Chapter 1775: 1714 Professional Analysis

Diagnosis... what a bullshit diagnosis!

Zheng Ren looked at Su Yun on stage, and his mind began to recall the medical history he had mentioned earlier.

"Here are copies of other data materials and existing case files." Su Yun said with a smile: "Because things happened rather suddenly, this case discussion is just a rehearsal. The effect seems not bad, Chang Yue—do you think I'm handsome?"

Su Yun handed out the medical records one by one, and as he walked past Chang Yue, he asked.

"If you devoted half the time you spend showing off to surgery..." Chang Yue took the medical record and said only half a sentence.

"I kinda regret giving you the medical records." Su Yun paid no mind to Chang Yue's trash talk, smiling: "Because you basically can't understand them."

"Abdominal pain—what's hard about diagnosing it?" Chang Yue scoffed, adjusted his glasses, and began to carefully examine the medical records.

After Zheng Ren received the medical record, he also began to examine it.

Su Yun highlighted the key points; the information on the medical record was more detailed.

Nausea, vomiting, abdominal pain—no bacterial or viral infection—what should we consider?

His brows furrowed, and he referenced countless case reports from the literature he had read recently.

"How about it, Chang Yue? Share your thoughts." Su Yun waited a few minutes, seeing that everyone had almost finished reviewing the records, then said with a chuckle.

"Consider kidney stones." Chang Yue gave his answer: "Nausea, vomiting, left lower abdominal pain—these all fit the diagnostic criteria for kidney stones."

"What a wonderful diagnosis—I almost hate to dismiss this fairy-tale-like diagnosis." Su Yun said with a smile: "But this is the Medical Team's first case discussion, and Director Luo is present, so you still need to be serious."

Chang Yue rested his hand on his glasses, and sharp light flashed from his eyes.

The pain caused by kidney stones can be severe, and when the stone is located in certain positions, it can present similarly to acute abdominal pain.

When the stone causes obstruction and hydronephrosis, pyonephrosis may occur, and vomiting can be a prominent manifestation of severe kidney stones.

Several of the patient's manifestations point to this diagnosis; I guess you looked at the urinalysis. Inside, RBC ++ gave you a clear hint—this is due to kidney stones.

Chang Yue's hand stopped.

Su Yun spoke exactly like a tapeworm in his own gut—his diagnosis logic was entirely his own, without the slightest deviation.

If only this guy's mouth weren't so sharp and bitter, how nice that would be.

"Too bad, these are all wrong!" Su Yun laughed: "You definitely forgot that I specially mentioned menstruation—the red blood cells in the urine could be from menstrual blood, not from bleeding due to ureteral mucosal cell rupture caused by urinary tract stones."

"How do you know!" Chang Yue asked coldly.

"Doctor Chang, the patient's enhanced abdominal CT image—I think you didn't see it clearly. The stone is in the kidney, the ureter is smooth, so your diagnosis is 99.9% wrong." Su Yun blew a breath, his black hair fluttering in front of his forehead.

"The reason I didn't say 100% is to spare your pitiful self-esteem." Su Yun said contemptuously.

Zheng Ren was truly helpless; Su Yun, this sharp-tongued guy, has managed to stay alive without being beaten to death—it's practically a miracle.

"Yun Ge'er, there's something off with the ECG." Lao He, being somewhat decent, interrupted Su Yun's words at this moment, also suppressing Chang Yue's anger.

The medical record contained an ECG image, but Su Yun didn't list the ECG.

Some cardiac diseases manifest in the gastrointestinal tract with nausea and vomiting. Since Su Yun had previously ruled out all gastrointestinal diseases, Lao He immediately spotted the abnormality on the ECG.

The 12-lead ECG recorded during this visit showed supraventricular tachycardia; the ECG also showed prolonged RP interval.

After adenosine administration, the recorded rhythm strip showed termination of the supraventricular tachycardia.

After a ventricular ectopic beat and a brief atrial ectopic beat, the patient developed sinus tachycardia; a subsequent 12-lead ECG confirmed persistent sinus tachycardia.

This is the most likely, Lao He thought to himself.

He had to perform, he had to perform! As a senior anesthesiologist, Lao He was highly sensitive to cardiac and respiratory matters.

At a glance, he felt the ECG was off.

"No." Before Su Yun could speak, Zheng Ren suddenly shook his head and said: "The patient's rhythm strip shows tachycardia with narrowed QRS complexes, which is consistent with supraventricular tachycardia."

The patient's rhythm is regular, so atrial fibrillation and multifocal atrial tachycardia are unlikely. The patient had an abrupt onset of tachycardia, making sinus tachycardia unlikely.

Sinus tachycardia involves a gradual increase in heart rate, rather than a sudden jump to over 200 beats per minute.

Therefore I suspect the patient's regular rhythm supraventricular tachycardia is one of the following three types: atrioventricular nodal reentrant tachycardia; atrioventricular reciprocating tachycardia via retrograde conduction through an accessory pathway; or focal atrial tachycardia.

But regardless of which type, although the ECG changes after adenosine, the symptoms remain unchanged, so we temporarily do not consider abdominal pain caused by cardiac disease.

Zheng Ren lowered his head, and his clear, rigorous logical analysis overturned Lao He's diagnosis.

Su Yun chuckled; Lao He being able to think of this already counts as an experienced senior clinician.

But this is still not enough; the patient's condition is quite strange, and Su Yun so far only has a preliminary diagnosis.

He doesn't say it.

Don't say it out loud, or the boss will reject it—then the whole stage effect would be ruined, quite a buzzkill.

"Director Luo, do you have any considerations?" Su Yun softened his tone and asked Director Luo.

"The patient has taken oral opioid medication." Director Luo said calmly: "Opioid withdrawal can explain tachycardia, agitation, nausea, vomiting, and abdominal pain. However, the patient shows no sweating, yawning, goosebumps, or pupillary dilation—typical signs of opioid withdrawal."

"So, I currently suspect the patient has serotonin syndrome."

Su Yun smiled.

He was also considering serotonin syndrome.

Serotonin syndrome is a cluster of symptoms caused by taking serotonergic medication or combining serotonergic medication with a monoamine oxidase inhibitor.

Typical clinical cases are relatively rare.

Changes in mental state and behavior, such as mild mania, agitation, and alterations in motor system function.

Autonomic dysfunction causing fever, nausea, diarrhea, headache, tremor, flushing, sweating, tachycardia, tachypnea, blood pressure changes, pupillary dilation, etc.

The patient's various manifestations highly match serotonin syndrome.

After Director Luo's judgment, Su Yun's confidence surged. That boss, at most, would only think of this level.