Chapter 1714

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.

"Here are other data and copies of existing cases." Su Yun said with a smile, "because things happened suddenly, this case discussion is only a preview. The effect seems to be good. Chang Yue, do you think I'm handsome?"

Su Yun sent out the medical records one by one and asked when he passed Chang Yue.

"If you spend half 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 didn't care about Chang Yue's mouth gun. He smiled and said, "because you can't understand it at all."

"Abdominal pain, what is the difficulty of diagnosis?" Chang Yue disdained, stroked his glasses and began to look through the medical records carefully.

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

Su Yun pointed out that the information on the medical record is more detailed.

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

His eyebrows wrinkled, and he had in his mind countless cases in the literature he had seen during this period.

"Well, Chang Yue, tell me your opinion." 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 his answer, "nausea, vomiting and left lower abdominal pain meet the diagnostic criteria of kidney stones."

"It's a beautiful diagnosis. I can't bear to deny this fairy tale diagnosis." Su Yun said with a smile: "however, this is the first case discussion in the medical group. Director Luo is also here. You should be more serious."

Chang Yue put his hand on his glasses and his eyes shone with sharp light.

"The pain caused by kidney stones can be serious, and when the stones are located in some places, they will have a performance similar to acute abdominal pain.

When stones cause obstruction and hydronephrosis, urinary sepsis may occur, and vomiting may be a prominent manifestation of severe renal stones.

Several manifestations of the patient suggest this diagnosis. I guess you read the urine routine test sheet. The red blood cells + + inside give you a clear hint that it is caused by kidney stones. "

Chang Yue's hand stopped.

Su Yun is like an Ascaris worm in his stomach. He is completely talking about his own diagnostic logic without any deviation.

If only the goods didn't have such a sharp mouth.

"Unfortunately, these are all wrong!" Su Yun said with a smile: "you must have forgotten that I specifically mentioned the menstrual period. The red blood cells in the urine are considered to be caused by menstrual blood, regardless of the bleeding caused by the rupture of ureteral intimal cells caused by urinary calculi."

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

"Doctor Chang, I don't think you understand the enhanced CT image of the patient's abdomen. The stone is in the kidney and the ureter is smooth, so your diagnosis is 99.9% wrong." Su Yun breathed, his black hair floating on his forehead.

"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 Renzhen is very helpless. Su Yun has sharp teeth. It's a miracle that he hasn't been killed until now.

"Brother Yun, there's something wrong with your ECG." Lao he was kind. At this time, he interrupted Su Yun and killed Chang Yue's anger.

There are ECG images in the medical record, but Su Yun didn't list the ECG.

There are some heart diseases, manifested in the gastrointestinal tract, nausea and vomiting. Because Su Yun denied all gastrointestinal diseases before, Lao he saw the abnormality on the ECG at a glance.

The 12 lead ECG recorded at this visit showed supraventricular tachycardia; ECG also showed prolonged RP interval.

The arrhythmia recorded after adenosine administration showed the termination of supraventricular tachycardia.

The patient developed sinus tachycardia after one ventricular ectopic beat and transient atrial ectopic beat. The subsequent 12 lead ECG confirmed persistent sinus tachycardia.

This is the most likely, Lao he thought to himself.

To show, we must show! As a senior anesthesiologist, Lao he is very sensitive to heart and breathing.

At the first glance, he felt that the ECG was wrong.

"No." Before Su Yun spoke, Zheng Ren suddenly shook his head and said, "the patient's cardiogram shows tachycardia and the QRS complex narrows. This finding is consistent with supraventricular tachycardia.

The patient's rhythm is regular, so atrial fibrillation and multifocal atrial tachycardia are unlikely. The patient has sudden tachycardia, so sinus tachycardia is unlikely.

Sinus tachycardia has a phase of gradual increase in heart rate, rather than a sudden increase in heart rate to more than 200 beats / min.

Therefore, I suspect that the patient's regular supraventricular tachycardia is one of the following three types: atrioventricular nodal reentrant tachycardia; Atrioventricular reentrant tachycardia caused by retrograde conduction through an additional pathway; Or focal atrial tachycardia.

But no matter what kind, the ECG changes after the use of adenosine, but the symptoms do not change. We do not consider the abdominal pain caused by heart diseases for the time being. "

Zheng Ren bowed his head and overturned Lao he's diagnosis with a very clear and rigorous logical analysis.

Su Yun smiled. Lao he could think of it. He was already an old doctor with rich clinical experience.

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

But he didn't say.

Don't let the boss deny it. In that case, the whole stage effect will be gone. It's very disappointing.

"Director Luo, do you have any consideration?" Su Yun calmed down and asked director Luo.

"The patient has taken opioids orally." Director Luo said calmly: "opioid withdrawal can explain tachycardia, agitation, nausea, vomiting and abdominal pain. However, the patient did not show opioid withdrawal such as sweating, yawning, goose bumps or mydriasis."

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

Su Yun smiled.

He's also thinking about serotonin syndrome.

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

Clinically, typical cases are rare.

Changes in mental state and behavior, such as mild mania, agitation, and changes in motor system function.

Fever, nausea, diarrhea, headache, trembling, blushing, sweating, tachycardia, shortness of breath, blood pressure change, mydriasis and other symptoms caused by autonomic nerve dysfunction.

The various manifestations of the patient were highly consistent with serotonin syndrome.

With Director Luo's judgment, Su Yun's confidence greatly increased. Boss, that's the best I can think of.