Back in 2002 as a doctor

Page 468

"Long-term oral antihypertensive drugs, some people's taste will change, and mosquitoes will no longer bite." Huang Lao said.

"..." Zhou Congwen was speechless.

He really didn't know about it. Similar summaries had never appeared in journals or in his own clinical experience.

"This kind of thing is a summary of mysterious and mysterious experience, and there is no way to write it into a report." Mr. Huang said vaguely, pointing his fingers, "I started taking antihypertensive drugs at the age of 62, and after that I rarely suffered from mosquito bites. .Otherwise, if you go out for a walk in summer, you will be bitten to death.”

"The patient suffered from aortic dissection at the beginning of the ascending aorta, and the intima was torn into the heart!" Zhou Congwen said immediately.

"This question doesn't count for your answer." Huang Lao said with a smile, "If you were here, you would definitely not be able to diagnose it."

This is what Zhou Congwen admitted.

The boss was playing tricks to a certain extent, but he also intentionally or unintentionally told Zhou Congwen a relatively rare clinical experience-some people who took oral antihypertensive drugs would have fewer mosquito bites.

This inconspicuous point is the beginning of the diagnosis, and the rest is still vague to ordinary people, but it seems logical to Zhou Congwen.

The case Huang Lao mentioned was a very special case of aortic dissection without typical signs.

Moreover, this case is different from other cases without typical signs, and it is particularly deeply hidden.

The typical clinical symptoms of aortic dissection are usually acute severe chest pain and hypertension, but occasionally patients without chest pain can be encountered clinically.

Patients without chest pain will also have other symptoms, such as a large difference in pulse pressure between the left and right arms.

Zhou Congwen understood that the boss always remembered the significance of this case. Aortic dissection without chest pain, low blood pressure, and small outer diameter of the aorta is indeed very rare in clinical practice.

And the patient's blood pressure is normal, which is enough to deceive most doctors and will not consider aortic dissection.

It is estimated that the patient is taking antihypertensive drugs orally, and his blood pressure is well controlled.Cardiac tamponade and...

"Boss, you are too shameless!" Zhou Congwen said suddenly when he thought of this.

Huang Lao laughed, he knew that Zhou Congwen had already thought of where he reversed the inspection order.

It turned out that I saw that there were no mosquitoes around the patient, so I asked about the history of blood pressure and knew that the patient's blood pressure was well controlled in the past few days.

Because the blood pressure was low after oral medication, the patient had not taken antihypertensive drugs recently.

Mr. Huang didn't tell Zhou Congwen about these things, so Zhou Congwen naturally had no way of guessing.

Although it was a joke, Zhou Congwen knew what the boss meant, but he still grinned and complained, "Boss, you can't hide or falsify your medical history."

"Okay then, look at the man next to the third booth, what's wrong with him." Huang Lao asked.

Zhou Congwen knew that what the boss didn't like was being flattered, and he might have already gotten used to it, and it was inevitable that he would get bored if there were too many.

But when eating, my boss likes the fireworks in the world and is unwilling to sit in a private room.

Looking back at the location the boss said, Zhou Congwen saw a burly man drinking.

This person is a typical person drinking from a plastic box with 24 bottles of big green sticks in it.

The big green stick was already half drunk, and the man was half grinning, but he was not drunk. One could tell from a glance that his alcohol capacity was very good, very good.

But stepping on the box to drink, he should be in high spirits, but the strange thing is that he is frowning, just silently pouring beer cup after cup.

Drinking such a large amount of beer and still frowning, if it's not something on your mind, it's gout.It wasn't that the man had something to worry about, but his joints hurt so he frowned.

Zhou Congwen thought of the diagnosis in an instant, so he searched for clues.

……

……

Note: After taking antihypertensive drugs, there are fewer mosquito bites. I didn’t see it in journals, but I heard about it from a friend. I asked nearly a hundred patients in the clinic, and there is a certain probability that similar situations will occur.But there is no research on specific drugs and the like, so let’s just talk about it here, everyone should just watch it for fun.

Chapter 0804 as long as you can't drink to death, drink to death

The man's lower limbs were highly swollen, and his knee joints were red and whitish. It didn't take a careful physical examination to confirm that he had severe gout.

Zhou Congwen sighed, "Boss, this is too obvious. The typical gout symptoms can be diagnosed accurately with the heel."

"That's true, but his situation may be special."

"It looks heavy, boss, what do you see?" Zhou Congwen asked.

"I guess he sneaked out to drink from the hospital." Huang Lao shook his head, "Sneaking out to drink with such severe gout, it is estimated that a knee joint puncture can extract milky urate crystals."

Urate crystals are generally found in the urine of patients with severe disease, but rarely appear in the joint cavity of patients with gout.

And the milky urate crystals that the boss said...

If more than 100 milliliters of milky urate crystals are really pumped out... Zhou Congwen has never seen such a severe gout patient for a long time.

The person in front of him is really a model of drinking as long as he can't die, he will drink to death.

"Xiao Zhou, are you going to persuade him?" Deng Ming said with a smile.

"It's useless for anyone to persuade you to die." Zhou Congwen shook his head.

Just as he was talking, the door of the restaurant was kicked open, and the cold wind rushed in.

Zhou Congwen looked sideways, and a woman in her 30s walked in with a baseball bat in her hand.

"You're still drinking!" the woman pointed a stick at the man's nose and cursed.

"Sister, sister, Xiaohui is just greedy." A person beside the strong man stood up, with a smirk on his face, and said in a slightly humble manner.

"Get the hell out of here! I know that you are eating, drinking and having fun with your friends, and you are all in the hospital, don't you know! I hurt myself and don't know? Why did my parents give birth to such a stupid thing like you?"

"I am willing!" The strong man raised his neck.

"Bang~"

The baseball bat swept across and hit the strong man's shoulder without a word of extra nonsense.

"Ow~"

The strong man couldn't hold back his pain.

"How dare you drink it, you'll die!" The woman threw the stick directly on the table, and the wine bottles and dishes slammed, breaking the table.

"Is your folk so tough? You strike at the slightest disagreement. I used to think that you were joking, but I didn't expect it to be true." Deng Ming looked helpless and asked Zhou Congwen in a low voice.

"This kind of situation is rare, but there are quite a few fights in small counties because of a sentence like what you look at." Zhou Congwen also smiled helplessly.

"I let you drink it!" The woman threw away the stick, grabbed the collar of the strong man with one hand, and slapped him in the face with the other hand.

With a crisp sound of "啪~", the strong man was obviously stunned.

The "buddy" sitting next to him timidly pretended that he didn't exist. The non-physical performance was done to the extreme, and he wanted to shrink into a corner so that the woman could not see him.

"Do you want to drink or not!" The woman yelled, and then she slapped her again, "Pa~"

"I just drank a few bottles of beer, and I didn't go out to cause trouble, so why can't I drink it!"

"Ma'am, I'll let you drink again! Pop~"

"Isn't it beer! Pop~"

"Isn't it enough to drink? Pop~"

One slap after another was slapped on the strong man's face, and both sides of his face were swollen with just a few slaps.

Zhou Congwen felt that the woman's gesture of slapping her hand was particularly sassy, ​​so she took note of it secretly.

"I……"

The brawny man's aura had been knocked down, and just as he was about to argue a few words, the woman lifted her foot and kicked him on the knee, causing him to limp to the ground in pain.

"What the hell are you! How dare you run out of the hospital? Are you reasonable?!"

"Boom~" The woman kicked the strong man's swollen knee again, and Deng Ming was dumbfounded.

This is really angry, under the dead hand.

"I don't worry if I beat you to death." The woman kicked and kicked, slap after slap.

None of the people around the strong man dared to come up to persuade her, so they tried their best to make themselves smaller and denser, and sneaked away from her.

"Fuck off! If anyone brings my younger brother out for a drink in the future, I'll kill your family!" The woman put her hands on her hips, and picked up a baseball bat in the other hand, sweeping the group of "husbands and dogs".

The others stared awkwardly without daring to look at her, and walked out quickly with their heads down.

"Next time, no matter who can make your family have a chicken and a dog, even if I don't have one!"

Deng Ming smiled wryly.

This was the first time he had seen this kind of situation. A woman could be said to be aggressive or sassy, ​​but her younger brother was a bit disappointing.

"Go back or not!" The woman asked coldly as she saw the others leaving in an instant, holding a baseball bat in her hand.

"Back, can't I go back?" The strong man was beaten and cried, and the aura of drinking just now disappeared without a trace.

"If you run out again, you are ready to die."

After the woman finished speaking, she kicked the strong man's swollen knee viciously, and then cried.

Zhou Congwen sighed.

Only Mr. Huang remained unmoved, holding his chicken paws, as if nothing had happened.

"Boss, have you seen such a big scene?"

"What is this?" Elder Huang said leisurely, "You are young, and you have caught up with the peaceful and prosperous age. It is normal that you have never seen it. This is a good thing, and it is worth celebrating."

Zhou Congwen was speechless.

It is estimated that the boss is talking about things that will be 404 if you say it.

The woman cried for a while, wiped her tears twice, and went to the boss to settle the score.Damaged things have to be compensated, but the boss has already been frightened. In the eyes of the boss of this store, women are simply desperadoes.

It wasn't until the woman pushed the wheelchair away the strong man that the restaurant became quiet.

"Boss, you really don't panic when Mount Tai collapses in front of your eyes, it's amazing." Zhou Congwen said with a smile.

"Don't talk nonsense, have you ever seen milky urate crystals?" Huang Lao asked.

"I've seen it. I only pumped it once with my own hands, and I pumped out about 150ml of milky urate crystals. How should I put it, it's like milk, and it scared the nurses who assisted me."

Mr. Huang stopped talking, and Deng Ming smiled helplessly. At Zhou Congwen's age, he could see diseases that he had never seen before, and he spoke so naturally, that he couldn't tell that he was lying.

"Let's go later..." Zhou Congwen saw that the boss's meal was almost the same, so he made arrangements for the next step.

As he was talking, the words were interrupted by the ringing of the phone.

"It's Director Zhang, wait for the boss." Zhou Congwen was about to stand up with his mobile phone, but he seemed to think of something, and sat firmly opposite Mr. Huang.

"Director Zhang, I'm having dinner with the boss, what do you want?"

"Oh, I see."

Zhou Congwen covered the microphone and glanced at Huang Lao, "Boss, the director of the Cardiothoracic Surgery Department of the Second Hospital."

"Let's talk about things if you have something to do. I'm not a little daughter-in-law who is afraid of seeing people." Huang Lao said with a smile.

Zhou Congwen raised his eyebrows, smiled and told Zhang You an address and asked him to come over.

Chapter 0805

"Xiao Zhou, are you going to take Director Zhang for surgery this year?" Deng Ming asked with a smile while holding a thermos.

"Director Zhang... how should I put it, I have never wanted to do interventional surgery. I beat him and wanted to drag him along. No, after hearing about the World Surgery Competition, I started thinking about it." Zhou Congwen said, "But I don't have a part this year." , It's too late to join in."

"When working at the grassroots level, it is very important to unite the comrades around you. They are all human beings, who can be careless." Huang Lao glanced at Zhou Congwen and said earnestly.

"I know, Boss." Zhou Congwen nodded, "If I go on the rampage according to my previous temper, I will definitely knock him to the ground. But I don't want to climb up by myself, I want to do things, so I endured him for a long time."

Deng Ming smiled honestly, Zhou Congwen is really interesting, interesting beyond imagination.

If you want to climb up, you will continue to destroy along the way. No matter who stops in front of you and kicks you, just step on it and go up. Anyway, with the protection of the boss, at least you don't have to think so much until you reach the 912 level.

But Zhou Congwen made it very clear that he had to do something.

If the two words of doing things are really to be put into practice, there must be a lot of connections, and construction is ten thousand times more difficult than destruction.

Seeing Zhou Congwen rampage like a bull, but the delicate things in his heart are like hair, this made Deng Ming feel emotional.

Talented and willing to do things, the boss really found a good apprentice.

"Not bad, Xiao Zhou." Deng Ming smiled, "Does Director Zhang agree?"

"What I'm talking about now is rather vague, but I have intentions. This year, I led the medical team to become the world's No. [-]. It is estimated that Director Zhang's mind has completely warmed up. We are not bragging, but telling the truth." Zhou Congwenming noticed the details.