I can see the status bar

Chapter 298 Reasoning (special addition)

Chapter 298 Reasoning (special addition)
Sun Lien felt that all the things in front of his eyes were crumpled into a ball, and all kinds of colorful colors and shapes were twisted together, converging into a blur in front of his eyes.After about two seconds, the blur began to disappear, rapidly fading from the center of the field of vision to the surroundings.The scene that reappeared in front of Sun Li'en was similar to before, but it seemed to be more colorful.

"Are you okay?" Yuan Pingan, who was standing behind Sun Lien, sensed that something was wrong with Sun Lien in time. "uncomfortable?"

"It's all right." Sun Li'en shook his head, and found a reason to fool him, "I didn't stand firmly just now." After he fooled Yuan Ping'an's concern with very insincere prevarication words, he looked at the lying man again. Xia Hongyuan on the bed.

"Xia Hongyuan, male, 26 years old, left common iliac vein thrombosis (78.27.33), left lower extremity popliteal vein thrombosis (73.44.18), left pretibial blood blister (71.36.12), small intestinal ischemic necrosis (51.08.25 ) Stroke (05.34.55)." The status column is different, and each symptom is followed by a bracket.upgraded?This was Sun Lien's first reaction.Then he fell into serious confusion.

What the hell are these numbers?
Sun Lien was confused for five seconds.

Now is not the time to be in a daze!He brought his attention back to the symptom at hand.Didn't he still see a doctor when there were no numbers?Now that the status bar is still there, there is nothing to worry about.

"Should I contact the Imaging Department?" Seeing that Sun Li'en seemed to be fine, Yuan Pingan began to put forward his own suggestions. "Let them prepare, and take a head CT first?"

"Get in touch and arrange it as soon as possible." Sun Li'en had already seen this case of venous thrombosis in Chen Wen's case.He frowned, and while talking to Yuan Ping'an, he put on a mask, gloves and goggles, and then lifted the quilt covering Xia Hongyuan's lap - when he was admitted to the hospital, he was completely naked, which made him feel uncomfortable. Sun Li'en didn't want to use scissors to cut open his pants.

The blood blister on Xia Hongyuan's right tibia was displayed in front of Sun Lien and Yuan Pingan. After identifying it for a while, they looked at each other, "This does not seem to be caused by trauma." Yuan Pingan said, "Thrombocytopenic purpura? "

"There is no large area of ​​blood stasis, it may be vasculitis or tumor." Sun Lien frowned and replied, "Do a blood test and check the tumor markers." He paused, pretending to have just remembered , "Blood problems cannot be ruled out, and then check the clotting time." Sun Lien touched Xia Hongyuan's left foot, and the pulse of the artery was a little weak.

Venous thrombosis, the most likely cause of this state is the hypercoagulable state.In addition, the stroke is also likely to be due to blood clots, so this check is very important. "The pulsation of the dorsalis pedis artery is weakened, so do a color Doppler ultrasound to see the blood flow."

Yuan Pingan went to arrange the inspection, while Sun Lien walked into the small conference room.This small conference room has almost become a dedicated office for the treatment team. Both Xu Yourong and Yuan Ping'an brought their laptops from home.Although there is no way to directly connect to the hospital intranet to issue prescriptions through the laptop, at least it can be used to check the information.It is much more convenient than before.

"I thought you would be reluctant to leave." Xu Yourong raised an eyebrow at Sun Li'en, "Rachel said that Hu Jia's competitive level in games is very good, so she has found an opponent."

Sun Lien recalled Rachel's cheating method of unplugging the power. It is hard to believe that the two sides can be regarded as "matches of chess".But people said so, face is always given. "I don't quite understand the games they play. After studying for a long time, I don't know who is beating whom..."

"It's not important that you don't know, as long as you figure out what's wrong with this patient." Xu Yourong replied, "How is it? You've also met the patient and his family members, do you have any clues?"

"The patient has blood blisters. According to the family members' description, the blood blisters have appeared for more than three days. And this morning, he seems to have gastrointestinal symptoms." Sun Lien replied with a frown. He was a little worried that other routine examinations might delay the patient's brain. Stroke results check speed.After he finished speaking, he went out again, grabbed Yuan Ping'an and said, "After the blood is drawn, send it to the imaging department for a head CT, an abdominal CT... let's do the lower body, and take a look at the pelvic and abdominal cavity by the way." The condition of the leg."

After arranging the inspection content, Sun Lien hurried back to the small meeting room, and began to read the records of the patients before and after admission.

"This hyperalgesia is a bit strange." After reading the content several times, Sun Li'en said to Xu Yourong, "If it hurts to wear clothes all over his body, then why can he still stand on the plastic board? There are nerves in his feet, right? The weight is all on the feet, won't he have pain in his feet? Will the pain sensitivity only focus on other parts of the body?"

Xu Yourong pondered for a moment and replied, "I think...the key may not be contact."

There are many types of pain sensitivity, and most patients will have attacks due to different types of sensations.Some people can't stand the pressure, some can't stand the touch of a brush, and some people feel pain from heat or cold.And these tolerance differences are also reminding doctors that patients suffer from different diseases.

"You mean...the temperature?" Sun Lien immediately followed Xu Yourong's judgment, "The reason why he took off all his clothes was because the temperature made him hypersensitive to pain?"

"It's possible." Xu Yourong replied, "Hyperalgesia usually resolves on its own, and rarely persists. And when he woke up in the hospital, he was still in pain—in order for him to recover from hypothermia, It was actually heated.”

"So, at first I thought it might be burning mouth syndrome or erythematous extremity pain." Yuan Ping'an also walked in, and joined the conversation between the two without hesitation, "But the problem is, he feels pain. , not burning. Therefore, the burning mouth syndrome is ruled out. And his limbs do not have paroxysmal redness, swelling and heat pain - he took off all his clothes, indicating that the pain does not come from the limbs, but systemic. The color Doppler ultrasound results suggest that there is Popliteal vein thrombosis, the blood flow of the left common iliac is not very clear, but there is also a slow flow."

"I still think we should contact the pain department." Xu Yourong ignored Yuan Ping'an, but said seriously to Sun Lien, "The pain department should see more patients like this than the emergency department. At least they can give some advice."

"Just call Shennei and the dermatology department for a consultation." Yuan Pingan sat behind the desk and sighed, "Professor Liu is not in the hospital, he is rushing here from the academy."

Sun Li'en pondered for a while, but he didn't dare to take anticoagulant treatment casually - stroke is divided into two types: hemorrhagic and ischemic.If it is ischemic, anticoagulant and thrombolytic therapy is the right way, but in case of bleeding, anticoagulant therapy will directly kill Xia Hongyuan. "Don't rush to anticoagulation, wait until the results of blood coagulation and imaging tests come out. As for the consultation, wait for the results to come out - although we are a major emergency department, we can't use other departments as auxiliary departments. Even a little is used for diagnosis. It is not appropriate to call a consultation if there is no relevant information.”

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"Full aortic CTA?" The Imaging Department made preparations as quickly as possible, but when Xia Hongyuan delivered it, Sun Li'en asked for additional examinations.This made it a little difficult for the doctors in the imaging department. "It's not on the prescription."

"I'll have someone make it up now, you guys do it first." Sun Li'en was also a little helpless, who would have thought that the imaging department prepared so quickly, and he didn't even have time for Yuan Pingan to increase the inspection items. "This patient's situation is quite special, so I'm sorry to trouble you."

The doctor in the imaging department scratched his head, but said nothing.It's just that the contrast agent needs to be prepared, and it can only take effect after the contrast agent is injected into the patient's body. "I'm getting people ready now, but the CTA has to be done later."

Sun Li'en nodded, handed over to Xu Yourong who came with him, and hurried to the laboratory to urge the results - since he had nothing else to do, it would be good to harass Shi Yanquan to relieve the pressure.

"Brother, don't rush." ​​Shi Yan really showed a face that he didn't tire of bothering. "The routine blood test is very fast. What's the use of urging me on the coagulation time? Don't you need to compare the samples?!"

"I'm in a hurry to save people, so be quick!" Sun Lien knew that Shi Yan was not the one who did the coagulation time experiment, so he naturally felt no pressure when he urged him - anyway, he didn't have to worry about making mistakes in his busy schedule, "I've been doing it for so long, why? Still clumsy?"

Shi Yan cursed a few times, and then threw the blood test results on Sun Lien's face. "If you have nothing to do, read the report first, don't come to my place to urge your life!" After speaking, he turned his head and entered the laboratory.

The blood routine results were not a big problem, and the platelet count that Sun Lien was most worried about was still within the normal range.The white blood cell index is also normal, and it seems that there is no sign of infection.

Unlike an infection, the platelet count is normal.Sun Lien rubbed his chin, the prompt on the status bar is actually very direct.Xia Hongyuan's abdominal pain should be the result of necrosis of the small intestine, which may suggest that his stroke was ischemic, also known as cerebral infarction, which can also be matched with left common iliac vein thrombosis and popliteal vein thrombosis of the left lower extremity. .And if cerebral infarction is confirmed, then pain sensitivity can also be explained—brain damage does cause pain sensitivity.

But the question is, where do so many thrombi come from when the platelet count is normal?The status bar alone indicated two blood clots in the veins of the lower extremities, and cerebral infarction indicated that there was at least one small blood clot in the cerebral blood vessels.However, the blood running route of the veins of the lower extremities determines that deep vein thrombosis must first enter the heart, and then be pumped to the lungs for gas exchange.If there is a thrombus, Xia Hongyuan should have a pulmonary infarction first.

How do these clots skip the lungs and go straight to the brain?

Sun Li'en rubbed his head, and put the question aside.He has more important questions to answer -- what do those numbers that follow status mean?
 In order to celebrate the book friend Luohun · Lonely Soul (what a broken name...) successfully admitted to the School of Forensic Medicine of Southern Medical University, a new chapter is added to fulfill the promise.

  Once again, candidates admitted to Peking Union Medical College, Peking University School of Medicine, Shanghai Jiaotong University School of Medicine, West China School of Medicine, Sichuan University, and Southern Medical University can enter the group in exchange for an additional chapter with the photo of the admission notice.

  do what you say~
  
 
(End of this chapter)

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