When a doctor opened a plug-in

Since then, Tan Zhonglin has successfully joined Chen Cang's team and became Chen Cang's second support, referred to as the second room!

The addition of Erfang made Chen Cang's auxiliary team more competition.

An Yanjun, who was in the main house, finally walked out of his comfortable environment and began to compete with Tan Zhonglin.

However, this kind of competition is obviously beneficial. Both parties rely on their abilities to compete for love, and the enthusiasm for learning is much greater.

But in the end, An Yanjun, who is the main house, has a big advantage. After all, there are three young nurses who have the pump.

After all, only by leaving Chen Cang behind can they compete fairly.

In case of being snatched by Tan Zhonglin, it would be boring to fight back and forth.

At this time, Chen Cang suddenly found that Qi people's happiness was not good, and the two were annoying... Chen Cang suddenly felt a little nostalgic for Qin Yue.

Do not speak or say anything.

It's good to shout occasionally.

Big eyes blinked.

I also feel good about the operation.

The main thing is still pleasing to the eye.

These two jealous old men, Chen Cang looked really upset...

...

...

October 1st finally arrived, Chen Cang first line,

Although the emergency department is as busy as fighting, but... at least it's not that annoying.

He finally understood why so many ancient officials died young, so tired!

In the daytime, everything is managed, and at night...

Hey……

The number of patients in the National Day Hospital is much less, and the outpatient volume is less than half of the usual.

However, the emergency department will not be easy. In addition to Chen Cang and Wang Yong in the surgical team, the two have been busy all morning.

And Doctor Yao from the internal medicine department is as busy as a dog, because doctor Yan Mingyan is on duty with him today.

Doctor Yan is a well-known hand-handling shopkeeper in the emergency department. Compared with Li Baoshan's style, he swayed with the thermos cup every day. The patient came for consultation.

All in all, the emergency department is the nursing department.

The hospital doesn't want to care about this kind of person. I think I can retire for two years. After all, there will be no big problem with him.

Although Yan Ming doesn't care about things, he knows how to protect himself, which is a skill in today's general background.

Now, when any doctor is on duty, the first lesson the teacher teaches them is how to protect themselves.

Yao Zhiwen and Chen Cang came in as a group. They were postgraduates in the Department of Cardiology at Dongyang Medical University. They were the same as Wang Qian and Qin Yue.

Yao Zhiwen is relatively introverted and doesn't like to talk. He always smiles with you when he meets people. He looks like your shy girl and is relatively simple and honest. He is unlucky when he meets Yan Ming.

I was so busy all morning without rest.

At about eleven o'clock, Yao Zhiwen hurriedly found Chen Cang, and said with some worry: "Doctor Chen, help me see a patient!"

Chen Cang nodded and followed Yao Zhiwen to the rescue room.

Yao Zhiwen said as he walked: "The patient was a middle-aged man, 41 years old, with a chest pain and 120. He fell into a coma not long after he came, and his condition is very serious."

When Chen Cang heard Yao Zhiwen's words, he keenly caught several clues.

"Chest pain!"

"coma!"

Is it a heart attack?

This is Chen Cang's first feeling.

Yao Zhiwen continued: "The patient started to be unconscious and unconscious as soon as he arrived in the emergency department. The 120 was sent, and when he talked to the car doctor about the road, the patient was still awake, but said that his chest was tight and his chest pained. Just like acupuncture, nitroglycerin was not relieved, and ECG is normal."

Chen Cang was taken aback, and quickly asked, "Have you got an electrocardiogram in the emergency room?"

Yao Zhiwen nodded: "I made it up, and I checked my troponin urgently."

"I didn't see any signs of acute myocardial infarction, and I took blood to see that troponin was elevated."

When Chen Cang heard this, he frowned. After arriving in the room, Yao Zhiwen quickly took the ECG and handed it to Chen Cang, "Look."

Chen Cang took the electrocardiogram and found that the electrocardiogram did not show typical myocardial infarction, and ST was basically normal...

This is strange!

Yao Zhiwen: "I'm still worried about the heart problem. I called the cardiology emergency consultation just now, but I haven't come down yet, Dr. Yan... please go up!"

Chen Cang couldn't help but sneered...

Both of them know that even if the electrocardiogram does not have a typical waveform, the patient still cannot rule out the possibility of acute myocardial infarction.

When encountering a typical myocardial infarction, the electrocardiogram does have characteristic patterns such as ST waveforms. This is easy to understand, because normal myocardial cells will have electrical activity, and necrotic myocardial cells have no electrical activity. The waveform is displayed by capturing such anomalies.

However, in the early stage of myocardial infarction, the myocardium may not be completely necrotic, and the electrocardiographic response still exists, which means that the electrocardiogram may not have the typical performance.

In addition, troponin is mainly contained in cardiomyocytes, and its increase often indicates that the cardiomyocytes are damaged.

Chen Cang asked, "What's the history?"

Yao Zhiwen said: "The oral medical history of the family members is basically reliable. They have had a history of high blood pressure, hyperlipidemia, and fatty liver. So... it is impossible to rule out the possibility of acute myocardial infarction."

Chen Cang let out a cry, "Do you suspect that it is cardiogenic shock?"

Yao Zhiwen nodded!

During the speech, the two had arrived in the rescue room, and the patient was undergoing ECG monitoring.

When Chen Cang first saw the patient, he did not see any special features on his face, and he was in a coma, lying on the hospital bed without any movement.

On ECG monitoring: the heart rate is 120 beats, which is a bit fast, and the blood pressure is 8050mmHg, which is low... the blood pressure of a normal person should be 90-14060-90mmHg,

The blood pressure of 8050 is low anyway, and the blood pressure is low, indicating that the patient has shock.

All clues are still unclear.

More ills!

The patient usually has a history of hypertension, and at this time there is only 8050 blood pressure. In this case, the blood pressure cannot meet the blood supply of the brain. To put it simply, the heart is like a water pump, which pumps blood all over the body, and the water pump provides The pressure is not enough to get water on the head.

The brain is very sensitive to ischemia and hypoxia. Once the blood supply and oxygen supply are reduced, it will be unconscious!

In order to quickly rule out myocardial infarction, Chen Cang once again gave the patient an ECG.

Chen Cang hesitated: "I'll ask the family what is going on."

The patient’s family is his wife, with a foreign accent.

Chen Cang asked: "When did chest pain occur?"

His wife was obviously frightened, and her words were somewhat illogical: "He is usually fine, he just likes to drink, but...I...I can't remember how long he was sick. It should have been yesterday. I didn't care, but I couldn't walk if I was serious today. I rushed to call 120 and fell into a coma soon after I came to the emergency room."

While talking, she was crying as she talked, terrified.

Chen Cang sighed and understood. After all, a good-natured person suddenly passed out in a coma, and whoever changed would be nervous.

Chen Cang understands her, but now is not the time to comfort her.

Because myocardial infarction is terrible,

If the diagnosis is confirmed, every minute must be raced against, and then sent for interventional treatment in time.

What is myocardial infarction?

It is that the blood vessel of the heart itself is blocked by the embolism formed, and the blood flow is blocked. The heart is actually a muscular tissue, and all its movements depend on the blood supply of the coronary arteries.

If the ischemic time of the heart is too long, the cardiomyocytes will gradually become necrotic. When there are enough necrotic cardiomyocytes, the heart will lose strength. At this time, heart failure will occur, followed by shock, and finally death.

This process may only take a few minutes at the earliest!

Therefore, once the myocardial infarction is confirmed, the most effective treatment is to open the blood vessel immediately, immediately, decisively, and as soon as possible. Whether it is drug thrombolysis or interventional stent, the purpose is to open the blocked blood vessel and restore blood flow to the heart.

So everything is imminent!

Chen Cang habitually put his hands on the patient, looked at his pupils, and checked the reflexes.

This is an operation that a surgeon is accustomed to.

When Chen Cang's other hand touched the patient's stomach, Chen Cang was stunned!

Thinking of this, Chen Cang hurriedly said to Yao Zhiwen: "Have you had a physical examination?"

Yao Zhiwen shook his head: "No time!"

Chen Cang shook his head and quickly picked up the patient's clothes.

Press it with your hand!

My stomach is a little tight...

This is not normal. The abdomen of a normal person should be loose when lying flat. No matter how hard your abdominal muscles are, your stomach should be soft.

Moreover, this patient has been unconscious, why is his stomach hard?And it's tight!

This man is obese, obviously not abdominal...

Yao Zhiwen also discovered this situation suddenly, touched it quickly, and was stunned!

"Muscle tension?"

Tightness in the abdomen often indicates inflammation in the abdominal cavity. The inflammation stimulates the peritoneum, causing the abdominal muscles to tighten, so it feels a little tight to the touch.

Could it be that the patient's myocardial infarction caused abdominal tension?

At this time the ECG result came out, the nurse handed it over, Chen Cang took it, and looked at it carefully, but still did not see the typical myocardial infarction pattern.

Chen Cang couldn't help asking his family members: "How long has it been since the attack?"

His wife was dazed: "Have you been for several hours? Three or four..."

Chen Cang looked at Yao Zhiwen: "It's not like a myocardial infarction! It has been three or four hours. If it is really an acute myocardial infarction, there should be obvious changes in the electrocardiogram."

Chen Cang couldn't help asking: "Have you done a chest radiograph and CT?"

Is there another cause for chest pain?

Yao Zhiwen took the film, and Chen Cang looked at it and it was basically normal!

This is so strange for him?

what happened!

Chen Cang's brain flew quickly, thinking about various possibilities.

Thinking back to thinking, but Chen Cang kept his hands on the patient's abdomen, trying to discover more information.

Just as he routinely performed a painful examination of the liver area, he was tapping the liver and found that the patient suddenly frowned, showing a painful expression.

This shocked Chen Cang!

A comatose patient has a painful expression. What does this mean?

There is only one possibility!

That is Chen Cang did hurt him!

Well, this is not nonsense, it is true!

Even when a person is in a coma, he feels severe pain.

A normal person with percussion pain in the liver area will not have any response unless he has a disease of the hepatobiliary system!

And also those acute inflammatory diseases, such as liver abscess, or cholecystitis, biliary colic and so on.

Seeing the man's painful expression, the wife thought he was awake, and quickly patted and beat in his ear, calling out his name loudly, but there was no reaction at all.

In order to further verify the idea, Chen Cang placed his left palm on the patient's lower right chest and pressed the gallbladder area with his left thumb. If the patient has gallbladder inflammation, such a deep pressure will inevitably cause severe pain in the patient.Because the gallbladder is under Chen Cang's thumb.

really!

When the left thumb was pressed down deeply, the patient's brows became more frowning and twisted into a ball!

Chen Cang suddenly took a long breath.

The patient is in shock, but the patient is not cardiogenic shock, but may be septic shock.

Cardiogenic shock refers to shock caused by heart disease. If it is myocardial infarction, intervention or thrombolytic therapy should be done immediately.

However, if the gallbladder infection is severe and the septic shock occurs, the treatment is completely different.

Inflammation of the gallbladder and bile duct can also cause chest pain. Although it is rare, it is possible. Conversely, myocardial infarction can also cause abdominal pain instead of chest pain.

The human body is very complicated, and it is by no means a simple disease wherever it hurts!

At this time, the patient is likely to be a disease of the gallbladder system!

Chen Cang: "Give me the test sheet."

If you get the two wrong and miss the opportunity for treatment, the patient may die.

After receiving the patient's laboratory report and reading it carefully, the blood test indicated that the white blood cell was high, not too high.

However, myocardial infarction itself can lead to high white blood cells and infections, so blood tests alone cannot be used to make a distinction.

Chen Cang looked at Yao Zhiwen: "Rehydration first! A lot of fluid replacement!"

Yao Zhiwen also understood what happened at this time: "You mean...worry about septic shock?"

Chen Cang nodded!

In fact, whether it is cardiogenic shock or septic shock, it is correct to supplement fluid at this time.

As long as the patient's blood volume and blood pressure are increased, the blood and oxygen supply to each organ can be guaranteed. Otherwise, those organs that are ischemic and hypoxic will starve to death one by one!

"Notify the B-ultrasound room for emergency consultation!" Chen Cang decisively gave the doctor's order.

The little nurse quickly picked up the phone and started to contact.

In order to be foolproof, Chen Cang performed a detailed examination of the patient again. There were no abnormalities in the cardiopulmonary auscultation. Reading the chest radiograph again did not indicate heart failure or pulmonary edema. After another ECG, he still did not see the typical myocardium. Infarct performance, the patient is really not myocardial infarction!!!

Chen Cang is basically certain!

In order to diagnose myocardial infarction early, the most objective way is to keep doing ECG.

The electrocardiogram is cheap, convenient, and without radiation. It also provides great value. It is really a rare good examination.

The B-ultrasound room was nearby, and soon they pushed the machine over.

Not long!

The result of the check is out.

As a result, Chen Cang and Yao Zhiwen were taken aback!

B-ultrasound shows that the gallbladder is obviously enlarged, the walls of the gallbladder and bile duct are thickened, there are many stones in the gallbladder, and the bile duct is obviously expanded!

All this shows that the patient's gallbladder and bile duct are inflamed, and it is likely to be acute obstructive suppurative cholangitis.

Once the stone blocks the common bile duct, bile cannot flow out of the digestive tract smoothly, and it will inevitably accumulate more and more, which will eventually lead to increased pressure in the bile duct and reverse flow of bile into the blood. Accompanied by bacteria entering the blood, obvious symptoms of sepsis will occur. , Severe cases may have shock.

Chen Cang directly took out the phone and called Zhang Youfu, Zhang Zhixin was on duty, and ran down!

Discuss with the B-ultrasound teacher Bai.

The patient’s condition was comprehensively evaluated, and acute obstructive suppurative cholangitis and septic shock were clearly considered. It is recommended to immediately transfer to general surgery and perform bile duct decompression and drainage in a timely manner. As long as the bile duct is cut open, the erupting bile can flow. Come out, the condition will improve significantly.

As for the... gallstone problem, we can discuss it later and cut it slowly.

After the patient was sent away, Yao Zhiwen was sweating profusely.

Chen Cang patted him on the back and found that there was sweat behind him.

With dim tears in Yao Zhiwen's eyes: "Chen Cang...you said...if I don't invite you...isn't he gone?"

One sentence dumbfounded Chen Cang.

Chen Cang sighed, wondering what to say.

The diagnosis of the disease is too complicated, who can guarantee that he will be able to diagnose accurately?

Chen Cang has a plug-in, but he can't see through it at a glance. If he didn't touch it lightly, Chen Cang himself would not guarantee...

Chen Cang looked at Yao Zhiwen, he can't be blamed...

Illnesses are ever-changing, and the symptoms and auxiliary examinations of different diseases often overlap. If you don't identify them carefully, it is very easy to make mistakes.

so.

Those who practice medicine should be trembling, walking on thin ice!

At this time, Doctor Yan came back...a doctor with a cardiology department.

Chen Cang sighed and looked at Yao Zhiwen: "You are very good, at least you didn't run..."

Yao Zhiwen laughed and cried, really laughed and cried, and his tears flowed down.

"I really want to be a good doctor!"

Chen Cang smiled: "You are already..."

What else can I say besides comforting him at this time?

Yan Ming ran over in a hurry: "Xiao Yao, how about people? Where are the patients?"

Seeing Yao Zhiwen crying, Yan Ming shuddered in fright: "Anyone gone?"

Chen Cang sighed, shook his head, and went back to the emergency surgery.

ps: Thank you Xiaoya for the reward, thank you!

To be a clinical doctor really needs to walk on thin ice. Before any young doctor grows into a real senior doctor, he needs to exercise constantly. I was also in the clinic at the beginning. I encountered this kind of thing. At a loss.