Chapter 715: A Seemingly Simple Physical Examination

The patient's stomach was so tense and hard that it attracted Lu Chen's attention.

Abdominal tension often indicates inflammation in the abdominal cavity.

Inflammation stimulates the peritoneum, causing the abdominal muscles to tighten, so the stomach feels a little tight when touched.

Lu Chen muttered to himself, "Could it be that the patient's myocardial infarction caused the abdominal tension?"

This situation is rare!

At this time, the patient's electrocardiogram for reexamination also came out.

Lu Chen took it and looked through it carefully, but still did not see the typical myocardial infarction pattern.

At this time, it had been three or four hours since the patient had obvious chest pain.

If it was really an acute myocardial infarction, there should be obvious electrocardiogram changes.

However, this pattern is similar to the previous one!

"Could there be another cause for chest pain?" Lu Chen frowned.

In his mind, aortic dissection, pulmonary embolism, pneumothorax and other "chest pain" diseases that can endanger life in the short term flashed through his mind.

However, none of them are very similar!

Moreover, the emergency department has also conducted a preliminary investigation of such diseases.

Lu Chen's mind was working rapidly, thinking about various possibilities.

At the same time, his hands never stopped, and he was always checking the patient's abdomen, hoping to find more useful information.

Lu Chen performed liver percussion on the patient.

That is, clench your right fist and gently hammer the skin on the surface of the patient's liver.

Just like that, Lu Chen found that the patient's brows suddenly tensed and showed a very painful expression.

There is only one possibility for a comatose patient to suddenly show a painful expression.

That is, he was really hurt!

Normal people are not willing to have liver percussion pain, except for some acute inflammatory diseases, such as liver abscess, or cholecystitis, etc.

The patient's wife saw the patient's painful expression and thought he was awake, so she hurriedly called his name loudly beside him.

But there was no response at all.

…

At this time, the emergency doctor came back with a newly opened hospitalization certificate in his hand.

He said to the patient's wife: "Take the hospitalization certificate now and be admitted to the U ward!"

The patient's wife was about to take the hospitalization certificate, but was stopped by Lu Chen.

"Wait a minute!" Lu Chen said.

"Mr. Lu, what's wrong?" The emergency doctor looked at Lu Chen in confusion. Wasn't it him who asked him to get the hospitalization certificate?

Lu Chen looked at the patient lying on the bed and said in a deep voice: "The patient may not have acute myocardial infarction, but may have a gastrointestinal disease!"

"Ah?" The emergency doctor was slightly stunned, not knowing why Lu Chen said that.

At this time, in order to further verify his idea, Lu Chen placed his left palm on the lower right chest of the patient and pressed the gallbladder area with his left thumb. If the patient had gallbladder inflammation, then his deep pressure would inevitably cause severe pain to the patient.

Because the gallbladder is under Lu Chen's thumb.

Sure enough!

When Lu Chen pressed his left thumb deeply, the patient frowned even more, and even twisted his eyebrows into a ball!

Seeing this, Lu Chen took a long breath and slowly said to the emergency doctor beside him: "The patient is in shock, but it is not cardiogenic shock, but septic shock!"

The emergency doctor saw Lu Chen's physical examination and was surprised. He said loudly: "Are you talking about acute cholecystitis?"

Lu Chen nodded slightly, "Cholecystitis, cholangitis, these are not ruled out!"

Cardiogenic shock refers to shock caused by heart disease. If it is myocardial infarction, intervention or thrombolytic therapy should be performed immediately to restore blood supply to the myocardium, so as to save the shock.

But if the gallbladder is severely infected and septic shock occurs, the treatment is completely different.

Inflammation of the gallbladder and bile duct can also cause chest pain, although it is rare, but it is possible!

Conversely, myocardial infarction can also cause abdominal pain instead of chest pain.

If you make a mistake in the two and miss the best opportunity for treatment, the patient may really die.

……

"Do you have a bedside ultrasound machine in your emergency department?" Lu Chen turned to the emergency doctor.

"Yes!" The emergency department nodded immediately.

"Bring it here quickly. I'll do an abdominal ultrasound for the patient to see if there is a liver and gallbladder problem." Lu Chen said.

The emergency department doctor was a little surprised. Mr. Lu did the ultrasound himself?

He also did an abdominal ultrasound for liver and gallbladder?

This ultrasound machine is only used by one or two people in the emergency department.

However, he was just slightly stunned. Now is not the time to doubt these things.

He immediately ordered the trainee to push the ultrasound machine next door.

Lu Chen took advantage of this time to ask the nurse to replenish the patient with fluids.

In fact, whether it is cardiogenic shock or septic shock, it is good to replenish fluids at this time.

Only by increasing the patient's blood volume and blood pressure can the blood supply and oxygen supply of various organs be guaranteed.

Otherwise, various organs of the human body will die one by one due to ischemia and hypoxia!

In order to be foolproof, Lu Chen gave the patient a detailed physical examination again, and there were not many abnormalities in the heart and lungs.

He took another electrocardiogram, but still did not see the typical manifestations of myocardial infarction!

…

At this time, the trainee from the emergency department came over with an ultrasound machine.

Lu Chen immediately sat beside the patient's bed and applied coupling agent to the ultrasound probe.

All the movements were smooth and done in one go.

Abdominal ultrasound is still very simple. Lu Chen is now mainly looking at the gallbladder, bile duct, etc.

Under Lu Chen's operation, the image of the gallbladder soon appeared on the ultrasound screen.

"Oh my god, the gallbladder is so big!" The emergency doctor can't do ultrasound, but he can still identify it.

The B-ultrasound shows that the gallbladder is obviously enlarged, the walls of the gallbladder and bile duct are thickened, there are many stones in the gallbladder, and the bile duct is obviously dilated!

The result did not surprise Lu Chen. It was really a problem with the gallbladder and bile duct!

Lu Chen said in a deep voice: "The patient's gallbladder and bile duct are inflamed, and it is very likely to be acute obstructive suppurative cholangitis."

Once the stones block the common bile duct, bile cannot be discharged from the digestive tract smoothly, and it is bound to accumulate more and more.

Eventually, the pressure in the bile duct increases, bile flows back into the blood, and with bacteria entering the blood, obvious sepsis symptoms will occur, and severe cases may have shock!

"Hurry up and ask the hepatobiliary surgery department for consultation! Surgery as soon as possible!" Lu Chen immediately put away the ultrasound instrument and said to the emergency doctor next to him.

The emergency doctor also knew the urgency of the matter, and immediately instructed the nurse to make an emergency consultation call to the hepatobiliary surgery department. UＵReading www． uukａnsｈｕ.net

The surgeon came soon and confirmed the diagnosis of acute suppurative cholangitis. He was quickly pushed to the operating room for bile duct decompression and drainage.

As long as the bile duct is cut open and the gushing bile is allowed to flow out, the condition will be significantly improved. Later, surgery will be considered to completely solve the gallstone problem.

…

"Mr. Lu, thank you so much!"

After the emergency doctor thanked him repeatedly, Lu Chen left the emergency ward.

The system's gratitude value and upgrade completion rate rose again.

The emergency doctor looked at Lu Chen's back and sighed. This time, thanks to Mr. Lu!

The emergency department was too busy, and he didn't have time to give the patient a physical examination.

In fact, no matter how busy the doctor is, the necessary physical examination is still necessary!

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