The preliminary diagnosis was made, and the sophomore who was "neglected" was indeed the critically ill patient referred to by the system.

Although the preliminary diagnosis was available, Luo Hao's task was not completed.

The diagnosis of cardiac tamponade is only a complication of the underlying condition and is not definitive.

Luo Hao condensed and looked at the patient deeply.

The diagnostic assistance AI has not yet been upgraded, and Luo Hao has begun to urgently hope that the system can issue a little more tasks so that he can accumulate enough fragments to synthesize and upgrade as soon as possible.

I just hope that it will never see the end like Pinduoduo.

The quality of the medical staff in the emergency department of the First Hospital of the Medical University is very high, and you can tell at a glance that they have experienced a lot of battles.

It took less than 15 minutes to contact the cardiology department and transfer the patient.

"Xiao Luo, let's go. Yes, this kind of patient can give a diagnosis, which is really amazing. Liu Haisen had some admiration for Luo Hao unconsciously, and said kindly.

In his subconscious, Luo Hao has been upgraded from Boss Lin's nephew to a doctor of the same level who can talk to him about difficult diseases.

"Hmm." Luo Hao nodded.

When Liu Haisen took Luo Hao to continue to "visit" the First Hospital of the Medical University and walked out of the emergency building, Luo Hao suddenly stopped.

"Teacher Liu, that patient ......"

"Which one? Patients with cardiac tamponade? ”

"Well, I'd like to go and see, is it convenient for you?"

Although Luo Hao used a question sentence, his tone was affirmative and unquestionable.

Unconsciously, Luo Hao already had a little bit of Wang Guohua's domineering energy in the mine.

Liu Haisen scratched his head.

What is there to see about a patient? It has been admitted to the hospital, and naturally there are doctors and professors from relevant departments who are responsible for diagnosis and treatment.

Luo Hao is a little too much.

"Xiao Luo, with your temper, it was okay when you were young, but you may not be able to do it when you are thirty. Learn to relax and not be too empathetic, patients ......"

"Teacher Liu, that's not what I meant."

"Oh? So what do you mean? Liu Haisen came to be interested.

"I'm afraid that the First Hospital of the Medical University will not understand it, which will delay the diagnosis and treatment of patients."

Chen Yong almost raised his hand to cover his eyes.

That embarrassing feeling swept through his body like a wave, and in just a moment, Chen Yong pulled out three bedrooms and one living room on the ground.

LUO Hao,

he

Are you afraid of misdiagnosis in the first hospital of the Medical University?

Who did he think he was!

Liu Haisen thought that he had heard it wrong, and was stunned for 3 seconds, repeatedly tasting Luo Hao's words, and finally looked at this kid who "didn't know the height of the sky" with a smile.

"Xiao Luo, you ...... It's just so confident. Liu Haisen did not scold Luo Hao, but gently described it as confident.

In Chen Yong's view, this is not self-confidence, but is close to arrogance and rudeness.

"Teacher Liu, can you take me to have a look?" Luo Hao asked politely and firmly.

Liu Haisen hesitated slightly, but still said, "Okay, but let's say it first, we can't interfere with the treatment of cardiovascular medicine." ”

"Teacher Liu, there are some examinations that I still need you to urge. I feel that if the patient does not get a diagnosis in the shortest possible time, the situation will be very dangerous. ”

Liu Haisen really doesn't know who gave Luo Hao so much confidence.

Self-confidence is a good thing, but Luo Hao's self-confidence is a little overflowing.

In both public and private, Liu Haisen chose to be "used to" Luo Hao and took him and Chen Yong to the Department of Circulatory Internal Medicine.

Along the way, Chen Yong wanted to talk to Luo Hao about how embarrassing Luo Hao's speech and demeanor were just now, but he never found a chance.

When I came to the Department of Cardiology, several people sat down in the doctor's office, and the doctor on duty was doing a pericardiocentesis, and there was no time for the time being.

Liu Haisen and Luo Hao had a casual chat, and waited for nearly half an hour for the doctor on duty to come back.

After the exchange, it was learned that the patient was admitted to the hospital, and immediately rushed to the cardiac catheterization laboratory for pericardiocentesis, and about 1500ml of serum was discharged.

Preoperative emergency laboratory tests for pericardiocentesis revealed that lactic acidosis was 8.71 mmol/L, pH 7.18, anion gap 28 mmol/L, acute kidney injury blood urea nitrogen 25.1 mg/dl, creatinine 1.94 mg/dl, and elevated aminotransferases, suggesting decreased systemic perfusion.

"What do you suspect the patient is?" Liu Haisen asked.

The doctor on duty in the Department of Cardiology shook his head, "Director Liu, the patient still needs to improve the relevant examinations, and now he has only returned a few emergency tests, and I don't know what kind of nausea, vomiting, blood in the stool, pericardial effusion, and acute ...... are induced."

He uttered more than a dozen diagnoses in a row.

Bangs Haisen's head is buzzing.

As soon as he heard it, he knew that the patient's condition was extremely troublesome, and it was very unlikely that he would be able to give a definitive diagnosis now.

There is a high probability that the whole hospital will have a consultation on Monday and find experts from all relevant departments in order to make further discoveries.

"Xiao Luo, the patient's pericardial tamponade has been properly disposed of, don't worry. Let's go and take you to taste the delicious food of the provincial capital. Liu Haisen suggested after asking about the patient's situation.

In his opinion, there was no need to stay.

But Luo Hao was still silent, his expression was serious, and his sunny smile disappeared.

This kid.

Liu Haisen sighed in his heart.

Luo Hao is still young, just like when he was young, he thinks that as long as it is a disease, he should get an accurate diagnosis and timely treatment as soon as possible.

As everyone knows, there is no end to manpower.

The medical resources in the provincial capital are still high-end and abundant, but over the years, Liu Haisen has seen patients with unclear diagnoses, and I don't know how many.

The vast majority of these patients have tried their best, but still do not have a clear, accurate, and correct diagnosis.

This is the enthusiasm of young people.

But always know the current affairs, Luo Hao just came to the provincial capital to do business, and he will go back soon, Liu Haisen smiled, he couldn't even get the corresponding laboratory examination in such a short time, Luo Hao thought so much.

Luo Hao doesn't have the inner drama that Liu Haisen thinks.

This is because the system interface in the upper right corner of the field of view has changed.

【Serious Patient Hidden in the Crowd】Originally, only one patient was required to be diagnosed, and the patient was reminded that the patient was seriously ill, so please hurry up.

But more than ten seconds ago, the system task interface suddenly flashed, although there was no sound, but the flashing red had already sounded.

In the task, after the four words "serious patient" in the emergency department, a () appears to indicate that the patient has developed hepatic shock.

Liver shock just after pericardiocentesis?!

Luo Hao's eyebrows were twisted.

"Xiao Luo?" Liu Haisen saw that Luo Hao didn't speak, so he patted him.

"Huh?" Luo Hao woke up.

The flickering red light of the system told Luo Hao that the matter was urgent, Luo Hao did not hesitate, and said directly, "You can borrow me to wear a white suit, I want to see the patient." ”

Liu Haisen was very unhappy, "Xiao Luo, there's no need for this." This is the first hospital of the Medical University, so I'm still worried that you might as well be the head of the mine. ”

He said this very seriously, and Luo Hao had already exhausted Liu Haisen's patience.

"Teacher Liu, this senior brother, I suspect that the patient's condition has deteriorated further."

The doctor on duty was surprised that Luo Hao called himself senior brother, which is what a doctor with a teacher can call him so.

Although he did not despise Luo Hao, he was still dissatisfied with Luo Hao's expression.

Luo Hao is questioning his own disposal!

In the eyes of the doctor on duty, Luo Hao suspected that he had damaged the patient's heart muscle.

"Pericardiocentesis was done under ultrasound, you don't think I'm penetrating the myocardium?" The doctor on duty asked directly.

"I want to take a look." Luo Hao said, clasped his hands together, and moved lightly twice.

That kind of urgency but powerlessness was infectious.

Even Luo Hao himself didn't notice that the skills of "acting" magnified his state of mind and invisibly cleared some obstacles.

"Let's take a look." Liu Haisen was still used to Luo Hao, and he said helplessly, "If there is nothing to do, let's leave, and I will invite you to dinner in a while." You just come to the provincial capital for a day, and you can't go back hungry. ”

"Thank you, thank you." Luo Hao folded his hands and bowed slightly, with a grateful smile on his face.

This expression is very ordinary, but with the blessing of "acting", it is extremely infectious, as if he made a big mistake by refusing Luo Hao's request.

The doctor on duty was also helpless, but in the end he got Luo Hao a white suit of his own.

After changing his clothes, Luo Hao entered the ward.

Something is wrong with the patient!

If it is usual, without system prompts, Luo Hao may ignore the subtle changes of the patient. But the system clearly wrote "liver shock" in black and white, and Luo Hao could see the changes in his skin at a glance.

Yellow!

"How does it feel?" The doctor on duty asked.

At the same time, Luo Hao walked up to the patient and said in a deep voice, "Close your eyes." ”

The patient was stunned for a moment, and subconsciously obeyed Luo Hao's instructions and closed his eyes.

"Huh?" The doctor on duty walked to the bedside, and at this time Luo Hao had already rolled the patient's eyelids.

"Yellow?! !! The doctor on duty was startled and burst into foul language in front of the patient.

"Blood draws, tests." Luo Hao said in a deep voice.

Yellowish eyelids are a sign of jaundice, and a patient with cardiac tamponade suddenly developed jaundice, which the doctor on duty did not expect.

Liu Haisen originally only stood at the door and didn't come in at all, but after hearing the words of the doctor on duty, he took three steps and made two steps to "fly" over.

Flipping the patient's eyelids with his own hands, a chill rose from the bottom of Liu Haisen's heart.

Why is the patient yellow!

Impossible!!

Blood was drawn, laboratory tests, and the doctor on duty personally took the specimen and trotted to the laboratory department.

The doctor on duty personally sends the specimen, and the doctor of the laboratory department will definitely do the emergency liver function test as soon as possible, which is the most time-saving method.

It is also the most helpless way.

"Xiao Luo, how do you know?" Liu Haisen came out of the ward and asked in a daze.

"Teacher Liu, I guess."

"......" Liu Haisen glanced at Luo Hao viciously.

This kid must not be telling the truth.

"Wait for the lab tests to come back, it should be soon."

Liu Haisen had a stomach full of questions, but he couldn't ask them.

Chen Yong stood aside, also thinking about question marks.

However, without laboratory tests, there is no way to determine the degree of hepatic shock by physical examination alone.

Soon, the doctor on duty came back with a serious face.

On the way, he had already contacted the second line, and after coming back, he didn't wait for Liu Haisen to ask, and said directly, "Fulminant liver failure, AST > 7000 U/L, ALT 4141 U/L!" ”

Gan!

Liu Haisen thought that the patient was in critical condition, but he did not expect that the laboratory indicators would deteriorate to such an extent in a short period of time.

"This ...... Senior brother, what is your opinion? The doctor on duty asked.

Can he give a diagnosis? Liu Haisen also looked at Luo Hao.

To tell the truth, Liu Haisen doesn't believe it.

Liu Haisen knows the patient's medical history, and it is simple to say simple, but complicated...... It's complicated to the extreme.

Because of drunkenness and vomiting a week ago, it led to blood in the stool, pericardial effusion, and explosive liver failure a week later.

Is there a causal link between this?

At least Liu Haisen can't connect them.

"I'll try."

"Try?"

"Try?"

Liu Haisen and the doctor on duty asked in unison.

If you can't do it, if you can't do it, try what the hell it is.

In a surprised gaze, Luo Hao took out his mobile phone, made a call and began to "try".

The phone was quickly connected, and it was the voice of a kind female old man.

"Teacher Zhao, hello, I'm Xiaoluo." Luo Hao greeted him cordially.

"Xiaoluo, are you still in the imperial capital?" Teacher Zhao asked.

"No, I'm in my hometown provincial capital, and there is an emergency sick patient here......"

Luo Hao didn't say anything long-winded, and began to report his medical history after a brief greeting.

Just like a full-staff round, Luo Hao concisely explained the patient's situation clearly and reported it to the senior doctor.

Liu Haisen and the doctor on duty were dumbfounded.

Try it, it turns out that is what it means.

It's just to call and shake people, but I don't know where Luo Hao is sacred.

"Oh, that's right." The old man muttered for a few seconds, "Check anti-nuclear antibodies, anti-dsDNA, complement C3 and C4." The puncture fluid of the pericardial effusion is pathologically examined and is estimated to be an exudate. ”

"Okay, Mr. Zhao, what kind of disease do you think it is?" Luo Hao asked.

"There is a high probability of systemic lupus erythematosus." The old man on the other end of the phone said without hesitation.

“……”

“……”

Liu Haisen, the doctor on duty, and Chen Yong were messy for a while.

The patient's history seems to me to be complex and clueless, and all those who come into contact with the patient are like flies without a head, unable to find the point.

But Luo Hao just made a phone call, concisely reported his medical history, and the old man on the other side of the phone gave a diagnosis.

"Although there is only a 1.2% probability of causing cardiac tamponade due to systemic lupus erythematosus, the diagnosis is still based on complications such as explosive liver failure and kidney failure."

"Go check it out, and call me if you can't get it back."

"Okay, Mr. Zhao, thank you for your hard work." Luo Hao bowed as he spoke, as if the old man was opposite him, and as if the old man could see his respect.

"Then I'm hanging, when are you going to come to Ann? Remember to come to me. I haven't seen you in a few years, I miss you a little, hurry up. The old man didn't say much and hung up the phone.

Liu Haisen and the doctor on duty are like sculptures, stupid and don't know what to do.

"Senior brother, please take blood for testing, check antinuclear antibodies, anti-dsDNA, complement C3 and C4."

"It generally takes 48-72 hours for antinuclear antibodies to produce results, but if you rush it tightly, you can get results in 3 hours."

"I'm in trouble."

Luo Hao said, bowing slightly.

"Harm, what's polite." The doctor on duty walked quickly, but when he got to the door of the doctor's office, he turned around and asked, "Which big guy are you consulting?" ”

Luo Hao said a name, but the doctor on duty had never heard of it.

"In the 80s, the old man presided over the general rounds of ZJ Province." (Note)

Belch......

Provincial General Rounds?

It's not just the young doctor on duty, this outlandish statement has not even been heard of Liu Haisen.

The ward rounds of the medical system are generally limited to the internal departments, and there are almost no major surgical rounds in the hospital, and only high-level tertiary hospitals still exist in the major internal medicine rounds.

There have been no inter-hospital rounds in the city, let alone provincial rounds.

The provincial general ward round is still a province with so abundant medical resources......

Liu Haisen burst into tears.

He hadn't heard of it, but he believed it at once by just a few words.

The old man's words were firm and powerful, and his tone was calm but unquestionable.

What kind of fairy is this!

The doctor on duty was busy in a daze, Luo Hao looked at Liu Haisen, "Teacher Liu, can you help me urge the antinuclear antibody?" Patients may not survive that long. ”

"I'll do it." Liu Haisen sighed and began to call and shake people.

Although it takes a lot of favorability and honor points to shake people on weekends, Liu Haisen still did it.

First, because the patient's condition is indeed serious, Luo Hao is not alarmist.

Second, Liu Haisen was also curious about whether this diagnosis was correct.

Luo Hao's try, he actually tried out the big guy of ZJ Province's general rounds, and the old man was nearly 100 years old.

The old man listened to Luo Hao's report and directly gave a diagnosis, and spoiled Luo Hao abnormally, urging Luo Hao to see her.

Luo Hao is like the most favored little grandson under her knees.

This kid, there's something!

Three hours later.

Liu Haisen looked at the data on the computer screen in a daze.

The second-line professor of the circulation department next to him made a nervous call, and his hands trembled a little.

If you are undecided, you must look for rheumatic immunity.

The "just right" patient's lab report would have almost definitively diagnosed it as systemic lupus erythematosus.

"Director Liu." After the call, the second-line professor was much more relaxed, "Thank you." ”

"......" Liu Haisen was a little dazed, but still accepted this thanks.

He knew that if there was no Luo Hao's try, when the patient's examination results came out, his condition would inevitably be delayed.

I can't say that I can't save it, but if I can be a day earlier, it will be a day, and if I can be an hour earlier, it will be an hour.

Things were already on the right track, and Liu Haisen glanced at Luo Hao.

The task was completed, Luo Hao was looking at the system panel, happy.

The patient's diagnosis was clear, and Luo Hao did not believe that the First Hospital of the Medical University could not even treat systemic lupus erythematosus.

If you "point fingers", it will be eventful, and Luo Hao has always had a sense of proportion.

"Teacher Liu, will you take me somewhere else?" Luo Hao whispered.

After leaving the Department of Circulatory Medicine, Liu Haisen stood in the corridor and stopped, and looked back at Luo Hao deeply.

"Teacher Liu, what instructions do you have?"

"Little Snail, you said try it, that's what you mean?"

"Uh, what else?" Luo Hao was a little stunned.

“……”

"Mr. Zhao is a great doctor in the discipline of rheumatology and immunology, and if you are undecided, you must find a doctor of rheumatology and immunology to give it a try."

"Do you know her well? Just call casually to disturb people. Liu Haisen asked.

"It's not casual." Luo Hao smiled, "Human life is at stake, Teacher Zhao won't be unhappy." And if we are doctors, don't we have to report to the senior doctor if we can't understand the disease, and call and shake people, this is a basic skill. ”

“……”

Liu Haisen once again fell into a deep confusion and could not extricate himself.

Calling and shaking people, this sentence is not rough.

But in Liu Haisen's mind, it was limited to this hospital, and other hospitals in the provincial capital were not within his consideration.

And what about Luo Hao?

A phone call was made to Mr. Zhao from the general ward round of ZJ Province.

Liu Haisen didn't know how to describe his tangled and complicated feelings.

Originally, I wanted to take the opportunity of Luo Hao's visit to the First Hospital of the Medical University to introduce him to him, so that Luo Hao knew that the mine was just a puddle.

But it wasn't until now that Liu Haisen remembered that Luo Hao was a doctor of the eight-year program of Xiehe, and it was said that he was prosperous in Xiehe back then, but he didn't know what happened before he returned to the mine.

Looking at it now, it was definitely not a rumor that Luo Hao was prosperous in Concord back then, and it was even a little demeaning to a certain extent.

Luo Hao is not only thriving in Concord.

It was not early, it could even be said to be late, and I missed lunch time.

"Xiao Luo, are you still in time? Don't be in a hurry to go back. Liu Haisen glanced at his phone.

"Teacher Liu, I have to pick up the car and rush back to Donglian before dark."

"Huh, before dark?"

"Yes, I don't take the night highway if possible." Luo Hao was a little regretful, but then smiled, "It's okay, it's okay, Mr. Liu, don't you still have to go to the mine for surgery, I'll invite you next weekend." ”

Liu Haisen still has some regrets, I don't know why.

Before he could answer, his phone rang.

picked up the phone, and there was a hurried voice on the other side, and before Liu Haisen could speak, he hung up the phone.

The bangs were as if they were wearing a mask of pain, and their muscles were infused with concrete, hard.

"Teacher Liu, that ......"

"Don't leave yet, let's wait a while." Liu Haisen frowned and said.

"What's wrong?"

"The director of the Department of Rheumatology and Immunology said I must see you."

Luo Hao is nothing, he doesn't know the director of rheumatism and immunity of the First Hospital of the Medical University, so he stood at the gate of the inpatient department and found a secluded place to talk and laugh with Liu Haisen.

During this period, Luo Hao received a call from Section Chief Duan, and they wanted to "ride" Luo Hao's hitchhike back to Donglian City.

Before the director of rheumatism and immunity appeared, Section Chief Duan and Zhou Tianci walked to find Luo Hao.

They didn't take the car, so they probably got off the bus outside the hospital and walked into the first hospital of the Medical University.

The coal boss's car is too ostentatious, and it must not be good for people to see.

"Xiao Luo, I'm causing you trouble again." Section Chief Duan waved from afar, with a gentle and kind smile on his face.

"Section Chief Duan, you're welcome." Luo Hao smiled, "Please wait a while, I still have something to do here." ”

"Harm, look at what you said, it was me and Xiao Zhou who bothered you."

As he spoke, Section Chief Duan's face sank, and he pretended to be a serious "reprimand" and said, "I said that I called Brother Duan, why are you still called Section Chief Duan." ”

Zhou Tianci was slightly embarrassed, but still stood aside with a smile on his face.

"Uncle, uncle!"

An old doctor with full white hair ran out of the inpatient unit, shouting loudly as he ran.

He ran straight to Liu Haisen, and Liu Haisen was stunned for a moment.

Brother-in-law?

Who is Uncle?

Who is Director Shen shouting?!

……

……

Note: An old director who graduated from Zhejiang Medical University and is about to retire talked about it when he was chatting, and he still had the provincial general ward inspection when he was a trainee in the eighties.