"40 beds, male, 36 years old, admitted to the hospital at 5:20 p.m. yesterday......"

Zhang Tianyang quickly recounted yesterday's situation, and selectively skipped the part about betting against Senior Sister Liang.

Professor Liu listened silently, a little surprised in his heart.

He has been practicing medicine for decades and has been teaching students for nearly 20 years, and few students can report for the first time as fluent and clear as Zhang Tianyang.

Many junior doctors who are not psychologically qualified will even stutter in front of him.

This made Professor Liu couldn't help but become interested in Zhang Tianyang, and deliberately turned his face.

"According to you, the patient has both high blood pressure and regular dialysis for kidney failure, so why do you think that his situation yesterday was due to the fact that he did not get dialysis in time?"

Hearing this, the senior brother who had just been reprimanded widened his eyes and quietly leaned back to reduce his sense of existence.

This kind of desperate pursuit of the problem is the most terrifying.

The most difficult clinical aspect is the differential diagnosis of various diseases, which can be missed by a fraction of a second.

The reason why senior doctors are always authoritative is not because they are older, but because they have a lot of clinical experience. And these experiences have given them the ability to distinguish diseases.

And doctors like them, who have less than three years of clinical experience, are originally here to learn how the bigwigs diagnose and treat, and this kind of problem can make them break out in a cold sweat.

Fortunately, there are junior brothers to help at the bottom!

The senior brother lowered his sense of presence and made a cheering gesture at Zhang Tianyang.

Senior brother, I was scolded by you in front!

The brother will support you mentally!

Zhang Tianyang didn't know what his senior brother was thinking, so he blinked and sorted out his language.

"My judgment is based on three main points.

First, there is clinical monism.

When a patient has multi-organ and multi-system damage, it is unlikely that he has a primary lesion in all organs of the body at the same time.

The more likely reason is that one of his organs or systems has a problem, creating a chain reaction that leads to secondary problems in other organs and systems.

And the 40-bed patient, considering that he is only 36 years old, he is relatively young, and he has no family history of hypertension, and I have seen that his history of kidney failure is more than two years longer than hypertension.

So I judged that his high blood pressure should be caused by kidney failure.

80%~90% of patients with end-stage renal disease have hypertension.

In such patients, nephrons are lost substantially, resulting in increased water, sodium retention, and extracellular capacity, as well as renal RAAS activation and decreased sodium excretion. Hypertension further increases the pressure in the glomerular capsule, forming a vicious circle and aggravating kidney lesions.

40 beds should be like that. ”

It is reasonable, the logic is smooth, and even the mechanics are explained to you clearly.

When these words came out, the faces of the two senior sisters except Senior Sister Liang changed from casual to surprised, and the faces of the senior brothers became even more sluggish.

The smile on Professor Liu's face seemed to become a little thicker, "There are two more points, you continue." ”

"The second point, I'm thinking about hyperkalemia.

The kidneys have a strong compensatory capacity for K+ excretion, but 40 beds are themselves kidney failure patients, and I calculated that his GFR was below 5.

In this case, blood pressure dialysis is necessary to maintain normal potassium levels in the blood, and if you do not dialysis for a long time, it can lead to hyperkalemia.

Symptoms of the 40 beds included muscle weakness, especially in the lower extremities, and cardiac arrhythmias, which are fully consistent with the clinical symptoms of hyperkalemia.

At the same time, I didn't see the severe headaches, vomiting, hemiplegia, and retinopathy that transient hypertension can cause.

So I'm more inclined to think that he has hyperkalemia caused by not having dialysis for a long time.

And the results of the final blood test confirmed my judgment. ”

The second point is also reasonable, and Professor Liu can't help but nod slightly.

And the three senior sisters and one senior brother even temporarily forgot Zhang Tianyang's identity as an intern and started the lecture mode.

Especially the senior brother, the thought of "junior brother scolding for me" has long been thrown out of the clouds, and now he is holding a small book to remember the key points of Zhang Tianyang.

Maybe I'll take the test in the future!

"Yo, how about a lecture early in the morning?"

Professor He from the next group couldn't help but be attracted by the situation here, and greeted Professor Liu with a smile.

Professor Liu waved his hand to signal him to hold back his words and let Zhang Tianyang continue.

Zhang Tianyang is not stage frightened, and his face is calm.

"Finally, in the circumstances, dialysis treatment is necessary and beneficial regardless of whether the patient's condition is changed for various reasons.

Moreover, I deliberately asked the nurse sister to prepare calcium gluconate and sodium bicarbonate for hyperkalemia immediately.

Nitropusside injection for hypertensive emergencies I also saw that Cory had a backup.

So, no matter how my condition changes, I can always respond to all changes. ”

The words fell, and there was silence all around.

The three senior sisters were shocked, one senior brother was busy memorizing a small notebook, and the two professors were still appreciating and reminiscing.

After a pause for a few seconds, Professor Liu smiled and applauded.

Lao He asked me if I was lecturing, and I saw that it was!

Nice lad!"

Then, Professor Liu turned his head to the senior brothers and sisters, "You guys, listen carefully, when your clinical thinking can be so clear, I can rest assured that you will be able to fly by yourself!"

As he spoke, he glared at his senior brother, "Especially you, who also have hyperkalemia, look at how people deal with it!"

The senior brother nodded like pounding garlic, and stood up obediently and was beaten.

Originally, I was thinking that "my junior brother will attract firepower for me", but I didn't expect it to become "people are better than people, I have to throw them", and I was used as a negative teaching material.

But he didn't resent Zhang Tianyang at all, but admired it incomparably, "Senior brother is really amazing!"

Clinically, this is the case, who is capable and who is the greatest.

Professor He, who had just come over, couldn't help it, everyone has a love for talent, "Lao Liu, is this the new attending physician in your group?"

The grades in the hospital are roughly divided into professors>associate professors> attending > inpatient > advanced training> planning and training> internships.

Zhang Tianyang looks too young to look like a professor and an associate professor.

But seeing that he is well organized, has a rich knowledge base, and exudes an air of "reliability", Professor He is more inclined to guess his qualifications.

"The main director is definitely not, he is still called Senior Sister Xiaoliang. And it's not a resident, so I don't have a residency in my group. ”

Professor Liu didn't know much about Zhang Tianyang's level, but seeing that he was so sophisticated, "It should be a doctor, right? ”

Zhang Tianyang shook his head with a smile, and just wanted to speak, but was blocked by Professor Liu again.

"That's the regular training doctor! You can, you can have such clinical thinking in the regular training stage! So how many years are you in the regular training?"

Senior Sister Liang couldn't stand it anymore, "Professor, junior brother is a new intern......"

"What did you say?" Before Professor Liu could react, Professor He called out first, "Is it the intern's internship?"

Zhang Tianyang looked at the two professors embarrassedly and explained,

"Yes, I'm a senior and have just entered my clinical internship, which is my second week in the clinic. ”

At this moment, both professors fell silent.

"Liar, isn't it?intern?second week?Master Zu's food?" Professor He glared at and muttered quietly.

Professor Liu solemnly looked at Zhang Tianyang's badge and said the same thing for the third time.

"Zhang Tianyang, Xiao Zhang, you're good, it's okay!"

"Why didn't you let me meet such an intern?!Is the assignment of the student's teaching secretary aimed at me!"

Professor He actually began to make a fuss, and put his arm around Professor Liu's shoulder,

"Lao Liu, let's discuss something, you see that there are so many people in your group, there are only two or three in our group, why don't you give me one of them?"

"I don't take advantage of you, I just want an intern, how about it?"

"Hehe!" Professor Liu scolded with a smile, "Go back quickly!"

Zhang Tianyang is such a good seedling, when it comes to his hands, how can he let it go again!