Chapter 430 More and More Timid!

Chen Cang's regulations are very clear!

First, the cause of the patient is deduced based on clues such as symptoms and signs.

Then, based on the history of current illness and past history, we can jointly launch the possibility!

Then start to verify your judgment through physiological and biochemical tests.

Chen Cang used a simple rescue procedure to form a logical thinking framework for many disciplined 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 even more curious.

"Yes! Mr. Chen, the serum electrolytes haven't come out yet. How did you guess the serum potassium value! Is it based on experience?"

"Yes! Teacher Chen, you were so handsome just now. How did you judge it? Do you have any secrets?"

...

Looking at a group of students, Chen Cang smiled: "Of course there is a secret!"

When everyone heard this, their eyes suddenly lit up, and they quickly took out pens and paper, this is "dry goods"!

Real dry goods!

Seeing this, Chen Cang was also very happy to share.

What did that sentence say?

right! Knowledge is not one's own, one is only the user and disseminator of knowledge.

The more people get this knowledge, the more people can be saved.

"Actually, did you notice that I just did an electrocardiogram."

Everyone nodded: "Well, I saw it, but...the electrocardiogram is just a waveform, what does it have to do with blood potassium?"

At this time, Chen Cang said to Xiao Lin, "Xiao Lin, I just had an extra electrocardiogram, you can help me get it."

Just now, just to be on the safe side, Chen Cang added an extra electrocardiogram, which just came in handy now.

Xiaolin took it in a hurry and handed it to Chen Cang.

Chen Cang took the electrocardiogram and said to everyone, "Don't underestimate any examination, such as a thermometer, sphygmomanometer, heart auscultation or electrocardiogram, x-rays, etc..."

"These inspections can tell us a lot of clues!"

"And the performance of hyperkalemia and abnormal ECG is even a typical example. I hope everyone will take what I say next and remember!"

When everyone heard it, they quickly prepared their notebooks and pens and listened carefully.

"When the serum potassium increases, the permeability of the cell membrane to potassium ions during the repolarization phase is increased, which makes the action potential gradient steeper and the time shortened. The first ECG manifestation of hyperkalemia is that the T wave is towering and the QT is shortened, so I saw the ECG. At the time, it was basically determined that the patient was hyperkalemia.”

"Everyone knows that patients with hyperkalemia come and go in a hurry."

Chen Cang's words "coming and going in a hurry" made everyone laugh, but everyone knows that it is true, hyperkalemia can cause cardiac arrest at any time, which is life-threatening!

Chen Cang continued: "Indeed, serum electrolyte testing is the gold standard for hyperkalemia, but by the time the biochemical test comes out, the patient has already passed an hour or two, and the patient is long gone. Why do I want this gold standard?"

"So, at this time, if you suspect hyperkalemia, you must do an electrocardiogram. This is a clinical trick!"

"Moreover, with the increase of blood potassium, different concentrations will have different performance, start to remember!" Chen Cang reminded.

"When serum potassium is greater than 6.5mmol/L, the QRS is uniformly widened, and ventricular myocardium can occur at this time;

When the serum potassium is greater than 7.0 mmol/L, the P wave will decrease and the time will be widened;

When the serum potassium is about 8.5 mmol/L, the disappearance of the P wave can occur, and the sinus conduction is formed. "

These are all officially reported and can be used clinically, so when Chen Cang said it, he did not hesitate.

If it was just Chen Cang's personal experience, he would be very conservative!

After everyone heard one by one, their eyes flashed green light, and they kept recording.

A lot of knowledge can only shine brightly when it is combined with clinical practice.

At this moment, Chen Cang in their eyes has a halo special effect!

One by one is thirsty.

They could think that the difference in the electrocardiogram can reflect the abnormal signal of human blood potassium.

This is something they never imagined.

Just like what Chen Cang said, if you wait for the serum electrolytes to arrive and the patients are gone, you don't know why!

As a doctor, is to constantly improve their skills.

This technology includes diagnostic techniques, treatment techniques, surgical techniques, and techniques for communicating with patients.

Knowledge is everywhere in life.

At this time, a student couldn't help but ask: "Mr. Chen, will you die immediately when your blood potassium reaches 10?"

Chen Cang: "The serum potassium concentration further increased, and when it reached 10 mmol/L, the QRS gradually widened, and even merged with the T wave to form a sine wave, and finally died of ventricular arrest or ventricular fibrillation."

Having said that, Chen Cang looked at everyone.

"So, the most taboo in clinical practice is experience, especially in emergency room. Don't use your usual experience to see a doctor, let alone persuade or encourage others how to do it in your 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 just followed the routine electrolyte imbalance, you vomited and diarrhoea! Isn't it just fluid replacement to adjust electrolytes? Supplement with sodium, potassium, calcium, iron, zinc, selenium and vitamins... If this is the case, what does the patient look like! Yourselves Think hard."

"Medicine, there's no room for sloppiness. I've been in the emergency room for two months, and I'm not saying how much I hope you can learn, but you must learn a little!"

"That's danger and caution."

In a word, let all the students who are present at the scene quiet down.

There are many such examples in life. A method that may be applicable to yourself may become the real culprit in the death of others.

so!

The most suitable persuasion and advice may be: go 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 doctor is getting more and more timid, and the butcher is getting more and more daring!"

The words are very humorous, and when everyone hears it, they can't help but smile.

But... 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 did not expect this group of people to remember everything, but he must remember one thing: when treating patients, be sure to:

careful!

careful!

careful!

At this time, in the crowd, a man was sweating profusely!

He was terrified and didn't dare to lift his head.

Thinking of his own ability, he felt very naive...

If this old man really handled it in his own hands...

As a result, what will it be like?

This is a living life, and I am only in my early 30s. If something goes wrong, who can be held responsible?

Who is responsible for the elderly!

Only one life?

Who can let you try?

...

...

ps: What I want to tell you about this story is that good advice for others may not be suitable for others.

Disease is so!

Why isn't life like this?

Without sufficient understanding of the disease, seemingly well-intentioned advice leads to misdiagnosis or mistreatment.

Without sufficient awareness of other people's circumstances, what can result from seemingly well-intentioned advice?

Chinese medicine believes that medicine is the Tao. In fact, life and medicine have many things in common. I hope this story will give you a little enlightenment.