I'm really an intern

Chapter 15 Do you know how hard I work!

On Wednesday morning, as usual, it was a daily computer rounds.

Professor Liu sat upright in front of the computer, followed by a group of white coats, each of them leaning against the chair with half of their buttocks, stretching their necks to see the text on the screen clearly.

Sitting at the farthest place, Zhang Tianyang unexpectedly felt the benefit of "eyesight +1".

If I can go back to the third year of high school, my current eyesight should increase the score of the college entrance examination by two or three points, right?

"Okay, next one, 40 beds."

Professor Liu's words brought back Zhang Tianyang's attention.

"There is nothing special about bed 40. The vital signs are stable. There are no obvious abnormalities in the chest X-ray and electrocardiogram. There are still many other results that have not come out."

Zhang Tianyang opened his own small notebook and reported based on the words written on it.

Every doctor has one of these little books.

Record the patient's vital signs during ward rounds, and record important data when checking the test results. The instructions of the superior doctor will occasionally appear on it, and the daily tasks can be seen at a glance just by opening it.

Zhang Tianyang's eyes were fixed on the red circle, and he raised his head to ask Professor Liu for instructions.

"This patient needs to make an appointment for dialysis downstairs tomorrow, and the professor needs to contact you for this."

"When was the last time you had dialysis?"

Professor Liu manages a lot of patients, and there are also many outpatients, so he often can't remember the specific situation of each patient.

At this time, the doctor in charge of the bed cannot lose the chain.

"The last dialysis was on Monday night, this patient used to be on regular dialysis twice a week, but the patient has high blood pressure"

Zhang Tianyang reported the basic conditions of some patients, and Professor Liu remembered it quickly.

"Is this the one who received emergency dialysis that night?"

"correct."

"I'll take a look."

Professor Liu called out the data of 40 beds and looked at it for a long time, then suddenly turned his head and looked behind him.

Brother Wang happened to be sandwiched between Professor Liu and Zhang Tianyang, and the shirt inside the white coat was soaked with sweat in an instant.

"How do you think this patient's treatment and medication need to be adjusted?"

This sentence is for Zhang Tianyang.

Senior Brother Wang breathed a sigh of relief, and moved with the chair along with his buttocks.

Little by little, gradually leaving Professor Liu's sight

Professor Liu suddenly glared at Senior Brother Wang.

"Move, move, sit down for me!"

Brother Wang's face was filled with flattering smiles instantly, "Well, professor, I'll make room for you and the younger brother. Aren't you asking the younger brother a question~"

"A lot of nonsense."

Professor Liu looked disgusted, "Why don't you think about it, why don't I ask you questions?"

why don't you ask me questions

Because I cook

Senior Brother Wang curled up on the chair, wanting to cry but not crying.

"I have tried so hard to reduce my sense of existence, but I still refuse to let me go.

Do you know how hard I work!

Beep! "

Zhang Tianyang did not expect that he would become a "other person's child" again, so he could only give Senior Brother Wang a sympathetic look.

Dude, you are too difficult!

Apart from Brother Wang's interruption, Zhang Tianyang became serious again.

The elder brother with 40 beds was the first patient he managed in a real sense. Zhang Tianyang had also seriously thought about his condition. ,

So he thought about it for a while, opened his mouth cautiously, and first summarized the patient's situation.

“40床是36岁的男性，有五年的透析史，长期血压170-200/100-110mmHg。

The patient's previous dialysis routine was twice a week, with low-sodium dialysis each time, and his weight increased by about 2 kg between dialysis.

The long-term drugs used by the patient now include Baixintong 2/day, Ambovi 2/day, Nitrin 2-3/day, Terazosin 2/day, and Betoprolol 1-2/day.

But blood pressure remains high. "

Hearing this, Professor Liu couldn't help nodding, "That's a good summary, let's continue."

Behind Professor Liu, the three senior sisters were listening carefully, only Senior Brother Wang had a subtle expression.

God knows how many times he was interrupted by Professor Liu every time he reported the patient's situation!

But now, the younger brother said it in one breath, Professor Liu not only didn't interrupt, but also said it was very good?

Although he is not a graduate student in nephrology, he just came here on a rotation basis, so he can be regarded as a non-specialist in surgery.

But, but, Junior Brother is even an intern!

Are the current interns already so against the sky?

Zhang Tianyang couldn't hear Senior Brother Wang's chatter in his heart. At this moment, he was reading the thoughts he wrote down in the small notebook.

"According to the monism, the patient has no family history and no obvious unhealthy living habits. It is considered that his high blood pressure is renal hypertension caused by renal function damage.

Therefore, modifying the treatment plan should first start from this aspect. "

"Given the circumstances in which this patient presented on Monday night, I don't think his twice-weekly dialysis is adequate.

It is recommended to increase to three times a week, 4 hours each time.

Simultaneously, a blood volume test was performed.

Each dialysis can choose to reduce body weight by 0.2-0.3kg. "

Professor Liu nodded, "It's a very reasonable suggestion. Considering that he will have dialysis tomorrow, which is Thursday, I can contact the dialysis room below and change his dialysis time to every Tuesday, Thursday and Saturday."

"Is there any more? Go on."

"Aiming at the high blood pressure of patients, I think we should start with diet first.

When I checked the literature, I found that for patients with stage 3 and stage 4 chronic kidney disease with poorly controlled hypertension, a low-sodium diet can significantly reduce blood pressure.

Combined with the condition of this patient, sodium intake should be controlled to 2-3g per day. "

"Have you checked the literature?"

The satisfaction on Professor Liu's face seemed to be overflowing in the next second, and in the next second, he used Zhang Tianlai to beat the group of white coats behind him.

"Look at your juniors, and look at yourselves!

I heard that Xiao Zhang didn't leave the department until seven or eight in the evening for the past two days, and he still checked the literature for the sake of rigor.

Next time someone tells me that the clinic is too busy and has no time to read the literature, let me face the wall! "

Hearing this, Senior Brother Wang and Senior Sister Qi couldn't help but have erratic eyes.

The two secretly complained in their hearts, obviously the clinic is very busy!

It's just that the younger brother is too against the sky, how can the younger brother be regarded as a weight and measure!

Professor Liu brought the topic back with a smile.

"What about the medicine? How should his medicine be adjusted in this case?"

"Do you want me to talk about the medicine?" Zhang Tianyang hesitated a little.

"After all, I don't have much clinical experience, why don't I listen to your drug treatment plan?"

Professor Liu stared.

"If you tell me to say it, just say it, what are you afraid of! At worst, if you make a mistake, I will tune it for you.

Clinicians need to be bold and careful.

Say! "

Zhang Tianyang sighed.

"My consideration is that a centrally acting alpha agonist, such as methyldopa and clonidine, could be added.

Direct vasodilators such as minoxidil may be considered, but patients should be observed for fluid retention and tachycardia.

When necessary, nitrolipid drugs can also be used to lower blood pressure. "

"Professor, look, is this medication plan okay?"

(End of this chapter)