The system takes me for surgery

Xie Tianmu turned to look at Dr. Guipei, and said: "Although you Guipeisheng are not capable of dealing with such a complicated disease, you can try to think about it, listen to it, and take notes. Don't be like a monk. Heaven knows how to recite scriptures."

Doctor Guipei looked at each other in blank dismay. Now everyone is used to Xie Tianmu's strange eyes.Seeing that Zhong Yubo's eyes could hardly be opened, Liang Yi asked, "Brother Zhong, why were you so sleepy yesterday when you weren't on duty?"

"I said yesterday that I wanted to discuss this case, so I did some research and stayed up until two o'clock." Zhong Yubo said.

Liang Yi gave a thumbs up.

Although Zhong Yubo's skills and talents are limited, but he is a good doctor who is diligent and down-to-earth. Whenever he has time, he will read the materials, and he is very safe and cautious in doing things.
There is also a little bit of cleanliness, and Liang Yi has to wash his hands twice whenever he sees Liang Yi touching the place where the routine stool specimens are placed in the nurse's station.

Director Xie Tianmu spoke to Director Li Zhengping for the first time, and asked, "What do you think of Zhengping?"

The discussion of possible difficult cases is a step for the two "fairies" in the emergency department to break the ice. It is normal to have conflicts of interest with each other. If they can work for a common goal, they are worthy of this industry.

Li Zhengping nodded and said: "This patient is a young male, usually in good health. This acute onset, manifested as fever, cough, laboratory examination of white blood cells is not high, chest X-ray showed new exudate changes in the left lower lung, the diagnosis considers SARS Type pneumonia, the reason for the absence of hyperthermia in the early stage is the problem of medication, and combined antibiotics should be used.

Xie Tianmu, director of the emergency department, agreed with Director Li Zhengping's point of view.

Zhong Yubo, who was sitting by the side and didn't dare to take a nap, had prepared a lot of materials and wanted to speak, but Director Xie Tianmu said: That concludes today's case discussion!
Zhong Yubo was so angry that he couldn't speak. After the two chief directors left, he complained: "This is too disrespectful. If you tell all the doctors to discuss together without asking the opinions of other members, then this Is it still called a discussion meeting? Wouldn’t it be more appropriate to call it a leader’s speech?”

Dr. Gong Zhengnan hurriedly persuaded: "Forget it, they are all chief directors. If they do this, there is nothing we can do. Sometimes I prepare all night and don't say a word the next day."

Since it is a case discussion, it should look like a discussion, not just a formality. If it is just a formality, then there is no need to notify other members to prepare.

After the case discussion, the patient was treated with combined antibiotics for anti-infection, and the patient's body temperature gradually returned to normal.

However, the patient's body temperature was normal, but his condition was getting worse and worse. At one point, he had difficulty breathing, and he used oxygen inhalation to maintain blood oxygen.

Because of the case discussion, everyone is more concerned about this patient's condition. Although he is not Zhong Yubo's patient, he will also read the latest test report of this patient in the morning.
During the ward rounds, I will take a look at the patient's test report by the way.

During the ward rounds, they found that the patient's condition was getting worse and worse. After reading it, Zhong Yubo shook his head and said, "These two chief directors may have made the wrong diagnosis."

He used to auscultate the patient's heart and said: "If there is an arrhythmia, it may be easier to rule out the heart, which is safer."

Liang Yi nodded and said, "This patient has symptoms of arrhythmia and heart failure. It is best to have an echocardiogram."

"I'll talk to Lao Gong later." Zhong Yubo nodded and said.

Every doctor, like a detective, has an instinctive desire to challenge difficult cases, and wants to find the true pathogenesis of the disease among complicated diseases.

Dr. Gong performed an enhanced chest and abdomen CT scan on the patient and found pulmonary embolism.

Further examination: Superficial lymph node B-ultrasound showed multiple flat lymph nodes in the bilateral neck and submandibular.The cause of the patient's multiple infarctions is unknown.

Echocardiogram: It indicates that the left ventricular function is decreased, and the possibility of myocardial insufficiency cannot be ruled out.

The disease of non-compaction of the outer myocardium is so rare!
When the results of the cardiogram came out, the diagnoses of the two chief directors were slapped in the face.

In fact, being able to overturn the director's judgment is also a manifestation of the strength and potential of the younger generation.

Because of the particularity of this case, there is a need for a second collective discussion.

Zhong Yubo was seriously preparing materials when he was on duty. After seeing Liang Yi, he asked curiously: "Liang Yi, how did you know that this patient may have a series of complications caused by heart problems."

Liang Yi thought for a while and said: "I usually expand the mind map table in my mind, the disease corresponding to each symptom, and then infer the symptoms from the disease. I have never seen this disease, but there are One general direction is to think about the heart." Liang Yi truthfully told Zhong Yubo the whole process of thinking about the disease.

"Nice! Niubi! I also understand this truth, but sometimes I can't remember the knowledge points in the textbooks, or there are omissions, so I can't string all the diseases on one network like you." Zhong Yubo said.

He tried to do what Liang Yi said, to form a thinking network with all the relevant signs and symptoms, but as the thinking network spread out, he soon couldn't go on.

"No, there are too many gaps and gaps in my knowledge points, and there is no way to weave them into a web. Do you know all the knowledge points very clearly?"

Liang Yi said: "If it is the knowledge points in the textbooks of internal and external women and children, there should be no problem."

"Internal and external women's and children's textbooks, you're fine! This..." Zhong Yubo gasped as he thought about the few books in the Blue Life and Death series.

"You are the boss. It's a waste of talent in a city hospital at your level."

Liang Yi laughed dumbly.

After a clear diagnosis was made and the medication was adjusted, the previous symptoms were quickly relieved, and echocardiography after 1 week showed that the heart function had improved significantly compared to before.

The patient was discharged five days later.

The director felt that this case was very precious, so he carried out the second retrospective analysis of difficult cases, because Zhong Yubo and Dr. Gong Zhengnan suggested that an echocardiogram be performed, and the diagnosis of this disease gradually surfaced.

And this also gave him the right to speak in a case discussion.

After Dr. Gong Zhengnan gave a brief description of the course of treatment, the discussion this time was much more rigorous than before.

It was Zhong Yubo's turn to speak. He took a deep breath, then exhaled the turbid air, walked to the computer, and opened the disease mind map made last night. The entire disease diagnosis process was very clear in an instant.

He said: "Myocardial noncompaction is a rare abnormality of ventricular myocardium, which is mainly characterized by thick reticular muscle trabeculae and deep intertrabecular recesses communicating with the left ventricular cavity.