This question sparked discussions from the expert group.

A thoracic surgeon expert slapped the table angrily, "This kind of question is a joke, how can people answer it!"

"That is, heparin was given in interventional surgery, and contrast agent was pushed, and then suddenly there was a sudden respiratory circulatory arrest during the operation. However, heparin had been used in previous medications, and the enhanced cta was also done, and the contrast agent was also taken. It was not considered as a drug.

Something is right."

"Who can accurately judge apart from the vascular surgery interventionist? If I guess, it might be a coma caused by touching the carotid sinus. But below also says that the patient's lungs are covered with wet sarcoma, and there may be problems with the heart.

"

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

In the opinion of experts, it is impossible for a regular doctor to answer such nonsense questions.

Not to mention doctors who do not have a professional certificate, this question is put into the chief physician's promotion examination, and probably few people can give the correct answer.

Zhou Tianbo sat in the corner and listened to the comments of the experts from the expert group. It was like a clueless consultation in the hospital. He felt it was interesting and his mind was a little confused.

On the Internet, Zhou Tianbo saw that the exercises of primary school students were so difficult that he could not solve them, but he never expected that the current practice doctor exam would be so difficult.

But the difficulty is beyond imagination, but that little guy Ji Xiang gave another perfect answer.

"Since someone can answer the full score, the question should be fine."

Suddenly, someone said.

The noise in the classroom suddenly became quiet.

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

"That's right, this question must be related to intervention and stent removal. I don't believe that regular training doctors can get into level 4 surgery."

"Yes! Generally, municipal-level tertiary hospitals do not have vascular departments, and even if they have carotid artery stents, they dare not get rid of them."

Other experts objected after a short period of silence.

"Wait a moment, I will consult with our hospital's vascular intervention expert." One person said.

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

Zhou Tianbo felt that it was not like a system problem, but because Ji Xiang was good at performing interventional surgery.

As time passed, what happened between Ji Xiang and Qin Chu and Qin Boss, Ling Tian, ​​and Zhou Tianbo heard about it.

Although I don’t believe it, Ji Xiang is now conducting scientific research on interventional partial nephrectomy in the Second Affiliated Hospital, and the amount of surgery is quite considerable.

Zhou Tianbo must have had something wrong with the surgery process, thinking to himself.

"Director Lu, just fight here so you can avoid reposting it back and forth."

"Stop messing around, let's listen together."

The man thought about it and felt it made sense, so he took out his cell phone and called.

"Director Zhongliang, I, Lao Lu." The man said, "Are you busy? I have something to consult a vascular expert."

Director Lu then told this question to Director Lu.

"We think there is something wrong with this question."

"Who asked this?" the person across the phone asked directly.

"What's wrong?"

"This is a practicing physician exam? In clinical practice, 99% of doctors can't answer it. Is the vocational medical exam so difficult now?" The experts on the other side were a little confused.

Director Lu said, "That's why I'm going to ask you. You know more about interventional surgery. What's wrong with it? Is it because I encountered a carotid sinus when I was removed from the stent, causing sudden respiratory circulatory arrest?"

"It has nothing to do with the surgery." The man opposite said.

"Director Tadara, you say it again, it has nothing to do with the surgery? It's impossible."

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

"!!!"

"!!!"

Everyone raised their ears, including Zhou Tianbo.

No

Maybe, absolutely impossible, it must be because there is something wrong with the surgery process, Zhou Tianbo's intuition told him.

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

"Pre-operative heparin shock anticoagulation is used to shock the patient, which causes allergic shock. The question said that the large amount of wet rosy in both lungs, etc., all prove this indirectly."

"It's impossible. The patient uses low molecular weight heparin in the neurology department and has no allergic reaction."

"Low-molecular heparin is low-molecular heparin, it is not heparin."

"…"

"…"

"…"

Most people were stunned.

A small number of people who know this also lament the sinister intentions of the questioner.

"Is there any difference?" Director Lu was puzzled.

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

"It sounds like a medicine, but in fact, after careful study, it is completely two medicines." The man opposite said.

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

Ordinary heparin is a kind of sulfate glucosamine extracted and refined from the pig intestinal mucosa or bovine lungs. It is a mixture with a molecular weight ranging from 3000 to 30000kd and an average molecular weight of about 15000kd.

Low molecular weight heparin includes low molecular weight sodium heparin, heparin calcium, enoxaparin sodium, treparin, dysalin, etc. It is a fragment of sulfate glucose amino acid after cleavage of common stem cells, with an average molecular weight range of 3000 to 8000kd."

"Secondly, the mechanisms of action of drugs are 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.

Inhibit activated coagulation factors such as ii, ix, x, xi and xii to prevent coagulation. Low molecular weight heparin mainly affects the activity of coagulation factor xa, and has little effect on thrombin and other coagulation factors."

"So using low molecular weight heparin is not allergic, which does not mean using heparin is not allergic."

"Although heparin rarely causes allergic reactions, and there is no need to take a skin test before the operation, but once it appears, it will be rescued, which is a headache. Stop the medication immediately after allergies in internal medicine. They don't see much. We used a large amount of it when we performed the surgery.

I've seen two similar patients in the past ten years or so."

"Uh..." Director Lu was stunned.

"And, even if it is a skin test, you will rarely find it. The amount of heparin we use to intervene in anticoagulation is large, so we can directly inject it into one tube to avoid thrombosis. Forget it, I won't talk too much, that's probably the reason."

"This question is just difficult. Not to mention Director Lu, you rarely have contact with heparin and low molecular weight heparin, but not many professors in our department can understand it."

"Is it so difficult to set questions for the vocational medical exam now? Give me a copy of the test paper, and I'm under my hands... Cough cough, I'll do it for them. I can't even find the questions for the vocational medical exam, and I'll still sing my beard all day long.

I am the best in the world, I will teach them a lesson! Hahaha."

Opposite the phone, Director Zhongliang laughed.

In the classroom, there was a quiet state, only awkward laughter was echoing.

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

This is not only difficult, but also difficult!

(End of this chapter)

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