Chapter 1713 Professional Analysis

Diagnosis... There is a diagnosis of wool!

Zheng Ren looked at Su Yun on the stage, and began to recall the medical history he had told before in his mind.

"Here are other data and copies of existing cases." Su Yun said with a smile: "Because things happened suddenly, this case discussion is just a rehearsal. The effect seems to be pretty good, Chang Yue, you said Am I handsome?"

Su Yun went through the illness history one by one, and asked when he walked past Chang Yue.

"If you spend half of your handsome time on surgery..." Chang Yue took the medical record and said half a sentence.

"I regret giving you the medical records." Su Yun paid no attention to Chang Yue's talk, and said with a smile, "Because you don't understand it at all."

"Abdominal pain, what's so difficult about the diagnosis?" Chang Yue dismissed, stroked her glasses, and began to read the medical records carefully.

After Zheng Ren got the medical records, he also began to look.

Su Yun is the key point to say that the information on the medical record is more detailed.

Nausea, vomiting, abdominal pain, no bacterial or viral infection, what to consider?

His brows furrowed, and he had in his mind the countless cases in the literature he had read during this period of time as a reference.

"How is it, Chang Yue, tell me what you think." Su Yun waited for a few minutes. Seeing that everyone had almost finished reading the medical records, he said with a smile.

"Consider kidney stones." Chang Yue gave her own answer, "Nausea, vomiting, and pain in the lower left abdomen, all meet the diagnostic criteria for kidney stones."

"It's a wonderful diagnosis. I can't bear to deny this fairy tale diagnosis." Su Yun said with a smile: "However, this is the first case discussion of the medical team, and Director Luo is here, so you still have to Seriously."

Chang Yue put her hand on her glasses, and a sharp light shot out from her eyes.

"Pain from kidney stones can be severe, and in certain locations the stone can resemble acute abdominal pain.

Urosepsis may occur when the stone causes obstruction and hydronephrosis, and vomiting may be a prominent feature of severe kidney stones.

Several manifestations of this patient suggest this diagnosis, and I presume you have seen the urine test sheet. The red blood cells in it ++ give you a clear hint that this is caused by kidney stones. "

Chang Yue's hand stopped.

Su Yun is like a roundworm in his stomach, what he said is completely his own diagnostic logic, without the slightest deviation.

It would be nice if this guy didn't have such a snarky mouth.

"Unfortunately, these are all wrong!" Su Yun said with a smile: "You must have forgotten that I mentioned the menstrual period in particular. The red blood cells in the urine are considered to be caused by menstrual blood, and it is not considered that the ureteral intimal cells are ruptured due to urinary calculi. caused bleeding."

"How do you know!" Chang Yue asked coldly.

"Doctor Chang, I don't think you understand the CT-enhanced image of the patient's abdomen. The stones are in the kidneys and the ureters are smooth, so your diagnosis is 99.9% wrong." Su Yun sighed, black hair floating on his forehead Ya floating.

"The reason why I didn't say 100% is because I have to take care of your poor self-esteem." Su Yun said contemptuously.

Zheng Ren was really helpless. Su Yun, this guy with sharp teeth and sharp mouth, was able to live without being beaten to death, which was a miracle.

"Brother Yun, there's something wrong with the electrocardiogram." Lao He was still kind. At this time, he interrupted Su Yun's words and stifled Chang Yue's anger.

There are images of electrocardiograms in the medical records, but Su Yun did not list the electrocardiograms.

There are some heart diseases, manifested in the gastrointestinal tract, nausea and vomiting. Because Su Yun had previously denied all gastrointestinal diseases, Lao He saw the abnormality on the electrocardiogram at a glance.

A 12-lead ECG recorded at this visit showed supraventricular tachycardia; the ECG also showed prolongation of the RP interval.

Cardiac rhythms recorded after adenosine administration showed termination of supraventricular tachycardia.

The patient developed sinus tachycardia after a single ventricular ectopic beat and a brief atrial ectopic beat. A subsequent 12-lead ECG confirmed persistent sinus tachycardia.

This is the most likely possibility, Lao He thought to himself.

To perform, to perform! As a senior anesthesiologist, Lao He is very sensitive to heart and breathing.

As soon as he glanced at it, he felt that the electrocardiogram was wrong.

"No." Before Su Yun could speak, Zheng Ren suddenly shook his head and said, "The patient's heart rhythm map shows tachycardia and the QRS complex is narrowed, which is consistent with supraventricular tachycardia.

The patient's heart rhythm is regular, so atrial fibrillation and multifocal atrial tachycardia are unlikely. The patient had a sudden tachycardia, so sinus tachycardia was unlikely.

Sinus tachycardia has a phase of gradually increasing heart rate rather than a sudden increase in heart rate to over 200 beats per minute.

So I suspect that the regular rhythm supraventricular tachycardia in this patient is one of three types: AV segmental reentrant tachycardia; AV reentrant tachycardia via retrograde conduction through an additional pathway; or Focal atrial tachycardia.

But no matter what, the electrocardiogram changed after the use of adenosine, but the symptoms did not change, and the abdominal pain caused by the heart disease was not considered for the time being. "

Zheng Ren lowered his head, and a very clear and rigorous logical analysis overturned Lao He's diagnosis.

Su Yun smiled, Lao He could think of this, he is already a veteran doctor with rich clinical experience.

But this is not enough. The patient's condition is very strange, and Su Yun has only a preliminary diagnosis for the time being.

But he doesn't say it.

Don't say it and let the boss deny it. In that case, the whole stage effect will be gone, which is very disappointing.

"Director Luo, do you have any considerations?" Su Yun softened and asked Director Luo.

"The patient took opioids orally." Director Luo said casually: "Opioid withdrawal can explain tachycardia, agitation, nausea, vomiting and abdominal pain. However, the patient did not sweat or yawn. , symptoms of opioid withdrawal such as goose bumps or dilated pupils.”

"So, I now suspect that the patient has serotonin syndrome."

Su Yun smiled.

He was also considering serotonin syndrome.

Serotonin syndrome is a group of symptoms caused by taking serotonergic drugs or combining serotonergic drugs and monoamine oxidase inhibitors.

Typical clinical cases are rare.

Mental state and behavioral changes such as hypomania, agitation, and changes in motor system function.

Symptoms such as fever, nausea, diarrhea, headache, tremors, flushing, sweating, tachycardia, shortness of breath, changes in blood pressure, and mydriasis caused by autonomic dysfunction.

The patient's various manifestations are highly consistent with serotonin syndrome.

With Director Luo's judgment, Su Yun's confidence greatly increased. The boss, you can think of this level at most.