Doctor of Healing

Chapter 343 Review Paper

This question sparked a discussion in the expert group.

A thoracic surgery specialist slapped the table angrily, "This kind of question is just for fun, how can someone answer it!"

"That is, heparin was given during the interventional operation, and a contrast agent was injected, and then a sudden respiratory and circulatory arrest occurred during the operation. However, heparin was included in the previous medication, enhanced CTA was also done, and the contrast agent was also administered, regardless of the drug. thing."

"Other than the interventional vascular surgeon, who can accurately judge? If I guess, it may be a coma caused by touching the carotid sinus. But the following also said that the patient's lungs are full of moist rales, and the heart may also have problems. "

Everyone has different opinions, pointing the finger at this question, and they didn't even see the answer on the answer sheet to be reviewed.

In the eyes of the experts, it should be impossible for a regular training doctor to answer this kind of nonsense question.

Let alone doctors who have not yet obtained a license to practice, this question is placed in the chief physician's promotion exam, and it is estimated that few people can give the correct answer.

Zhou Tianbo was sitting in the corner, listening to the discussions of the expert reviewers. It was like a hospital-wide consultation with no clue. He found it interesting and confused at the same time.

Zhou Tianbo saw on the Internet that the elementary school students' exercises were so difficult that he could not solve them himself, but he never expected that the current medical license exam would be so difficult.

The difficulty was beyond imagination, but that little fellow Ji Xiang gave a perfect answer.

"Since someone can answer with full marks, there should be no problem with the questions."

Suddenly, someone said.

The noise in Xiaoshi's classroom suddenly fell silent.

"Who knows what's wrong with the computer system."

"That's right, this question must have something to do with intervention and stenting. I don't believe that Dr. Guipei can handle level 4 surgery."

"That's right! Most prefecture-level tertiary hospitals don't have vascular departments. Even if they do, carotid artery stents are not dared to be placed."

Other experts raised objections after a brief silence.

"Wait a minute, I'll consult the experts in vascular intervention in our hospital." One person said.

After he finished speaking, he stood up and wanted to go out to make a phone call.

Zhou Tianbo didn't think it was a problem with the system, but because Ji Xiang was good at interventional surgery.

A long time has passed, and what happened between Ji Xiang in Shanghai, Boss Qin Chuqin, and Ling Tian gradually spread, and Zhou Tianbo heard about it.

Although I don't really believe it, Ji Xiang is now doing interventional + partial nephrectomy research in the Second Affiliated Hospital, and the amount of surgery is quite considerable.

Something must have gone wrong during the operation, Zhou Tianbo thought to himself.

"Director Lu, just call here, so you don't have to repeat it back and forth."

"Don't worry about it, you turn it on and let's listen together."

The man thought about it, thought it made sense, took out his mobile phone and made a call.

"Director Zhongliang, I, Lao Lu." The man said, "Aren't you busy, I need to consult a vascular specialist."

Director Lu then told Director Lu about this question.

"We think there is a problem with this question."

"Who the hell asked this question?" The person on the other side of the phone asked directly.

"what happened?"

"Is this the exam for medical practitioners? In clinical practice, 99% of doctors can't answer the questions. Is the exam for professional medical practitioners so difficult now?" The expert on the opposite side didn't understand.

Director Lu said, "That's why I'm going to ask you for advice. You know more about interventional surgery. What went wrong? Did it touch the carotid sinus when the stent was removed, causing respiratory and circulatory arrest?"

"It has nothing to do with the operation," said the person opposite.

"Director Zhongliang, tell me again, it has nothing to do with surgery? Impossible."

"I guess the answer to this question...Let's put it this way, I have encountered two similar cases clinically."

"!!!"

"!!!"

Everyone pricked up their ears, including Zhou Tianbo.

Impossible, absolutely impossible, there must be something wrong with the operation, Zhou Tianbo's intuition told him.

"Director Zhongliang, what's going on?" Director Lu asked suspiciously.

"Heparin shock anticoagulation was used before the operation, and the patient was allergic to heparin, which led to anaphylactic shock. The question said that there were a lot of wet rales in both lungs, etc., which all proved this point."

"Impossible, the patient was treated with low molecular weight heparin in the Department of Neurology, and there was no allergic reaction."

"Low-molecular-weight heparin is low-molecular-weight heparin, it's not heparin."

"..."

"..."

"..."

Most people are stunned.

A small number of people who knew about this incident also lamented the sinister intentions of the person who wrote the question.

"Is there a difference?" Director Lu wondered.

He is not engaged in vascular surgery or intervention, so he only has a little understanding of the pharmacology of heparin, not profound.

"It sounds like one kind of medicine, but after careful study, it is completely two kinds of medicine." The person opposite said.

"First, the molecular weights of the two drugs are different.

Unfractionated heparin is a kind of glucosamine sulfate extracted and refined from pig intestinal mucosa or bovine lung.It is a mixture with a molecular weight range of 3000 to 30000KD and an average molecular weight of about 15000KD.

Low-molecular-weight heparins include low-molecular-weight heparin sodium, heparin calcium, enoxaparin sodium, dropparin, dalteparin, and the like.It is the glucosamine sulfate fragment after cleavage of ordinary dry protein, with an average molecular weight ranging from 3000 to 8000KD. "

"Secondly, the mechanism of action of the drug is different.

Heparin mainly binds to platelets through antithrombin III, inhibits the formation of thrombin on the surface of platelets, and inhibits the aggregation and release of platelets.

Anticoagulation by inhibiting activated coagulation factors such as II, IX, X, XI and XII.Low molecular weight heparin mainly affects the activity of coagulation factor Xa, but has little effect on thrombin and other coagulation factors. "

"So not allergic to low molecular weight heparin does not mean not allergic to heparin."

"Although heparin rarely causes allergic reactions, and there is no need for skin tests before surgery, once it occurs, it needs to be rescued, which is a headache. Immediately stop the medicine if there is an allergy to the medicine in internal medicine, and they don't see it often. We use a lot of it during surgery. I've seen two similar patients in the last decade or so."

"Uh..." Director Lu was stunned.

"Besides, even a skin test rarely finds out. We use a large amount of heparin for interventional anticoagulation, and we inject it directly into a tube to avoid thrombus aggregation. Forget it, don't talk too much, that's probably the reason."

"It's difficult to ask this question. Not to mention Director Lu, you rarely come into contact with heparin and low-molecular-weight heparin. Not many professors in our department can figure it out."

"Is it so difficult to come up with questions for the professional medical exam now? Give me a copy of the test paper, and my subordinates... cough cough cough, I will do it for them. I don't even know the questions of the professional medical exam, and I still blow my beard and stare all day long. Lao Tzu is number one in the world, teach them a lesson! Hahaha."

On the other side of the phone, Director Zhongliang laughed.

In the classroom, there was silence, only embarrassing laughter echoed.

This question seems to be a clinical case analysis, but in the end it turned into a pharmacological problem.

This is not only embarrassing, it is simply embarrassing!

(End of this chapter)