Professor Tong took the medical record report handed over by Chen Qi, put on his reading glasses and looked at it for a while, and then pursed his mouth.

The doctors from the other Xijing hospitals next to them didn't dare to say anything after seeing it, everyone knew that Teacher Tong was pouting, and he often encountered problems.

Professor Tong handed the medical records to the students behind him:

"Look at it, everybody has their own opinions."

Several of Cui Tongzhi's colleagues started to talk about it, because these doctors were obviously outsiders, why did they suddenly meddle with the patients in the People's Hospital?

Intellectuals are a bit particular about the "right to privacy".

One of the staff members knew Chen Qi, so he asked softly, "Dean Chen, these are ......?"

Chen Qi smiled and quipped:

"You don't know Taishan, this is a big professor in Xijing Hospital, you see these doctors behind him, almost at the level of professor director. With this Professor Tong's number, you won't be able to hang up if you go to Xijing Hospital without queuing for seven days and seven nights. ”

The staff member was taken aback: "Xijing Hospital? Just the one in Xi'an? This hospital is a great one. ”

"Yes, so the professors of the people are helping you see the disease for free today, do you think Lao Cui has gone out of shit luck?"

The staff of several post offices nodded again and again, and then they all looked at these professors from the northwest with expectant expressions.

As a result, the doctors from the northwest had a headache.

Everyone gathered around to study the medical records first, and then took out all the examination reports, and even many doctors took the initiative to come forward to do a physical examination of the patient and auscultate the heart and lungs.

Nothing came of it.

The average doctor trusts the results of ancillary tests.

One by one, the diagnosis came out of their mouths, and then one by one they were overturned by their own colleagues, and everyone's eyebrows were furrowed.

Some people are already complaining: "This is really evil in Vietnam, how can it be all these incurable diseases." ”

"Organic diseases can be ruled out, the stomach, pancreas, gallbladder, liver, and spleen seem to have no problems at present, and the test results do not support the lesions in these parts, so is the problem still in the intestines itself?"

"Could this be epileptic abdominal pain too?"

Chen Qi's performance just now was so amazing, the problem that the gastroenterology department of the entire Xijing Hospital couldn't find out, and he got it done with a few details, which made people have to admire.

Professor Tong also looked at Chen Qi: "Xiao Chen, I see that you are confident, do you have any diagnosis and treatment ideas?" ”

Insiders don't just ask, do you know what kind of illness he is?

It's so hard that the doctor can only say that he doubts how and how......

Just like Chen Qi's previous diagnosis of Yu Sisi's epileptic abdominal pain, it was not recognized from the beginning, but based on reasoning to verify his diagnosis and treatment ideas.

For example, when he saw the corner of the girl's mother's mouth twitching, he thought about the possibility of epilepsy?

If the mother has epilepsy, will the disease be passed on to the child?

If it can be passed on to girls, can epilepsy cause abdominal pain?

If I suspect that my abdominal pain is caused by epilepsy, what tests should I do to verify it? What medications are taken for treatment?

This set of diagnosis and treatment ideas is like doing a math problem, listing them step by step, and finally getting a result.

Medicine, like mathematics, the result is important, but the process is also important, and in the medical exam, the idea of solving the problem is the same as that of mathematics.

Explain the importance of the process, or the idea.

This problem-solving process is the "clinical pathway", as long as the diagnosis and treatment ideas are correct, then it can provide a new clinical approach to other doctors, which is the characteristic embodiment of empirical medicine.

Chen Qi asked rhetorically: "Professor Tong, what do you think?" ”

"Now we can only do the elimination method, and the trauma can be ruled out, because there is no relevant record in the medical history. Inflammatory causes such as acute gastroenteritis, appendicitis, various perforations and peritonitis can also be ruled out because there is no relevant record according to the examination report. ”

Chen Qi nodded slightly and continued to listen to Professor Tong's analysis:

"So is it possible that the pain is secondary, the patient's abdominal pain is just a symptom, that is, the real cause is not in the abdomen, but other parts of the periphery, which is also something that is ignored by everyone."

"Oh, it seems that Professor Tong thinks the same way as me."

At this time, Professor Tong had a seizure: "Then Xiao Chen, should we make a bet to see who can guess which part is wrong." ”

Chen Qi's nature is not stable, and he became interested as soon as he heard the bet:

"Okay, let's compare a batch with Professor Tong today, let's write down the parts we guessed on the paper, and then light it up to see who is more accurate."

"Okay, it's a word, bring a pen and paper."

Professor Tong and Chen Qi both joke a lot, and of course, there is also a factor of "not admitting defeat" to their peers.

Although Professor Tong Shanggao wants his disciples and grandchildren to come to Yuezhong to receive some stimulation and lessons, as Liang Wenwen said, do you want the cards of Xijing Hospital anymore?

In Yu Sisi's body, Xijing Hospital can be said to have lost face this time, although the trip to Yuezhong is a good thing for the patient, because the cause was found out to her.

But on the face of it, when this news spread, the gastroenterology department of Xijing Hospital became a laughing stock in the national health system.

So Professor Tong wants to win back a game through this kind of joke.

Cui Tongzhi's case is also a difficult and miscellaneous disease, in case Chen Qi guessed wrong, he Tong Shanggao guessed correctly based on his decades of experience, and it can be regarded as a one-to-one draw.

Xijing Hospital's face has been somewhat saved.

As soon as they heard that their ancestors were going to make a bet with Chen Qi, the doctors in Xijing Hospital were secretly encouraged, and they were all red-faced.

The medical staff at the People's Hospital are calm, their own President Chen is out of the house, and there are still diseases that can't be seen well?

Anyway, there are more than 1,300 employees in the People's Hospital, except for a certain deputy secretary, almost everyone else is Chen Qi's brainless fan.

After a while, the little nurse brought paper and pen, and Chen Qi and Professor Tong wrote a word at random and handed in the paper.

The two of them put the white paper on the desk together, and the people next to them eagerly surrounded them, and then made a burst of "ho~~~~" sounds.

I saw that Chen Qi and Professor Tong both wrote one word together on the paper: heart

Chen Qi and Professor Tong looked at each other and smiled, everything was silent.

Yi Zewen is the head of the emergency department, and he couldn't help but ask first:

"Teachers, why is your answer that there is a problem with the heart? This is obviously a patient with abdominal pain. ”

The doctors at Xijing Hospital also had questions, except for the veteran Director Liang and Director Zhou, who were thoughtful and seemed to be reasoning about this possibility.

Cui Tongzhi only had abdominal pain, not dead or unconscious, and he couldn't be surprised when he heard this answer, but he touched his left chest and was half scared to death.

Good guy, what can I do if my stomach hurts again? If something goes wrong with this heart, it really deserves to die with braids.

"Doctor, help, save me~~~"

Other doctors also wanted to ask their own questions, especially the doctors at the Viet Cong People's Hospital, Chen Qi has always advocated this kind of open and enthusiastic academic atmosphere, anyone can ask questions, don't be afraid of what authority is not authoritative.

"Dean Chen, what's going on?"

"Dean Chen, why do you think it's a heart problem?"

But Chen Qi waved his hand,

"Now is not the time to explain, if Professor Tong and I are correct, then the patient is now very dangerous. Zhang Xing, you do an electrocardiogram right away. Chen Li, you go to the laboratory in person, and ask them to immediately expedite the cardiac enzymes, as well as troponin, quickly. ”

Everyone saw that Chen Qi's face became serious, and they all started to act.

Professor Tong saw Zhang Xing running over with an ECG and grabbed it: "I will do this ECG myself." ”

Zhang Xing was still a little afraid to do it: "Professor Tong, how can you do this kind of rough work ......?"

"Okay, there's no time, since we have a guess, let's race against time!"

After speaking, Professor Tong had already started to install the leads on the patient himself, and several little doctors next to him were so frightened that they hurried to help.

The electrocardiogram of the Vietnamese People's Hospital is imported from the United States, although it is second-hand, but the sensitivity is still very high, and as soon as the switch is pressed, the ECG drawing will be spit out.

All the people, including Chen Qi, surrounded them, and many doctors even stood on stools to see the results of the ECG.

Suddenly, several of the doctors at the front of the crowd exclaimed:

"Inferior myocardial infarction!"

As soon as they heard the heart attack, everyone trembled, and after Cui Tongzhi heard it, he almost fainted, and several colleagues next to him were also obviously anxious.

Myocardial infarction, in the 80s, was almost an inevitable death-threatening illness, and everyone avoided it.

In fact, even in 2023, when medicine is highly developed, the out-of-hospital mortality rate of myocardial infarction will reach more than 30%. Note that it is "above".

Because in many remote areas, many patients die of heart attack, but because there is no autopsy or no timely help, the mortality rate is more than 70% or even higher.

Even in the "hospital infarction" with complete medical equipment, the mortality rate has reached about 13%, which can be described as "notorious".

Chen Qi's eyes were fixed on the electrocardiogram, and he introduced to Professor Tong, who was presbyopia:

"ST segment elevation in leads II, III, and AVF, ST segment depression in leads I and AVL, and ST segment depression greater than or equal to 0.1 millivolts in v1~v3 leads, is indeed inferiority myocardial infarction, and the infarct area is large, and the posterior lateral wall and the lower 1/3 of the posterior ventricular septum are involved."

Professor Tong sighed: "Xiao Chen, the patients in your hospital, you can deal with them." ”

He understands that when he encounters a patient with a heart attack, this is a dead end, and this patient is already very lucky.

Chen Qi immediately shouted to the doctors and nurses in the surrounding emergency department:

"Thrombolysis is done right away, along with coronary angiography and if possible, immediate interventional surgery. And a few of your colleagues, hurry up and inform Cui Tongzhi's family. ”

Several employees of the post office have been stupid:

"Oh, okay, notify the family, by the way, notify the family, but where is the family? ……”

At this time, Yi Zewen coughed lightly a few times and reminded in a low voice: "President Chen, our hospital has not carried out coronary angiography examination. ”

Chen Qi slapped his forehead, thinking that he had patronized endoscopy, and he didn't care about what surgeries other departments were carrying out.

In fact, he can't be blamed, Chen Qi has only been the president for a few days, and how many departments there are in the entire hospital, and a director with three heads and six arms can't be busy.

"There is no coronary angiography...... No interventional surgery was performed......"

Chen Qi was stunned for a moment, as a rebirth doctor, he understands the criticality of myocardial infarction very well, and also knows that coronary angiography is the gold standard for diagnosing heart disease, and intervention is the key to life and death of myocardial infarction.

Thrombolytic therapy alone is not a guarantee, especially in the 80s, when thrombolytic drugs were very ineffective.

This is also the reason why everyone's face changed when they heard about the heart attack, and even the doctors at Xijing Hospital were tied up.

Coronary angiography is not an uncommon thing, as early as 1958, the first imaging was done in a foreign hospital.

It is the gold standard for diagnosing macrovascular disease in coronary heart disease,

Coronary angiography can detect whether or not the coronary arteries are narrowed, which blood vessels are narrowed, and to what extent, and based on the results of the coronary angiography, evaluate whether to stent or bypass surgery for the narrowed vessels.

If coronary angiography shows coronary artery stenosis, and the stenosis of a single lesion is more than 75%, stent placement is recommended.

If coronary angiography shows lesions in more than two blood vessels and the stenosis is greater than 75%, coronary artery bypass surgery is recommended.

Therefore, this examination is very important, and it is also the key to the success of follow-up rescue.

The so-called interventional treatment, which began with percutaneous coronary angioplasty (PTCA), was invented by Swiss doctors in 1977.

The surgical method is to infuse through the peripheral arteries, send the balloon catheter to the vascular lesion, relieve the stenosis through balloon dilation, restore coronary blood flow, and then remove the balloon.

However, in subsequent clinical applications, it was observed that there were serious problems with PTCA, including restenosis, acute vascular occlusion, etc.

As a result, medical researchers from all over the world had to make improvements, and the most direct idea was to support a shelf at the narrowed blood vessels, and the stent was born, so that the rate of PTCA restenosis was significantly reduced.

In 1986, the first coronary stenting was performed by a French doctor.

The problem is that it is only 1989, and it is impossible for a new clinical procedure to be transmitted to China at once.

In this year, China is half a beat slower than developed countries, which is also a helpless thing.

But others don't know how to do imaging and intervention, Chen Qi knows.

This thing has almost been popularized in hospitals in later generations, not to mention tertiary and secondary hospitals, and even the awesome first-level hospitals, that is, the central town health center, can do it.

But in the Viet-Chung Hospital in 1989, it was not so simple to play interventional treatment.

This requires a set of special tools, as well as a professional medical angiography X-ray machine, and a special catheter guidewire stent.

This set of things is in Chen Qi's space operating room, and the problem is that when it is taken out and used, how to keep it secret has become a big trouble.

(End of chapter)