted by Professor Liu every time he reported on a patient's condition!

And now, when the junior brother said it in one breath, Professor Liu not only did not interrupt, but also said that it was very good?

Although he is not a graduate student in nephrology, he just came to rotate, so he has no specialization.

But, but, junior brother, he's even an intern!

Is the current intern already so rebellious?

Zhang Tianyang couldn't hear the chatter in Senior Brother Wang's heart, and at this time he was reading the ideas he had written down before in the small notebook.

"Again, according to monism, the patient has no family history and no obviously unhealthy lifestyle habits, and it is considered that his hypertension is due to renal hypertension caused by renal impairment.

Therefore, to modify the treatment plan, you should first start from this aspect. ”

"Considering what happened to this patient on Monday night, I don't think his twice-weekly dialysis was inadequate.

It is recommended to increase to 4 hours three times a week.

At the same time, blood volume is measured.

There is an option to lower your body weight by 0.2-0.3kg per dialysis. ”

Professor Liu nodded, "Very reasonable suggestion, considering that he will have dialysis tomorrow, that is, Thursday, I can contact the dialysis room below and change his dialysis time to every Tuesday, Thursday and Saturday." ”

"Anything else?" ”

"For patients with high blood pressure, I think the first thing to start with is diet.

When I checked the literature, I found that for patients with stage 3 and 4 chronic kidney disease who have poorly controlled hypertension, a low-sodium diet can significantly lower blood pressure.

Combined with the patient's condition, sodium intake should be controlled to 2-3 g per day. ”

"Did you check the literature?"

The satisfaction on Professor Liu's face seemed to be overflowing in the next second, and in the next second, Zhang Tian was used to knock on the white coats behind him.

"Look at your junior brothers, and then look at yourselves!

I heard that Xiao Zhang didn't leave the department until seven or eight o'clock in the evening in the past two days, and they still checked the literature for rigor.

Next time someone tells me that the clinic is too busy to read the literature, let me go to the wall!"

Hearing this, Senior Brother Wang and Senior Sister Qi couldn't help but have their eyes fluttering.

The two of them secretly complained in their hearts, obviously they were very busy clinically!

It's just that the junior brother is too rebellious, how can he treat the junior and younger brother as weights and measures!

Professor Liu pulled the topic back with a smile.

"What about the drug, how do you adjust his medication in this case?"

"Drug...... Do you want me to say it too?" Zhang Tianyang hesitated slightly.

"After all, I don't have much clinical experience, why don't I listen to your drug treatment plan?"

Professor Liu's eyes widened.

"If you say it, you can say it, what are you afraid of! It's a big deal, I'll adjust it for you if it's wrong."

Clinicians are meant to be bold and careful.

Say!"

Zhang Tianyang sighed.

"My consideration is that α agonists with central action, such as methyldopa and clonidine, could be added.

A direct vasodilator, such as minoxidil, may be considered, but care should be taken to see if the patient will develop fluid retention and tachycardia.

If necessary, nitrate drugs can also be used to lower blood pressure. ”

"Professor, can you take this medication?"