Sun Lien made his own diagnosis for the first time, and he was very confident in it.

Can this diagnosis be ...... There is absolutely no way to convince Zhou Jun, who has always been strictly forbidden.

In fact, based on the existing medical history and the symptoms of the patient, the simultaneous outbreak of syphilitic encephalopathy and syphilitic liver disease is not even in the list of "possible diseases". If it weren't for the status bar, Sun himself would not have believed that a patient with tertiary syphilis would show symptoms of both encephalopathy and liver disease. This is not in line with the "common principle" of diagnosing a condition. At the very least, all other possibilities should be ruled out before extending to syphilis.

"First do the blood routine, liver function five items and microbiota culture. Zhou Jun immediately made a decision and began to instruct the diagnosis work. "Polyene phospholipids were applied immediately after the liver failure status was confirmed. Give him two slow pushes first to see the effect. "Polyene phosphos refers to the commonly used liver protection drug polyene phosphatidylcholine injection. Western medicine names are mostly long and awkward, and doctors often use conventional abbreviations to refer to them. This kind of designation varies from hospital to hospital and even from department to department.

"By the way, check the liver function and do a brain CT to make sure there is no bleeding in his brain. Zhou Jun continued to add, and he suddenly said to Sun Lien, who was recording, "What do you think are the other inspection items?"

"I think it's ......," Sun Lien thought for a while, "add a lumbar puncture to rule out other neurological pathologies." ”

"Hmm......" Zhou Jun nodded thoughtfully, "There are enough medical reasons, and it's very uncomfortable to do." He smiled at Sun Lien, "I like this idea. ”

That's not part of the retaliation...... Sun Lien smiled bitterly and nodded.

Deputy Director Liu still did not come back, probably continuing to supervise Lin Lan's operation in the operating room. Jiang Lun, who was called by Sun Lien on a phone call, moved quite quickly. As soon as Zheng Xiaoyu's blood was drawn here, he appeared in the rescue room.

"We don't have many opportunities to be called in for a consultation in our department. Jiang Lun shook hands with Zhou Jun with a smile, walked to the side of the bed and looked at Zheng Xiaoyu, "What's wrong, it's this turtle son." ”

"Why did he come to you to see the outpatient clinic?" Sun Lien's eyes lit up, "What are the symptoms?"

"This turtle son said he had ulcers on his body. Jiang Lun recalled the scene at that time, "But he said that he is usually busy with work, and when he has time to look today, the ulcers on his body have healed, and there are only some scars." I don't see anything wrong with it. ”

A specific form of ulcer is one of the manifestations of tertiary syphilis. As the syphilis rash grows, the center begins to soften the break and discharge a purulent discharge. However, this ulcer will not get better quickly, and if left untreated, it will take half a year to heal on its own.

"The patient himself denied the history of travel. "Metallurgical travel history is the medical term for "high-risk sexual experiences." Jiang Lun seems to have guessed Sun Lien's thoughts, but his views on syphilis are as conservative as those of other doctors. "If this turtle son suddenly fainted, it was because of syphilis. The course of his illness would have lasted at least 10 years, and he had not been cured during this time. Dr. Jiang shrugged his shoulders, "It's the 21st century, and penicillin is no longer called penicillin." Can a syphilis be cured for 10 years? Impossible. ”

This person can delay more than half a year before coming to the doctor after committing syphilis rash, which must be a delay in the advanced stage of cancer. Sun Lien sighed, "Does he have any other symptoms?"

"I don't think he's got a good ear. Jiang Lun suddenly slapped his thigh, "I asked him if he had a history of drug allergies, and he only understood after asking five or six times." ”

That's not a listening problem...... The symptom of tertiary syphilis is the same as that of paralytic dementia. Sun Lien silently ticked another tick on the checklist in his heart.

"Overall, I think this might be a lunatic. Jiang Lun gave his opinion, "If you don't worry, then even the five infectious diseases can be done together." ”

Jiang Lun left with his hands behind his back, and Sun Lien also got what he wanted.

"Dr. Jiang suggested that we do five infectious diseases. Sun Lien took the chicken feathers as an arrow and began to fool his teacher. He said the patient had vehemently denied his travel history. ”

For doctors in dermatology and venereology, vigorously denying it is basically equivalent to having a ghost inside. Treponemal pallidum antibody test is included in five items of infectious diseases. As long as this test is done and it is confirmed that Zheng Xiaoyu has syphilis, then Zhou Jun will definitely realize that he is facing a very difficult case of compound tertiary syphilis.

Zheng Xiaoyu here was clearly arranged by Sun Lien. And the high school student who was previously protected by Sun Lien with his body was also pushed out of the CT room. The results of the contrast-enhanced angiography were very clear, and this was another cerebrovascular accident.

It was not the cerebral aneurysm hemorrhage that he suffered from the fall, but the aneurysm's hemorrhage caused him to lose control of his body and fall into a coma. Fortunately, the high school student was still a little self-conscious and wore a helmet on his head. Otherwise, the pavement stones that broke his helmet alone would have killed him.

"Hang up a bottle of mannitol first, and ask for a consultation from outside the nerves. "A ruptured aneurysm in the brain is a very dangerous disease, and Zhou Jun, who took the initiative to take over the case, threw himself into intense work. A cerebral hematoma caused by a ruptured aneurysm can compress brain tissue, and depending on the location of the compression, different symptoms of neurological disease may occur. If the brainstem is compressed, it may even suppress the patient's heartbeat and breathing. In addition, excessive cranial pressure may even squeeze the already fragile brain tissue to other locations, resulting in brain herniation.

Mannitol is one of the drugs that are commonly available in the emergency room. As a good diuretic, it can effectively act on various organs of the human body, increase plasma osmotic pressure, and make organs dehydrate rapidly. In short, it is capable of shrinking the brain.

The shrunken brain frees up more space to reduce intracranial pressure, which reduces the likelihood of herniation in the setting of cerebral hematoma – the fatality rate of cerebral hemorrhage is 30%, and the fatality rate of cerebral herniation is as high as 80%. Although the shrinkage of the brain after dehydration may cause the blood vessels that were originally compressed to lose pressure and re-bleed, the reason for the two evils to meet and the lesser of them is exactly the same in medical decision-making.

The weather is gradually getting cooler, and more and more patients with cardiovascular and cerebrovascular accidents have begun to encounter in the emergency room of the Fourth Central Hospital. The Fourth Central Hospital, which is responsible for both the stroke center and the chest pain center, has become busy.