I can see health

Chapter 275 Shocked in a cold sweat

"Lu Chen, go see the patient first." Li Yao looked at Lu Chen.

Lu Chen nodded knowingly.

Yin Chao on the side was slightly surprised.

Let a master's student come to see this patient?

Will it be a little sloppy?

This patient has been in their department for three days, but there is still no definite diagnosis.

Even blood pressure hasn't dropped yet!
Or maybe, Professor Li should just let Lu Chen practice his hand, Yin Chao thought to himself, he should check it himself later.

……

Lu Chen walked to the patient's bedside and began to ask about the patient's medical history.

Patients with high blood pressure are mainly asked about the course of hypertension, maximum blood pressure, specific oral drugs, blood pressure control level, etc.

After asking about the routine medical history, Lu Chen didn't find any special condition.

The patient felt dizziness, headache, and occasional lower limb edema in the past month, and then went to a clinic near his home to measure his blood pressure, only to find that his blood pressure was particularly high.

The patient had no previous medical history, no genetic disease, heart disease and other medical history.

After asking about the medical history, Lu Chen began to conduct a physical examination.

He picked up the stethoscope and put it on the auscultation area of ​​the heart and lungs, but no special noise was heard.

The only meaningful sign was mild edema of the patient's lower extremities.

The two most common causes of edema are cardiogenic and nephrogenic.

In addition, the patient is typically abdominally obese with a large belly.

"Cardiopulmonary abdominal auscultation was negative, and both lower extremities were slightly edema."

Lu Chen reported the abnormalities found in his physical examination.

"The basic clinical skills are quite solid."

Yin Chao was quite surprised to see Lu Chen's medical history and physical examination process.

Now the younger generation of doctors are relying more and more on imaging technology, thus ignoring the most basic physical examination.

Many doctors prescribe CT and ultrasound when they see a patient, directly omitting the two items of physical examination and medical history.

"Doctor Lu, if you finish reading, let's go back to the office to see the patient's examination results." Yin Chao said.

The basic situation of the patient has been understood. According to the routine process, the results of the blood draw and examination after the patient's hospitalization are checked.

Especially for patients with refractory hypertension, cumbersome examinations are required to rule out whether there is secondary hypertension.

However, Lu Chen shook his head and refused.

"Director Yin, I have one more question, and it will be over after I ask."

Yin Chao was taken aback for a moment, then smiled, "Just ask."

Lu Chen noticed that there was a little girl about five years old sitting at the end of the hospital bed.

The little girl looks very cute with pink makeup and jade, but she doesn't look like the patients in the hospital bed at all.

"I want to ask about your marriage history and menstrual status." Lu Chen said.

Clinically, as long as women are in childbearing age, they must ask about their marriage and childbearing and menstrual conditions.

Hearing this, the patient whispered, "I'm married, but I haven't had any children."

"What about menstruation?"

"Menstruation is very irregular, sometimes once a month, sometimes once every two or three months. If I drink traditional Chinese medicine to regulate menstruation, it will be more regular. However, I haven't taken traditional Chinese medicine for a long time."

"When was the last time you had your period?" Lu Chen asked.

The patient thought for a while and said, "It was probably two or three months ago, and I don't really remember."

Lu Chen nodded, looked at Li Yao and Yin Chao beside him: "I'm done asking."

Yin Chao smiled. He thought Lu Chen was going to ask some serious questions, but it turned out that he was only asking about his marriage history and menstrual history.

They have asked this question before.

"Then shall we go back to the doctor's office?" Yin Chao looked at Li Yao and asked her opinion.

"Okay." Li Yao nodded.

Only then did Yin Chao lead Li Yao and Lu Chen to the doctor's office of the Cardiology Department.

……

Walk into the doctor's office.

Yin Chao greeted: "Xiaolin, bring over the medical records of the 31-bed patient, and type out the test sheets and inspection sheets!"

"Okay!" A resident doctor named Xiao Lin quickly responded.

At this time, other doctors in the department also saw Li Yao and Lu Chen coming.

Li Yao and Lu Chen sat at the table in the middle of the office.

Yin Chao clapped his hands and signaled the people present to be quiet: "Professor Li Yao came to our department to guide the work today. Everyone is warmly welcome."

There are not many doctors in the office.

As soon as the words fell, there were sparse applause in the department.

"Professor Li will check the situation of bed 31 first, and then start our teaching rounds today."

Dr. Lin quickly handed over the medical records of the 31-bed patient to Li Yao.

Li Yao handed it over to Lu Chen who was beside him.

Dr. Lin looked a little dazed, who is the overly young doctor next to him?
Yin Chao explained in a low voice from the side: "Xiao Lin, this is Director Li's graduate student named Lu Chen, you two can have a good chat."

Xiao Lin is a graduate student who just graduated this year. Because his family is in Fengmao County and he doesn't want to be too far away from his parents, he stayed in the County People's Hospital.

"You tell Professor Li and Dr. Lu about the patient's diagnosis and treatment in the past three days."

"Okay." Doctor Lin nodded.

Lu Chen flipped through the medical records while listening to Dr. Lin's report.

The patient's diagnosis and treatment in the past three days was very simple.

It is mainly to improve the items of secondary hypertension inspection.

In terms of treatment, urapidil and oral antihypertensive drugs are given to lower blood pressure.

Dr. Kobayashi continued: "The patient's blood pressure has been hovering around 180/100mmHg, and the systolic blood pressure occasionally rises above 200mmHg."

"Currently, the patient's creatinine is high, and the urine protein and urine occult blood are positive. In addition, other test results, including potassium ions, are normal."

"We consider that the diagnosis may be secondary hypertension waiting to be discharged, hypertensive kidney damage. What is more confusing is that the patient's blood pressure has not been lowered."

Lu Chen frowned.

The patient's serum potassium was normal, which ruled out many diseases of the endocrine system.

Echocardiography and bilateral renal ultrasound were also normal, temporarily excluding aortic coarctation, renal artery stenosis and other diseases.

The most difficult problem is that the patient's blood pressure remains high.

No matter what kind of high blood pressure, with so many antihypertensive drugs, blood pressure should also be able to drop!

"Professor Li, do you have any comments on our diagnosis and treatment process?" Yin Chao asked from the side.

Li Yao smiled, turned her head to look at Lu Chen who was beside her, "Lu Chen, tell me first."

Yin Chao frowned.

At this time, this Professor Li is still testing his students?
Lu Chen pondered for a moment before slowly opening his mouth and said, "According to the current examination results, our common secondary hypertension factors, such as pheochromocytoma, protoaldehyde, adrenoma, etc., can all be ruled out."

Kobayashi nodded, this was also where he was confused.

Common secondary hypertension factors have been ruled out, is this patient essential hypertension?
However, Lu Chen's next words made all the doctors in the Cardiology Department of Fengm County break out in a cold sweat.

"However, you have missed one situation, that is hypertension during pregnancy!"

　Forced to go out for shopping... the update is late

　　
　
(End of this chapter)