I'm really an intern

Chapter 216 I Read and Understand Myself!

"it's actually really easy."

Being watched by everyone, Zhang Tianyang was very calm.

He originally wrote this medical record, but now he is just stating his thoughts.

He himself knew this, and Lin Ke'an next to him knew it, but the others didn't know it!

The only informed neurology hospitalization always doesn't care about the ICU.

So in everyone's eyes, it is just a little intern preparing to start talking big without knowing the heights of the sky and the earth.

In just an instant, a group of people in white coats had different expressions.

The white coats who were far away looked at Zhang Tianyang with spectator and pity.

To reach the step of regular training, the time spent in the clinic is at least one year.

They have seen many teachers who like to ask questions like the attending physician.

People like Zhang Tianyang, who are obviously just interns, feel like they know everything, are number one in the world, and dare to answer everything, and they have seen a lot of them.

When their eyes glanced at Zhang Tianyang's "pretentious" face, they had already imagined how badly this poor little intern would be taught by reality after a while.

The eyes of the white coats who were closer were much sharper, with varying degrees of blame and even hatred.

They managed to hide here, but because of this little intern who wanted to show off, they became the focus of everyone!

Don't dare to move, don't dare to slip, but also pretend to be serious and hardworking.

Are they easy!

Hurry up and say it!

Hurry up and scold after you finish speaking!

After scolding, they can continue to fish happily!

After all, the three resident doctors were relatively calm, and the expressions on their faces were impeccable.

But he didn't look serious either.

He just silently stared at the screen twice.

Just an intern.

It is not sure whether the intern can have a clear idea when writing the medical record, but I want him to figure out the thinking behind a well-written medical record?

Nine times out of ten it is impossible to answer.

And then the question finally has to be asked of them.

It is better to prepare early.

Senior brother Guipei, sweating profusely, also looked at Zhang Tianyang, his eyes full of gratitude.

Fortunately, there was an intern with a strong head to help him share the attention of the senior brother in charge, so that even if he scolded later, it would still be scolded by two people together.

It is a lot more comfortable to be accompanied by someone!

The faces of the attending physician and Lin Ke'an were rather strange.

A famous person who has heard of Zhang Tianyang can vaguely guess Zhang Tianyang's ability.

The other saw Zhang Tianyang write this medical record with his own eyes, and everyone was drunk and sober.

After taking in the faces of the white coats around them, the faces of the two became more and more strange.

Lin Ke'an was even holding back his laughter.

Zhang Tianyang glared at her, straightened his expression, and began to state his thoughts when writing the medical records.

"Sudden change of consciousness for 1 hour after drinking a little alcohol, extreme arousal, unable to control one's speech and behavior. This is the patient's symptom."

The first sentence was quite satisfactory, and everyone's eyes did not change.

"I think there are many possible reasons for the patient's symptoms, such as alcoholism, disulfiram-like reaction, poisoning of contraband, intracranial infection, mental illness, hyperthyroidism, etc."

The second sentence directly related to the possible disease, and the eyes of some experienced white coats changed a little.

In this medical record, no diagnosis was given.

There is no such words as "excluding the possibility of xx" or "considering the possibility of xx".

At most, there is only the main diagnosis given in the upper right corner: "meningitis".

Many interns and regular trainees are actually just a tool for asking medical history when they are seeing patients in the clinic.

They are only responsible for asking about the medical history, then writing the medical record, and then reporting to their superiors.

The real diagnosis, differential diagnosis, and doctor's orders are all the judgments of the superior doctors, and they are only responsible for translating these judgments into practice.

Specifically, what diseases this patient may have, how to make a differential diagnosis, how to choose drugs, and how to consider the dosage, they don't know at all.

But Zhang Tianyang opened his mouth and directly gave six possible diseases.

And if you think about it carefully, if you only look at the chief complaint, it seems that these diseases are indeed possible.

This is a differential diagnosis that really shows strength!

Watching the show and looking at them with pity changed, many white coats inexplicably stood up straight, frowned slightly, and entered the thinking mode.

Zhang Tianyang paused, and continued to state his thoughts.

"Painful face, pale and clammy skin, accompanied by fever, dizziness, vomiting, profuse sweating, and neck resistance. These symptoms indicate a high possibility of intracranial infection."

"I had a "cold" recently and didn't take any medicine. It once again proved the possibility of intracranial infection, and also ruled out a disulfiram-like reaction."

"No weight loss, protruding eyes, shaking hands, etc. can help rule out hyperthyroidism."

"He has a good drinking capacity, no bad habits and no history of mental illness. Past history can help rule out alcoholism, poisoning of prohibited substances and mental illness."

Zhang Tianyang broke down the entire course of the disease into small sections to explain, and gradually revealed his diagnostic thinking in front of everyone.

All the white coats present understood and agreed with this kind of thought that had been torn apart and crumbled.

"So it is!"

"Looking at it this way, this sequence is really great. If the related ones are connected together, the corresponding diseases can be ruled out."

"Sure enough, I still need to learn. If this kind of detail is not explained in this way, who would have thought of it!"

For a while, the ICU ward was quiet, only the sound of countless pens brushing and recording on the small notebook.

This is dry goods!

Write it down well, and try to use it in practice in the future, and your ability and level will be greatly improved.

There were no more mocking and pity eyes around, or even hostility and resentment. The eyes in a circle of white coats gradually turned into surprise, but there was still a trace of hesitation.

After all, this is just an explanation given by Zhang Tianyang, an intern, and the chief executive hasn't spoken yet.

Although they felt that they were suddenly enlightened and didn't hear any problems, maybe they were not capable enough?

The three residents couldn't help giving Zhang Tianyang a high look.

They don't lack abilities, so naturally they knew that Zhang Tianyang was not talking nonsense.

They were just surprised that Zhang Tianyang was able to speak in such detail.

Although they can also see the idea of ​​medical record writing, they may only be able to correspond to four or five of the six possibilities for a while.

This intern has something!

The attending doctor's gloomy face just now has fully unfolded like a flower.

This little Zhang is indeed as rumored, he is a big baby!

I found the treasure, I found the treasure!

I hold the right to use this big baby for two weeks in my hand, and now it is only the first hour of the first day, and it gives me such a comfortable feeling, how comfortable it is for two weeks!

In other words, do you want to think of a way to convert the two-week use right into a permanent property right?

He smiled and was about to exaggerate Tianyang, but Zhang Tianyang paused and continued to speak.

"Among intracranial infections, there are possibilities of encephalitis, meningitis, and brain abscess."

"So the first thing to consider after admission, in addition to relieving the patient's hyperactive state, is the three possibilities of differential diagnosis."

"In addition to medical history and clinical symptoms, cerebrospinal fluid examination, brain CT, and nervous system examination can all help in differential diagnosis."

This paragraph is not only talking about the symptoms of admission, but also the idea of ​​diagnosis and differential diagnosis after admission.

Very clear and correct.

The attending physician was happy to hear it, and couldn't help but ask a question.

"Xiao Zhang, what you said is great! How could you see the diagnosis of this medical record so quickly?"

Zhang Tianyang, who was eloquent and eloquent just now, suddenly stopped talking.

It wasn't that he had stage fright, but that senior brother Gui Pei, who was standing next to the attending doctor with a pale face and sweating profusely, was really pitiful.

There's no need to chase after him.

He thought for two seconds, and just wanted to speak modestly.

Lin Ke'an next to him couldn't hold back anymore, and burst out laughing with a "poof".

"Brother, because he wrote this medical record last night!"

　monthly ticket monthly ticket

　　

　

(End of this chapter)