"Doctor, is my wife's illness serious?" A middle-aged woman followed the physician out of the emergency room.
Zheng Ren was stunned when he heard someone speaking.
"It's serious!" the physician said with certainty: "The gastrointestinal tract is bleeding, and there is a faucet inside that is bleeding. Do you think it's serious?"
The emergency physician said, looking up and seeing Zheng Ren, he greeted: "Mr. Zheng, is the director okay?"
"It's okay." Zheng Ren smiled, "What patient?"
"Nausea, vomiting, low blood pressure, upper gastrointestinal bleeding is considered, and I am going to be admitted to the hospital."
This situation is relatively common. TIPS surgery is targeted at patients with portal hypertension, as well as ulcers, rupture and bleeding in the fundus of the stomach and intestinal mucosa.
If it were not for cirrhosis of the liver with portal hypertension and gastric varices and hematemesis, the bleeding artery would generally not be very large. Admission to the hospital would give gastrointestinal decompression and intravenous hemostatic drugs, which would be enough for 2-3 days.
"What's your blood pressure?" Zheng Ren asked casually.
"75/50mmhG." The emergency physician took the patient's family to write a hospitalization bill and left a piece of data for Zheng Ren.
Fortunately, although the blood pressure was in shock, it was not particularly low.
Zheng Ren took a look and saw a middle-aged man lying on the bed in the emergency room. His face was pale, and the value displayed on the ECG monitor...
Why is the blood oxygen saturation so low? There are also some problems with the waveform of the ECG oscilloscope.
Zheng Ren felt something was wrong and walked in to take a look.
The system panel was frighteningly red, and the diagnosis was like bleeding - massive pericardial effusion and aortic adventitial ulcer.
Uh... what kind of disease is this
Zheng Ren knew that the emergency medicine doctor’s diagnosis was wrong. As for why he made this mistake, he didn't think about it for the time being.
He immediately opened a drawer on the console, which contained a mercury sphygmomanometer and stethoscope.
Picking up the stethoscope, Zheng Ren began to auscultate the patient.
A large number of moist rales can be heard in both lungs, and the heart sounds are low and distant, which is undoubtedly the heart sound of pericardial tamponade.
Because he was a man, Zheng Ren did not check whether there were any "disguised" patients he encountered last time.
Cardiac tamponade is also divided into acute and chronic types. If it is traumatic, a large hole is broken in the heart, blood cannot flow out, and the blood accumulates in the pericardial cavity, it is acute cardiac tamponade.
Cardiac insufficiency and renal insufficiency may lead to fluid circulation disorders and chronic cardiac tamponade.
The occurrence of pericardial effusion and even cardiac tamponade is understandable. But aortic adventitial ulcer, what the hell is this diagnosis? how come
Ulcers can also occur in the aorta, which occurs when atherosclerotic plaques on the intima of the aorta rupture to form ulcers, which penetrate the internal elastic lamina.
However, the big pig's trotters showed aortic adventitial ulcer.
Have inflammation? Or something else
Just as he was thinking about it, the emergency medicine doctor came out after writing the admission form for hospitalization in the Department of Gastroenterology and asked him to escort the patient to the hospital.
When she saw Zheng Ren checking up in front of the bed, she asked, "Mr. Zheng, what's wrong?"
"Don't rush to the hospital first. Let's order a lung CT." Zheng Ren said: "What is the medical history?"
The emergency medicine doctor was stunned for a moment. It was clear that he was bleeding from the upper gastrointestinal tract. Why didn't Mr. Zheng admit him to the hospital and ordered a lung CT examination
"Male patient, 42 years old. He came to our hospital for treatment due to repeated nausea, vomiting and dyspnea for 3 hours." Although he had doubts, the emergency medicine doctor habitually reported the medical history.
The superior doctor's power is no joke, he has become accustomed to it.
"The patient suddenly developed dyspnea and slight chest tightness 3 hours ago, accompanied by nausea and vomiting many times. Each time, there was a small amount of stomach contents and a small amount of brown matter. There was no abdominal pain and it had nothing to do with the eating position. He had fecal incontinence and his stool was yellow and thin. Convenience."
"Nausea and vomiting? Brown color?" Zheng Ren asked.
"Well, the occult blood is positive. It is considered to be caused by upper gastrointestinal bleeding. Because there is no vomiting of blood, the bleeding should not be serious." The emergency medicine doctor said.
Zheng Ren pondered.
Something is very wrong.
Based on the medical history, the emergency physician's diagnosis was correct.
Nausea, vomiting, and the vomited items were sent for examination, and there was positive occult blood, indicating upper gastrointestinal bleeding. It's all logical and there's nothing wrong with it.
But why is it difficult to breathe
Seeing Zheng Ren looking at the patient in a daze, the emergency medicine doctor whispered: "Mr. Zheng, hurry up and send him to the gastroenterology department. If the bleeding can't be stopped, he needs to be rescued or something like that."
Is it the emergency department? Once you have the diagnosis, you can send them wherever you need to go.
They are all doing rescue work in the emergency department, which is too busy.
There are dozens or dozens of emergency patients outside. If you encounter someone with a bad temper or a serious condition, you will just open your mouth and curse.
Even being beaten was not uncommon.
It is not uncommon for someone to be slapped in the face for rescue.
Zheng Ren shook his head and said, "Go get a lung CT, and I'll take the patient for examination."
The emergency physician didn't know why Zheng Ren insisted, and she didn't hesitate. The superior doctor said it, and she also gave her opinions. If he didn't listen, she would just follow the superior doctor's orders.
If the sky collapses, there will be senior doctors holding on to it, so what are you afraid of
"What kind of patient, boss." Su Yun finished dealing with the female student and returned to Zheng Ren.
"It's strange, listen to it." Zheng Ren gave the stethoscope to Su Yun.
"Huh? Weird?"
"According to the medical history, the patient was diagnosed with upper gastrointestinal bleeding. There is no doubt. However, there are problems with both lungs and pericardium during auscultation. I am going to take the patient to do a CT first."
Su Yun held the stethoscope doubtfully and began to auscultate.
In less than a minute, he raised his head with a solemn expression and said, "If there is a problem, hurry up and check it out."
After saying that, Su Yun asked again: "Upper gastrointestinal bleeding?"
"Nausea, vomiting, vomitus occult blood test positive."
"Mr. Zheng, the CT order has been ordered. Can you take it with you?" the emergency physician asked.
"Um."
The patient's family was a little confused. They had just told him to send him to the gastroenterology department for hospitalization. The doctor also described the condition as very serious, and he might die if he was a little later. Why do you need to check again now
"Doctor, what's going on?" the patient's family asked anxiously.
"Have you suffered any trauma recently?" Zheng Ren asked without explaining, while he and the accompanying examiner were busy carrying the patient onto the flat car.
"Recently? No." The patient's family member said: "I had an injury a few years ago, a fractured clavicle, and had surgery. Nothing happened recently, everything is normal."
Zheng Ren took a glance and saw that there was an old surgical scar on the left side of the patient's sternum, which happened a long time ago.
Strange, there is no trauma, where did the aortic adventitial ulcer come from
According to Big Pig Hoof's diagnosis, Zheng Ren began to think about it.
But no matter how you think about it, it's a dead end and there is no idea at all.
Zheng Ren and Su Yun pushed the flat cart, trotted all the way, and escorted the patient to the CT room.
It wasn't until the patient got on the bed and started the CT scan that he breathed a sigh of relief.