My medical skills add experience

Chapter 469 Airway Obstruction, All Diagnosed Correctly

After checking the house, he was somewhat worried about Director Tang Fei's current situation.

After getting into trouble, you should ask about the situation of the other party no matter what.

The relationship with Director Tang Fei is basically a superior-subordinate relationship, which can be regarded as a certain friendship, but the sister-sibling relationship with Director Xueyan is far from it.

Just in time for a good excuse to call.

He's about to head into the emergency operating room and start his day.You can ask how the child diagnosed yesterday is doing.

The phone call was made, and it was connected quickly.

Explain that the situation is fine.

"Director Tang, I'm sorry to disturb you so early!"

Zhou Can spoke first.

"What's the matter, I've already gone to work in the hospital." She seemed to be in a good mood.

Zhou Can took courage and asked tentatively, "I'm sorry for causing conflicts in your family yesterday! If you need my cooperation to clarify the misunderstanding, please speak up."

"Haha, I didn't expect to be careless yesterday, and the car overturned. The person who should apologize is me. Fortunately, after explaining clearly to my family, he didn't get angry anymore. He got up early this morning and made breakfast for him. I'm eating it!"

She also felt amused when she mentioned what happened yesterday.

Zhou Can also specially reminded her not to close the door, so as not to cause misunderstanding.It turned out to be so wicked, she was busy with work and forgot her wedding anniversary.Her husband came to the hospital to look for her with a gift, and happened to find that she and Zhou Can stayed in the office with the door closed for a long time.

"It's fine if there's nothing wrong. Has the patient been checked?"

Zhou Can was slightly relieved when he heard that everything was fine.

"Many departments were off work yesterday, so there is no way to arrange them. But I communicated with the family members, and they agreed to do those tests. It should be done this morning."

It was almost eight o'clock in the evening when Zhou Can came out of her office.

Most of the hospital's laboratory staff are off work.Capsule endoscopy department, as long as there are no special circumstances, generally requires an appointment in advance.

"Doctor Zhou, Doctor Zhou, there is an emergency patient over there, his face is purple!"

There are nurses looking for the superior doctor to direct the rescue, but it is not yet time to hand over the shift.The strongest doctor on duty is the attending level.

She saw Zhou Can on the phone by the window at the end of the corridor, and hurried to him for help.

"Okay, I'll go right now!"

After Zhou Can finished speaking, he explained to Director Tang Fei on the other end of the phone, "Director Tang, let's do this first. There are patients on my side who need to be rescued."

"you busy!"

The two ended the call.

The misunderstanding yesterday did not cause too much trouble to her marriage, so Zhou Can was relieved.

I followed the nurse towards the emergency hall, and soon saw an older patient lying on a movable flat bed.The two family members gathered around nervously.Dr. Xie is still on the night shift today, and the shift has not been handed over yet.

He's on the triage table.

At this moment, the patient fell into a coma, and Dr. Xie was working hard to give the patient cardiopulmonary resuscitation.

It's just that the patient's face is cyanotic with a little grayish white, which is a sign of a problem with blood oxygen exchange and the end of life.

Dr. Xie performed very professionally during the rescue. He pressed the chest with just the right intensity. After [-] compressions, he gave the patient artificial respiration.

When performing artificial respiration, Dr. Xie chose mouth-to-nose artificial respiration.

In this case, the patient's mouth is usually difficult to open, severe trauma, or in water, or the doctor's mouth is smaller than the patient's mouth.

In movies and TV dramas, the heroine often drowns, and the hero kisses the heroine's mouth to give artificial respiration.That's really what the plot needs, and it's not professional at all.

The correct approach should be mouth-to-nose artificial respiration.

Also, when a female doctor or female nurse encounters a patient who is suddenly unconscious on the road and needs to do cardiopulmonary resuscitation, the mouth of women is usually smaller than that of men.If they are mentally strong enough, they may choose mouth-to-nose artificial respiration.

Because if female doctors and nurses give artificial respiration to patients, their mouths are too small to completely seal the patient's mouth.When insufflated, air escapes from the unoccluded area and cannot enter the patient's lungs.

This situation belongs to invalid artificial respiration.

When blowing air into the patient's mouth, do not pinch the patient's nose. This kind of unprofessional rescue is generally for ordinary people.It is a common sense error.

"The patient seems to have a problem with the airway."

Zhou Can has rich rescue experience, and he can see that the patient's chest can see obvious ups and downs during artificial respiration.

It means that the inhaled gas has reached the lungs.

Help the patient complete the expansion of the lungs.

We all know that the breathing of the lungs is accomplished through the expansion and contraction of the alveoli.Intuitively, it can be understood that when the left and right lungs are inflated like balloons, they are inhaling.The contraction is getting smaller and it is venting.

The changes in the lungs can be seen very clearly when the mice are dissected.

As for the general teacher, don't even think about it.

The remains used for medical research are all human beings whose lives have ended. Using living people for medical research, only little devils are so cruel and anti-human.

Zhou Can stepped forward, tried to raise the patient's head at a greater angle, put his hand against the patient's chin, and lifted it up.

This is the most commonly used method of raising the head and cheeks.

The patient's teeth are clenched and the mouth is closed tightly.

He slightly squeezed the patient's mouth open, revealing a slit two or three centimeters wide, and then observed the situation inside the mouth.

"It turned out that the back of his tongue blocked the airway!"

At first, I thought it was choking caused by food getting stuck in the intake pipe while eating.

This situation often occurs when the patient has a mental disorder, and the pharyngeal muscles relax, causing the base of the tongue to fall backward, thereby blocking the airway.

Both the tongue and the epiglottis are connected to the mandible. At this time, just like Zhou Can, pushing the mandible upward can force the tongue and epiglottis to lift away from the back wall of the pharynx, and the patient's airway can be restored.

After Zhou Can's help, the patient's airway became unobstructed, the cyanosis on his face disappeared little by little, and he gradually returned to normal.

"How did he fall into a coma?"

The patient is now in a state of complete loss of consciousness.

This is also the main reason for the tongue base to fall back and block the airway.

"My dad has always had high blood pressure, and he loves to drink. The doctor told him not to drink, and we were very careful not to let him drink. He went out early this morning, bought a bottle of wine outside, and drank some. No After a while, slurred speech and inability to stand still appeared. We hurriedly sent the person over. The person was still awake and able to speak on the way, but he fell into a coma immediately afterwards."

The family members are a middle-aged couple in their 40s.

The answer should be the son.

The daughter-in-law stood by and didn't speak, but looked anxiously at the unconscious patient.

"Ms. Lu, have you measured his blood pressure?"

If you have high blood pressure, try not to drink alcohol, because no one knows what the result will be if you take a sip of alcohol.

Especially for such elderly people, the consequences are often serious.

"180 systolic, 120 diastolic."

Nurse Lu is an experienced nurse in the emergency department, and she often has strong professional predictability when rescuing patients.

She can figure out what kind of patients need to call a superior doctor for support.

"Quickly check the cardiovascular and cerebrovascular! I think his condition is very bad."

Zhou Can deduced from some symptoms of the patient that it was probably a cerebral hemorrhage.

High blood pressure must be well controlled. Once a cerebral hemorrhage occurs, the probability of stroke is extremely high.Moreover, the danger is particularly high, and the prognosis is often very bad.It is good to end up with a hemiplegia.

……

He went into the operating room for surgery, and he didn't care about the outside world.

When he came out to eat at noon, he heard that the patient had ruptured a cerebral blood vessel and suffered intracranial hemorrhage.Now the person has been transferred to neurosurgery for treatment.

Neurosurgery at Tuya Hospital actually includes brain surgery.

Some hospitals have specialized brain surgery.

Many ordinary patients think that the outside of the mind belongs to the outside of the brain, which is completely reversed.The field of neurosurgery is much wider than that of the brain.

Nerves are present in every part of the human body.

The nerves of the head and the spine are the most studied outside the nerves.

The head can be regarded as the nerve center, and the spinal nerves are the main road leading to the body.

Some children have suffered spinal injuries during dance practice, high falls, or accidental falls.Then it is directly paralyzed, and the paralysis of the lower limbs often occurs the most.

This is because the nerves in the spine are compressed and injured.

When practicing dance, the child's endurance is limited. When the leg is pressed or the waist is lowered, if the child expresses that it is very painful, then it must not be forced.It needs to be done step by step, gradually increasing the difficulty of the movements.

Some dance teachers always think that they are very professional, and they are fine after teaching so many children, so they are the same rude to every child.

What they pursue is that strict teachers produce excellent apprentices.

As everyone knows, if this situation does not happen, it will be fine. As long as you happen to meet a child with a weak body, or when you are doing dance training, the lumbar spine is too heavy, and it is easy to cause the child to suffer from hemiplegia.

Some children may be fine at the scene, or may just feel pain.

The teacher also thought she was hypocritical.

Then after a period of time, usually from a dozen hours to two or three days, the child suddenly became paralyzed.

It's too late to say anything at this time.

So, don't foolishly confuse the supernatural with the supernatural.

The nerve center is in the head, but the diseases treated outside the brain are not limited to neurological diseases, and may also be cerebrovascular, brain herniation and so on.

Zhou Can checked WeChat on his phone while eating.

No way, he is too busy.

Responding to Su Qianqian's messages, or checking other people's private messages, can only be done at noon or after get off work.

"Doctor Zhou, the child's test result has come out. I'll send it to you for a look."

Director Tang Fei really wasn't affected, so she should send a private message to Zhou Can, so we can chat.

Director Xueyan hasn't contacted Zhou Can in the past two days, which inevitably makes him a little worried.

Zhou Can checked the test results of the child, and the anti-glutamate antibodies LGC and LGA were all positive.It seems that Zhou Can's diagnosis is correct, the child is indeed celiac disease.

Anti-endomysial LGA antibody was weakly positive.

This is consistent with the patient's condition.

Although the child has celiac disease, it is not typical.

Capsule endoscopy showed that the small intestinal mucosa in groups 2, 3, and 4 was swollen and gyriform, and the surface of the mucosa was eroded in spots.

At this point, the diagnosis can be confirmed without a doubt.

No wonder the child's fecal occult blood was intermittently positive.

The small intestine is one of the three major nutrient-absorbing organs in the human body. It is also the most important nutrient-absorbing organ, and it has advantages that other organs do not have, so it can be called unique.

The small intestine is not only the longest organ, but also has many folds, and the inner wall has countless villi and fine villi.

This gives it an astonishing total absorption area of ​​over 200 square meters.

Think about it, what is this concept?
The house most of us live in is more than 100 square meters, and its area is almost as big as two small houses with three bedrooms and one living room.

Continue to look down, the children's small intestines in groups 5 and 6 were swollen and granular, and bleeding points were found on the mucosal surface.

Ulcers were found in the small intestine of group 6.

The area is not large, only about 2.5mm*2.5mm.It was covered with white moss, and Zhou Can's mucous membrane was obviously congested.

After checking this step, there is no need to check again, and the diagnosis of celiac disease is undoubtedly.

"The cause of the disease has been found out, which is good, and it can be treated according to celiac disease. I hope that child can recover soon."

After reading the test results, Zhou Can breathed a sigh of relief.

Every time he successfully finds out the cause of the patient, or watches the patient recover and leave the hospital after treatment, he feels very happy and has a sense of accomplishment.

The purpose of studying a doctor is to help patients relieve their pain.

For example, this child has been examined and treated by so many experts, but his condition keeps recurring.When the family members brought the child to Tuya Hospital for treatment, they were probably quite desperate.

This is also a true portrayal of many patients and family members.

As long as a disease is treated in two or three hospitals without any effect, they will no longer have much confidence.I think the disease I am suffering from is very difficult and difficult to cure.

Just as Zhou Can finished replying to the message, Director Tang Fei called directly.

connected.

"Did Dr. Zhou undergo surgery?"

"Yes, I just had an operation and I'm eating in the cafeteria."

"Do you have any suggestions for the treatment of this child?"

Treatment of celiac disease, pediatrics is no problem at all.

The disease is mainly difficult to diagnose.Especially this less typical one, it is easy to treat it as duodenal ulcer or enteritis.

During capsule endoscopy, it was indeed found that ulcers occurred in the small intestine of group 6.

It's just that if it is really treated according to the ulcer, it will definitely have no effect.

Director Tang Fei is now humbly asking Zhou Can for advice and treatment advice, out of respect for Zhou Can.

"It's nothing else, just go to the gluten diet, and considering that the patient has almost no symptoms of diarrhea, hormone therapy can not be used. The last thing is to say hello to the family and make psychological preparations for long-term diagnosis and treatment review. "

Zhou Can really didn't have any special suggestions.

Some methods, skills, and experience in the treatment of celiac disease are thanks to several chief physicians in the Department of Gastroenterology.When Zhou Can was training in this department, these chief physicians gave him a lot of guidance and never kept his secrets.

Director Tang Fei accepted all his advice on diagnosis and treatment.

Just after chatting with Director Tang Fei, Director Le from the Department of Cardiothoracic Surgery also sent him a private message.

After examination, the patient who underwent cardia cancer and total gastrectomy has had results.Consistent with Zhou Can's deduction, the patient was indeed in severe pain because of the reflux of bile and pancreatic juice, which invaded the esophageal mucosa.

The cause is clear, but the operation has already been done, so it is quite difficult to solve it.

"Her situation needs to be solved, I am afraid that a second operation is required. And it can only be alleviated, and it is difficult to completely solve it."

Zhou Can sent Director Le a message back.

This operation is purely Director Le's operation plan without consideration.If it is possible to consider the possible reflux of bile and pancreatic juice after the operation when resectioning the whole stomach, some leeway should be reserved for another more difficult surgical method.

(End of this chapter)