Chen Cang’s rules were very clear!
First, deduce the patient’s condition based on symptoms, signs, and other clues.
Then, use the current medical history and past history together to infer the possibilities!
Next, begin to verify your judgment through physiological and biochemical tests.
Chen Cang’s simple rescue procedure formed a framework of logical thinking for many regulatory trainees.
Chen Cang smiled, “This is clinical thinking!”
Everyone was startled.
Actually, for a doctor, the most important thing is the formation of clinical thinking.
At this moment, Xu Dongdong’s words made everyone even more curious.
Source: novgo.co“Yes! Teacher Chen, the serum electrolytes haven’t come back yet, how did you guess the value of the blood potassium? Was it based on experience?”“Right! Teacher Chen, you were so cool just now, how did you make that judgment? Do you have a secret trick?”
…
Seeing a group of students, Chen Cang smiled, “Of course, there’s a trick!”
On hearing this, everyone’s eyes lit up, and they quickly pulled out pens and paper—this was going to be “solid stuff”!
Actual solid stuff!
Chen Cang, seeing this, was also happy to share.
How does that saying go?
Right! Knowledge is not one’s own; one is merely a user and disseminator of knowledge.
The more people who have this knowledge, the more people can be saved.
“In fact, did you all notice that I just did an electrocardiogram (ECG)?”
Everyone nodded, “Mmm, we saw it, but… the ECG is just a waveform, what does that have to do with blood potassium?”
Chen Cang then said to Xiao Lin, “Xiao Lin, I printed an extra ECG just now, can you get it for me?”
Chen Cang had printed an extra ECG earlier for safety, and now it came in handy.
Xiao Lin hurriedly brought it over and handed it to Chen Cang.
Chen Cang took the ECG and said to everyone, “Don’t underestimate any test, whether it be a thermometer, sphygmomanometer, heart auscultation, or ECG, X-rays, and so on…”
“These tests can give us many clues!”
“Hyperkalemia and its ECG abnormalities are even a typical example. I hope everyone will remember what I am about to say!”
On hearing this, everyone quickly prepared their notebooks and pens, listening intently.
“When blood potassium levels rise, it increases the permeability of the cell membrane to potassium ions during the repolarization phase, making the slope of the action potential steeper and the duration shorter. The first ECG manifestations of high potassium are peaked T-waves and shortened QT intervals. So when I saw the ECG, I had already basically confirmed the patient had hyperkalemia.”
“As you all know, patients with hyperkalemia come and go in a hurry.”
At Chen Cang’s phrase “come and go in a hurry,” everyone laughed, but they all knew it was indeed the case—hyperkalemia could cause cardiac arrest at any moment, endangering the patient’s life!
Chen Cang continued, “Indeed, serum electrolyte testing is the gold standard for diagnosing hyperkalemia, but by the time the biochemical tests come back, one or two hours would have passed, and the patient could already be gone. What would I need this gold standard for then?”
“So, at that moment, if you suspect hyperkalemia, you must do an ECG. This is a little clinical tip!”
“Moreover, as the blood potassium level rises, different concentrations will present different manifestations. Start taking notes!” Chen Cang reminded them.
“When blood potassium is greater than 6.5 mmol/L, there is uniform widening of the QRS complex, which could result in ventricular conduction block;
When blood potassium exceeds 7.0 mmol/L, there may be a reduction in P-wave height and an increase in duration;
And when blood potassium is around 8.5 mmol/L, P waves can disappear, resulting in sinus-ventricular conduction.”
This was officially reported, and it could be used clinically, so Chen Cang spoke without hesitation.
If it had been just his personal experience, he would have spoken more conservatively.
After hearing this, everyone’s eyes sparkled as they fervently took notes.
Many pieces of knowledge only shine when combined with clinical practice.
At this moment, the Chen Cang they saw had his own halo effect!
They were all thirsty for knowledge.
How could they have imagined that different ECG patterns could reflect abnormal signals in human blood potassium levels?
This was something they could never have imagined.
Just like Chen Cang said, if you wait for the blood electrolyte results and the patient is already gone, you won’t even know why!
As a physician, one must continuously improve one’s skills.
These skills include diagnostic techniques, treatment techniques, surgical techniques, and the art of communicating with patients.
Life is full of lessons to be learned.
At this moment, a student couldn’t help but ask, “Teacher Chen, will a person die immediately if their blood potassium reaches 10?”
Chen Cang said, “As the blood potassium concentration further increases to 10 mmol/L, the QRS will broaden even more, may blend with the T wave into a sine-wave appearance, ultimately resulting in death from ventricular standstill or fibrillation.”
Having said that, Chen Cang looked at everyone.
“So, the most taboo thing in clinical practice is reliance on experience, especially in emergency situations. You must never use your habitual experience to treat others, and you should not casually advise or encourage others in daily life.”
“Without full knowledge of the patient’s condition, anything you say might be wrong, any advice you give could be lethal!”
Chen Cang took a deep breath, “If you had followed the routine for an electrolyte disorder just now, with vomiting and diarrhea, is it not just rehydration and electrolyte adjustment? Supplementation of sodium, potassium, calcium, iron, zinc, selenium, vitamins… If so, consider what state the patient would be in! Think about it for yourselves.”
“Medicine does not tolerate the slightest carelessness. In the two months in the emergency department, I’m not expecting you to learn too much, but there is one thing you must learn!”
“That is to be cautious and prudent.”
With that statement, all the attending trainees fell silent.
There are no shortages of such examples in life. A method that might work for oneself could be the direct cause of someone else’s death.
So!
The most appropriate advice might just be: go see a doctor!
Chen Cang smiled, “So, do you know what the difference is between a doctor and a butcher?”
The crowd was startled and looked up at Chen Cang.
Chen Cang said earnestly, “A doctor becomes more timid with more experience, while a butcher grows bolder!”
The remark was humorous, and the group couldn’t help but smirk upon hearing it.
But inside… they couldn’t laugh!
The more they smiled, the heavier they felt.
Chen Cang looked at everyone, stood up, and left, heading towards the office. He did not expect the group to remember everything, but there was one thing they must remember: when treating patients, always be:
Cautious!
Cautious!
Cautious!
At that moment, within the crowd, a man was sweating profusely!
He was terrified and dared not raise his head.
Thinking about his own show of bravado, he felt utterly childish…
What if he had managed the elderly patient on his own…
What would the result have been?
This was a living life, and he was just over 30 years old – if something went wrong, who could be held responsible?
Who would be accountable for the elderly patient!
Life only happens once?
Who would let you retry?
…
…
ps: What I want to convey with this story is that well-meant advice might not always be suitable for others.
So it is with diseases!
Is it not the same with life itself?
Without sufficient understanding of the disease, well-intended advice can lead to misdiagnosis or mistreatment.
Without sufficient awareness of another person’s circumstances, what can seemingly well-intentioned advice lead to?
Traditional Chinese medicine regards medicine as a path; in fact, in life and medicine, many things are shared. I hope this story provides everyone with a little food for thought.
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