"What's going on?" Zheng Ren asked.
"There was a female student who fell down while going down the stairs." Su Yun had a slightly weird expression, but spoke quickly, "I came to the hospital for a check-up and found pneumonia in the right lower lung accompanied by a large amount of effusion in the right pleural cavity."
"At Fang Lin's side?" Zheng Ren asked.
Su Yun glanced at Zheng Ren while driving, and asked, "Did I tell you that you fell down when going down the stairs?"
“…”
"Craniocerebral injury, left temporal bone fracture accompanied by pneumatosis, traumatic shock, occipital... This is not important." Su Yundao, "Fang Lin went to the consultation and felt something was wrong. Give me a call for consultation."
"What did you think about it?"
"A large amount of pleural effusion, a 19-year-old girl, what would you consider?" Su Yun asked.
"Tuberculous pleurisy, the first impression is this." Zheng Rendao: "But if we consider that the fall also caused a fracture of the left temporal bone and traumatic shock, it cannot be ruled out that she fell due to shock."
"Shock, accompanied by a large amount of pleural effusion, that's what I thought too." Su Yundao said.
"Take a look and then talk." Zheng Ren pondered the patient's condition, and his hands unconsciously returned to the state they were in when watching movies.
"Boss, if you keep this state on the road, you will look very handsome, silly and handsome." Su Yundao said.
"Shock, pleural effusion... What if it doesn't matter? It's just a simple pleural effusion?" Zheng Ren ignored what he said and whispered to himself.
"If that were the case, it would be easy."
"By the way, Fang Lin saw the patient. What did he think about it?"
"The patient's left temporal bone fracture was accompanied by pneumatosis, but the patient's right calf had a large area of bruises. He felt it was a blood vessel embolism." Su Yundao.
"Well, Fang Lin is good." Zheng Ren said, "It should be uncommon for a chest department to consider blood clots at a glance. The patient may have pulmonary embolism... maybe... No, it should be pulmonary embolism!"
"Boss, pulmonary embolism is very common, okay!" Su Yun said disdainfully: "It's just that this patient's situation is quite special, so Fang Lin ordered an echocardiogram and called me for consultation."
"I think Fang Lin's diagnosis is well-founded." Zheng Ren outlined the patient's condition in his mind and said: "The strangest thing is that young students will have a large amount of pleural effusion, which is rare. Falls and coma are quite common.”
"Well, plus the bruises on his legs, I think Fang Lin's logical process is the same."
"Yes." Zheng Ren said, "It's okay. After the examination, we probably have a confirmed diagnosis before we return to the hospital. Maybe even thrombolytic drugs have been used..."
After saying that, Zheng Ren was startled.
Cerebral hemorrhage and thrombolysis are two completely different treatments.
If low-molecular-weight heparin sodium plus warfarin is used for thrombolytic treatment, will there be massive bleeding in left temporal bone fractures? Eventually leading to brain herniation
But if left untreated, blood clots alone can be fatal!
"When will the car arrive?" Zheng Ren asked.
"3 minutes."
"Tell Xiao Feng to go to the hospital quickly." Zheng Ren's tone immediately became anxious.
Su Yun was startled.
"Fang Lin, are you with the patient?"
"Call! Do the ultrasound immediately!" Zheng Ren spoke in a loud voice, "If you find any problem, immediately seek consultation from the entire hospital, including the vascular department and circulatory department."
"I think it may be pulmonary embolism, accompanied by syncope. The situation is very urgent. Anticoagulants cannot be used in large quantities and emergency thrombectomy is required." Zheng Rendao.
After everything that needed to be explained was done, Zheng Ren hung up the phone.
Su Yun also finished the call. Seeing Zheng Ren's anxious expression, he asked, "Boss, are you making a fuss?"
"Fang Lin's intuition is right!" Zheng Ren said firmly: "A fracture of the left temporal bone will hardly cause a large area of bruises on the right calf. It is caused by venous embolism in the lower limbs."
"So young..."
"Contraceptive pills may cause venous thrombosis of the lower limbs." Zheng Ren said: "Hurry up and go back. You and Fang Lin keep in touch."
As he said that, a car stopped not far from the roadside with double flashes, and at the same time, Su Yun's cell phone rang.
Su Yun glanced at the license plate number and walked over.
After getting in the car, Zheng Ren heard the "ding dong" mission reminder sound in his ears.
Urgent task: misdiagnosis.
Task content: Many times, people focus on the "major" diseases, especially bleeding. But the disease within is more serious and even fatal. Please rescue a patient with pulmonary embolism in time.
Task time: 3 hours.
Mission reward: 10,000 experience points and 1,000 skill points.
Uh... Zheng Ren hasn't seen a mission with such meager rewards for a long time.
However, the greatest significance of the emergence of this mission is that it confirms the guess just now. Whether Zheng Ren, Su Yun or Fang Lin's guesses were correct.
It's pulmonary embolism! Rather than temporal bone fracture complicated by pneumatosis.
So-called traumatic shock is also a wrong diagnosis. It was because of the occurrence of pulmonary embolism that the symptoms of shock appeared. Trauma, that's for later.
Various emboli in the systemic circulation break off and block the pulmonary artery and its branches, causing a clinical pathophysiological syndrome of pulmonary circulation disorder.
The most common pulmonary embolism is thrombus, and pulmonary embolism caused by thrombus is also called pulmonary thromboembolism.
Patients suddenly develop unexplained collapse, pale complexion, cold sweats, difficulty breathing, chest pain, cough, etc., as well as symptoms of cerebral hypoxia such as extreme anxiety, fatigue, nausea, convulsions, and coma.
Transient cerebral hypoxia leads to coma and falls.
A large amount of effusion in the right pleural cavity indicates blockage of the right pulmonary artery trunk, which is an acute pulmonary embolism.
The patient’s blood oxygen saturation is now…
Zheng Ren thought, he might as well enter the system space directly and click to purchase surgical training time.
The system operating room rose from the ground, and Zheng Ren went straight in.
The experimental subject lay on the operating table obediently and was diagnosed with pulmonary embolism, deep vein thrombosis of both lower limbs, etc.
Compared to pulmonary embolism, other diagnoses really don’t matter.
Zheng Ren took a look at the experimental subject's ECG monitor. The blood oxygen saturation was 85%, which was a very dangerous value.
Let's do the surgery. There was no other way. Zheng Ren took a deep breath and started the thrombectomy.
Generally speaking, after the deep vein thrombosis breaks off, it flows with the blood flow to the right atrium and then to the right ventricle, and then flows to the pulmonary artery, which will block the branches of the pulmonary artery or the larger pulmonary artery.
This is a form.
In addition, small emboli in the lower limbs continue to fall off, causing continuous embolism in the small pulmonary arteries, and eventually leading to large embolism.
Another reason is that the emboli formed in the right heart system break off and flow to the pulmonary artery, causing pulmonary embolism. For example, congenital heart disease causes the right atrium to enlarge, form thrombus, and fall off.
The patient in front of me suffered from deep vein thrombosis in the lower limbs.
Zheng Ren still has considerable confidence in thrombectomy.
However... After the thrombectomy catheter passed through the inferior vena cava and reached the right atrium and right ventricle, he was shocked.