Qi Jing’s best-in-class is infectious diseases. When he encounters a disease that cannot be understood, he will subconsciously eliminate the infectious diseases first.

Of course, other infectious departments and emergency doctors will also consider the factors of infection, but the difference compared with Qi Jing is that they only care about the patient's condition first, while Qi Jing will attribute the medicines the patient took before to the patient will take together.

After all, people are still a whole. External objects are still external objects. Even drugs that fight disease evils are also external objects, so there is a saying that "there are three parts poisonous drugs."

This is particularly prominent in the large families of drugs such as antibiotics.

From the beginning of penicillin, antibiotics were the main force in humans' fight against bacterial microorganisms. However, as more and more patients taking medication samples and more research became more and more in-depth, doctors began to notice their backlash.

The most troublesome thing is drug allergies, which typically represent the prevention and treatment of penicillin allergies, which is a compulsory content for every medical staff when they are on duty. The drugs after penicillin are treated well in allergies, but the stimulation to the body is getting bigger and bigger.

In fact, the research and development of antibiotics is the same as the development of weapons.

At the beginning, if the firepower is insufficient, it is easy to cause accidental damage. After that, the accuracy will gradually increase, and the accidental damage will be alleviated. However, because the enemy becomes more and more cunning, if you want to increase the winning rate, the firepower can only be made more and more fierce. Although excessive firepower can wipe out the enemy's troops, it will also cause huge damage to the surrounding environment when used.

The stronger the firepower, the greater the damage. This is a consensus. If it is a major operation and requires joint forces to fight at the same time, the scope of the damage will be even more unimaginable.

In addition to the most common gastrointestinal reactions, these damages also have various serious side effects such as ototoxicity, nephrotoxicity, and hepatotoxicity.

What Qi Jing is now targeting the side effects of patients after taking medicine. Of course, this is also because of more than ten years of clinical experience. Because many side effects will be verified one by one in the future, but in 2004, not only were the reports small in number, but the explanation of the mechanism was also very vague.

"You said she had problems with her medication?"

He Tianqin came to Qi Jing and took the medical record in his hand: "I remember the medicine that the patient has used recently, so there should be no problem."

"Putting the medicine aside, I think it can be confirmed. This is a case of myasthenia gravis crisis caused by a sudden attack of myasthenia gravis." Qi Jing reorganized his thoughts in his mind, looked at the patient lying on the bed and continued, "All the symptoms can be explained, and it should not be wrong."

The three people beside the bed looked at each other: "Mysas gravis? Isn't this Director He's previous guess?"

Xu Jiakang had to admire Qi Jing's diagnostic thinking. In just a few minutes, he eliminated so many suspicious objects, and finally focused on the rare disease of myasthenia gravis: "It's the same as we had guessed before, but..."

"It's just what?" Qi Jing asked.

"Xiao Qi, I thought there was something wrong with my respiratory muscle group before, but the patient was quite enthusiastic about sports and had participated in the half marathon before." He Tianqin retorted, "She was still running before coming to the hospital, so she just told me if she was a mg-like or not."

Xu Jiakang had to insert a mouth at this time: "The development of mg has a long course, usually from weak eyelids, weak swallowing, weak pronunciation to weak head and neck muscles, and finally to limbs and whole body. I have never seen mg that omit the process of several months in the middle and develop directly to the state of death, just like a tumor that grows overnight."

“It’s too subjective to say omitting…”

Qi Jing also wanted to explain further. At this time, the doorbell of the ICU was ringing from outside. The nurse at the door hurriedly opened the door, and saw an old couple standing at the door, looking at the doctors inside the door nervously: "We are Wang Yiling's parents, how is she doing now?"

Seeing that it was the patient's family, He Tianqin hurriedly called Xu Jiakang: "The patient is resting, let's go to the office to talk."

For Qi Jing, he had a diagnosis, and the next thing he cared about was the argument to verify this diagnosis. The argument was like a puzzle, half of which had been found in the patient, and the other half should be on the family.

So he didn't hesitate and walked out with the two of them.

He Tianqin specially found his desk and sat around the old couple, while Xu Jiakang and Qi Jing were standing by the wall. One wanted to make appropriate supplements at the right time, while the other wanted to hear some news from the two of them.

In fact, Wang Yiling's condition sounds very simple.

While waiting for the x-ray, I suddenly had difficulty breathing, and my chest tightness and breathing were easy to understand, and I could understand it at first glance. However, the reason is different. This is what the family members want to know the most. The root cause must be cured. Even if it cannot be cured, they must die with peace of mind.

Xu Jiakang didn't answer and looked at He Tianqin.

He Tianqin had no choice but to bite the bullet and said, "The patient's condition appeared very suddenly. We had a goal of doubt, but we couldn't make a conclusion for the time being. However, after getting on the ventilator, her condition had improved, and at least her vital signs had stabilized."

When facing the condition of their family members, their families are all greedy, and the word "stable" alone cannot satisfy them: "Since they are stable, can they remove the ventilator?"

"I'm afraid this won't work." He Tianqin shook his head.

At this time, the right to speak came to Xu Jiakang: "There are many ways to supply air by ventilators, but they are roughly divided into two types. One is that the patient has his own breathing, and the ventilator only assists in supplying air. The other is that the patient's own breathing is completely stagnant, and the entire breathing process is completed by the ventilator."

Both Wang Yiling's parents have received good education and have clear ideas. After saying this, they have guessed it: "What do you mean is that her condition is very bad..."

"It's a pity that Wang Yiling is the latter type." Xu Jiakang was also helpless, but this is the truth.

"What should I do next? What medicine should I use? Or should I send it for surgery?" My father was really anxious. "You have to give me an explanation. It is impossible for me to live on a ventilator in my next life, right?"

In the emergency department of internal medicine, you often encounter serious patients with unknown causes. Faced with the families of these patients, the doctor can only try his best to comfort them. However, Xu Jiakang was about to speak, but was stopped by Qi Jing: "Don't be anxious about what's going on, I want to ask you a few questions first."

In a sense, Qi Jing had already surpassed his power, but at this time He Tianqin was full of patients, so he naturally would not have any scruples.

Although he is usually impatient and has to do whatever he says, and there is no possibility of bargaining. After all, the hospital is a place to save people, and there is no need to always show off as a big shot in front of the patient's life.

What's more, Qi Jing's views are just not supported by evidence, and are not completely unreasonable.

Breathing is originally an action that controls rhythm and depth by the respiratory center, and completes the lungs' relaxation and contraction through the respiratory muscles, which runs throughout a person's life. If there is a problem with breathing, there are only three reasons: the center, lung and respiratory muscles.

Now the center and both lungs are good, and it is normal to suspect that the muscles are on.

If it is really mg, the key point is in the onset process. Why did a chronic disease that should have been pedaled with one foot suddenly change into a turbo engine and go directly to the F1 track?

"Your daughter loves sports?"

"Well, she has been playing sports since she was a child, such as long-distance running, badminton, roller skateboarding, and skateboarding." My mother knew better about life and said quickly, "She is in good health and has never been sick. This... It's so sudden now, so suddenly!"

Speaking of this, my mother remembered every bit of daily life, couldn't help but cry and hugged her father.

Qi Jing nodded: "Do you live together?"

"She bought a house outside last year and lived separately at the beginning of this year." Qi Jing's questions were always a bit impatient. "What's the point of asking these? She has always been in good health. Even if you ask me again, I won't understand."

"Don't be anxious first." Qi Jing tried to comfort them and continued to ask, "Did she say she was tired recently?"

"This..." The couple looked at each other, "She is under great pressure to do creative advertising. Sometimes she stays up until two or three in the morning, how can she not be tired?"

"Yes, sometimes I fall asleep on the table while doing it."

Qi Jing knew that they had misunderstood her, so he quickly explained: "I don't mean my brain is tired or staying up late. I mean physical and muscle fatigue."

"I haven't told us these, I don't know."

"She hasn't fallen recently? Has the number of runs and distances decreased?"

Qi Jing's question became more and more biased, and he had no intention of caring about the exhausted respiratory system. This made his father very disgusted, and his daughter was heartbroken: "She has poor lungs, why do you ask her if she falls?"

"This question is very important." Qi Jing didn't want to waste time explaining the complex pathogenesis of mg, but just asked, "Did you fall?" At this time, I still have to rely on my careful mother: "I heard her say when I delivered her food before, and it seemed that she had fallen twice. When I saw her last week, a hole was cut on her right shoulder. She told me that the soles of her feet slipped and hit the iron fence of the green belt on the side of the road."

Qi Jing nodded and looked at He Tianqin: "Director He, I think so many injuries on her body are caused by running and falling. But the frequency is not high, and it doesn't look much, so she doesn't become alert either."

In fact, the evidence alone is already very obvious, and such inexplicable respiratory failure originally required to rule out the possibility of mg, but it only takes some time to diagnose it. However, respiratory muscle weakness is one of the two major end forms of mg, and the other is myocardial weakness.

He Tianqin and Xu Jiakang never understood what caused Wang Yiling's muscles to suddenly fail to this extent.

"It's the levofloxacin she took before." Qi Jing took the medical record and turned to that page, pointed to the name of the medicine and said, "This is a powerful catalyst."

"Levox has this effect? ​​Isn't it safe all the time?"

"It just looks safe. In fact, there have been reports abroad for a long time, and the earliest report in China was in April this year. A very short summary, about a few hundred words, is not even a review." Qi Jing said, "In that article, it clearly stated that levooxygen can induce and aggravate the symptoms of mg."

"So that's how it is..." Xu Jiakang then understood why the condition developed so rapidly. "Which magazine is it?"

"Oh, it's not a magazine. I remember it's a summary of a neurology conference." Qi Jing seemed to have forgotten the specific name, "It's quite short anyway, so I just scanned it roughly and forgot the specific name."

He Tianqin still didn't understand, a little subverting his previous medication method: "Can quinolones induce mg? What is the mechanism of action?"

"In fact, not only quinolones, but also aminoglycosides can also..."

There is still a lot of content to be discussed on the use of antibiotics, but Qi Jing's mobile phone rang at this time.

He couldn't help frowning as soon as he saw the call message, but after a moment, Qi Jing completely integrated his frown into other expressions. After briefly weighing the pros and cons, he did not answer the phone, but hung up and sent a message:

While typing, he explained: "By the way, I'm afraid the tendon tear on her right foot and ankle is also related to left oxygen. It is a serious side effect that has been studied abroad. Let the neurology department do an electromyography first, and then call the immune department to guide the treatment."

He Tianqin was still shocked. The broad-spectrum antibacterial drug levofloxacin, which was so easy to use, fell from the altar in an instant: "I didn't expect it to be the result. If it was really mg, I would definitely have to transfer to a specialist and continue treatment after it stabilized."

"I'll go to the call god for consultation." Xu Jiakang turned around and picked up the phone on his desk.

The sudden appearance of the old couple saw something, and they asked quickly: "Director He, what is the situation now? Do you know the cause of my daughter? What is the problem? What are you talking about? What is copper? What is mg?"

He Tianqin is not as relaxed as Qi Jing. The patients in the ICU just ran from one extreme of sudden death to another extreme of chronic death. For the family, mg is not much better than the current situation.

The old couple, who heard the result, was in a mood. Myasthenia gravis was a chronic disease that was constantly aggravated and needed early detection and intervention. However, the patient did not take it seriously and had been delayed for a while. Now, after being induced by levofloxacin, he directly stepped on a crisis.

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