Top-tier doctoral supervisor, reborn as a first-year graduate student in standardized residency trai

Chest pain, radiating pain in the back, and a difference in blood pressure between the two upper limbs.

Once these clues are connected, the true direction of the question gradually becomes clear.

Gu Lin didn't rush to write the final diagnosis; he first wrote three lines on the draft paper.

Acute coronary syndrome, aortic dissection, pulmonary embolism, and then a heavy horizontal line was drawn after aortic dissection.

When many people see ST segment changes, their first reaction is to think of "heart attack," but the real danger lies here.

If this is a dissection involving the coronary artery, rushing into anticoagulation and thrombolysis could result in the patient dying during the treatment process.

Five minutes later, Gu Lin stood in front of the reporting desk.

The teacher from the Science and Education Department glanced at the timer.

"start."

Gu Lin placed the medical records on the table, his tone calm.

"In this case, I first considered acute aortic syndrome, and aortic dissection must be ruled out first."

As soon as the words were spoken, the expressions of several contestants in the back row changed slightly, and some subconsciously looked down to reread the question.

ST segment changes, chest pain, and hypertension.

If you only glance at it at first glance, it is indeed easy to mistake it for an acute myocardial infarction.

Gu Lin continued:

There are three reasons.

"First, the pain radiates to the back."

"Secondly, there is a significant difference in blood pressure between the two upper limbs."

"Third, changes in the electrocardiogram cannot explain the entire condition in isolation, especially when the dissection involves the coronary artery, similar manifestations may also occur."

He didn't make his words complicated; every point was very clear.

On the judges' panel, the emergency room instructor sat up slightly.

Gu Lin continued:

"In terms of treatment, we cannot directly proceed with the routine anticoagulation and thrombolysis procedures for acute coronary syndrome."

"Blood pressure and heart rate should be monitored and controlled immediately, bedside ultrasound and aortic CTA should be performed, and cardiac or vascular surgery should be contacted if necessary."

"Simultaneously retain the differential diagnosis between acute coronary syndrome and pulmonary embolism."

"But until the aortic dissection is ruled out, any treatment that may increase the risk of bleeding should be approached with caution."

He finished speaking with one minute remaining.

The training room was quiet. The teacher from the Science and Education Department glanced down at the scoring sheet, then looked up.

"If the patient's troponin levels are elevated, would you still insist on ruling out aortic dissection as a priority?"

As soon as the question was raised, the people around him subconsciously looked at Gu Lin.

Gu Lin did not hesitate.

"persist in."

"Elevated troponin levels only indicate myocardial damage and cannot be directly equated with primary acute coronary artery occlusion."

"If the dissection involves the coronary artery ostium, it can also lead to myocardial damage."

"Therefore, the key is not a single indicator, but whether the medical history, physical signs, and examinations are consistent."

On the judges' panel, someone was writing something on a form.

The teachers from the Science and Education Department continued to ask follow-up questions.

"If the family demands immediate resuscitation for a heart attack, saying they can't wait for tests, how do you communicate with them?"

Gu Lin looked up and continued.

"I will tell the family that the patient does have a heart risk, but there is an even more dangerous possibility, which is an aortic tear."

"If this possibility is not ruled out, hastily using certain medications for treating myocardial infarction could drastically increase the risk of bleeding."

"So it's not about delaying treatment, but about avoiding pushing the patient into more dangerous situations."

As soon as those words were spoken, a doctor-patient communication teacher next to the judges looked up.

This answer not only demonstrates medical expertise but also shows a clear understanding of how to explain the risks to family members.

Many young doctors can articulate their case analyses beautifully, but become stiff when it comes to communication.

Gu Lin did not use technical jargon.

He translated the most critical risks into language that the family members could understand.

The first stop has ended.

When Gu Lin stepped down from the reporting platform, the gazes around him had changed.

Someone was looking at him with admiration in their eyes.

"His thinking is very solid. He wasn't misled by the electrocardiogram, and his communication and responses are also very strong. He truly deserves to be someone who can stand up for himself in hospital presentations."

Song Zhe sat in the viewing room, watching with great interest.

He originally came just to watch the fun, but as soon as the first round started, he felt a strange sense of pride, like his own child getting a perfect score on stage.

A surgical instructor standing nearby glanced at him.

"Is Gu Lin, the person in charge of your gastrointestinal surgery, like this all the time?"

Song Zhe stroked his chin and thought about it seriously.

"It's even more infuriating on a regular basis."

Upon hearing this, the other person paused for a moment.

Song Zhe sighed.

"Because after he answered, he didn't feel anything was wrong at all."

Surgical supervising physician: "..."

After the first round, the results were not announced immediately, and the selection process proceeded directly to the second stage, skills operation.

The procedures included cardiopulmonary resuscitation, simulated endotracheal intubation, surgical suturing, and puncture localization, with several procedures performed in rotation.

Gu Lin didn't act particularly flamboyant at this stop; he just did what he was supposed to do.

The movements were standard, the rhythm was stable, and there were almost no mistakes.

But the more it's like this, the more terrifying it seems to the judges.

Because he wasn't demonstrating skills, but rather performing a clinical task that had been repeated countless times.

When it was time for surgical suturing, several other contestants couldn't help but look over.

Gu Lin's hands were very steady; he controlled the needle insertion angle, stitch length, and thread tension extremely well.

There were no fancy moves, but every step was so clean that no one could find fault with it.

The surgical skills instructor in charge of scoring looked down at the model, remained silent for a moment, and then wrote down a score on the scoring sheet.

The young teacher next to him glanced at it, and his expression changed slightly.

Nearly perfect score.

After the skills training session ended, the atmosphere in the training room became noticeably tense.

Some people initially thought Gu Lin was only good at case analysis, but now they've discovered that his operational skills are also incredibly stable.

The third stop truly set the tone for the selection process.

The team simulated a rescue.

The teachers from the Science and Education Department divided the remaining people into several groups, and each group randomly drew a question to simulate the emergency rescue process on site.

In Gu Lin's group, besides himself, there was Zhao Qiming from the internal medicine base, Xu Ran from the anesthesia base, and Shen Qing from the obstetrics and gynecology base.

They are all top talents promoted from their respective bases.

Zhao Qiming is one of the most promising resident trainees at the internal medicine training base this year. He is quick to react, has strong operational skills, and his training results have always been among the top.

Before drawing the question, he glanced at Gu Lin.

"You'll be the team leader?"

Gu Lin looked at him. Zhao Qiming's tone wasn't exactly provocative, but it also didn't exactly show any respect.

"You have strong case analysis skills, but team rescue and individual reporting are different."

Gu Lin understood what he meant; he hadn't originally intended to compete with Zhao Qiming.

"You're from the internal medicine department; you're more suitable to be the team leader."

Zhao Qiming was stunned for a moment. He originally thought that Gu Lin would answer, since everyone was watching their group.

If Gu Lin wants to prove himself, seizing the team leader position is the most direct way.

But he didn't.

Gu Lin gave up the captain's position, and even did so in a very natural tone.

"I'm responsible for assessment and filling in the gaps."

Now it was Zhao Qiming's turn to fall silent.

Xu Ran, who was at the anesthesia center next door, glanced at Gu Lin with a hint of surprise in her eyes.

Outside the training room, several judges also noticed this scene.

The teacher from the Science and Education Department tapped the evaluation sheet lightly.

"He didn't try to take command."

The emergency room instructor's eyes were fixed on the screen.

"That's what makes team competitions so valuable."

"Being a team leader isn't unusual, but knowing when not to take advantage of others is very difficult."

The simulated rescue operation began quickly.

The question is now open.

"The patient, a 32-year-old female, experienced sudden onset of shortness of breath, chest tightness, restlessness, decreased blood pressure, and increased heart rate two hours after a cesarean section."

"No history of identifiable cardiopulmonary disease."

"Physical examination: Cyanosis of the lips, decreased oxygen saturation, cold and clammy extremities, the patient complained of tightness in the chest and a clear sense of impending death."

"After the attack, there is a brief period of confusion, but the patient can respond when called."

"Bedside reports indicate minimal vaginal bleeding, but slight oozing is visible in the incision dressing, and oozing continues even after pressure is applied to the venous puncture site."