My medical skills add experience

Chapter 273 Ignorant mother, Director Dai is a little flustered
Zhou Can had nothing to do, secretly thinking about the cause of this obese female patient?
There are many causes of sudden pauses in breathing during sleep.Such as genetic factors.

If people in the family have the disease, the chances of it being passed on to the offspring are very high.This kind of patients can usually be seen through inspection.For example, the tongue is huge, which is often referred to as the big tongue disease, the kind that stutters a bit when speaking.

This is the most typical genetic.

Almost all patients with large tongues are at risk for sleep apnea.Their tongues are hypertrophied and easily withdrawn to block their throats.

There are also micrognathia, uvula hypertrophy, turbinate hypertrophy, etc., all of which are at risk of apnea during sleep.

These people belong to the high-risk group of the disease.

Experienced doctors can come out by visual inspection.

In addition to genetic factors, there are also people who like to drink alcohol and smoke, and are also prone to this disease.

Excessive alcohol consumption can easily aggravate sleep apnea symptoms.

Some people lay on the ground after being drunk and left alone, and they were dead when they were found the next day.There is not just one such tragedy, but many.

The image of the obese female patient and her parents flashed in Zhou Can's mind one by one, and there was no obvious appearance defect.

The voice of their family is clear, and there is no such thing as macroglossia.

During the consultation just now, the parents of the female patient did not mention that other family members had this disease.

Then the family inheritance can basically be ruled out.

She has been smoking and drinking for a long time, and she doesn't look like that kind of woman.

Airway narrowing caused by obesity can basically be ruled out.Because she had already undergone surgery in this area, the family members made it clear that after the surgery, the patient's symptoms still existed.

This means that it is most likely not caused by narrowing of the airway.

Or her situation is very special, in addition to the cause of airway narrowing, there are other lesions.

What could be the cause?Endocrine disorders?

This possibility is really there, and the probability is quite high.

Metabolic disorders can also cause sudden pauses in breathing during sleep.

Zhou Can's diagnostic thinking is basically stuck in this place.In order to make a further diagnosis, she must wait for her to complete the bronchoscopy and enhanced CT before proceeding.

At this time, a woman who was seeing a doctor at the next table caught Zhou Can's attention.

The woman was holding a toddler who was only one or two years old and was telling doctors about the child's symptoms.

"Doctor, please help me. My son seems to have caught a cold for the past two days. He makes a strange sound when he breathes, as if something blocked his nose. And his forehead is a little hot."

The woman looks 23 or [-] years old, her dress is a bit old-fashioned, and her skin is relatively dull and rough.Anyone who dresses like this probably has poor family economic conditions.

And the cultural level is generally low.

The living conditions of this type of people are not good in themselves, plus they don't pay much attention to health, have low educational level, and have no concept of medical knowledge at all.There are even some people whose thinking is extremely stubborn and conservative.

If you are sick, you don’t seek treatment from a regular doctor, but you like to pray to God or Buddha, or you are superstitious about some local prescriptions and folk remedies.

If she was sick herself, that would be all right.

Anyway, no matter how much she tosses, the one who suffers is herself.

The most fearful thing is that the child is sick, and she will do the same.The ones who suffer are the children.

Zhou Can could tell at a glance that the child's face was turning cyanotic, indicating that he was already seriously ill.She only brought the child to see a doctor at this time, and she really has a big heart to be a mother.

The person sitting next to Zhou Can is Director Dai Shan of Tuya Pediatrics.

Her age is estimated to be around 41-[-] years old.

Short hair and ordinary looks make her look capable and ordinary.

Being able to become a chief physician at around 40 years old in Tuya Hospital is already a very young chief physician.

Although the deputy senior professional title is reviewed by the municipal competent department, the senior professional title is reviewed by the provincial competent department.It seems that it has little to do with the hospital, but in fact there are many subtleties in it!
The chief physicians of BR county-level tertiary hospitals and provincial-level tertiary hospitals seem to be judged by the province.

Levels can vary widely.

Take Tuya as an example. When recruiting doctors, he was stuck at the level of training and training, and the recruitment requirements were extremely demanding.Every winner is selected from tens of thousands of doctors through layers of competition.

The foundation itself is much stronger than Gui Peisheng in the county's third-level hospital.

In the later stage of training, county-level hospitals are even more incomparable.

Whether it is the level of teachers, or the hospital's scientific research, teaching, software and hardware, diagnosis flow, treatment experience of difficult and miscellaneous diseases, etc., provincial hospitals far surpass county-level hospitals in almost every aspect.

It is conceivable that there will be a big gap in the level of doctors at the same level between county-level hospitals and provincial-level hospitals.

But this kind of thing is not absolute.

Some county-level hospitals also have strong chief physicians.

Conversely, provincial tertiary hospitals also have general-level chief physicians.

In short, Dai Shan was able to be promoted to the chief physician of pediatrics at such a young age, and her strength must not be much worse.

Zhou Can had a little impression of the young female doctor sitting next to her.

Chen Jiaojiao, a student in Gui Pei who was in the same class as him.

This girl's grades in the regular training recruitment examination are extremely dazzling, and her surgical ability is also quite strong.

After nearly two years of regular training, their group of regular trainees has gradually begun to participate in formal diagnosis and treatment work.

Attending consultations with the chief physician is the prelude to practicing medicine independently.

Director Dai stared at the child carefully, without much expression on his face.

"How old is the child?"

"One year and seven months."

"Are you weaned?"

"I have been weaned a long time ago, and now the child eats with the adults."

Children from poor families seldom eat milk. They are basically weaned at about one year old, and then eat with adults.Many children from wealthy families in the city eat milk as their staple food until they are three years old.

There is another phenomenon that is also particularly interesting.

Urban female white-collar workers seldom breastfeed their children after giving birth.On the one hand, they have to work and cannot take care of their children at home.On the other hand, they pay great attention to their figure and shape, and worry that breastfeeding will cause problems such as sagging breasts and dryness, which will affect their appearance.

Therefore, they are more willing to spend thousands of yuan a month to buy milk to feed their children.

Until recent years, there have been problems with milk on the market, coupled with scientific studies showing that breastfed babies are healthier and smarter.More and more female white-collar workers in the city choose to breastfeed their children.

In addition, the extension of maternity leave also creates favorable conditions for female white-collar workers to breastfeed their children.

The child no longer drank breast milk, which meant that he had to rely on his own immunity to resist the virus after he got sick.

Zhou Can could faintly hear the child making a screaming sound when breathing.

It's like the strange sound made when blowing a pipe, or like a puppy barking.

"Oops, there must be inflammation in the child's throat, and it's probably acute."

From the child's cyanotic face and lips, it can be inferred that the child is likely to have a high fever at this time.There are also problems with breathing, and blood oxygen exchange may be severely deficient.

"Doctor Chen, take the child's temperature and do a physical examination."

Director Dai said to Chen Jiaojiao.

"Ok!"

Chen Jiaojiao, who was petite and sweet-looking, seemed particularly quiet.

Who would have thought that this seemingly delicate young girl was not only a graduate student of Imperial Medical University, but also possessed strong surgical skills?

She got up and walked to the sick child, smiled at the child, and said in an extremely gentle voice, "Be good, little friend, auntie will check you, don't cry!"

She skillfully clamped the thermometer to the sick child's armpit.

Then start to measure the key basic signs data such as heart rate, pulse, blood pressure and respiration for sick children.

It can be seen that the child's body is still quite strong.

The small arms and neck are all fleshy.

His face also looks chubby.

"Oh, his body temperature is as high as 41.3 degrees! It's scary!"

After a while, Chen Jiaojiao took out the thermometer and looked at it, her face paled and she exclaimed.

A body temperature above 39°C is considered hyperthermia.

The sick child's body temperature has reached 41.3 degrees, which is really scary.

This also shows that the child's immune system is frantically burning the energy stored in the body to resist the virus.

"I reckon his glottis is swollen, and pretty badly swollen."

Zhou Can couldn't help but said beside him.

Anyway, it's okay, why don't you see the director of pediatrics to diagnose this sick child.

When the sick child cries, his voice is hoarse, and there will be a slight barking sound every time he inhales.

"Doctor Zhou seems to be very good at pediatric diseases too!"

Chen Jiaojiao looked at Zhou Can.

She should have been following Zhou Can for a long time, but her personality is relatively shy and introverted, so she has no chance to talk to Zhou Can.

Even though the two sat between two adjacent consultation tables, they did not have any conversation during this period.

"Well, I'm only a three-legged cat, but I dare not say what I'm good at. The child's condition looks quite worrying, but it's true. If you can't get effective treatment as soon as possible, I'm afraid the condition will take a turn for the worse, and the prognosis will be very poor. Look at him Now the four concave signs have begun to appear."

Zhou Can is really not good at pediatric diseases.

The sick child has already had a fever like this, and even began to show four-concave signs when breathing, which means that the child's condition is rapidly deteriorating.

It was also the child's mother who was ignorant and failed to send the child to the hospital quickly when the child's condition just deteriorated.

Don't wait until it's so serious to come to see a doctor.

To put it bluntly, the child was about to die, so he came to see a doctor. It is hard to say whether the child will survive without mentioning the child's suffering.

The four-concave sign refers to inspiratory dyspnea. Because the gas is not easy to enter the lungs through the glottis during inhalation, the thoracoabdominal auxiliary respiratory muscles are compensatoryly strengthened to expand the chest to help breathing, but the lung lobes cannot respond. Therefore, the negative pressure in the thoracic cavity increases, causing the chest wall and its surrounding soft tissues, such as the suprasternal fossa, supraclavicular fossa, substernal fossa, substernal xiphoid process or upper abdomen, and intercostal spaces to be inwardly depressed during inhalation.

Once this symptom appears in the child, don't hesitate to send it to the doctor immediately.

When, like this sick child, his face turned cyanotic, it was already an early sign of respiratory failure, and his body began to lack oxygen.

"It's really serious." Chen Jiaojiao nodded in agreement with Zhou Can's point of view. "Director Dai, what do you think is going to happen next?"

When the child's mother heard that the two young doctors said that her child's condition was serious, she panicked.

He looked anxiously at Director Dai with anxious eyes.

In the face of terrible diseases, the only thing ordinary people can rely on is doctors.

"The high fever is so severe, and the four depressions appear again, so do a laryngoscopy immediately. If purulent secretions are found, you must take medicine immediately, otherwise, once the throat is blocked, he will definitely not be able to breathe."

Director Dai gave further diagnostic advice.

"Mother of the child, you should take the child to the hospital for diagnosis and treatment earlier! You have dragged the child's illness into this state. First prescribe a laryngoscopy for the child, and then decide on the next treatment plan. Do you think it is okay?"

Director Ju's words were critical of the child's mother.

"I... I didn't expect it to be so serious. The child has had a cold before, and he will be fine in two days! The child's father is not at home. I have three children, and I can't get away at all. It's today , I also asked my neighbors to help take care of the other two children, so I took him to the hospital for treatment."

The child's mother was already trembling when she spoke.

"Doctor, please treat my son as soon as possible! I finally gave birth to such a son after giving birth to the third child. He must be fine!"

It seems that this mother is not only ignorant, but also patriarchal.

Although the feudal ideology of son preference has been eliminated in many places, in reality, too many families want boys.Many people still think that girls will marry sooner or later to help others raise their children.

"First take the application form to pay the fee, and then quickly check the child. There are two main items, blood routine and laryngoscopy. Come to me as soon as you get the results."

Director Dai told the child's mother.

The disease of this sick child is not difficult to diagnose, because it is all on the bright side, and the symptoms and diseases are clear at a glance.

What's really hard is the treatment.

Given the current dangerous situation of the sick child, there is a risk that the respiratory tract will be blocked by viscous purulent secretions at any time.

……

About an hour later, a nurse hurried over.

"Director Dai, not long ago that sick child with high fever and difficulty breathing was in danger during the examination, please hurry over and have a look."

The nurse didn't say it clearly, probably because she was worried about the negative impact in front of many patients and their families.

"Girl, please take us there."

Director Dai's face changed slightly after hearing this, and he stood up and left.

Chen Jiaojiao followed closely behind.

It would not be a good thing if some patients died during the examination on the first day when the experts from Tuya Hospital went to Xinxiang Hospital to open an expert outpatient clinic.

"Doctor Zhou, what danger do you think happened to that child?" Deputy Director Shi next to him looked curious.

"It's really hard to say. The most likely situation is that the bronchus is blocked. Have you noticed that the child's face is cyanotic, indicating that the body is hypoxic. I suspect that the bronchi of the sick child had already been covered with thick pus at that time." Most of the sexual secretions are blocked. In addition, the throat is swollen, and the bronchial outlet is further squeezed, which will make it more difficult for the sick child to breathe."

Zhou Can replied worriedly.

The child is most likely to have a breathing problem.

In this case, if it is at home, most of the people will be gone.

In the hospital, as long as the doctor's level is slightly higher and the rescue experience is richer, generally nothing serious will happen.

At least in Zhou Can's opinion, if he treats this child, he will not die.

Director Dai took Chen Jiaojiao to the laryngoscopy and bronchoscopy examination room, and saw the sick child lying on the bed, his face turned purple from suffocation, and his expression was extremely painful.

He wanted to cry, but it was difficult for him to make a sound.

Director Dai has rich clinical experience in pediatrics. When he saw this situation, his heart skipped a beat, and his expression became extremely serious.

"Is the sick child's airway blocked?"

"Because the child was still young, he started shortness of breath not long after prying open his mouth to spray the anesthetic, which was extremely laborious. We immediately administered nebulization to him, but the effect was not obvious."

The laryngologist looked very calm.

The emergency rescue measures taken are also very appropriate.

The level of Xinxiang Maternity and Children's Hospital is not bad, and its comprehensive strength is also quite strong.Especially in the fields of gynecology, obstetrics, and pediatrics, which are the fields it is good at.

"Did he have a laryngoscope?"

Director Dai used a flashlight to shine a light on the child's mouth which was still opened by the pry board.The deciduous teeth have not yet grown in. At this moment, the sick child clenches his teeth tightly, and his tongue is a little stiff under the action of the anesthetic.

Breathing is almost undetectable, with less air in and out.

"About the throat, the sick child's throat is obviously red and swollen, accompanied by inflammation, and there is purulent sputum in the depths. He dare not go in deeper. His situation is very scary. Do you need an emergency tracheotomy? technique?"

With such a small child, tracheotomy is not only extremely harmful to the child, but also extremely risky.

Director Dai frowned, pondered for a few seconds, and asked, "Is your hospital confident in performing tracheotomy?" There is actually some discrimination in this statement, which will make the doctors and nurses of Xinxiang Women's and Children's Hospital unhappy.

But human life is at stake, and it's normal for Director Dai to be worried.

"The tracheotomy in our hospital should be fully competent in terms of technology and hardware conditions. The only worry is whether the rescue after tracheotomy can be carried out smoothly? The director of our hospital, Meng Chun, just went abroad for further training. He has no such experience. Those with rich experience in rescue, you are a pediatrician from Tuya Hospital, and you will perform the rescue after tracheotomy, is that okay?"

The laryngoscope doctor explained the real intention of inviting Director Dai to come over.

　Thank you book friends, Xiaoqian Feiyu for your support!

　　
　
(End of this chapter)