Chapter 275: : Practice medicine, when walking on thin ice!

Since then, Tan Zhonglin successfully joined Chen Cang's team and became Chen Cang's second assistant, referred to as the second room!
The addition of the second house made Chen Cang's auxiliary team more competitive.
An Yanjun in the main room finally came out of the comfortable environment and began to compete with Tan Zhonglin.
However, this kind of competition is obviously beneficial. Both parties have their own strengths to compete for love and love, and they have a lot of energy to learn.
However, after all, An Yanjun, who is the main house, has a great advantage. After all, there are three young nurses holding the pump.
After all, Chen Cang can only compete fairly.
In the event of being snatched by Tan Zhonglin, it would be boring to scramble.
At this time, Chen Cang suddenly found that Qi Ren's happiness was not good. The two were annoying ... Cang Cang suddenly nostalgic for Qin Yue.
I do n’t speak, I do n’t speak.
Occasionally shouts that you can do it.
Blink big eyes.
Surgery also has a good mood.
The main thing is still pleasing to the eye.
The two old jealous old men, Chen Cang looked really upset ...
Uh ...
Uh ...
终于 October 1st finally arrived, Chen Cang's first-line class,
Although the emergency duty is as busy as fighting, it is not that annoying at least.
终于 He finally understood why so many ancient officials died early, so tired!
You have to manage every day during the day, and every day at night ...
Hey……
The number of patients in the National Day Hospital is much smaller, and the number of outpatients is less than one-half of the usual.
However, the emergency department will not be easy. In addition to Chen Cang and Wang Yong in the front-line class of surgery, the two were busy all morning.
Dr. Yao from the medical department was as busy as a dog, because Dr. Yan Mingyan was on duty with him today.
Doctor Yan Yan was a well-known shopkeeper in the emergency department. Compared with Li Baoshan, he was full of heads. He wore a thermos cup every day and came to the patient for consultation.
In short, the emergency department is a senior care department.
The hospital is not willing to care about this kind of person. He wants to retire after two years. After all, there will be no big problem with him.
Although Yan Yanming is not very in charge, he is very good at protecting himself. This is a skill in the current context.
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, they are a group of graduate students who came from Dongyang Medical University. They are the same as Wang Qian and Qin Yue. They are compiled.
Yao Zhiwen has a more introverted personality and does not like to talk. He usually smiles at you when he meets people. He looks just like your shy big girl, and he is also kind.
I was so busy that I didn't rest.
At about eleven o'clock, Yao Zhiwen hurriedly found 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, and sent 120 with chest pain. He was unconscious not long after he came. The situation is very serious."
Chen Cang heard Yao Zhiwen's words and keenly caught several clues.
"Chest pain!"
"Coma!"
Is it a myocardial infarction?
This is Chen Cang's first feeling.
Yao Zhiwen continued: "The patient's consciousness and consciousness began to appear shortly after the patient arrived in the emergency department. When I sent it to the doctor, I was sober when I was on the road, but said that the chest was tight and the chest pain was not good. Acupuncture is the same, but nitroglycerin is not relieved, and ECG is normal. "
Chen Cang suddenly asked, "Did you get an ECG at the emergency department?"
Yao Zhiwen nodded: "I made up and urgently checked troponin."
"I didn't see the appearance-like pattern of acute myocardial infarction, and blood was drawn to see that troponin was elevated."
When Chen Cang heard it, he frowned. After arriving in the room, Yao Zhiwen quickly took the ECG and handed it to Chen Cang: "Look."
沧 Cang Cang took the ECG and found that the ECG did not show typical myocardial infarction, and s-t was basically normal ...
This is weird!
Yao Zhiwen: "I'm still worried about heart problems. I just called the emergency department of cardiology, but I haven't come down yet. Doctor Yan ... went up to please!"
Cang Cang couldn't help but chuckled ...
Both know that even though the ECG does not have a typical waveform, patients still cannot rule out the possibility of acute myocardial infarction.
When encountering a typical myocardial infarction, the ECG does have the characteristic patterns of waveforms such as st, which is easy to understand, because normal myocardial cells have electrical activity, and necrotic myocardial cells have no electrical activity. Waveforms are displayed by capturing such anomalies.
However, when the myocardial infarction is early, the myocardium may not be completely necrotic, and the ECG response still exists, which means that the ECG may not have the typical performance.
In addition, troponin is mainly in myocardial cells, and its rise often indicates that myocardial cells are damaged.
Chen Cang asked, "What's the history?"
Yao Zhiwen said: "The oral history of the family members is basically reliable, and they have a history of hypertension, hyperlipidemia, and fatty liver. So ... the possibility of acute myocardial infarction cannot be ruled out."
Chen Cang said, "Do you suspect cardiogenic shock?"
Yao Zhiwen nodded!
The two have reached the rescue room while talking, and the patient is now on ECG monitoring.
When Chen Cang glanced at the patient for the first time, he did not see any special features on his face, and he was already in a coma. He was lying on the bed without any movement.
On ECG monitoring: heart rate 120 minutes, a little faster, blood pressure is 8050hg, low ... Normal blood pressure should be 90-14060-90hg,
The blood pressure of 8050 is low anyway, and the blood pressure is low, indicating that the patient has shock.
All clues are unknown.
There are so many evils!
The patient usually has a history of hypertension, and at this time the blood pressure is only 8050. In this case, the blood pressure cannot meet the blood supply of the brain at all. To put it simply, the heart is like a water pump. There is not enough pressure to hit the water on my head.
大脑 And the brain is very sensitive to ischemia and hypoxia. Once the blood and oxygen supply are reduced, you will be unconscious!
In order to quickly rule out myocardial infarction, Chen Cang made another ECG for the patient.
Chen Cang hesitated: "I'll ask my family what's going on."
The family member of the patient is his wife with a local accent.
Chen Cang asked, "When did you experience chest pain?"
His wife was obviously frightened, and his speech was a bit illogical: "He is usually good, he just likes to drink, but ... I ... I can't remember he's not comfortable for a while, it should be yesterday, I I didn't care, but today I ca n’t walk if it ’s serious. I hurried to 120 and came to the emergency department and was unconscious.

Talking, she cried as she spoke, terrified.
沧 Chen Cang sighed and understood, after all, a good person suddenly passed out in such a coma, and whoever changed, would be nervous.
Chen Cang understood her, but now was not the time to need comfort.
Because myocardial infarction is terrible,
If the diagnosis is confirmed, you must race against time and then send it in time for interventional treatment.
是 What is myocardial infarction?
Is the heart's own blood vessels blocked by the formation of emboli, blood flow is blocked, the heart is actually a muscle tissue, his movements are all dependent on the supply of coronary arteries.
If the heart ischemia 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 may take only a few minutes as soon as possible!
So once the myocardial infarction is confirmed, the most effective treatment 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.
So everything is imminent!
沧 Chen Cang habitually put his hand on the patient, looked at the pupil, and checked the reflex.
This is the operation that is customary as a surgeon.
When Cang Chen's other hand touched the patient's stomach, Chen Cang stopped!
Thinking of this, Chen Cang quickly said to Yao Zhiwen, "Have you performed a physical examination?"
Yao Zhiwen shook his head: "No time!"
Chen Cang shook his head and quickly lifted up the patient's clothes.
Press it with your hand!
My belly is a little tight ...
This is not normal. Normal people should relax their abdomen when lying down. No matter how hard your abdominal muscles are, your stomach should be soft.
And, this patient is already in a coma, why is his stomach hard? And tense!
男子 The man is fat, obviously not abdominal muscles ...
Yao Zhiwen suddenly found out about this situation, he touched it quickly, and suddenly hesitated!
"Tense muscles?"
Abdominal tension is often an indication of inflammation in the abdominal cavity. The inflammation stimulates the peritoneum and causes abdominal muscles to tighten, so the stomach feels a little tight.
Is the patient's myocardial infarction causing abdominal tension?
At this time, the ECG results came out, the nurse handed it over, Chen Cang took it, and looked carefully, still not seeing the typical pattern of myocardial infarction.
Chen Cang couldn't help asking his family members: "How long has it been since the outbreak?"
His wife stumbled: "How many hours have you been? Three or four ..."
Cang Chen 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 ECG changes."
沧 Cang Cang couldn't help asking: "I did a chest radiograph, did ct?"
Is there another cause of chest pain?
Yao Zhiwen brought the film over, Chen Cang saw it, basically normal!
How strange is this?
what happened!
Chen Cang's brain flew quickly, thinking about various possibilities.
Thinking and returning to thinking, but Chen Cang didn't stop, always examining the patient's abdomen, trying to find more information.
While he routinely examined the patients for pain in the liver area, when he tapped the liver, he found that the patient suddenly frowned and showed a painful expression.
I was shocked by Chen Cang!
痛苦 You show a painful expression in a coma patient, what does this mean?
There is only one possibility!
That's why Chen Cang really hurt him!
Huh, this is not nonsense, it is true!
Even when a person is in a coma, they feel severe pain.
And normal people's liver pain will not have any response, unless he has liver and gallbladder disease!
And also those acute inflammatory diseases, such as liver abscess, or cholecystitis, biliary colic and so on.
Seeing the man with an expression of pain, his wife thought that he was awake, and slammed and beat in his ear, calling out his name aloud, but there was no response at all.
进一步 In order to further verify the idea, Chen Cang's left palm was placed flat on the lower part of the right chest of the patient, and the gallbladder area was compressed with the thumb of the left hand. If the patient has gallbladder inflammation, such a deep pressure will inevitably cause severe pain in the patient. Because the gallbladder is under Chen Cang's thumb.
Sure enough!
患者 When the thumb of the left hand was pressed down deeply, the patient's brows frowned even more and twisted into a ball!
沧 Cang Cang breathed a long breath.
The patient is shocked, but the patient is not cardiogenic shock, but may be septic shock.
Cardiogenic shock refers to shock caused by heart disease. If it is a myocardial infarction, intervention or thrombolytic therapy should be performed immediately.
But if the gallbladder infection is severe and septic shock occurs, the treatment is completely different.
胆 Inflammation of the gallbladder and bile ducts may also cause chest pain, although it is rare, but it is possible. In turn, myocardial infarction may also cause abdominal pain instead of chest pain.
The human body is very complicated. It is by no means simple where it hurts or where it gets sick!
此时 At this point, the patient is likely to be a gallbladder disease!
Chen Cang: "Give me the test sheet."
If you make a mistake and miss the treatment, the patient may die.
After receiving the patient's test report, after reading it carefully, the blood routine indicates that the white blood cells are high, not too high.
However, myocardial infarction itself can lead to high white blood cells and infections, so it can not be identified by looking at blood routines alone.
Chen Cang looked at Yao Zhiwen: "Rehydration first! A lot of fluid replacement!"
Yao Zhiwen also understood what happened at this time: "You mean ... worried about septic shock?"
Cang Cang nodded!
In fact, whether it is cardiogenic shock or septic shock, fluid supplementation is correct at this time.
As long as the blood volume of the patient is raised and the blood pressure is raised, the blood supply and oxygen supply of each organ can be guaranteed, otherwise, the organs that are ischemic and hypoxic will starve to death one by one!
"Notify the emergency consultation of b-ultrasound!" Chen Cang decisively ordered the doctor.
The little nurse quickly picked up the phone and started practicing.
In order to be sure, Chen Cang performed a detailed physical examination on the patient again. There were not many abnormalities in cardiopulmonary auscultation. Reading the chest radiograph again did not indicate the symptoms of heart failure and pulmonary edema. After redrawing an electrocardiogram, he still did not see the typical heart muscle. Infarction manifestation, the patient really is not a myocardial infarction! !! !!
Cang Cang is basically sure!
If you want to diagnose myocardial infarction early, the most objective method is to do ECG continuously.
The ECG is cheap, convenient, and free of radiation. It can also provide great value, which is really a rare good check.
The 超 b ultrasound room is nearby, and after a while they push the machine over.
Not long!
The inspection results came out.
The result surprised Chen Cang and Yao Zhiwen!
B ultrasound saw the gallbladder significantly enlarged, the gallbladder, bile duct wall thickened, there are many stones in the gallbladder, and the bile duct is still significantly dilated!
一切 All this shows that the patient's gallbladder and bile ducts are inflamed, and they are likely to be acute obstructive suppurative cholangitis.
Once the stones block the common bile duct, bile cannot be smoothly discharged from the digestive tract, and it will inevitably accumulate, eventually leading to increased pressure in the bile duct, bile flowing back into the blood, accompanied by bacterial blood, and it will produce obvious sepsis. In severe cases, there may be shock.
沧 Cang Cang directly called Zhang Youfu, Zhang Zhixin was on duty, and ran down with a jump!
讨论 Discuss with teacher B-Bai.
The patient's condition was comprehensively evaluated, and acute obstructive suppurative cholangitis and septic shock were clearly considered. It is recommended to immediately switch to general surgery and promptly perform bile duct decompression and drainage. As long as the bile duct is opened, the bile flow is spurting. Come out, the condition will improve significantly.
As for the problem of gallstones, it will be fine to discuss it later.
After the patient was sent away, Yao Zhiwen was sweating with fear.
Chen Cang patted his back and found that all the sweat was behind him.
Yao Zhiwen's hazy tears in his eyes: "Cang Cang ... you said ... If I don't invite you ... Is he gone?"
A few words made Chen Cang's eyes dumbfounded.
沧 Chen Cang sighed, not knowing what to say.
Diagnosis of the disease is too complicated ~ EbookFREE.me ~ Who can guarantee that they can be accurately diagnosed?
Cang Cang has a plug-in, but it can't be seen through at a glance. If it is not a touch, Chen Cang himself cannot guarantee ...
Cang Cang looked at Yao Zhiwen, this can't blame him ...
Diseases can be ever-changing. Symptoms and auxiliary examinations between different diseases often overlap. If they are not carefully identified, they are very easy to make mistakes.
so.
Healers, be warriors, like walking on thin ice!
这个 At this time, Doctor Yan is back ... Doctor with heart medicine.
沧 Cang Cang sighed and looked at Yao Zhiwen: "You are excellent, at least you haven't run ..."
志 Yao Zhiwen laughed and cried, she really laughed and cried, and her tears burst down.
"I really want to be a good doctor!"
沧 Cang Chen smiled: "You are already ..."
What can he say besides comforting him?
Yanming hurriedly came over: "Xiao Yao, what about people? Where have the patients gone?"
I watched Yao Zhiwen cry and was frightened by Yan Ming: "Is anyone gone?"
Chen Cang sighed, shook his head, and returned to emergency surgery.
S: Thank Xiaoya for your reward, thank you! This chapter is a bit touchy, because I was crying at the time ... Hey, I followed the senior doctor at that time, if it was not the senior doctor, I really don't know what to do.
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