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Chapter 255 A Little Troubled (Second Update)

Medical ethics is a very illusory thing.Generally speaking, once a doctor's actions are interpreted as "arrogant, arrogant, indifferent, and greedy", they will be directly labeled as "no medical ethics", and then they will be criticized by ordinary people.

And doctors basically don't use "no medical ethics" to comment on their peers.After all, something like morality should be placed deep in the heart to restrain oneself.Taking it out and throwing it at other people's faces all day long, even the best original intention will change the taste.

It was a misunderstanding that Chen Tianyang said that Sun Li'en had no medical ethics.And Zhou Jun said that Chen Tianyang has no medical ethics, this... probably counts as deliberate revenge.

Chen Tianyang, who was scolded, said angrily, "In order to guide Sun Lien to write that crap paper, I haven't had a good night's sleep for three days. I must sleep when I get on the plane! Which doctor starts to observe the surrounding passengers as soon as he boards the plane when he is idle? of?"

"Me." Zhou Jun pointed to himself, then lowered his head to touch the phone. "You don't even have the habit of observing signs, are you a surgeon?"

Emergency physicians are neither internal medicine nor surgery.Strictly speaking, they are probably closer to a mix of GP, Intensive Care Medicine, Anaesthesiology and Orthopedics.

Because of the diversity of work, emergency doctors can follow the trend of black surgeons or physicians.This is probably one of the few perks that emergency physicians can get from a day-to-day, hectic job.

The hacked Chen Tianyang was speechless, his rebuttal stuck in his throat and he couldn't get it up or down.After a while, Chen Tianyang let out a long breath and sighed, "There is a full-time flight attendant in the business class, and she may have observed the condition of the previous patient. Why don't you call and ask."

Zhou Jun took the phone away from his face, and said angrily at Chen Tianyang, "Keep down, I'm asking the flight attendant about the situation."

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The flight attendant's answer didn't help much, and the passengers she saw showed nothing unusual.No shaking, no coughing, no headache, no forcing myself to sit up straight - nothing, everything was normal.In fact, the most abnormal behavior in the entire business class was Chen Tianyang.He has obvious sleep apnea syndrome, and he can hear clearly in the cabin. After a deafening snore, he has to hold his breath for a long time before exhaling.The time of holding her breath was so long that the little flight attendant was very worried that Chen Tianyang might suffocate herself to death.

"Nothing useful." The ambulance had pulled onto the highway and was racing at top speed again.Zhou Jun sat aside, completely ignoring the shaking of the car body.He readjusted the inspiratory oxygen content on the ventilator, from pure oxygen in the previous emergency to 90% oxygen concentration, and then he made another call to go out. "Is it the imaging department? I'm Zhou Jun from the emergency department. We will send a critically ill patient to the hospital in about 8 minutes, leave a CT, and then invite Director Zhao Hua from the nuclear medicine department to watch the film."

Before developing pulmonary edema, the patient had no hypertension, infection, or forced sitting due to left heart failure.In other words, the sudden acute pulmonary edema of this patient had no symptoms about two hours ago.While the progression of acute pulmonary edema can be rapid, it is always preceded by signs.

Acute pulmonary edema due to other symptoms?Zhou Jun frowned, and asked Chen Tianyang, "Is there a loss of pressure in the plane?"

"Loss of pressure? What loss of pressure?" Chen Tianyang was at a loss when asked.

Zhou Jun sighed, and asked another question, "Did the breathing mask on the plane fall off? It is the breathing mask with a tube connected to it and a yellow plastic mask on it."

"It's fallen." Chen Tianyang nodded.

Zhou Jun's frown deepened, and the rapid loss of pressure at high altitude may cause severe pulmonary edema in some patients.This order of reasoning is in line with the patient's condition and Chen Tianyang's testimony.But Zhou Jun still felt that something might not be right.

He looked at Chen Tianyang, who was alive and kicking, and then asked, "When did the breathing mask on the plane fall off? Was it before the plane bumped and vibrated, or after the vibration? When the mask fell off, did the flight attendant tell you to wear a mask... He sighed, "Forget it, just sit down, and I'll make another call to ask."

Zhou Jun looked at Chen Tianyang and thought of a very crucial question.If the patient's acute pulmonary edema was caused by the loss of pressure at high altitude, why did Chen Tianyang seem to be fine?The patient was a middle-aged man in his 30s and almost 40 years old, and he seemed to have stronger physical fitness than Chen Tianyang, the fat white man.If he suffered from acute pulmonary edema due to high-altitude decompression, then Chen Tianyang should at least be in some physical discomfort.

However, considering that Chen Tianyang doesn't even know what it means to lose pressure, it is obvious that his testimony may not be reliable.Zhou Jun has seen in the news that sometimes, the oxygen masks on the plane may fall due to the violent vibration of the fuselage.The quickest way to determine whether a patient's acute pulmonary edema is caused by decompression is to ask the flight attendant.

"Did the oxygen mask fall after the plane shook violently, and there was no instruction from the cabin?" Zhou Jun got the answer he needed, but this answer did not reveal the root cause of the patient's acute pulmonary edema.It just makes an already clueless diagnosis a little more difficult.

Pulmonary edema not caused by decompression.

"We're at the hospital." While Zhou Jun was meditating, the ambulance had already rushed into the main road in the quiet area of ​​Ningyuan City with its siren on.About 400 meters away, the logo of Ningyuan Fourth Central Hospital shines brightly.

"The injured man, Anonymous, about 35 years old, is highly suspected of cervical vertebral fracture, unexplained acute pulmonary edema, unconsciousness, and a coma score of 9." Zhou Jun quickly conveyed his examination results and preliminary diagnosis to the doctor who picked up the car. "Send it to the CT room immediately, is Director Zhao here?"

"125 milliliters of 20% mannitol, hang up right away!" The doctor who came to pick up the car was Cao Yanhua. He asked the nurse to go back to the emergency room to get the medicine, and said to Zhou Jun, "The Imaging Department called just now, and Director Zhao has arrived."

Another advantage of ambulance transfer in your own hospital is that you don't have to rush to move the patient from the emergency transfer bed to the hospital gurney.The emergency team of the Fourth Central Hospital has left two ambulances as a backup force for dispatching by the corresponding 120 emergency center, so there is no need to worry about the bed pressing problem.

By the time a group of people rushed to the door of the Imaging Department pushing the emergency transport bed, Mannitol had already been hung beside the bed.A group of strong male nurses grabbed the sheet of the emergency transfer bed with their hands, and then gently moved the patient into the CT machine.

"Sweep the cervical spine, the chest cavity, and add another lumbar spine." Zhou Jun said the request quickly, and when the CT machine started to run, he suddenly added, "After the chest cavity is finished, don't rush to check the lumbar spine. Add a brain CT to see."

The CT results come out very quickly, and even Zhou Jun can tell that the patient has C5 and C6 cervical dislocations, and there are uneven cloudy shadows scattered in both lungs without Director Zhao Hua reading the films.These two points proved Zhou Jun's diagnosis of the patient's "cervical spine damage" and "acute pulmonary edema".However, the cause of acute pulmonary edema was still uncertain—chest CT confirmed that the patient had mild left ventricular hypertrophy, but the lungs had no signs of infection, and cardiogenic pulmonary edema and infectious pulmonary edema could be ruled out.

Zhou Jun's frown deepened. He already had a rough guess, but this guess still needs to be confirmed by the results of CT examination.

"Go ask Vice President Liu to come here." The brain CT scan is about to start, Zhou Jun turned to Cao Yanhua and said, "Please come here immediately, this patient may be a bit troublesome."

(End of this chapter)