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PS: Watch the exclusive story behind "Genius Famous Doctor", listen to more suggestions for the novel, pay attention to the starting point official account (add friends on WeChat - add official account - enter qdread), and tell me quietly! Hearing his "original" tunes in a foreign country, Qin Chuan is also very proud. Pen, fun, pavilion www. biquge。 info

Speaking of which, the song "Fireworks" is also very good for the opening song of the party. Everyone's emotions have been mobilized. Even Wang Ze, who has a very reserved personality, also blended into the atmosphere of the party.

"Xiao Qin, come here, let's have two more drinks today." Although it seems to be a little different from Qin Chuan, it does not prevent the two fellows from talking about their hometown.

Qin Chuan Xiang Gillian. Jacobs gestured for a moment, then walked over with a wine glass, "Dr. Wang, let's get drunk today." ”

"No problem, get drunk. Let me tell you, I just received a green card from the USCIS recently, and I am in a very good mood. Although Wang Ze has been engaged in medical work in the hospital for more than ten years, he has always been engaged in the laboratory in the background of the hospital, and the biggest expectation in his heart is that the situation will go to the operating room at the front desk.

"Do you think I'm particularly flattering? In fact, with my current experience, if I go back, life will definitely be easier than here. You can even get very good treatment. But just go back like this, I'm not reconciled. I've been here for more than a decade, and I just go back like this, and I feel gray. And most importantly, the gap between the domestic environment and here is too big. I often see news of domestic doctors being attacked by patients. Relatives and friends in China also advised me not to go back as much as possible. Most cities in the country are now in smog for half of the year. Xiao Qin. I know you have ambitions. I also wish you success. But I, who am already a father of three children, want to give my three children a better environment to grow up. I'll tell you the truth. I'm now the dad of three Americans. Ha ha. ”

Wang Ze's smile is very vicissitudes. Qin Chuan could hear his helplessness in his laughter.

Qin Chuan patted Wang Ze on the shoulder: "Come, drink!" ”

"In fact, it is not easy to stay here now, the economy is sluggish, employment opportunities are very tight, and it is becoming more and more difficult for Chinese students to stay here, and many of them have chosen to return to China. If you choose to go back, it may be a very good choice. You're not bad. It was able to get Ms. Gillian's approval. She doesn't just approve of anyone. Wang Ze said with a smile.

"She probably thinks I've been a doctor in China. A little more experienced than other students. Qin Chuan said with a smile.

"Yes. The emergency department is truly a place to exercise. Especially in our domestic emergency department. I've heard that every day is full of people. Wang Ze nodded, but seemed a little absent-minded.

"I got here to learn about Lao Mei's situation. It turned out that Lao Mei didn't go to the emergency room casually. The cost of an emergency department is more expensive than a regular outpatient clinic. And if it is not necessary, the outpatient clinic can refuse to admit patients. We're all there to come. Slowly, it is about to develop into a general department. Qin Chuan took the cup and touched the cup with Wang Ze.

"Let's go, I'll take you over to meet some people. All are doctors at Johns Hopkins Hospital. It's also good for you in the future. Don't look at what Lao Mei does to talk about principles, actually. They don't look at relationships any less than we do. If you have such an opportunity in the future, you must actively participate. Dealing with these experts will be very helpful for you in the future internship and internship. By the way, you graduated from a domestic medical school with a bachelor's degree. You don't have to wait until you have completed the basic courses to apply for the USMLE (United States Medical Licensing Examination). By then, before you graduate, your USMLE card will already be in hand. "Wang Ze still takes good care of Qin Chuan, a fellow countryman.

"I've signed up." Qin Chuan has already applied for STEP1 and STEP2 this semester. This kind of exam is not too difficult for Qin Chuan. Taking the usmle certificate is naturally something that Qin Chuan, who has a [Genius Famous Doctor] system, is naturally handy. However, Qin Chuan does not plan to develop in the United States in the future, and this certificate does not have much significance for Qin Chuan.

At the end of the show. Wang Ze specially exchanged contact information with Qin Chuan.

"Xiao Qin, come to my house this weekend to be a guest. It's been a long time since our family had domestic guests. Wang Ze warmly invited.

"No problem, as long as you don't bother me. Been here for so long. It's been a long time since I've eaten a domestic taste. Your family should still eat domestic flavors. Qin Chuan said with a smile.

"Of course. My wife used to be a full-time wife at home, and we ate Chinese food every day. I'm still not used to this old and beautiful taste. Wherever we Chinese go, we will bring the taste of China to wherever we go. And there are Chinese supermarkets everywhere, and it is also very convenient to eat Chinese food. Wang Ze seems to have finally met a domestic person, and he unconsciously spoke a lot.

After the end. Qin Chuan stayed behind to help Gillian. Jacobs packed his things.

"Thank you so much, Qin. That's right. Tomorrow my team will have a consultation, if you are interested, you can come and attend. "Gillian. Jacobs is thanking Qin Chuan in disguise for giving Qin Chu a very good learning opportunity.

Qin Chuan naturally would not let go of such an opportunity. Speaking of which, this is the first time he has encountered such a situation since coming to the United States.

"It's a great honor." Qin Chuan hurriedly agreed.

Seeing Qin Chuan's very eager eyes, Gillian. Jacobs smiled.

The next day, Qin Chuan didn't go to class, and went directly to Johns Hopkins Hospital to find Gillian . Jacobs' office.

"Qin, follow me, my colleagues have already arrived." Gillian. Jacobs led Qin Chuan to a small conference room.

There were three people seated in the conference room. Two males and one female. They are all in their early thirties. See Gillian. Qin Chuan next to Jacobs, those three people were very strange.

"Ladies and gentlemen, I would like to introduce you to a doctor from China, Qin. He is now studying at Johns Hopkins University School of Medicine. Come and join us for a discussion today. Qin has obtained his medical license in China. And has a wealth of clinical experience. "Gillian. Jacobs gave a brief introduction to Qin Chuan's situation.

"Hello everyone." Qin Chuan greeted the group very friendly. Dubov. Paul, this patient, is now Gillian. Key cases in Jacobs' group.

Dubov. Paul, 50, has been diabetic for 15 years and developed an infection with a plantar ulcer 3 weeks ago. Plantar ulcers are a common complication in the later stages of diabetes. The outpatient doctor prescribed him antibiotics to control the infection. 3 days later, Dubov. Mr. Paul developed a high fever rash and was admitted to hospital. To identify the cause of the rash and fever, the medical ward consults a specialist in connective tissue disease (CTD).

The current director of CTD is Taylor. Dr. McDonald. Taylor. Dr. MacDonald is a professor of medicine, and he is familiar with medical books. Mr. Paul's condition immediately reminded me that the book said that polyarteritis nodosa was included in the differential diagnosis of fever rash. To prove her vision, Taylor. Dr. McDonald for Dubov. Mr. Paul took a skin biopsy. The pathology report is back. Leukocyte invasion of the arteriole wall is seen, consistent with the pathological changes of polyarteritis nodosa. Taylor. Dr. MacDonald believes that pathological examination supports the diagnosis of polyarteritis nodosa. In line with her judgment, immediately give Dubov. Mr. Paul was given a large dose of hormones. Taylor. Dr. MacDonald was thrilled and compiled a detailed literature on polyarteritis nodosa in his medical record. She also told the resident that although she was a professor of CTD, it was the first time that she had made a diagnosis of polyarteritis nodosa from the beginning of the symptoms.

Dubov. Mr. Paul thus became a patient with polyarteritis nodosa. Dr. MacDonald became a doctor who could diagnose and treat polyarteritis nodosa.

Large doses of hormones completely suppress the immune system, causing the body to lose its resistance to infection, and the patient's pre-existing infection will generally be exacerbated. Therefore, guidelines for the use of high-dose hormone therapy state that patients should be actively looked for tuberculosis and bacteria. or evidence of other microbial infections and treat them accordingly. X-ray showing Dubov. Mr. Paul has fibrosis at the apex of his right lung, indicating that he may have had tuberculosis. And Dubov . Mr. Paul has been to Mexico, where medicine is outdated and treatment is not standardized. Drug-resistant tuberculosis bacteria are common. With this in mind, Taylor. Dr. MacDonald gave Dubov according to the guidelines for the treatment of drug-resistant tuberculosis. Mr. Paul was prescribed a combination of 5 anti-tuberculosis drugs, plus vitamin B6 to prevent side effects. Dubov. Mr. Paul's illness began with a plantar ulcer and then a high fever, although it is not certain or deniable that the infection has spread, for the sake of safety. Two other broad-spectrum antimicrobials were also used.

A week later, Dubov. Paul's plantar ulcer healed. The rash subsided, his condition worsened, the high fever did not go away, the consciousness gradually decreased, the organ dysfunction appeared, and he was transferred to the ICU. Since the spectrum of antibiotics has already covered tuberculosis and bacteria, Dubov. Paul was given antiviral drugs and invited to the infectious disease department for consultation. The Department of Infectious Diseases has guidelines for the management of hyperthermia in immunosuppressed patients, which state that concurrent fungal infection must be considered in such patients who have a high fever despite antimicrobial therapy for more than 7 days. For this, Dubov. Antifungals were added to Paul's protocol.

Dubov. Paul had a persistent high fever for nearly three weeks, and his blood pressure dropped. His treatment regimen includes 9 antibiotics, as well as hormones, vasopressors, antipyretics, sedatives, nutrients and fluids. To give these things, 3 intravenous access rotates 24 hours a day. In addition, pulmonary artery cannulation to monitor cardiac output, radial artery cannulation to monitor blood pressure, endotracheal intubation to artificial ventilation, and femoral vein cannulation hemodialysis to replace the failing kidneys to eliminate metabolites. In addition, there is continuous monitoring of ECG, blood oxygen, and body temperature, and various signals can only be put down by two fluorescent screens. In addition to various tubular lines for monitoring and life-sustaining of ICU patients, Dubov. Paul was also covered with an ice blanket to physically cool down, and the formation was really bluffing. Dubov. Paul's case mobilized all specialties and monitored almost every indicator that modern medicine could monitor. His nursing needs a nurse and an assistant to keep him busy. Because each department has a routine examination of the inpatient doctor, followed by the attending doctor's rounds, Dubov. Paul's hospital room was so crowded with people that there were almost queues. That's why the resident doctor said Dubov. Paul is the focal point.

However, Dubov. Paul's condition continued to deteriorate.

Thanks to Taylor. Dr. MacDonald has been implicated in a number of medical malpractice cases. Jacobs had to arrange for Taylor. Dr. MacDonald took early retirement, and he had this key case in his hands. Naturally, someone else needs to take over. Leanne. Jacobs was unwilling to take over Dubov in no one. Paul's situation could only be taken over personally.

"Okay Dubov. Everyone already knows about Paul's situation, and they all give their opinions. "Leanne. Jacobs said.

Leanne. The three members of Jacobs' team are Jace. Wilson, Allen. Bowen & Ruth. McCallan.

Jace was the first to say, "It's a rare connective tissue disease. Presents with a triad of fever, rash, and organ insufficiency. Treatment of polyarteritis nodosa requires the use of high doses of corticosteroids, but the effect is unpredictable. Dubov. Mr. Paul is in serious condition with heart, lung, liver, kidney, and brain organ failure. In particular, Dubov. Mr. Paul was on high doses of hormones and a variety of antibiotics. But he has been suffering from high fever for more than three weeks, and his body temperature is almost above 40 degrees every day. And so on. will be very dangerous. ”

Gillian. Jacobs nodded: "Everyone has understood the basic situation, and I just want to know now, what is your solution to this case." ”

Ruth frowned and thought for a while and said, "Taylor. Dr. MacDonald was forced to retire because he was involved in multiple medical malpractices. I find his diagnosis questionable. We should re-examine the patient. Re-understanding of the patient's condition. ”

Alan also nodded: "I support Ruth's statement." Taylor. Dr. MacDonald's diagnosis was too subjective. If his diagnosis was wrong, then a series of subsequent treatments were problematic. ”

Gillian was not satisfied with their answers, and she set her eyes on Qin Chuan.

Qin Chuan came here today with a learning mentality, and he didn't plan to express his opinion. Just like when he was an intern, the instructor told them that those interns should talk less and see more and dare to do it.

"Qin, tell me what you think." Gillian didn't seem to intend to keep Qin Chuan silent.

The eyes of Jace and the others were all on Qin Chuan, and they also wanted to hear the opinion of this Chinese doctor.

Since Gillian was already asking for his opinion, Qin Chuan didn't plan to have any reservations.

"I think Taylor. Dr. MacDonald relied heavily on pathology reports, although he was right. However, I forgot that the pathological examination comes from a skin biopsy, which is very small and not an important organ, so the limitations are naturally great. Moreover, in the pathology report, it is used as 'consistent with polyarteritis nodosa'. It's a wording with a lot of reservations, which means that pathologists aren't actually sure. Dubov. The time of the onset of Mr. Paul's febrile rash coincided with his use of the first set of antimicrobials, but the possibility of a drug reaction was not ruled out from the beginning. Later, the rash disappeared and the high fever worsened, indicating that the fever and rash are no longer related, so the triad of polyarteritis nodosa is no longer established. Dubov. Mr. Paul receives nearly 20 kinds of drugs every day, and these high-purity chemicals have to be absorbed and metabolized in his body. It is entirely possible that it will lead to drug fever. And, most importantly and for sure. All drug treatments have been shown to be ineffective. Therefore, it is a good idea to try stopping the medication. Qin Chuan expressed his opinion.

"Discontinued?" Not to mention Jace and the others, even Gillian felt that Qin Chuan's idea was too bold.

The patient has already used a large number of antimicrobial drugs at this time, and once the drug is stopped, there is no suppression of antimicrobial drugs, and once the germs in the patient's body multiply rapidly, it is very likely to lead to the death of the patient.

"This can't be messed up. In the event of an accident, the patient will die directly. I think it's safer to do a thorough check-up first. Allen strongly disagreed with Qin Chuan's opinion.

"Yes, that's too risky. It's a joke on the patient's life. Jace objected as well.

Ruth was worried about another problem: "Although I am also in favor of re-conducting a comprehensive examination, it will inevitably cause Dubov to do so. Mr. Paul's treatment was again delayed. He's in a terrible condition, and there's no way to know for sure how long he'll be able to hold out. In the unlikely event that something goes wrong during the inspection, we will be very reactive. ”

Gillian didn't say what was right and who was wrong, and said to Qin Chuan with a smile: "This is a new idea. But how do you explain Dubov. What about Mr. Paul's multiple system failure? ”

It can be seen that in Gillian's eyes, Qin Chuan is still a first-year medical student.

Qin Chuan explained: "Dubov. Mr. Paul's organ dysfunction appeared after a week of persistent high fever. Persistent high heat changes the protein structure, which can naturally affect organ function, and there is no need to find another cause. ”

"Hmm." Gillian nodded.

Qin Chuan didn't know if Gillian was agreeing with his views or praising himself for being able to consider so many issues as a medical student.

For polyarteritis nodosa, Qin Chuan does not know much. This rare disease is something that Qin Chuan can hardly encounter in a hospital like Tanshan. However, in the [Genius Famous Doctor] system, Qin Chuan naturally saw various rare cases in the process of systematically learning the basics of medicine, and polyarteritis nodosa was among them. But Dubov. Paul's situation was very different from the illness that Qin Chuan understood. The previous diagnosis of the attending physician was problematic. This wrong way of treatment is exactly what led to Dubov. Paul was to blame for Paul's deterioration.

"Inform the inpatient department to stop Dubov. Mr. Paul's antimicrobial use. Gillian actually accepted Qin Chuan's opinion, which surprised the other three very much.

"But, teacher, Qin is just a medical student. If his judgment is wrong, there will be serious consequences. Jace said worriedly.

"No, I support his point of view. I also think Dubov. Mr. Paul's symptoms are inconsistent with the symptoms of polyarteritis nodosa. And Dubov . Mr. Paul is already in a very bad condition. Gillian said very firmly. (A good event for pie in the sky, cool mobile phones are waiting for you!) Pay attention to the ~ point / official account (WeChat add friends - add official account - enter qdread), participate now! Everyone has a prize, now pay attention to the qdread WeChat public account! (To be continued)

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