Chapter 276 Practice Medicine, Walk on Thin Ice! (5000 Chapters Plus More)

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

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

An Yanjun, who was in the main room, finally came out of the comfortable environment and began to compete with Tan Zhonglin for favor.

However, this kind of competition is obviously beneficial. The two sides compete for favor and love according to their abilities, and their enthusiasm for learning is much greater.

But in the end, An Yanjun, who is the principal, has a big advantage. After all, there are three little nurse maids who have the pump.

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

In case Tan Zhonglin took it away, it would be boring to fight back and forth.

At this time, Chen Cang suddenly found that the blessings of the people in Qi were not good, and the two were annoying... Chen Cang suddenly felt a little nostalgic for Qin Yue.

Do not speak or speak.

You can do it every now and then.

Blink big eyes.

Surgery is also a good mood.

Most importantly, it's still pleasing to the eye.

These two jealous old men, Chen Cang looked really upset...

...

...

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

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

He finally understood why so many high-ranking officials in ancient times died young, so tired!

During the day, you have to deal with all kinds of opportunities, and at night, you have to deal with all kinds of tasks...

Hey……

The number of patients in the National Day Hospital is much less, and the outpatient volume is less than half of the usual number.

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

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

Dr. Yan is a well-known emergency room shopkeeper. He is more pompous than Li Baoshan. He sways around with a thermos cup every day.

All in all, people's emergency department is the nursing department.

In the hospital, they don't want to care about such a person. They want to retire after two years. After all, there won't be any big problem with him.

Although Yan Ming is not very concerned about things, he is very wise to protect himself, which is also a skill in today's background.

Now, when any doctor is on the job, the first lesson the teacher teaches them is how to protect themselves.

Yao Zhiwen and Chen Cang came in in a batch. They are graduate students of the Department of Cardiology of Dongyang Medical University. Like Wang Qian and Qin Yue, they are staff members.

Yao Zhiwen has a relatively introverted personality and doesn't like to talk. He always smiles with you when he meets people. He looks like your shy big girl, and he is more simple and honest. It is unlucky for him to meet Yan Ming.

I was so busy all morning that I didn't rest my feet.

At about eleven o'clock, Yao Zhiwen hurriedly found Chen Cang, and said worriedly, "Doctor Chen, help me see a patient!"

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

Yao Zhiwen said as he walked: "The patient is a middle-aged man, 41 years old, who was sent by 120 who had chest pains. He fell into a coma not long after he arrived. The condition is very serious."

When Chen Cang heard Yao Zhiwen's words, he keenly caught several clues.

"Chest pain!"

"coma!"

Is it a heart attack?

This was Chen Cang's first feeling.

Yao Zhiwen continued: "Not long after the patient arrived in the emergency department, he began to have confusion and confusion. The patient was still awake when he was on the road with 120, but he just said that the chest was tight and the pain in the chest was unbearable. It was like acupuncture, but it was not relieved by nitroglycerin, and an electrocardiogram was normal."

Chen Cang was stunned for a moment, and quickly asked, "Did you get an electrocardiogram when you arrived at the emergency room?"

Yao Zhiwen nodded: "It's made up, and I also urgently checked troponin."

"I didn't see the appearance of acute myocardial infarction, and the blood was drawn to see that troponin was elevated."

Chen Cang frowned when he heard it. After entering the room, Yao Zhiwen quickly brought the electrocardiogram and handed it to Chen Cang: "Look."

Chen Cang took the ECG and found that the ECG did not show typical myocardial infarction, and the S-T was basically normal...

That's weird!

Yao Zhiwen: "I'm still worried about heart problems. I called the emergency department of cardiology just now, but I haven't come down yet. Dr. Yan... go up and ask!"

Chen Cang couldn't help but sneer...

Both of them knew that even if the ECG did not have a typical waveform, the patient could not rule out acute myocardial infarction.

When encountering a typical myocardial infarction, the electrocardiogram does have characteristic patterns of waveforms such as S-T, which is easy to understand, because normal myocardial cells will have electrical activity, while necrotic myocardial cells have no electrical activity. The mechanism of the electrocardiogram is that The waveform is displayed by catching such anomalies.

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

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

Chen Cang asked, "What's the medical history?"

Yao Zhiwen said: "The medical history given by the family members is basically reliable. There is a history of hypertension, hyperlipidemia, and fatty liver in the past. Therefore...the possibility of acute myocardial infarction cannot be ruled out."

Chen Cang snorted: "Do you suspect cardiogenic shock?"

Yao Zhiwen nodded!

While talking, the two had already arrived in the emergency room, and the patient was on ECG monitoring at this time.

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

On ECG monitoring: heart rate is 120 beats/min, a bit fast, blood pressure is 80/50mmHg, which is low... A normal person's blood pressure should be 90-140/60-90mmHg,

A blood pressure of 80/50 is low anyway, and a low blood pressure indicates that the patient is in shock.

All clues are still unclear.

Bad luck!

The patient usually has a history of high blood pressure, but at this time, the blood pressure is only 80/50. In this case, the blood pressure cannot satisfy the blood supply to the brain at all. To put it simply, the heart is like a water pump, which must pump blood throughout the body. Not enough pressure from the pump to hit the water on the head.

And the brain is very sensitive to ischemia and hypoxia. Once the blood supply and oxygen supply are reduced, it will be in a coma!

In order to quickly rule out myocardial infarction, Chen Cang performed an electrocardiogram for the patient again.

Chen Cang hesitated for a while: "I'm going to ask the family how the situation is."

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

Chen Cang asked, "When did the chest pain occur?"

His wife was obviously frightened, and her words were somewhat illogical: "He is usually fine, he just likes to drink, but...I...I can't remember how long he felt uncomfortable, it should be yesterday, I I didn't care, but today it's so serious that I can't walk, so I called 120 quickly, and I fell into a coma not long after I came to the emergency room."

As she spoke, she cried and cried, terrified.

Chen Cang sighed and understood, after all, a good-looking person suddenly passed out in a coma like this, and whoever changed it would be nervous.

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

Because myocardial infarction is fatal,

If it is diagnosed, it is necessary to race against time, and then send it for interventional treatment in time.

What is myocardial infarction?

It means that the blood vessels of the heart itself are blocked by the emboli formed, and the blood flow is blocked. The heart is actually a muscle tissue, and its movement all depends on the blood supply of the coronary arteries.

If the heart ischemia time is too long, the cardiomyocytes will gradually die. When there are enough necrotic cardiomyocytes, the heart will lose its strength. At this time, heart failure will occur, then shock, and finally death.

This process can be as fast as a few minutes!

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

So, 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.

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

Thinking of this, Chen Cang hurriedly said to Yao Zhiwen, "Have you done a physical examination?"

Yao Zhiwen shook his head: "I didn't have time!"

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

Press the button!

My stomach is a little tight...

This is not normal. When a normal person is lying down, his abdomen should be loose. No matter how hard your abdominal muscles are, your belly should be soft.

Moreover, this patient is already in a coma, why is his stomach hard? And it's tight!

This man is fat, obviously not abs...

Yao Zhiwen also suddenly discovered this situation, he touched it quickly, and was stunned!

"Muscle tension?"

Tension in the abdomen often indicates that there is inflammation in the abdominal cavity. The inflammation stimulates the peritoneum and causes the abdominal muscles to tighten, so it feels a little tight to the touch.

Could it be that the patient's myocardial infarction caused the abdominal tension?

At this time, the electrocardiogram result came out, the nurse handed it over, Chen Cang took it, and looked at it carefully, but still didn't see the typical myocardial infarction pattern.

Chen Cang couldn't help but ask his family, "How long has it been since the attack?"

His wife was in a daze: "How many hours? Three or four..."

Chen Cang looked at Yao Zhiwen: "It doesn't look like a myocardial infarction! It's been three or four hours. If it is really an acute myocardial infarction, there should be obvious changes in the electrocardiogram."

Chen Cang couldn't help but ask, "Have you had a chest X-ray or CT?"

Is there another reason for the chest pain?

Yao Zhiwen brought the film over, and when Chen Cang saw it, it was basically normal!

Is he weird?

what happened!

Chen Cang's brain twitched quickly, thinking about various possibilities.

Thinking came back to thinking, but Chen Cang didn't stop and kept checking the patient's abdomen, trying to find out more information.

Just when he routinely checked the patient's liver for percussion pain, when he percussion on the liver, he found that the patient's brows were suddenly wrinkled, showing a painful expression.

This time, Chen Cang was shocked!

You are a comatose patient showing a painful expression, what does this mean?

There is only one possibility!

That is, Chen Cang really hurt him!

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

Even when a person is in a coma, he can feel severe pain.

A normal person with percussion pain in the liver area will not have any reaction unless he has a disease of the hepatobiliary system!

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

Seeing the man's painful expression, the wife thought he was awake, so she slapped and slapped his ear and called out his name loudly, but there was no response at all.

In order to further verify the idea, Chen Cang placed 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 in the patient. Because the gallbladder is under Chen Cang's thumb.

really!

When the left thumb was pressed down deeply, the patient's brows frowned even more and became a ball!

Chen Cang took a long breath.

It is true that the patient is in shock, but the patient is not in cardiogenic shock, but may be in septic shock.

Cardiogenic shock refers to the shock caused by the disease of the heart. 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.

Inflammation of the gallbladder and bile duct may also cause chest pain. Although it is rare, it is possible. In turn, myocardial infarction may cause abdominal pain instead of chest pain.

The human body is very complex, it is by no means a simple matter of getting sick wherever it hurts!

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

Chen Cang: "Give me the test sheet."

If you get the two wrong and you miss out on treatment, the patient could die.

After taking the patient's laboratory report and reading it carefully, the blood routine showed that the white blood cells were high, not too high.

However, myocardial infarction itself can lead to high white blood cells and infection, so it cannot be identified by blood routine alone.

Chen Cang looked at Yao Zhiwen: "Rehydration first! A lot of rehydration!"

Yao Zhiwen also understood what happened 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 add fluids at this time.

As long as the blood volume of the patient is increased and the blood pressure is increased, the blood supply and oxygen supply to each organ can be guaranteed. Otherwise, those organs with ischemia and hypoxia will starve to death one by one!

"Notify the B-ultrasound emergency consultation!" Chen Cang decisively ordered the doctor.

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

In order to be safe, Chen Cang performed a detailed physical examination on the patient again. There was not much abnormality in the auscultation of the heart and lungs, and there was no indication of heart failure and pulmonary edema by reading the chest X-ray again. Infarction performance, the patient is not really myocardial infarction! ! !

Chen Cang is basically certain!

For early diagnosis of myocardial infarction, the most objective method is to keep doing electrocardiogram.

The ECG is cheap, convenient, has no radiation, and can provide great value. It is really a rare good test.

The B-ultrasound room was nearby, and after a while they pushed the machine over.

Soon!

The inspection results are out.

As a result, Chen Cang and Yao Zhiwen were startled!

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

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

Once the common bile duct is blocked by the stone, the bile cannot be smoothly discharged from the digestive tract, and it will inevitably accumulate more and more, which will eventually lead to an increase in the pressure in the bile duct, and the bile will flow back into the blood. , severe cases may have shock.

Chen Cang directly took out the phone and called Zhang Youfu. Zhang Zhixin happened to be on duty, and he ran and jumped down!

Discuss with Mr. Bai from the ultrasound.

After comprehensive evaluation of the patient's condition, acute obstructive suppurative cholangitis and septic shock are clearly considered, and it is recommended to transfer to general surgery immediately, and perform bile duct decompression and drainage in a timely manner. Out, the condition will be significantly improved.

As for... the gallstone issue, we can discuss it later and cut it slowly.

After the patient was sent away, Yao Zhiwen was sweating profusely.

Chen Cang patted his back and found that he was covered in sweat.

There were hazy tears in Yao Zhiwen's eyes: "Chen Cang...you said...if I don't invite you...will he be gone?"

A sentence made Chen Cang asked dumbfounded.

Chen Cang sighed, not knowing what to say.

The diagnosis of the disease is too complicated, who can guarantee that he will be able to diagnose accurately?

Chen Cang has a plug-in, but he can't see through it at a glance. If he didn't touch it lightly, Chen Cang himself wouldn't be able to guarantee it...

Chen Cang looked at Yao Zhiwen, he couldn't blame him...

Diseases are ever-changing, and symptoms and auxiliary examinations between different diseases often overlap. If they are not carefully identified, it is very easy to make mistakes.

so.

Practitioners of medicine should be trembling and walking on thin ice!

And at this time, Dr. Yan came back... with a doctor from the Cardiology Department.

Chen Cang sighed and looked at Yao Zhiwen: "You are very good, at least you didn't run..."

Yao Zhiwen cried with laughter, really cried with laughter, tears streaming down.

"I really want to be a good doctor!"

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

What can I say other than comfort him at this time?

Yan Ming hurried over: "Xiao Yao, where is the person? Where did the patient go?"

Seeing Yao Zhiwen cry, Yan Ming shivered with fright: "Are they gone?"

Chen Cang sighed, shook his head, and returned to the emergency surgery.

ps: Thanks to Xiaoya for the reward, thank you!

Being a clinical doctor really needs to walk on thin ice. Before any young doctor grows into a real senior doctor, he needs to constantly exercise. I was in the clinic too. Overwhelmed.