The sudden appearance of the inspiration in Qi Jing's mind made him fall into deep thought. Huang Xinghua called him three times before he realized.

"What's wrong with you?" Huang Xinghua asked.

"Oh, I suddenly thought of something." Qi Jing scratched his head embarrassedly, "I always feel that Wang Gui's shock symptoms are a bit strange, not only the ecchymns, but also the indescribable coma."

"Is he in a coma? At most, he is unconscious." Luo Tang, who was standing beside him, retorted, "He was still a little responsive after hearing your briefing."

"There is no neurologist there, so it is difficult to tell whether it is a deep sleep or a shallow coma. There are too many things to check, so it is impossible to go step by step, so it is basically based on listening to the conclusions of local doctors."

Even if Qi Jing is not around the patient, he can't tell what Wang Gui's symptoms are, but if you have both ecchymnia and septic shock of coma, it must have reached a point where it is difficult to recover. However, judging from the examination report given by Huang Xinghua's mobile phone, it is not that exaggerated.

"What do you mean?" Huang Xinghua asked.

Qi Jing’s meaning is actually very simple. Based on the two symptoms given by Ding Xiujuan, Wang Gui’s symptoms were stripped away.

The symptoms of parasite and bacterial infection were superimposed on each other before, and it was impossible to see who was who. Now, anti-parasitic drugs are used. The symptoms caused by parasites may have been relieved a little, but the symptoms of bacterial infection and shock are superimposed on each other, and continue to show a state of "you have me and I have you".

"Eczema and petechiae may have nothing to do with shock," said Qi Jing.

"What's the patient's coma?" Seeing that Yan Hong was gone, expert b lit a cigarette for himself, took a sip, and then said with a smile, "Is it because Wang Gui's brain had a problem before?"

"Um?"

"this......"

“???”

Expert b's casual words made the scene silent for a while. Everyone looked at each other for a few times, and they all felt that this sentence was very reasonable: "Maybe there was a problem with my brain first."

"meningitis?"

"There are respiratory symptoms first, and then the brain is further infected, and there is nothing wrong with it."

"The patient's neck is not hard, right? There is no increase in intracranial pressure." Expert b still felt that this idea was a bit untenable. "Even if the intracranial pressure is increased, Wang Gui would not have headaches, dizziness or even vomiting..."

It was not until this time that they knew why Qi Jing wanted to pull out the pecchymns and pecchymns.

These two things are the main symptoms of the middle and late stages of bacterial meningitis, and they all appear on Wang Gui. However, Wang Gui did not have the other group of headaches, dizziness and vomiting that matched the symptoms of meningitis, or it was very atypical in his body, but his wife Ding Xiujuan had it.

As for the discomfort in my stomach just mentioned, it is probably the prodromal reaction of vomiting, and conjunctival congestion may be the same as what she said, so I'll cry too much.

After Qi Jing reminded him that meningitis has become the biggest suspect now, and the next step is a very cumbersome screening work.

There are many bacteria that can cause meningitis, Neisseria meningitis, Streptococcus pneumoniae, Haemophilus influenzae type B, Staphylococcus epidermis, Escherichia coli, Staphylococcus hemolyticus...

"Brubacillus, the symptoms are very consistent." Expert c selected a pathogen of zoonotic diseases, "and I have seen many cases of meningitis caused by Brubacillus over the years."

"But the chance of meningitis caused by it is very low, and it is usually the main thing to have strong necks." Expert b shook his head, feeling that it didn't look like it.

Experts c argued: "The low probability does not mean that there is no possibility."

"But the white blood cells in the blood infection image of Brubacillus can't rise that much," Qi Jing said. "And the heat type of Brubacillus is generally relaxation heat and wavy heat, but the patient's body temperature has not dropped since the patient rose to 39 degrees."

"Yes, Wang Gui should be the one who is Jiliu."

"That considering multidrug-resistant Escherichia coli should be related to what you eat..."

......

Now, the members of the expert group in the former 3i conference room are divided into three groups.

One group is still mainly engaged in infectious diseases, and sits in the 3i conference room to continue discussing the patients' infectious pathogens.

The possibility of meningitis is higher now, which is good news for the infectious disease expert group that has no clue. At least so many possibilities I have thought about before can be eliminated one by one by one by one by the symptoms of meningitis.

The second wave is Huang Xinghua.

He handed over the full authority of the meeting to Qi Jing to preside over, and walked out of the conference room and made several calls.

The most important thing is that Lin Rong, who is far away in Yunchuan, must explain to him that the patient may have bacterial meningitis and needs further neurological examination and brain CT. In addition, the condition of cerebrospinal fluid must be monitored. Once the intracranial pressure increases, it must be dealt with in a timely manner.

Then I called Yan Hong who had just left and informed him of the progress of the discussion as soon as possible.

Finally, I asked someone to help. In this situation, instead of continuing to waste time, it would be better to bring reinforcements to the rescue. Although this does not match his original personality, it depends on who the rescue is.

The third group divided by the expert group was the running shock group. Now it has quickly arrived at the first floor where the fax machine is located, waiting for various inspection reports from Lin Rong.

There are seven experts in this group, with an average age of over 55 years old, but the one who leads the lead is Yan Hong, who looks younger.

Internal medicine is a place where female doctors gather together, and the ratio of men and women is generally around 3:7. Even if you are busy in the internal medicine emergency department, women still occupy the majority of the positions. Because even if you are busy for only 8 hours, compared to the surgical department, which can’t squeeze out time on day and night, internal medicine emergency department has at least some time to rest.

But at the level of deputy senior or director of emergency department, the number of women will be lost in large quantities.

There are two reasons, and it is not difficult to say.

One is the aunt who comes once a month.

Physiological discomfort can be tolerated, but the changes in hormones in the body are difficult to stop. Emergency clinics are a matter of time and time. They are rational to the freezing point. The emergency chief director is holding human lives in his hands. A little negligence will lead to a big mistake.

The second is work intensity.

Emergency doctors must be on call at any time. Even if they are resting, national holidays, going out at night or doing anything else, they must be present as long as the hospital calls. Of course, the doctors who make this call may be scolded, but it is more comfortable to be scolded by themselves than to take the blame after something happens.

In this context, female doctors have to make some choices between their ideals and the traditional culture of taking care of their husbands and children. If nothing unexpected happens, the options are often the latter.

This is not to say that female doctors are very useful, but the hospital will definitely choose men under the same conditions.

But Yan Hong is an exception. She is the director of the Internal Emergency Department of a Hospital in Jiangping City, 47 years old this year.

As early as 23 years ago, she resolutely chose her career. Fortunately, both parents "understand" her, and her husband is a middle school teacher. Although her work is not easy, she can completely let go of the matter of educating her children.

At the age of 47, coupled with the title of female chief director who is rare in emergency departments, she has become a beautiful landscape in the eastern region.

Clinically, the middle and late shock reversal has always been a difficult problem. It is equivalent to making a pot of baked dishes at least in the mouth. How to lay the ingredients and stir-fry them requires years of experience accumulation.

Medical students know what treatment methods to use for shock, and hospitalists know the various drugs represented by these treatment methods. When they reach the main treatment, they know how to distinguish the shock stage to allocate the order and time of the use of drugs. When they reach the secondary high, they start working on the dosage of drugs.

If you master the realm of equal doses, your strength will be not far from Director Zheng Gaoda.

Who's treatment guide is like a martial arts secret book. Learning is only the primary stage, and then it is the real beginning. How to use this secret book and when to deal with it depends on everyone's practice and understanding.

Clinical treatment will change due to changes in the patient's condition. This is the reason why "water is not fixed and soldiers are not constant."

I have to say that Wang Gui is really as famous as his name. He met Yan Hong at the critical moment when he needed shock treatment the most. And not only her, except for Ji Qing, a young doctor who had just entered the clinic for less than two years, the rest were all the directors of the internal emergency department in the top three.

For an emergency patient with septic shock, this lineup is luxurious.

While waiting for the fax, Yan Hong received a text message from Huang Xinghua immediately, which was the result of the discussion in the 3i conference room: meningitis. Since the process of obtaining the results was a bit complicated, Huang Xinghua did not explain it in detail, but these three words made the emergency officers present recall some of the previous details.

"It's still the careful group of people who are studying infectious diseases. I just said why Wang Gui didn't wake up?"

"Yes, I was so confused at the beginning. Now it seems that it is caused by meningitis."

"Mentantitis...the prognosis is not optimistic."

"I don't know if it's coma, and whether the intracranial pressure is high."

"I can only take one step at a time."

After waiting for three minutes, Lin Rong's fax arrived.

The first thing I arrived was Wang Gui’s basic situation page, which included the main complaints of the first admission, the treatment records in the first visit to the hospital, and the changes in the condition after entering the CDC.

The second picture shows the patient's current situation, including blood pressure, heart rate, blood routine, pct exceeds 18, CRP up to 300, and ck exceeds 50,000.

The complicated examination data came to Yan Hong's eyes, not numbers, but restrictive frameworks for setting treatment plans one by one.

"It is indeed similar to the results of their discussion. Wang Gui's shock has not reached the point where he has insufficient cerebral blood supply." Yan Hong said, "But Yunchuan is indeed short of critical doctors. He gave some key things, but the other part is not."

"There is no lactic acid indicator." Ji Qing looked at the inspection report and said.

"It's not just lactic acid, but many other things are missing." An old expert on the side looked at the third parasite immunology test report sent and shook his head, "There is no detailed blood gas analysis and urine volume monitoring!"

Yan Hong looked at the fourth piece of paper that appeared slowly, and couldn't help it. She opened her phone and dialed the number and called.

"Director Lin, I want to say a few important things now." Yan Hong glanced at the fourth doctor's order that he had just arrived, threw it casually to Ji Qing beside him, and then said to Lin Rong, "The patient's hemodynamics is still unstable. Please use glucocorticoids. I personally recommend that you hang hydrocortisone intravenously, and the dose is 200mg per day."

“Well, hydrocortisone?”

"Yes. The patient's blood pressure is unstable, his heart rate is fast, and he may have new insufficiency, so the infusion speed has all slowed down." Yan Hong did not explain much and continued, "There is the most critical thing. I did not see the blood electrolyte report, the blood gas analysis report, the urine volume monitoring report, and the latest liver and kidney function report."

Without the harsh scolding like Huang Xinghua, nor the sarcasm among other colleagues, Yan Hong was just talking about a normal treatment method, but this was even more embarrassing than scolding him in person.

Lin Rong has never been said like this since he went to Licheng. Although there was no trace of anger during the whole conversation, every word was as cold as ice slag and shook it on his face.

When I dreamed of going back to the internship period, I am afraid that Lin Rong only had these five words left in his mind now.

It is certain that he has no face, but in order to save the person, Lin Rong endured it.

......

At this time, on a highway far away from Minghai City, an old man was sitting in the back of a taxi, listening to the news from his phone. He had just got off the plane at 11 o'clock in the evening. He originally wanted to make a night in a hotel near the airport, but now it seems that the plan has failed.

The patient's condition is ups and downs, which is attractive enough.

However, he is different from those infectious disease experts far away in the International Conference Center. When he first heard the patient's condition, he thought of some special situations. The most important and simplest: "Did you forget all your money? What is the first sentence of the physical examination? You are calm and calm! He is definitely uneven, but you are not clear? Have you asked?"

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Chapter completed!