Outside the ward where Qian Wenlong is located.

"The emergency department is really good at income. This time I received a drink and had a harpoon stuck, and then the new g was positive." Sun Jun joked before entering the ward.

Emergency patients have always been sent to each other, without any repetition. The current isolation ward in the sixth ward can no longer be called severe isolation, but should be called "general ward".

The general ward is the inpatient department of the emergency department, and all patients are admitted. Now all major wards have become the back garden of the emergency department...

And you can't refuse it! Otherwise, you will have to receive ideological education from the leaders of the institute.

"Okay, they are all patients. The doctor's parents are all sent to you. Can you still return the goods?" Chen Riyuan smiled. Sun Jun was probably the most complaining doctor in the sixth wards.

However, Sun Jun just stood up and was angry about the emergency medical treatment system, not that he was unhappy in dealing with the patient.

Sun Jun: "I won't say anything anymore, I'd better go and see the unlucky guy who was stuck in the harpoon."

Hu Huan: "You open your mouth, how can you call the patient unlucky?"

Sun Jun laughed "hehe" and thought to himself that he was stuck by the harpoon, he was still unlucky.

...

Ma Dabo took the lead.

Perhaps Chen Riyuan felt that he had neglected the graduate student, so he took the patient and gave him a try.

Ma Dabo was also very satisfied.

I have been to Ward Six for so long and have not confiscated new patients.

Although he is a graduate student, he has always taken over old patients and dealt with them. New patients are always designated by Sun Jun or Chen Riyuan to Zhou Yewu.

A rare opportunity has come, but he is ready to show off his skills.

The past history has a history of "fatty liver" for 10 years. Four years ago, the patient had a history of abdominal colic for 1 day, which was relieved by itself, and had no treatment. There is no history of "hypertension, diabetes", no history of blood transfusion, no surgery, and injury. His personal history has been drinking for more than 10 years, equivalent to alcohol content of about 250g/day, smoking for more than 10 years, and 2 packs/day.

Physical examination: height 1.75m, weight 101kg, t     38.5℃, p    95 times/min, r22 times/min, bp120/84mmhg, clear spirit, no yellowing of the skin and sclera, no rash. The breathing sound of both lungs is clear, the heart is not big, the heart rhythm is uniform, and no pathological murmurs in each valve area of ​​the heart. Abdominal abdomen is bulging, soft touch, no tenderness in the entire abdomen, rebound pain, under the liver and ribs, under the xiphoid process, unsatisfied palpation, under the spleen and ribs, murphy’s sign (-), percussion pain in the liver area (-), mobility voice (-), intestinal rumbling sound 4 times/min.

Auxiliary examination: Admission examination: Blood routine: erythrocyte count: 4.93    ×10^12/l     ; Hemoglobin: 174    g/l, white blood cell count: 8.0    ×10^9/l, neutrophil 93.9%, plt    69    ×10^9/l, c-reactive protein (fast): 142.1   mg/l.esr   24   mm/h.

肝功能:alt    :60    u/l    ;    ast    :91    u/l    ;    ggt    :369    u/l    ;    akp    :71    u/l    ;    tbil    :59.6    umol/l    ;

dbil   :42.5    umol/l    ;    che   :8097    iu/l    ;    tba    :21.7    umol/l    ;    a   :40.0   ;    g   :28.8    g/l    .

Renal function:ur   :7.7    mmol/l     ;    cr   :85    umol/l;       ua   :615    umol/l    .

Immunoglobulin:igm:    1.55    g/l     ;    igg:    10.84    g/l     ;        3.04     g/l    ;    c3:   1.06     g/l    ;     c4:    0.29    g/l    .

Procalcitonin (pct): 68.95    ng/ml; fer:>2000    ng/ml; il6    :    108     pg/ml.

Virus full set (-); autoimmune series (-).

Chest ct: Increased texture of both lungs and interstitial changes. Elevated abdomen ct: fatty liver.

Clinical diagnosis: fever test

Diagnosis and treatment process: Diagnosis and treatment process: Based on the patient's admission status, the diagnosis is clear. After admission, the bilateral double-bottle blood culture examination is immediately improved to clarify the etiology.

At present, in addition to the traditional bacterial species identification methods, including macroscopic colony morphology observation; individual morphology observation of bacteria, that is, serotype identification through microscope observation; bacterial virility determination. The maldi-tof ms technology is also used to compare the mass map formed by maldi-tof analysis of microorganisms of different species through maldi-tof with the reference map in the database, so as to achieve the distinction and identification of target microbial species or strains. The essence of maldi-tof ms technology for microbial identification is to detect mass signals of biomarkers with genus, species or subtype specificity, mainly high abundance in microbial bacteria, expression of stable and evolutionarily conserved ribosomal proteins.

Both blood cultures on both sides of this patient were positive, and they were identified as the same bacteria.

The past history has a history of "fatty liver" for 10 years. Four years ago, the patient had a history of abdominal colic for 1 day, which was relieved by itself, and had no treatment. There is no history of "hypertension, diabetes", no history of blood transfusion, no surgery, and injury. His personal history has been drinking for more than 10 years, equivalent to alcohol content of about 250g/day, smoking for more than 10 years, and 2 packs/day.

Physical examination: height 1.75m, weight 101kg, t     38.5℃, p    95 times/min, r22 times/min, bp120/84mmhg, clear spirit, no yellowing of the skin and sclera, no rash. The breathing sound of both lungs is clear, the heart is not big, the heart rhythm is uniform, and no pathological murmurs in each valve area of ​​the heart. Abdominal abdomen is bulging, soft touch, no tenderness in the entire abdomen, rebound pain, under the liver and ribs, under the xiphoid process, unsatisfied palpation, under the spleen and ribs, murphy’s sign (-), percussion pain in the liver area (-), mobility voice (-), intestinal rumbling sound 4 times/min.

Auxiliary examination: Admission examination: Blood routine: erythrocyte count: 4.93    ×10^12/l     ; Hemoglobin: 174    g/l, white blood cell count: 8.0    ×10^9/l, neutrophil 93.9%, plt    69    ×10^9/l, c-reactive protein (fast): 142.1   mg/l.esr   24   mm/h.

肝功能:alt    :60    u/l    ;    ast    :91    u/l    ;    ggt    :369    u/l    ;    akp    :71    u/l    ;    tbil    :59.6    umol/l    ;

dbil   :42.5    umol/l    ;    che   :8097    iu/l    ;    tba    :21.7    umol/l    ;    a   :40.0   ;    g   :28.8    g/l    .

Renal function:ur   :7.7    mmol/l     ;    cr   :85    umol/l;       ua   :615    umol/l    .

Immunoglobulin:igm:    1.55    g/l     ;    igg:    10.84    g/l     ;        3.04     g/l    ;    c3:   1.06     g/l    ;     c4:    0.29    g/l    .

Procalcitonin (pct): 68.95    ng/ml; fer:>2000    ng/ml; il6    :    108     pg/ml.

Virus full set (-); autoimmune series (-).

Chest ct: Increased texture of both lungs and interstitial changes. Elevated abdomen ct: fatty liver.

Clinical diagnosis: fever test

Diagnosis and treatment process: Diagnosis and treatment process: Based on the patient's admission status, the diagnosis is clear. After admission, the bilateral double-bottle blood culture examination is immediately improved to clarify the etiology.

At present, in addition to the traditional bacterial species identification methods, including macroscopic colony morphology observation; individual morphology observation of bacteria, that is, serotype identification through microscope observation; bacterial virility determination. The maldi-tof ms technology is also used to compare the mass map formed by maldi-tof analysis of microorganisms of different species through maldi-tof with the reference map in the database, so as to achieve the distinction and identification of target microbial species or strains. The essence of maldi-tof ms technology for microbial identification is to detect mass signals of biomarkers with genus, species or subtype specificity, mainly high abundance in microbial bacteria, expression of stable and evolutionarily conserved ribosomal proteins.

Both blood cultures on both sides of this patient were positive, and they were identified as the same bacteria.

of     ms technology, the mass map formed by maldi-tof analysis of microorganisms of different species is compared with the reference map in the database, thereby achieving the distinction and identification of the target microbial species or strains. maldi-tof    ms technology is used for microbial identification
Chapter completed!