Doctor of Healing

Ten seconds later, the two had slightly weird expressions.

Surgeons are more open-mouthed on the operating table, but most of them drive in a straightforward manner without using their brains.

Although he understood what Ji Xiang said, he didn't understand it very well, so he had to search it.

She stabilized her mind and always wanted to win Jixiang once.

Suddenly, Zhai Yuhan had an idea, and said with a smile, "Mengmeng has never been to the clinic before, so I'm not used to it. Doctor Xiaoji, I'll test you on a clinical case, and see if you can answer it."

"Okay." As soon as Ji Xiang heard that there was a clinical case, he sat down immediately, put his hands on his knees, and his whole temperament changed suddenly.

Zhai Yuhan was a little surprised by Ji Xiang's attitude after hearing the case, but he still found the most impressive and most easily misdiagnosed case in his doctor's career.

"A male patient, 37 years old, was admitted to the hospital because of the complaint of 'two-day weakness of the lower limbs, aggravated with double lower-limb paralysis, and amaurosis for five hours'."

"Hei Meng?" Zhao Mengmeng grasped the point and whispered.

She also wants to perform well, after all, she has always been a top student since she was a child, but she didn't expect to participate in a reality show, but was accidentally abused by Ji Xiang to become a scumbag.

Amaurosis is a symptom with important diagnostic significance.

It often indicates that the ipsilateral carotid artery is about to be occluded, so it is often regarded as a harbinger of carotid artery disease clinically, and 70% to 97% of patients with temporary amaurosis can be predicted to have carotid artery disease.

But since Ms. Zhai Yuhan and Zhai were able to use this case to "examine" Ji Xiang, it shouldn't be so simple.

After Ji Xiang heard the main complaint, his expression did not change at all. He quietly looked at Zhai Yuhan and waited for the history of present illness.

"Two days ago, the patient developed weakness in both lower limbs. The measured systolic blood pressure was 2mmHg. After oral administration of hydrochlorothiazide and losartan, the systolic blood pressure dropped to 240mmHg.

The fatigue of both lower limbs was slightly relieved, and he did not go to the hospital for diagnosis and treatment.

Paralysis of both lower limbs with amaurosis occurred 5 hours ago. He had paroxysmal headache 1 week ago, no vomiting and fever, had a history of hypertension for 3 years, took medicine intermittently, and did not take antihypertensive medicine in the past 10 months.He denied any history of "diabetes" and "peripheral vascular disease". "

"Admission physical examination: blood pressure 152/86mmHg, clear mind, no murmurs were heard on cardiac auscultation, systolic murmurs could be heard in the right subclavian and carotid artery area, bilateral radial artery pulse was normal, muscle strength of both lower extremities was 0, both The muscle strength of the upper limbs was grade 4, the pulse of the dorsalis pedis artery on both sides was normal, and the pathological signs on both sides were negative.”

"Jixiang, Mengmeng, you two talk about your views."

After listening to Zhai Yuhan's history of present illness and past history, Zhao Mengmeng already had the answer.This question is not difficult, at least it is not difficult for doctors who know the definition of Heimong.

"Ms. Zhai, it's head ischemia caused by carotid artery stenosis." Zhao Mengmeng said confidently.

Zhai Yuhan was noncommittal and looked at Ji Xiang.

Ji Xiang pondered, thinking silently for nearly ten seconds.

"Mr. Zhai, what does the head CT report of the patient do?" Ji Xiang asked.

"Cranial MRI prompts: bilateral acute cerebral infarction in the parietal and occipital lobes; a small ischemic lesion in the left semiovale center."

Zhao Mengmeng was taken aback.

According to my own judgment, the patient's head MRI should be an ischemic focus. How could it be an acute cerebral infarction?

However, murmurs and amaurosis can be heard in the carotid artery area, which are signs of carotid artery disease.

"Didn't you have a carotid ultrasound?" Ji Xiang asked.

"It's done, it's okay." Zhai Yuhan smiled slightly, and said an important point.

Ji Xiang was also stumped. His thoughts were the same as Zhao Mengmeng's, but Zhai Yuhan obviously dug a lot of holes in the case questions.

Holding his breath, Ji Xiang came to the operating room of the system.

Chapter 482

"Doctor Xiaoji, do you have an answer?" Zhai Yuhan asked.

The diagnosis of this patient was not clear. At that time, the whole hospital consulted, and it took nearly two days for everyone to find the problem.

Fortunately, there was no delay. If it was changed to another hospital with a slightly lower level, the grass on the grave of the patient might already be as tall as a person.

Can Ji Xiang give the correct answer?

Zhai Yuhan thought it was impossible.

She thought that she did not intentionally make things difficult for Ji Xiang, but just wanted to teach Ji Xiang a "lesson" so that he could face clinically strange diseases more humbly.

Zhai Yuhan even pretended to forget that he did not explain the most critical step in the physical examination, which was misleading enough.

"Mr. Zhai, is there any key item in the physical examination that you didn't mention?" Ji Xiang asked suddenly.

Zhai Yuhan was startled, her heart beat involuntarily, as if she was trying to trick Ji Xiang but he found out.

But if you think about it carefully, it should be impossible. Ji Xiang will not see through the trap he set up without flaws.

"Oh?" Zhai Yuhan pretended to be calm on purpose, "What are you talking about. The physical examination I just mentioned is indeed rough. Do you have any questions?"

"Which arm was the patient's blood pressure measured after admission?" Ji Xiang asked.

"Which one is not the same?" Zhao Mengmeng looked at Ji Xiang suspiciously.

She felt that Ji Xiang had said something nonsense.

But Zhai Yuhan's expression froze immediately, she never expected that Ji Xiang would find the problem so quickly and sharply.

But Zhai Yuhan smiled slightly after being surprised, and Ji Xiang walked into the trap by himself like a prey.

"It's not the same." Ji Xiang said, "The blood pressure in both arms is different, which means aortic dissection. Mr. Zhai thought of this case after hearing what I just said about rib fracture combined with aortic dissection."

Zhai Yuhan was a little speechless, but Ji Xiang was indeed very smart.

Zhao Mengmeng looked at Zhai Yuhan full of doubts. Seeing her expression was frozen, she guessed that Ji Xiang was right.

But she recalled the patient's medical history again, but still had no answer.

"The blood pressure of the patient's left arm is 152/86mmHg, and the blood pressure of the right arm is 144/89mmHg." Zhai Yuhan said.

"That's about the same." Zhao Mengmeng glanced at Ji Xiang.

Di Yuhan threw out a hole he dug, and looked at Ji Xiang with great interest.

"Ms. Zhai, I still think it's aortic dissection. The CTA image shows it should be." Ji Xiang said slowly.

"Why?" Zhai Yuhan did not answer Ji Xiang's question, but asked.

"The patient's symptoms of paralysis of both lower limbs cannot be explained by bilateral parietal and occipital cerebral infarction. After excluding periodic paralysis and other diseases, I suspect that there is a spinal cord lesion, and the possibility of spinal cord blood supply disorder is inclined."

"Combined with the physical examination, the patient's right subclavian and carotid artery area can be heard and signs of murmurs. Although the amaurosis can be considered to be carotid artery disease, I still suspect the possibility of aortic disease."

"If you guessed right, the patient's CTA should show aortic dissection and changes in the vertebral artery."

"..." Zhai Yuhan silently looked at Ji Xiang.

At this moment, she has nothing to say.

Jixiang did not see the patient's information, and made a correct judgment based on the medical history of the two holes he dug.

You must know that when I met this patient, the First Affiliated Hospital went through 5 rounds of hospital-wide consultation + auxiliary examination, and it took a long time until the cause was finally found.

However, Jixiang showed a diagnostic level that surpassed the experts and professors of the First Affiliated Hospital.

"Doctor Xiaoji, tell me what you think about it." Zhai Yuhan didn't immediately admit that Jixiang's diagnosis was correct, and continued to probe.

She thinks that Jixiang is delusional, and he can't give a reasonable logic at all. If there is no logical closed loop, it doesn't seem to be regarded as her own loss.

"Paralysis of the lower extremities is a common clinical symptom, which can be divided into three categories according to the anatomical location of the lesion.

First, upper motor neuron paralysis is also called central.

Second, lower motor neuron paralysis, also known as peripheral.

Third, myopathic paralysis. "

Ji Xiang began to count one, two, three with his fingers.

"The characteristics of paralysis of the CTA unit of the thoracoabdominal aorta are: monoplegia, hemiplegia, and paraplegia are the main paralysis of the entire limbs, with increased muscle tone and tendon reflexes, pathological reflexes, and no muscle atrophy."

"..."

Ji Xiang talked eloquently, but Zhai Yuhan was speechless.

This is not just a logical closed loop. Ji Xiang even considered the details of every branch of guessing, starting from the most serious clinical symptom of the patient - paralysis, and analyzed it bit by bit.

"Lower motor neuron paralysis is characterized by muscle groups or individual muscles, decreased muscle tone and tendon reflexes, no pathological signs, and muscle atrophy. Myopathic paralysis is characterized by muscle atrophy in the proximal extremity, symmetrical distribution, no Sensory disturbance."

"In the case, the patient suffered paralysis of both lower limbs, no symptoms of hemiplegia, no muscle atrophy..."

Ji Xiang talked with his fingers for nearly 5 minutes, and finally gave a conclusion.

"I think the CTA images will most likely show aortic dissection, Stanford type A with changes in the vertebral artery."

"!!!"

Zhai Yuhan had already heard the exclamation mark at the end.

Until the end of Jixiang's speech, she stared blankly at the young doctor who was faintly exuding milky white light, feeling infinitely confused.

This level of diagnosis is already terrifying, at least not encountered in the First Affiliated Hospital or Zhai Yuhan's medical career.

Moreover, Ji Xiang's rigorous logic proved one thing - he did not just talk nonsense about Meng's diagnosis, but was well-founded and meticulously analyzed.

But Ji Xiang is not finished yet.

He didn't seem to notice Zhai Yuhan's expression, and continued, "The aortic dissection of this patient is painless, and it is easy to misdiagnose.

Painless aortic dissection is less common than painful aortic dissection in clinical practice. It is often accompanied by neurological symptoms such as limb paralysis, and is easily misdiagnosed as acute ischemic cerebrovascular disease. lead to catastrophic consequences. "

"But the treatment is not difficult. Use metoprolol, nifedipine, and urapidil to control the heart rate and blood pressure. When the condition is stable, the vascular surgeon can perform the operation."

"Mr. Zhai, the patient finally recovered and was discharged from the hospital. Has the patient recovered well?"

"Yes." Di Yuhan squeezed out a word from between his teeth.

Zhao Mengmeng's head was dewy.

Although she couldn't understand Ji Xiang's entire logical judgment at all, the word "yes" that Zhai Yuhan said at the end told Zhao Mengmeng a fact - Ji Xiang's judgment was accurate.

This is too strong!

Zhao Mengmeng was not as unwilling as Zhai Yuhan, but looked at Jixiang with a hint of admiration.

It would be great if I could answer questions as cleanly as Jixiang.

It's a pity that Zhao Mengmeng always feels that he is short of breath, and he still can't connect the knowledge in the book with reality.

Chapter 483 Expectations of the Operating Room

Director Fan is still busy.

Although he returned to the hotel to rest, he changed his usual habits.

I used to turn off my mobile phone when I was sleeping, but it has not been in the past few days. I keep it turned on 24 hours a day, so that the staff who stay behind in the hospital can send me a message whenever they have news.

Call directly if there is an emergency.

The patient's postoperative blood transfusion and intravenous hypernutrition, although he is an elderly patient, coupled with hemorrhagic shock, etc. have greatly affected his body, but he recovered very quickly.

On the second day after the operation, I went to the ground for rehabilitation training early in the morning.

After seeing this news, a stone fell from Fan Dao's heart.

He immediately called in the technicians to start editing the recording.

Even Director Fan was exposed to this kind of rush reality show for the first time. It was hard for him to believe that in those years, Xiangjiang Films would produce a high-quality film in more than 20 days.

But now that he is personally on the scene, Fan Dao feels that his blood has been opened up, his whole body is full of inspiration and energy, and he can't wait to prepare the editing and watch it.

It is estimated that when this episode is released, the number of people online at the same time will reach a peak, a record-breaking peak.

As for whether it can become a national-level variety show, that depends on fate.

After a day of non-stop editing and production, although there was still some regret overall, when the time came, Director Fan was quite satisfied. He slept lightly for a few hours, and woke up before the program started to watch the program and data at the same time.

……

……

First of all, three interns from the neurosurgery department made the foreshadowing, and the concept of "surgery day" was first proposed by the neurosurgery side.

The three interns followed suit on the stage. Although they looked like surgeons at first, there were no bright spots.

Although it is a detail, the program team is also more attentive, referring to the style of the giant white tower, and let several interns go on the catwalk.They look a little immature, but they also have the "style" of surgeons under the camera.

It looks good, but Director Fan knows that if there is no Ji Xiang and the whole process of the operation cannot be broadcast, the ratings of this program will be very limited.