Chen Cang''s regulations are very clear!
First, according to the symptoms, signs and other clues to deduce the cause of the patient.
Then, according to the current medical history and past history, jointly launch the possibility!
Then start to verify your judgment through physiological and biochemical tests.
Chen Cang''s simple rescue process has formed a logical thinking framework for many students.
Chen Cang smiled: "this is clinical thinking!"
Everyone was stunned.
In fact, as a doctor, the most important thing is the formation of clinical thinking.
At this time, Xu Dongdong''s words made everyone more curious.
"Yes! Mr. Chen, the serum electrolyte hasn''t come out yet. How do you guess the blood potassium value? Is it judged by experience?"
"Yes! Mr. Chen, you were so handsome just now. How do you judge? Do you have a secret?"
……
Looking at a group of students, Chen Cang smiled: "of course there is a secret!"
As soon as they heard this, their eyes lit up and they quickly took out pens and paper one by one. This is "dry goods"!
Solid dry goods!
Chen Cang saw this and was happy to share it.
What does that say?
yes! Knowledge is not their own, they are just the users and disseminators of knowledge.
More people get this knowledge and can save more people.
"In fact, have you noticed that I just had an ECG."
The crowd nodded: "well, I see, but... ECG is only waveform. What does it have to do with blood potassium?"
Chen Cang said to Xiao Lin at this time, "Xiao Lin, just now I had an extra ECG. Please take it for me."
To be on the safe side, Chen canggang gave an extra ECG, which is just in use now.
Kobayashi took it in a hurry and handed it to Chen Cang.
Chen Cang took the ECG and said to the crowd, "don''t underestimate any examination, such as thermometer, sphygmomanometer, heart auscultation, ECG, X-ray, etc."
"These inspections can tell us a lot of clues!"
"Hyperkalemia and abnormal ECG are even a typical example. I hope you will remember what I said next!"
As soon as they heard this, they quickly prepared their books and pens and listened carefully.
"When blood potassium is increased, the permeability of cell membrane to potassium ion in repolarization phase is increased, so that the gradient of action potential becomes steeper and the time is shortened. The first ECG manifestation of high potassium is T wave towering and QT shortening. Therefore, when I saw the ECG, I basically determined that the patient is hyperkalemia."
"As we all know, patients with hyperkalemia come and go in a hurry."
Chen Cang''s "coming and going in a hurry" made everyone laugh, but we all know that it is true. Hyperkalemia can cause cardiac arrest and endanger life at any time!
Chen Cang continued: "indeed, the serum electrolyte test is the gold standard for hyperkalemia, but when the biochemical test comes out, the patients have been gone for an hour or two, and the people have long disappeared. Why do I want this gold standard?"
"So, at this time, if you suspect hyperkalemia, you must do an ECG. This is a clinical trick!"
"Moreover, with the increase of blood potassium, different concentrations will have different manifestations. Start to remember!" Chen Cang reminded.
"When the blood potassium is greater than 6.5mmol L, the QRS is evenly widened, and ventricular conduction block can occur at this time;
When blood potassium was greater than 7.0mmol L, P wave decreased and time widened;
When the blood potassium is about 8.5mmol L, P wave disappears and sinus ventricular conduction is formed. "
These are officially reported and can be used clinically, so Chen Cang didn''t hesitate when he said.
If only Chen Cang''s personal experience, he would say very conservative!
After they heard it one by one, their eyes glowed green and kept recording.
A lot of knowledge will shine brightly only when combined with clinical practice.
At this moment, Chen Cang in their eyes has his own halo effect!
One by one.
They can think that the difference of ECG can reflect the abnormal signal of human blood potassium.
This is something they never thought of.
As Chen Cang said, if the serum electrolyte comes, the patient will be gone. You don''t know why!
As a doctor, we should constantly improve our skills.
This technology includes diagnostic technology, treatment technology, surgical technology, and communication technology with patients.
Knowledge is everywhere in life.
At this time, a student couldn''t help asking, "Mr. Chen, will blood potassium die directly at 10?"
Chen Cang: "the blood potassium concentration further increased. When it reached 10mmol L, QRS progressed and widened, even fused with T wave to form a sine wave, and finally died of ventricular arrest or ventricular fibrillation."
Speaking of this, Chen Cang looked at the crowd.
"Therefore, the most taboo in clinical practice is experience, especially emergency treatment. Don''t use your habitual experience to see a doctor for others, let alone persuade or encourage others to do it at will in life."
"If you don''t fully understand the patient, any word you say may be wrong, and any suggestion you make may be fatal!"
Chen Cang took a deep breath: "if you had electrolyte disorder according to the routine just now, vomiting and diarrhea! Isn''t it rehydration to adjust the electrolyte? Supplement sodium, potassium, calcium, iron, zinc, selenium and vitamins... If so, what is the patient like! Think about it yourself."
"Medicine can''t tolerate any carelessness. In the emergency department these two months, I don''t say how much I hope you can learn, but you must learn a little!"
"That is danger and prudence."
In a word, let all the students present be quiet.
There are many such examples in life. A method that may be applicable to oneself may become the real murderer of others'' death.
So!
The most appropriate persuasion and advice may be: go to see a doctor!
Chen Cang smiled: "so, you know: what''s the difference between a doctor and a butcher?"
Everyone was stunned and looked up at Chen Cang.
Chen Cang said seriously, "the more the doctor does, the more timid the butcher is!"
The words were very humorous. When they heard them, they couldn''t help smiling.
But... I can''t laugh in my heart!
The more you laugh, the heavier you feel.
Chen Cang looked at everyone, got up and left and walked towards the office. He didn''t expect these people to remember everything, but he must remember one thing: when treating patients, he must:
Be careful!
Be careful!
Be careful!
At this time, in the crowd, a man was sweating!
He was so frightened that he dared not lift his head.
He felt very childish when he thought of his arrogance
If the old man really disposed of it in his own hands
As a result, what will it be like?
This is a living life. I''m only in my early 30s. If something goes wrong, who can be responsible?
Who is responsible for the old man!
Only one life?
Who can let you try?
……
……
PS: what I want to tell you about this story is that good advice from others may not be suitable for others.
The disease is so!
Why isn''t life like this?
Without enough understanding of the disease, seemingly well intentioned suggestions lead to misdiagnosis or mistreatment.
If you don''t have enough knowledge of other people''s situations, what will seemingly good advice lead to?
Traditional Chinese medicine believes that medicine is Tao. In fact, many things in life and medicine are common. I hope this story will give you a little enlightenment.