Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Chapter 264 Disobedient patient!
Afterwards, several people returned to their seats.

In the afternoon, a male patient who had dysphagia and black stools for more than a month came in.

His complexion was a little bad, very pale, and looked like anemia.

However, his body is still burly and strong.

The doctor on duty in the afternoon is Wu Jiang.

As soon as I heard that the patient had dysphagia and black stools, it was naturally related to the digestive tract, and most likely it was the upper digestive tract.

First of all, blood was drawn for examination. It happened that the patient had not eaten breakfast so he could arrange a gastroscopy. By the way, he notified the gastroenterology doctor for consultation.

There is also an EKG and chest X-ray.

If dysphagia is an elderly patient, esophageal cancer should be considered first.

But the male patient in front of him was only in his early thirties.

You shouldn't have cancer, right?

Wu Jiang thought suspiciously, but it's hard to say until the final result came out.

Soon, a doctor from the Department of Gastroenterology came over.

"what's the situation?"

Wu Jiang said to him:

"Male patient, 30 years old, has dysphagia and black stools for more than two months. He said that no matter what he eats, he always feels that there is something blocked in his throat, whether he eats liquid food or hard food."

The gastroenterologist frowned and said immediately:

"Progressive dysphagia? Watch out for esophageal cancer."

Wu Jiang also nodded, so why didn't he mean that.

Soon the patient's checklist came out.

Gastroscopy showed that the lumen was severely narrowed, and there was also a mass in the lower esophagus, as well as slight bleeding.

Seeing the lump, the doctor in the gastroenterology department shook his head and said, "I'm afraid it's really esophageal cancer, and it may be in the middle and late stage. Have the ECG and blood routine results come out?"

"Come out, here."

Electrocardiogram, blood routine and other items are all right, but the hemoglobin is low, only 90g/L (male 120-150g/L).

This man is indeed mildly anemic.

A chest radiograph suggested that the patient had pneumonia, but it was not severe.

Suddenly, there was a call from the gastroscopy department.

"Hello, Wu Jiang from the Emergency Department."

"Yes, that patient was sent from the emergency department."

"Huh? Not finished? Okay, I see."

After Wu Jiang hung up the phone, he explained to the gastroenterology doctor:

"Just now when I was doing gastroscopy, I didn't continue, because the tumor on the patient's esophagus bleeds when touched, and the bleeding was quite profuse, so they didn't dare to probe inside anymore, for fear of causing massive bleeding. "

The gastroenterologist nodded and said:
"Okay, I see. At present, it seems that the preliminary diagnosis is esophageal cancer, and it is likely to be in the middle and late stage! Let him do a pathological classification to see what kind of cancer it is."

Judging from the results in the gastroscopy checklist, it does look like esophageal cancer.

Moreover, the patient's symptoms are more obvious, and he usually likes to drink strong tea and eat spicy and spicy things.

This has stimulated the wall of the esophagus for a long time, which is why it has such a consequence.

Hey!
A typical disease enters from the mouth!

Wu Jiang went to explain the situation to the patient.

The patient didn't believe it!
"No mistake, are you? Esophageal cancer at such a young age? Is it in the advanced stage?"

Not only did the patient not believe it, but he was also very angry.

Wu Jiang also understood the patient's mood and patiently explained:
"This is the checklist, you can take a look, the gastroscope shows that there is a mass in the lower esophagus and bleeding.

This bleeding is the reason why you always have black stools in the past two months.

Blood turns black as it exits after digestion in the stomach and intestines.

The mass on the esophagus is also the reason why you have difficulty swallowing in the past two months. "

The patient looked at Wu Jiang suspiciously, and then at the checklist in his hand.

After a few seconds he will check the single throw, yelling:
"Impossible! How can I get cancer at such a young age!"

The voice was so loud that it even attracted the attention of other patients.

"Don't get excited, this is only a preliminary diagnosis, and pathological typing is still needed, so don't get excited."

"I'm not excited even if I have cancer?! No way! I don't believe it! I have cancer at such a young age before I get married? I don't believe it!"

The patient got up and put on his clothes as soon as he said that, damn it, he didn't want to see this stupid disease anymore!
Or go to another hospital again.

"Hey patient, why did you go there? Your lump is very serious, and you will bleed easily if you touch it a little bit. You can't run around!"

Wu Jiang chased after him, but the man didn't listen, and said while walking:
"Damn it, it's really strange. It's not a big deal if I don't come to the hospital. When I came, the hospital said I had cancer?"

Just then Lin Yi came back from the outside.

One didn't pay attention and bumped into the patient.

Lin Yi quickly said:

"Sorry, I didn't bump into you, did I?"

The patient glared at Lin Yi and left without saying a word.

Immediately afterwards, Wu Jiang's voice came from behind:

"Oh, Lin Yikuai stopped this patient, he died of esophageal cancer, he insisted on leaving!"

"Esophageal cancer?"

"Yes, the lump on his esophagus is very large, and the stricture is very severe. The people in the endoscopy room said that the lump bleeds when touched, and they dare not probe inside."

If this kind of patient is sent home, it is easy to cause major accidents.

If you go home and eat something that causes heavy bleeding, it will be over for you.

As a result, the two turned their heads to look for someone, but they disappeared.

There are many people in the hospital, people come and go, this patient runs fast.

Turn around and disappear!
"What should I do? If I bleed a lot at home, I'm afraid it's too late to save it!"

"Yes, if this patient is really allowed to go home, the consequences will be disastrous!"

Lin Yi nodded and said, "Then look for it again, if you can't find it, forget it."

"Row."

After finishing speaking, Lin Yi and Wu Jiang searched again at the door of the emergency room and outside, but they still didn't see anyone.

Forget it, since the patients themselves don't want to be treated, there's nothing they can do about it.

The doctor from the gastroenterology department came over to take a look, and he was also stunned. Why did the kung fu man disappear after a while?
"What's the situation? What about the patient?"

Wu Jiang sighed helplessly, and said, "I ran away, saying that I didn't believe I had cancer."

"Ah? What... What if there is a lot of bleeding along the way?!"

"What else can I do? He wants to go, whatever."

Wu Jiang didn't bother to look for it after searching around but couldn't find anyone, so let's put it badly.

At [-]:[-] p.m., shift shift time, Lin Yi just got off work and changed his clothes when the ambulance brought a patient with stomach bleeding.

And it's the kind that vomits blood madly!
It happened that Wu Jiang was on duty at night, and the patient recognized Wu Jiang as soon as he came to Wu Jiang!

Isn't this the patient who ran away from esophageal cancer in the afternoon? !
"Quickly test the blood type! First get the replacement plasma, and then ask the blood bank to adjust the blood as quickly as possible. Plasma, red blood cells, and platelets are all needed!"

Wu Jiang quickly ordered to go down.

When this person ran away in the afternoon, he knew something was wrong!

look!Something went wrong!

In the afternoon, the platelet test showed mild to moderate anemia. If I continue to vomit like this, I am afraid I will have hemorrhagic shock in less than 10 minutes!
Wu Jiang looked around and asked:
"Where are the family members? Why didn't you see the family members? He is so serious now that he needs the family members to come over."

The emergency doctor also looked helpless:
"I don't know, he made the emergency call himself, he was still able to talk when we went, but two puddles of blood had already been vomited in the room.

I don't know the reason at present, but I suspect it is gastric varicose veins or gastric ulcer bleeding? "

Wu Jiang immediately denied:

"No, it's not gastric varicose veins or gastric ulcers, it's esophageal cancer!

This person had an examination in our hospital in the afternoon, but he didn't believe that he could get cancer at such a young age, so he ran home without treatment.

I didn't expect to be sent by an ambulance now!

Estimate how much blood he vomited from just now? "

"If not one thousand, at least seven or eight hundred."

Wu Jiang looked solemn after hearing this.

The blood has to come quickly, otherwise it will be too late to rescue the hemorrhagic shock!

At this moment, misfortune happened!
"Vag... vomit..."

"It's not good! The patient vomited blood again!" the nurse exclaimed.

While talking, he quickly took a plastic bag to pick it up.

But the blood vomited so suddenly, I couldn't hold it at all!
The entire pillow cover and bed sheet were instantly wet with blood!

"vomit……"

Still throwing up!
The patient will be confused, so vomiting blood is an instinctive reaction.

Everyone was shocked to see the bright red blood.

"It's not good! The blood pressure also dropped suddenly!"

Before any patient enters the emergency room, ECG monitoring, oxygen, and establishment of intravenous access are all standard rescue equipment.

At this moment, the blood pressure on the ECG monitoring has dropped from 84/60mmhg to 70/52mmhg!

"Oops! This person's blood pressure was only 94/64mmhg when he was admitted to the hospital for an examination in the afternoon! Now it has dropped to more than 70! Hurry up for a blood transfusion!"

Wu Jiang's voice was not loud, but everyone present could hear the seriousness of the matter.

Once the blood pressure drops further, the person will be gone!
Moreover, the patient's clinical manifestations of night sweats and rapid breathing, which are close to shock, are becoming more and more serious.

But now the problem is that there is a tumor on the esophagus, and it bleeds when poked.

In addition, there is no way to do a gastroscope to check the situation now that the bleeding is already massive, and there is no way to reach into the stomach to stop the bleeding.

It can only be stabilized by blood transfusion.

"The blood hasn't come yet, but the plasma is here!"

"Hurry up!"

If there is no blood, the fluid to expand the blood volume can be transfused first, and it can be delayed for a while.

"Call the gastroenterologist and have them come down and take a look."

"Ok!"

Lin Yi, who had just changed his clothes and came out to get off work, heard movement from the emergency room.

Before I got close, I smelled a very strong smell of blood.

Unable to hold back his curiosity, Lin Yi went to the emergency room to have a look.

Dang even asked in surprise: "Is this person the esophageal cancer patient you mentioned this afternoon?"

Wu Jiang looked anxious: "Yeah, I told him not to run around. Look, he was taken to the hospital by ambulance in just a few hours."

Looking at the blood stains on the entire bed and floor, Lin Yi knew that the blood vessels of the tumor on the esophageal wall of this man must have been completely ruptured.

As a result, when Lin Yi looked at the patient's esophagus and stomach, he immediately frowned!

Ok?
Isn't this esophageal cancer? !

This... This is not esophageal cancer at all!

Drop drop!
Suddenly, the ECG monitoring sounded again!

Not only did the patient's blood pressure drop this time, but his heart rate also gradually began to drop!
Even the ripples in the electrocardiogram gradually stabilized to the point where the ups and downs were almost invisible!
"It's over! It's a cardiac arrest! Adrenaline 1 mg static injection, Lobeline one static injection!"

Wu Jiang stood by the bed and performed heart compressions while ordering.

"it is good!"

"Wait!" Lin Yi hurriedly held Wu Jiang back: "Don't do heart compressions!"

Everyone turned their heads and looked at Lin Yi suspiciously.

"Why didn't the rescuer do heart compressions? This person is almost beating!"

Wu Jiang didn't understand what Lin Yi meant.

Shouldn't CPR be done in cardiac arrest?

"His bleeding point is in the lower part of the esophagus, right? It's just close to the heart. If you press it again, the bleeding will be worse?!"

Wu Jiang was stunned.

yes……

This will kill you faster...

"Then...then what should we do? Wait until he dies?"

Wujiang is gone.

Fortunately, at this time the blood came!

"Blood is coming, blood is coming!"

The nurse at the blood bank quickly sent over the red blood cells, plasma, and platelets, a total of [-] milliliters.

"Hurry up and enter it, and let me see his checklist in the morning. What kind of checks were done? How did you diagnose esophageal cancer?"

After Lin Yi appeared, the command of the scene was unknowingly handed over to Lin Yi.

"Chest X-ray, electrocardiogram, gastroscopy, blood routine have all been done."

Wu Jiang brought over the checklist that the patient had thrown away in the morning.

While reading the checklist, Lin Yi asked Wu Jiang to directly squeeze fresh blood into the patient with a pressurizer.

In the infusion tube, the blood was still flowing drop by drop, but under Wu Jiang's strong squeeze, it directly became a straight line, continuously pouring into the patient's body.

Although the blood was a bit cold, the nurses next to him covered the heat with their hands, trying to keep the blood temperature from being as cold as possible.

Fortunately, [-] milliliters of blood is useful.

After the infusion, the blood of the patient recovered, the medicine also took effect, and the blood pressure also increased.

Seeing Lin Yi staring at the checklist, Wu Jiang asked:
"Lin Yi, what's the name here? Could it be that this person has esophageal cancer? But the lump and bleeding on the gastroscope are very clear."

Of course Lin Yi knew that the results of the gastroscopy clearly showed that there was indeed a mass in the esophagus.

But the problem is, the cause of this person lies below the lump!
He is not esophageal cancer at all!

But...

But the doctor in the gastroscopy room didn't continue to probe because he was worried about breaking the lump and causing massive bleeding.

This problem was not discovered, which resulted in a misdiagnosis.

After watching for a while, seeing that the patient's condition had stabilized again, Lin Yi quickly ordered:

"Let the blood bank transfer 600 milliliters of platelets and plasma, and then send the person to the operating room as soon as possible."

"Ah? How...how can I send this to the operating room? Is it going to be operated directly to stop the bleeding? But...but how to stop the bleeding in this situation?"

Lin Yi glanced at Wu Jiang and said:

"I have a way."

This…………

Wu Jiang couldn't help being taken aback.

All right, I was worrying too much!

As soon as the gastroenterology doctor came down, he saw the emergency department sent the patient to the operating room.

"Hey, we haven't seen it yet, why did you send him away?"

The emergency nurse replied:
"Dr. Lin is here! He asked us to send the patient to the operating room."

Gastroenterologist: "Say it earlier, it will cost us a waste of time."

in the operating room.

Six hundred milliliters of blood arrived.

Performing blood transfusion at the same time is a very dangerous behavior.

But Lin Yi still went up under the pressure.

The gastroscopy doctor next to me felt a little guilty.

"Doctor Lin, can you still go to the operating room if you vomit blood so badly?"

(End of this chapter)