My medical skills add experience

Chapter 546 Only asymptomatic people are dangerous

When all kinds of acute and severe patients are sent to the hospital, the situation is often particularly scary.

At least when Zhou Can was an intern in the emergency department, he admitted five critically ill patients who were dying in one day.

"I remember your name is Xie Yu, right?" Zhou Can followed the little nurse towards the emergency room while talking to her.

"I didn't expect you to remember my name, I'm so touched!" The little nurse was flattered.

Now the doctors and nurses in the emergency department know that Zhou Can is an important figure in the department.With strength, status and bright future.Not to mention that everyone respects him, at least everyone has reached a consensus and treats Zhou Can as a heavyweight in the department.

"Let me tell you, patients with serious conditions like this are actually not scary. Those who really need to be vigilant are those patients who don't seem to be serious. For example, pulmonary embolism, the onset time is very short, and the death is even within one or two minutes. happen within."

Zhou Can pointed out the newcomer.

In the hospital, because the medical staff is a common interest body.Especially for members of the same department, if one person has an accident, it may drag down the entire department.Therefore, even the kind of withdrawn doctors or nurses will give proper guidance to newcomers as long as they have the opportunity.

Medicine can be passed on from generation to generation, and it is precisely because of everyone's spirit of being a teacher.

"What Dr. Zhou said is not an exaggeration at all. I still remember that when I was a nurse for the first year, I was examining a patient who was hospitalized for observation. The patient was very cheerful and talkative, and took the initiative to chat with me. His children also They are all accompanied by the bedside. I just took his blood pressure and found that his blood pressure has been dropping. Obviously the patient can still talk and laugh, and has no obvious symptoms. How can his blood pressure be so low? I am going to change his arm and measure again. As a result, the patient suddenly convulsed, fell on the bed, and turned his eyes upwards. The patient died soon. It was later learned that the patient had an aortic dissection and ruptured."

Jiang Wei also shared her own growth experience.

During the formation of aortic dissection, different degrees of pain will generally occur.

However, some patients have a strong tolerance to pain, and they don't care about some less intense pain at all, and it is easy to ignore it.

There is another kind of aortic dissection that is the most terrifying.

The time from formation to rupture is extremely short, and the mortality rate is basically [-]%.

Unless it can be detected in advance and then intervened, such as placing a vascular stent to seal off the torn part of the inner wall of the blood vessel.Otherwise, even the genius doctor can't save him.

"I have been taught, I will definitely be more cautious in the future! I never thought that asymptomatic patients are the scariest."

The little nurse took the words of these two seniors seriously.

The three of them had arrived at the triage table at this time, and saw a 34-year-old man lying pale on the emergency bed.

At a glance, he knew that it was an emergency patient pulled back by an ambulance.

The patient clutched his chest tightly, his face was pale, his forehead was covered with sweat, and his hair was all wet.

The expression is also extremely painful.

Breathing seems to be very labored.

Seeing Zhou Can approaching, the doctor on duty seemed to have found a savior, and quickly stepped aside to ask Zhou Can to examine the patient.

"Where does it hurt?"

Zhou Can first probed the patient's carotid artery.

When encountering such a patient with suspected chest pain, or a patient who suddenly fell into a coma, a lot of diagnostic information can be obtained by probing the carotid artery.

For example, the strength and presence of the carotid artery can roughly infer the working state of the heart.

Some patients also have neck stiffness, which has certain diagnostic significance for diseases such as meningitis and neuropathy.

"This one hurts badly! It seems that the left shoulder and the back are also in pain."

The patient's voice seemed weak, and he looked frightened that he might die at any time.

After Zhou Can heard the words, he tried to press the chest position indicated by the patient.

The patient just hummed twice, and the tenderness response was not obvious.

Some patients are already numb because of the pain, so they don't know where the pain is.All I know is that big piece hurts.

At this time, doctors need to use their own experience and medical knowledge to identify and finally locate the real pain site.

Everyone knows that pain is actually a kind of protection for the body.

Where there is pain, it means that the organ or body tissue in that part is undergoing serious lesions.The more intense the pain, the more serious the lesion, in theory.

In addition, if the pain is only a little bit at first and lasts for a long time, the pain will intensify a little bit.Or intermittent labor pains, which can basically indicate a chronic disease.

Only the kind that hurts at the beginning, people can't bear it soon, and the progress time from slight pain to severe pain is very short, so you should be careful.

Basically, they are all acute lesions, and the degree of danger is often very high.

Needless to say, chest pain and tightness, even if it is acute severe abdominal pain or headache, special care must be taken.

For example, the most common cerebral infarction, cerebral hemorrhage, acute appendicitis, acute intestinal perforation, etc., if the treatment is not timely, it is easy to lose the precious golden rescue time, and eventually die and become disabled.

Zhou Can pressed the patient's chest, and after the tenderness response was not obvious, he had a bottom line in his mind.

Most likely not a heart attack.

The doctor on duty may have heard that the patient had chest pains and vomiting, so he was a little panicked.

Since the pain area is not in the chest, it means that chest pain is radiating pain.

When the pain is severe, it can continue to spread to a certain area around it, and it can even radiate to a very far area.

For example, in the example of treating feet for headaches, it is possible that foot lesions may cause head pain.

Zhou Can began to press on the patient's abdomen.

"Aw... it hurts, it hurts..."

When Zhou Can's fingers pressed to the middle of the upper abdomen, a little above the navel, there was not much reaction at first.Slightly increased the pressure on the tract, and the patient suddenly let out a scream with a different tone, his body tensed up suddenly, and the veins on his neck burst out.

"It seems that the real pain zone is here. Not in the superficial middle of the upper abdomen, but deep in the abdomen. This location is the area where the stomach and pancreas are located. The stomach is in the relatively superficial upper abdomen, but the pancreas adjacent to it is It is at a deeper position in the rear. Analyzing his symptoms, it is more likely that there is a problem with the pancreas.”

While analyzing the patient's condition, Zhou Can turned to look at Dr. Xie who was on duty.

"Have the patient's body temperature and blood pressure been measured?"

Blood pressure and body temperature are two very important references for a patient's physical examination.

"After measuring, the body temperature is 37.8 degrees, the blood pressure is a bit low, and the systolic blood pressure is only about 80."

Dr. Xie has also worked in the emergency department for more than a year. Compared with when he first came in, he has obviously made great progress.At least after receiving patients, these details have been done relatively well.

However, this person belongs to the dull type of doctor. He is relatively rigid in diagnosing diseases. He has a lot of medical knowledge, but he can't use it flexibly.

The patient's body temperature is moderately hot.

The systolic blood pressure is even lower than 80mm. No wonder Dr. Xie panicked.

Chest pain combined with hypotension, which makes people think of aortic dissection first.

The normal range of systolic blood pressure is between 90 and 140 mm Hg. Below this value, it is clinically diagnosed as low pressure.Above this value, it is called high blood pressure.

Relatively speaking, there may be many reasons for clinical hypotension.

For example, long-term malnutrition, hypothyroidism, or taking antihypertensive drugs, etc.

Hypotension combined with chest pain is the most frightening. Almost all emergency doctors will immediately suspect rupture of aortic dissection and massive internal bleeding.

Zhou Can has six-level hemostasis and six-level pathological diagnosis, and has certain advantages in the diagnosis of various internal bleeding.

After a preliminary diagnosis, he believed that the possibility of massive bleeding in the patient's body was relatively low.

Many symptoms of aortic dissection highly overlap with this patient, but it does not mean that it must be aortic dissection.

Clinically, there are too many diseases with overlapping symptoms.

To measure the level of a doctor's diagnosis is to see whether the doctor can quickly and accurately synthesize many symptoms, conduct targeted examinations on patients step by step, and then screen out some suspected diseases with a high degree of overlapping symptoms, and diagnose the real disease. cause of disease.

It is easy to say, but it is extremely difficult to achieve this step.

Almost all doctors have been working in this direction all their lives, constantly learning and accumulating diagnostic experience.In the end, there are less than one in ten doctors who can really reach a high level.

With the advantage of the system, Zhou Can can use one or two years to reach the level that others need two to thirty years or even longer to reach. This is his biggest advantage at present.

Many doctors spent 30 to [-] years and may have raised the hemostasis to the sixth level, but there is no way to raise all other medical skills to this level at the same time.

This leads to a certain one-sidedness in their diagnosis.

Knowledge is bound to be narrow.

However, Zhou Can broke this routine and could upgrade multiple medical skills to level six or above at the same time.It is equivalent to combining multiple chief physicians with more than 30 years of diagnosis and treatment experience into one at the same time, which is quite terrifying.

It is definitely not as simple as one plus one equals two.

In fact, recently, he has been in the emergency department, pediatrics department, and cardiothoracic surgery department almost everywhere, solving many difficult cases that the chief physicians failed to solve after consultation.This is enough to see how good he is with multiple sixth-level medical skills at the same time.

Life-long learning.

He didn't stop there.

On the contrary, he is still working hard to improve various medical skills and strive to push them to the seventh level.

At that time, let alone number one in the world, it should be difficult to find an expert comparable to him in China.

Dr. Xie watched Zhou Can examine the patient, and didn't dare to make any urging, but stomped secretly in anxiety.

My dear mother, the patient's condition is already so urgent, and the symptoms are also highly coincident with aortic dissection. What is Dr. Zhou still thinking about?

He is really not in a hurry!

No matter whether it was Dr. Xie or the nurse next to him, no one dared to urge Zhou Can.

Without the presence of the chief physician, Zhou Can is the absolute leader.

Is the highest level of doctors on the scene.

Even in the presence of the attending physician, this is still the case.

"The body temperature is moderately hot, the blood pressure is low, and the deep pain in the middle of the upper abdomen..." Zhou Can frowned tightly, and he needed to quickly clear away the heavy fog to find the real cause.

At least one clear direction of diagnosis is required.

If it is not the rupture of aortic dissection, it will undoubtedly waste precious rescue time if it is checked as this disease.

When everyone's patience was exhausted little by little, the family members finally broke out first.

"This person is dying. Can you invite an older doctor to treat him? The young doctor is inexperienced, dawdling, and has not come out with results. He has been working like this. Don't worry, we The relatives of the patients are anxious!"

The family members were very emotional.

"The meat of the bun is not on the folds. A doctor doesn't necessarily have to be inexperienced and low-level because he is young. Dr. Zhou is an extremely high-level doctor in our department. He is concentrating on diagnosing the cause of your relatives. Don't disturb him. Otherwise, Delaying the treatment of patients is definitely not the result you want to see."

Jiang Wei stood up again to rescue Zhou Can.

She is like a shield, blocking the attacks and dissatisfaction from the family members.

"Our director is rescuing a critically ill patient in the ICU. As soon as the situation there is a little more stable, he will rush over. Doctor Zhou looks young, and his level is not lower than that of the director. Please be more patient."

Dr. Xie also helped Zhou Can speak and maintain Zhou Can's image and status.

No one will teach you this kind of thing.

It is a skill that is automatically evolved from a professional title.Those who can learn and use it well will soon be promoted and reused, step by step.A person with an elm bumpy head is likely to remain at the bottom for a lifetime.

After being appeased by the two, the emotions of the family members have stabilized a lot.

Zhou Can has been concentrating on thinking about the real cause of the patient, and ignored the family members' abuse.

"Are you thirsty?"

He suddenly asked the patient.

"Well, I really want to drink water!"

The patient struggled to answer.

At this time, the patient's breathing became much faster, very heavy, which made people more worried.

"When did you start feeling uncomfortable?"

"It seems that I didn't feel well when I woke up the morning before yesterday."

"Have you relieved your hands today?"

"not yet."

"Do you feel like peeing now?"

"Maybe not!"

Zhou Can nodded after listening to the patient's answer.

"His pulse is thin, heart rate is fast, moderate heat, low blood pressure, severe pain deep in the upper abdomen and lasts for a long time, and it is getting worse, even radiating to the back and shoulders. It is also accompanied by thirst and urination, which shows that his There is likely to be a serious problem with the pancreas. The initial suspicion is acute pancreatitis. Immediately draw blood for routine blood tests, and at the same time check a fasting blood sugar. Then send it to the ultrasound room for an abdominal B-ultrasound immediately.”

After getting the diagnosis, Zhou Can, like the commander in chief of the armed forces, issued the order of continuous suffering.

A series of laboratory and ultrasound examinations are quickly performed on the patient.

"It's not aortic dissection!"

Dr. Xie was stunned at the side listening.

It was really unexpected that Zhou Can's initial diagnosis turned out to be acute pancreatitis.

Dr. Xie deeply felt the gap with Zhou Can.

"If there is no problem, arrange for an examination immediately, and don't delay. You take the patient to do these examinations, and immediately contact me or the chief physician on duty when you have the results."

Zhou Can is well aware that the mortality rate of acute pancreatitis is quite high, so he never dares to be careless.

(End of this chapter)