Chapter 275

Since then, Tan Zhonglin has successfully joined Chen Cang's team and become Chen Cang's second auxiliary, referred to as the second room!

The addition of the second room made Chen Cang's auxiliary team a little more competitive.

An Yanjun of the main house finally came out of the comfortable environment and began to compete with Tan Zhonglin.

However, this kind of competition is obviously beneficial. Both sides compete for favor and love according to their abilities, and they have a lot of motivation to learn.

But after all, as the main room, an Yanjun has great advantages. After all, there are three little nurses and servant girls holding the pump.

After all, only by leaving Chen Cang can they compete fairly.

In case of being robbed by Tan Zhonglin, it will be meaningless to argue.

At this time, Chen Cang suddenly found that the happiness of the whole people was not good. They were annoyed... Chen Cang suddenly had some nostalgia for Qin Yue.

No words, no words.

It's good of you to shout occasionally.

Blink big eyes.

Surgery is also in a good mood.

The most important thing is still pleasing to the eye.

These two jealous old men, Chen Cang is really upset

……

……

October 1st finally arrived. Chen Cang's first class,

Although the emergency duty is busy like a war, at least it's not so annoying.

He finally understood why so many senior officials died young. He was too tired!

You have to manage everything every day during the day and at night

Hey

The number of patients in national day hospitals is much less, and the number of outpatients is less than half of that in normal days.

However, the emergency department will not be easy. In addition to Chen Cang and Wang Yong, the first-line surgical team has been busy all morning.

Dr. Yao in the internal medicine department is as busy as a dog, because Dr. Yan Mingyan is on duty with him today.

Doctor Yan is a well-known shopkeeper in the emergency department. He has more style than Li Baoshan. He swings with a thermos every day. When a patient comes, please consult him.

In a word, people's emergency department is a nursing department.

The hospital doesn't want to argue with such people. They want to retire for two years. After all, there won't be any big problems with him.

Although Yan Ming is not in charge, he is very good at protecting himself, which is also a skill in today's context.

Now, when any doctor is on duty, the first lesson taught by his teacher is how to protect himself.

Yao Zhiwen and Chen Cang are a group of graduate students in the Department of Cardiology of Dongyang Medical University. They are the same as Wang Qian and Qin Yue.

Yao Zhiwen is introverted and doesn't like to talk. He always smiles with you when he meets people. He looks like your shy girl. He is also simple and honest. It's bad luck for him to meet Yan Ming.

I was too busy to rest all morning.

At about 11 o'clock, Yao Zhiwen hurried to find Chen Cang and said with some worry: "Doctor Chen, help me see a patient!"

Chen Cang nodded and followed Yao Zhiwen to the rescue room.

Yao Zhiwen said as he walked, "the patient is a middle-aged man, 41 years old. He was sent by 120 for chest pain. He was in a coma not long after he came. The situation is very serious."

Hearing Yao Zhiwen's words, Chen Cang keenly caught several clues.

"Chest pain!"

"Coma!"

Is it a myocardial infarction?

This is Chen Cang's first feeling.

Yao Zhiwen continued: "shortly after the patient arrived at the emergency department, he began to have blurred consciousness and unconsciousness. 120 sent it and told doctor Che that when he was on the road, the patient was still awake. He just said that he had chest tightness and chest pain. Like a needle, he gave nitroglycerin and didn't relieve it. It was normal to do an ECG."

Chen Cang was stunned and hurriedly asked, "did you make up an ECG in the emergency?"

Yao Zhiwen nodded: "fill it, and urgently check troponin."

"I didn't see the pattern of acute myocardial infarction. Moreover, I saw that troponin was elevated after taking blood."

Chen Cang frowned. When he got to the room, Yao Zhiwen quickly took the ECG and handed it to Chen Cang: "look."

Chen Cang took the ECG and found that the ECG had no typical manifestations of myocardial infarction, and the S-T was basically normal

That's strange!

Yao Zhiwen: "I'm still worried about heart problems. I just called the cardiology department for urgent consultation. I haven't come down yet. Doctor Yan... Went up and invited me!"

Chen Cang couldn't help laughing

Both know that even if there is no typical waveform in ECG, patients still can not rule out the possibility of acute myocardial infarction.

When encountering a typical myocardial infarction, the ECG does have those characteristic patterns of waveforms such as S-T, which is easy to understand, because normal cardiomyocytes have electrical activity and necrotic cardiomyocytes have no electrical activity. The mechanism of ECG displays the waveform by capturing such abnormalities.

However, in the early stage of myocardial infarction, the myocardium may not be completely necrotic, and the ECG response still exists, that is, the ECG may not have typical manifestations.

In addition, troponin is mainly in cardiomyocytes, and its increase often suggests that cardiomyocytes are damaged.

Chen Cang asked, "what is your medical history?"

Yao Zhiwen said: "the family members' oral history is basically reliable. They have a history of hypertension, hyperlipidemia and fatty liver in the past. Therefore... We can't rule out the possibility of acute myocardial infarction."

Chen Cang said, "do you suspect it is cardiogenic shock?"

Yao Zhiwen nodded!

During the conversation, they have arrived in the rescue room, and the patient is under ECG monitoring at this time.

When Chen Cang first saw the patient, he didn't see any special face on his face, and he was in a coma. He was lying on the hospital bed without any movement.

ECG monitoring: the heart rate is 120 minutes, a little fast. The blood pressure is 8050mmhg, which is low... The blood pressure of normal people should be 90-14060-90mmhg,

The blood pressure of 8050 is low anyway. If the blood pressure is low, it indicates that the patient has shock.

All the clues are still unknown.

be fraught with grim possibilities!

The patient usually has a history of hypertension, but at this time, there is only 8050 blood pressure. In this case, the blood pressure can not meet the blood supply of the brain. To put it simply, the heart is like a water pump. It needs to beat the blood all over the body. At this time, the pressure provided by the water pump is not enough, so it is impossible to beat the water on the head.

The brain is very sensitive to ischemia and hypoxia. Once the blood and oxygen supply is reduced, it will be unconscious!

In order to quickly rule out myocardial infarction, Chen Cang gave the patient an ECG again.

Chen Cang hesitated: "I'll ask my family about it."

The patient's family is his wife with a foreign accent.

Chen Cang asked, "when did you have chest pain?"

His wife was obviously frightened and said something illogical: "he is usually very good. He just likes drinking, but... I... I can't remember how uncomfortable he was for a long time. It should be yesterday. I didn't care, but I couldn't walk today. I hurried to call 120 and went into the emergency room. It wasn't long before I fainted."

As she spoke, she cried, terrified.

Chen Cang sighed and understood that after all, a good man suddenly passed out in a coma. Whoever changed would be nervous.

Chen Cang understands her, but now is not the time to comfort.

Because myocardial infarction is fatal,

If diagnosed, we must race against time, and then send it to interventional therapy in time.

What is myocardial infarction?

The blood vessels of the heart itself are blocked by the formed embolus, and the blood flow is blocked. The heart is actually a muscle tissue, and its movement depends entirely on the blood supply of the coronary artery.

If the heart is ischemic for a long time, cardiomyocytes will gradually necrosis. When there are enough necrotic cardiomyocytes, the heart will have no strength. At this time, heart failure will occur, then shock and finally death.

The fastest process may only take a few minutes!

Therefore, once it is confirmed that it is myocardial infarction, the most effective treatment method is to open the blood vessels immediately, immediately, decisively and as soon as possible. Whether it is drug thrombolysis or interventional stent, the purpose is to open the blocked blood vessels and restore the heart blood flow.

Therefore, everything is imminent!

Chen Cang habitually put his hand on the patient, looked at the pupil and checked the reflex.

This is what a surgeon is used to doing.

When Chen Cang touched the patient's stomach with his other hand, Chen Cang was stunned!

Thinking of this, Chen Cang quickly said to Yao Zhiwen, "have you had a physical examination?"

Yao Zhiwen shook his head: "no time!"

Chen Cang shook his head and quickly lifted the patient's clothes.

Good press!

My stomach is a little tight

This is not normal. When a normal person lies flat, his abdomen should be relaxed. No matter how hard your abdominal muscles are, his stomach should be soft.

Moreover, the patient has been in a coma. Why is his stomach hard? And tight!

The man is fat, obviously not abdominal muscles

Yao Zhiwen also suddenly found this situation. He quickly touched it and was stunned!

"Muscle tension?"

Abdominal tension often indicates inflammation in the abdominal cavity. Inflammation stimulates the peritoneum, leading to the tightening of abdominal muscles, so you feel a little tight when you feel it.

Is the patient's myocardial infarction causing abdominal tension?

At this time, the ECG results came out. The nurse handed them over. Chen Cang took them over and looked at them carefully. He still didn't see the typical pattern of myocardial infarction.

Chen Cang couldn't help asking his family: "how long has it been since the attack?"

His wife said vaguely: "several hours? Three or four..."

Chen Cang looked at Yao Zhiwen: "it's not like myocardial infarction! It's been three or four hours. If it's really acute myocardial infarction, there should be obvious ECG changes."

Chen Cang couldn't help asking, "have you done chest film and CT?"

Is there another reason for chest pain?

Yao Zhiwen took the film and Chen Cang looked at it. It was basically normal!

Is that weird?

What the hell is going on!

Chen Cang's brain flew around quickly, thinking about all kinds of possibilities.

Thinking is thinking, but Chen Cang's hand doesn't stop. He has been checking the patient's abdomen, trying to find more information.

Just as he routinely gave the patient a percussion pain examination in the liver area, when he percussed the liver, he found that the patient suddenly frowned and showed a painful look.

This shocked Chen Cang!

You have a comatose patient with a painful expression. What does that mean?

There is only one possibility!

Chen Cang really hurt him!

Well, it's not nonsense, it's true!

Even when people are in a coma and encounter severe pain, they feel it.

Normal people will not have any reaction to percussion pain in the liver area unless they have diseases of the hepatobiliary system!

But also those acute inflammatory diseases, such as liver abscess, or cholecystitis, biliary colic and so on.

The wife saw that the man had a painful expression and thought he was awake. She clapped and beat in his ear and called his name loudly, but she didn't respond at all.

In order to further verify the idea, Chen Cang put his left palm flat on the lower part of the patient's right chest and pressed the gallbladder area with his left thumb. If the patient has gallbladder inflammation, such a deep pressure is bound to cause severe pain. Because the gallbladder is under Chen Cang's thumb.

Sure enough!

When the left thumb is pressed down deeply, the patient's eyebrows are even more wrinkled and twisted into a ball!

Chen Cang took a long breath.

Yes, the patient is in shock, but the patient is not cardiogenic shock, but may be septic shock.

Cardiogenic shock refers to the shock caused by heart disease. If it is myocardial infarction, intervention or thrombolysis should be done immediately.

However, if the gallbladder infection is severe and septic shock occurs, the treatment is completely different.

The inflammation of gallbladder and bile duct may also cause chest pain, although few, but it is possible. Conversely, myocardial infarction may also cause abdominal pain, not chest pain.

The human body is very complex, not simple. Where it hurts is where it gets sick!

At this time, the patient is likely to be a gallbladder system disease!

Chen Cang: "give me the test sheet."

If you make a mistake and miss the opportunity of treatment, the patient may die.

After receiving the patient's test report and reading it carefully, the blood routine showed that the leukocyte was on the high side, not too high.

However, myocardial infarction itself will lead to high leukocytes and infection, so it can not be identified by blood routine alone.

Chen Cang looked at Yao Zhiwen: "rehydrate first! Rehydrate a lot!"

Yao Zhiwen also understood something at this time: "you mean... Worried about septic shock?"

Chen Cang nodded!

In fact, whether it is cardiogenic shock or septic shock, it is correct to supplement fluid at this time.

As long as the patient's blood volume and blood pressure are increased, the blood and oxygen supply of various organs can be guaranteed. Otherwise, those organs with ischemia and hypoxia will starve one by one!

"Inform the B-ultrasound room for urgent consultation!" Chen cangguo broke the doctor's order.

The little nurse quickly picked up the phone and began to contact.

In order to be safe, Chen Cang did a detailed physical examination for the patient again. There were not too many abnormalities in cardiopulmonary auscultation. Reading the chest film again did not prompt the performance of heart failure and pulmonary edema. He pulled an ECG again. He still didn't see the typical performance of myocardial infarction. The patient is really not myocardial infarction!!!

Chen Cang is basically sure!

In order to diagnose myocardial infarction early, the most objective method is to keep doing ECG.

ECG is cheap and convenient, and there is no radiation. It can also provide great value. It is really a rare good examination.

B-ultrasound room is nearby. Soon they came with the machine.

Not long!

The results came out.

The result startled Chen Cang and Yao Zhiwen!

B-ultrasound showed that the gallbladder was obviously enlarged, the gallbladder and bile duct wall were thickened, there were many stones in the gallbladder, and the bile duct was obviously dilated!

All this shows that the patient's gallbladder and bile duct are inflamed, and it is likely to be acute obstructive suppurative cholangitis.

Once the stones block the common bile duct and the bile cannot be smoothly discharged from the digestive tract, it is bound to accumulate more and more, which will eventually lead to increased pressure in the bile duct, bile countercurrent into the blood, accompanied by bacteria into the blood, there will be obvious manifestations of sepsis, and severe cases may have shock.

Chen Cang directly took out the phone and called Zhang Youfu. Zhang Zhixin was on duty and ran down with leaps and bounds!

Discuss with Mr. Bai of B-ultrasound.

After a comprehensive evaluation of the patient's condition, it was clearly considered that acute obstructive suppurative cholangitis and septic shock should be transferred to general surgery immediately, and bile duct decompression and drainage should be performed in time. As long as the bile duct is cut open and the gushing bile flows out, the condition will be significantly improved.

As for... Gallstone, we can discuss it later and cut it slowly.

After the patient was sent away, Yao Zhiwen was sweating with fear.

Chen Cang patted him on the back and found that there was sweat behind him.

The dim tears in Yao Zhiwen's eyes: "Chen Cang... You said... If I don't invite you... Will he be gone?"

One sentence made Chen Cang look silly.

Chen Cang sighed and didn't know what to say.

The diagnosis of the disease is too complicated. Who can guarantee that he can make an accurate diagnosis?

Chen Cang has a plug-in, but he can't see it through at a glance. If he doesn't touch it gently, Chen Cang can't guarantee himself

Chen Cang looks at Yao Zhiwen. He can't be blamed

Diseases are ever-changing. Symptoms and auxiliary examinations of different diseases often cross. If they are not carefully identified, they are very easy to make mistakes.

So

Practitioners should be trembling and walking on thin ice!

At this time, doctor Yan came back... With the doctor of Cardiology.

Chen Cang sighed and looked at Yao Zhiwen: "you are excellent. At least you didn't run..."

Yao Zhiwen laughed and cried. He really laughed and cried, and his tears crackled down.

"I really want to be a good doctor!"

Chen Cang smiled: "you are already..."

What else can you say except to comfort him?

Yan Ming hurried over: "Xiao Yao, where are the people? Where are the patients?"

Looking at Yao Zhiwen crying, Yan Ming trembled: "people are gone?"

Chen Cang sighed, shook his head and went back to emergency surgery.

PS: thanks for Xiaoya's reward, thank you!

Being a clinical doctor really needs to walk on thin ice. Before any small doctor grows into a real senior doctor, he needs to exercise constantly. I was the same in clinic at the beginning. I was really at a loss when I met this kind of thing.