The Tang Building entered the ward.

After it was pitch black, a female model appeared in front of Tanglou.

The assistant doctor saw that it was Tanglou and deliberately took the case. He paused, but he didn't read the question: "Ahem~"

Tanglou naturally understood that this was his intentional "make trouble" and revenge on his previous show of revenge.

"please!"

Tanglou stretched out his hand and invited the young lady to continue the discussion.

This is almost the same. For your handsome and sincere invitation, I will not be as good as you.

"Patient: female, 55 years old, was sent to the emergency department by her community contracted doctor. In the past three weeks, her shortness of breath gradually worsened, her lower limbs edema, and her weight gained 10 kilograms. She denied chest pain and had no history of cardiovascular disease. She denied any symptoms of urinary revitalization of gastrointestinal tract."

"In the family history, her two sisters suffer from rheumatoid arthritis."

Tanglou nodded, took the physical examination and started looking:

Vital signs:

Body temperature: 36.7°Hg; heart rate 90/min, Luqi, breathing: 24 times/min.

Oxygen saturation is 93% (non-oxygen absorption).

...

"Doctor Tang, the patient has obvious difficulty speaking and breathing, but he is clear in consciousness. The heart examination significantly increased JVP (+ 6 cm), and the respiratory system examination was a distinct wet ralphus at the bottom of both lungs. The abdominal examination was normal. Concave edema was visible below the knees."

The assistant doctor continued to add.

Tanglou took another x-ray of the patient, showing a small amount of pleural effusion and pulmonary congestion on both sides.

“...Hb11.4, WCC 8.5, PLT 220, Na 131, K 6.4, Ur 35, Cr 220, HCO3 18.

The venous blood PH is 7.25.

The patient's previous examination showed that Cr was 80 at the last examination 5 months ago..."

"First question, what is it to ask the doctor to ask for a diagnosis and further examination of the patient?"

The first question to the Tanglou is naturally easy to get:

"Through vital signs and preliminary examinations, patients can be found to show symptoms and signs of excessive fluid, accompanied by hyponatremia, hyperkalemia and metabolic acidosis, which is obvious acute acoustic injury, also known as AKI."

“There are many definitions of AKI: Improve the global prognosis of kidney disease, namely KDIGO

Kidney?Disease: Improving Global Outes defines AKI as satisfying any of the following:

i.Sg/dl (≥26.5 umol/L) within 48 hours;

ii. SCr increases by ≥1.5 times baseline value, which is known or assumed to occur within the previous 7 days;

iii. Urine volume: 0.5ml/kg/h for 6 hours.

It is obvious that we can obtain from the physical examination that the patient's baseline ol/L is nearly 3 times the baseline level, which can diagnose AKI."

"above!"

The Tang Building looked at the assistant doctor with a graceful demeanor.

The young lady's mouth twitched, so it is natural that there is no problem to diagnose AKI, but most people will use classic domestic statements when referring to the definition of AKI.

The definition of KDIGO proposed by Tanglou is somewhat beyond the answers on the card in her hand.

"You wait..."

The assistant doctor ran out and picked up his cell phone to call his colleagues in the information room:

"Dongyaodongyao, I'm Dongguai. A large-scale show-off incident occurred in the examination room. I can't control it anymore and I need rescue in urgent need of rescue~"

"Speak human words!"

"...KDIGO definition, KDI...How do I know how to pronounce it...I want to know and ask you...oh...completely correct?...Okay..."

After several minutes, the assistant doctor ran back with a dark face. Looking at the harmless smiling faces of the people and animals in the Tang Building, he became more and more sure that this guy did it on purpose!

The definition of AKI proposed by Tanglou is more authoritative and rigorous than the classic domestic statements, but it is really rare.

Just like a normal person named Tanglou, he insisted on a Tang Kuobao (you know one, I will lose)!

Isn’t this a difficult nurse? I should be just a question-reading machine that can read the questions without learning and ignorance?

"Please continue to answer further examinations of patients."

The assistant doctor announced that the answer would continue without any sense of accomplishment.

Tanglou nodded and continued to start his super-syllabus answer. He really wanted to be low-key, but the task of total score of 90 was hanging. In order to get the full score, he had to answer all the things he knew.

The Tang Building is also very difficult, with delicate and trivial analysis:

There are three main types of disease-causing in AKI:

(i) Prerenal (i.e. hypoperfusion)

(ii) Renal (i.e., kidney itself lesions)

(iii) posterior renal (i.e. urinary tract obstruction).

The preliminary assessment should try to determine which causes AKI in patients.

Therefore, the first step of urine test is necessary and must be performed immediately, as it can help determine whether there is evidence of lesions in the kidney itself.

For example, tubular epithelial cells fall out in the urine during erythrocyte tubular type and glomerulonephritis, leukocyte tubular type and interstitial necrosis or acute tubular necrosis.

The second key test is to determine whether there is obstruction by renal ultrasound. During obstruction, hydronephrosis or ureteral hydronephrosis can be seen by ultrasound.

...

I was afraid of missing one, just like when I was answering questions in the liberal arts, I would never give up until I wrote the answer columns.

Tanglou continued to add carefully and rigorously:

"On this basis, further examinations, such as serological testing of glomerulonephritis, can be performed."

I recalled again and there should be nothing missing, and the Tang Building stopped.

The assistant doctor licked his lips, which was simply a detailed explanation of the answer. In fact, it was enough to get a full mark as long as the urine test and kidney ultrasound judgment.

The assistant doctor suddenly missed Yang Ming's words of cherishing words, and said so much that he was sorry for the saliva consumed by Tanglou:

"The first question, the answer is completely correct. +4""

"The second question, please give a brief description of the initial treatment plan for HDU?"

The assistant doctor arbitrarily aggravated his pronunciation on the brief description, for fear that the poor students in the review room would be covered with a shadow.

...

...

In the review room, the directors were also amused and crying.

"Although Tanglou's answer is a bit exaggerated, the theoretical knowledge is indeed rare in this age group."

Diao Xiwen looked at Tanglou and looked at the second Li Yundi, as handsome as she liked to show off.

A good saying I love you, I have to say that the night is so beautiful tonight.

But it's really good.

Among the eliminated players in the back row, there were also many emotions.

"If I don't search Baidu, I can no longer understand the answer of the master."

"It turns out that there are four ways to write the word "Lu Xun", which is really not a joke. Next time I must put my waist on my face in front of the nurse's beautiful girl: Hey, have you heard of the four definitions of AKI?"

"Even if you grow up like Tanglou, there are eight colors of shit, the little girl listens with relish. You can only know the ten ways to open Porsches."

The companion next to him said disgusted.

“…”

"I wonder if Yang Ming's second question was missing, can Tanglou get full marks?"

"It's very likely. I think the Tang Building is a kind of strong stamina. After all, it's not enough to have no experience for the first time. The more you go back, the more you get better!"

"Full marks, full marks!"

Many players in the back row became the support team of Tanglou.

...

...

Tanglou's calm answer rang in the ward:

"The initial treatment of this patient by HDU should focus on two major complications caused by AKI - capacity and electrolyte problems."

"...About the capacity, a catheter should be inserted so that the urine volume is accurately measured and the fluid intake, output and balanced measurements should be recorded every hour..."

"This patient is clinically manifested as excessive volume load, and chest radiographs also support this. Therefore, diuretic treatment should be given to both relieve symptoms and observe the impact on urine volume. Intravenous injection of furosemide is the first choice diuretic..."

When the Tang Building was discussing diuretics, the rest of the simulated personnel in the ward also started to operate according to the Tang Building's treatment plan.

One of the young nurses took a needle of furosemide and was about to simulate a vein of the model.

"Wait a minute, there is something wrong with your dose!"
Chapter completed!