I can see health

Chapter 564 High-Quality Critically Ill Patients! (Xuantengluo leader plus 5)

Go to the bedside of the patient in bed 12.

Xiao Shikang whispered to Lu Chen: "The purpose of our consultation is to roughly judge the patient's condition. If it is a disease of our department, he can be admitted to the hospital."

"Okay, Teacher Xiao, I understand." Lu Chen nodded slightly.

He holds the medical records of 12 bed patients in his hand.

This is an old man in his 60s.

Three years ago, due to a stroke, a large area of ​​cerebral infarction.

After two months of treatment, his life was saved, but left limb paralysis and aphasia remained.

Because I can't speak, my quality of life is not as good as before.

The family member of the patient was his wife, who explained from the side: "The doctor said back then that it would be very difficult for him to survive such a large cerebral infarction. He couldn't speak or get out of bed. The only way is to recover slowly."

Three years ago, the patient underwent rehabilitation exercises in many large hospitals, and his physical activities seemed to be slightly better, but he still could not speak.

"Oh, the old man asked for it!" The patient's wife sighed, "I used to let him take antihypertensive drugs, but he was stubborn! He refused to take the medicine all the time, so he didn't bother me in the end. You don't have to do it."

"But then again, thank God for being able to survive three years ago, thanks to your hospital..."

"Doctor, you rescued him three years ago, you can't leave him this time!" The patient's wife tugged on Lu Chen's cuff, tears were about to fall.

This time, the old man was hospitalized again.

Mainly fever, but also cough, sputum.

His own ability to cough up sputum is not bad, and he can cough up to his mouth, and his wife is wiping it off with a tissue.

Lu Chen looked up at his head, his HP was 65 (-).

Lu Chen was a little strange, this disease has nothing to do with their cardiology department, right?

Patients with sequelae of cerebral infarction may have swallowing and coughing dysfunction, and are very prone to aspiration and cause pneumonia, which is the case of the old man.

In the past three years, pneumonia has occurred repeatedly, and even the doctors are no strangers to it.

"Fan Jian, why do you ask us to consult with this kind of cerebral infarction patient?" Xiao Shikang was also surprised, and quickly called Fan Jian over.

Fan Jian stepped forward, picked up the patient's medical record, shook his head slightly, and said, "If the patient is just pneumonia, we will send him to the respiratory department of the hospital below. We have given the patient antibiotics in the emergency department for the past two days, and the effect is good. Coughing and expectoration are also less. But last night, an accident happened..."

Last night, after the patient's family fed the old man some fruit, they lay down and rested.

Not long after, the old man suddenly became short of breath.

The patient's wife added: "I was very nervous last night. After all, he has been in the hospital for so long, and he has never breathed like this. I think the condition may have worsened!"

Xiao Shikang frowned and said, "Is it aspiration? His swallowing function is not good. If you feed him like this, once aspiration occurs, it will easily lead to wheezing."

"No, it went well when I ate it." The patient's wife recalled, "I used to feed it like this, and it was fine."

At this time, Fan Jian said: "The patient did not cough obviously last night, and aspiration was ruled out. Later, our nurse measured the blood pressure and found that the blood pressure was very high at 200/120mmHg. If it was not aspiration, I thought it might be Acute heart failure due to hypertension."

The pressure in the peripheral blood vessels is high, the greater the work the heart needs to do to pump blood, it is even difficult to pump blood out!

At this time, the heart will become less and less powerful, and it is easy to induce acute heart failure, resulting in dyspnea and shortness of breath.

"Has the patient's heart ultrasound been done?" Xiao Shikang asked.

"I did." Fan Jian nodded, "It's because the echocardiography showed that the heart function was low, so I considered sudden heart failure, and I listened to the patient's lungs last night, and I could hear a small amount of moist rales. It's more serious than before."

"What about the intake and output of these two days?" Xiao Shikang asked.

"A few days ago it was okay, there was about 300ml of urine, but today it was very little, only [-]ml of urine."

Xiao Shikang nodded slightly, "Looking at the patient's condition now, he has no obvious difficulty in breathing."

"Well, but from last night to now, the patient still has intermittent symptoms of wheezing and shortness of breath. The heart failure may not be easy to control, so I will ask you to come to the heart for consultation."

After hearing Fan Jian's words, Xiao Shikang looked back at Lu Chen, "How about it, do you think this patient should be admitted?"

Lu Chen nodded slightly: "Perennial high blood pressure, and echocardiography shows cardiac dysfunction, the possibility of acute heart failure cannot be ruled out at present. In addition, he only had 300ml of urine during the day, and his kidneys may be damaged. I think it can be accepted." to our cardiology department."

Hearing Lu Chen's words, the patient's wife was stunned for a while.

The old man had suffered a stroke and was paralyzed on the bed. This time he said that he had heart failure, kidney failure, etc. Can he survive?

But after hearing what Lu Chen said later, "admission to the ward", my wife was a little excited again, and being able to live in it meant that there was still hope!
"Well, the analysis is good." Xiao Shikang nodded, turned to Fan Jian and said, "Old Fan, you should take some diuretics first to lower the blood pressure. After I finish seeing the other patients, we will write the consultation form together, and then I will send this patient Transfer to Cardiology."

"Okay, thanks." Fan Jian heaved a sigh of relief, patted Xiao Shikang's shoulder lightly, and then smiled at Lu Chen.

If a critically ill patient can be transferred away, his emergency room will also be safer.

……

"Let's go and see bed 22."

Time was limited, Xiao Shikang immediately took Lu Chen to see the 22-bed patient.

Bed 22 is a 35-year-old male patient who was admitted to the hospital mainly because of "chest tightness and dyspnea for more than 3 months".

His health is 56 (--).

The patient had no previous history of any particular disease.

In a lower-level hospital for a month or two, a lot of tests were done, but the cause was not found.

And the symptoms became more and more serious, and finally there was nothing to do, so I came to the Cardiology Department of the First Affiliated Hospital of Kyoto University.

Lu Chen came to the bed, and after a simple questioning, he began to examine the patient.

"Grade 2/6 systolic murmurs can be heard at the apex of the heart, wet rales can be heard in both lower lungs, and edema in both lower extremities."

After the physical examination was over, Lu Chen opened the patient's medical records.

Laboratory tests: BNP2312ng/L, echocardiography: LVEF30%, left ventricular end diastolic diameter 70mm, electrocardiogram report: complete left bundle branch block.

Messages flashed through Lu Chen's mind, 35 years old, heart failure, dilated left ventricle.

The cause of this patient is not clear for the time being, but it is obvious that it is indeed a cardiology disease.

"Do you think this patient should be hospitalized?" Xiao Shikang asked.

Lu Chen nodded without hesitation: "The patient should be suffering from heart failure, but we don't know the cause of heart failure for the time being. Further examination is needed to clarify the cause. The patient is so young, it would be the best if the root cause can be found!"

"Okay." Xiao Shikang smiled, "The judgment is very accurate!"

At this time, Lu Chen couldn't help but sigh in his heart, the quality of patients in this emergency department is not generally high!

If it was in Jinghua Second Hospital, this kind of patient might have been pushed to the inpatient ward long ago.

But at this moment, there was a sudden noise from the ward not far away, and the doctors and nurses in the emergency department ran towards one direction.

Lu Chen frowned, put down the folder of medical records in his hand, and took a closer look.

He was startled, this seems to be the direction of the 12-bed patient? !

(End of this chapter)