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

Lin Yi was not impatient either.

The time spent in the emergency department is not short, what kind of patients have not seen?
I have encountered a lot of troublemakers before. Although they will be taken away by the police in the end, those kind of people will go crazy and dare to do anything.

Lin Yi said in a very peaceful tone:
"Sir, are you here to see our doctor's age? Or are you here for treatment?"

"If you insist on looking for older doctors, there are plenty of rehired doctors in our hospital in their 80s, and I can introduce you to them."

"If you come to see a doctor for treatment, I can show you."

Seeing Lin Yi's calm demeanor, the middle-aged man's mood eased a little.

The nurse next to him immediately cooperated and said, "Don't look young to us, Dr. Lin, he is the leader of the independent clinic in our emergency department."

"The level is very high. It is well-known in our hospital. There is nothing wrong with him treating you."

When he heard that Lin Yi was in an independent clinic at such a young age, the middle-aged man lost most of his anger.

He hesitated for a moment and said, "Why don't you take a good look at me again to find out what's wrong with me. I'm very suspicious of what the doctor said just now."

As the man spoke, he took out all his inspection reports.

Lin Yi turned on the film viewing light, put the film on it, looked at it in detail for a while, and then carefully looked at the test results.

As for the man's illness, I already knew it in my heart.

"I already understand your condition, so what are you doubting?"

The man said: "My sputum was bloodshot. I was afraid it might be cancer. After the examination, I said that there was nothing serious about me. I didn't believe it."

Lin Yi looked at his inspection report for a while, then nodded:
"Well, you are indeed sick!"

When the middle-aged man heard Lin Yi say that he was indeed sick, his expression immediately became tense, and his hands even trembled a little.

"Doctor, am I really sick?"

"Am I lung cancer?"

"Am I dying?"

"Is there any help for me?"

A series of questions from the depths of the soul left Lin Yi speechless.

This is the same as the patient who always thought he was sick during the live broadcast.

He really wanted to say: "It's hopeless, just wait for death!"

But professional ethics does not allow him to do so.

Even the nurse next to him suppressed a smile.

Although she is not a doctor, this middle-aged man has been diagnosed by Dr. Wang, and basically he can't make mistakes.

Saying that he has no serious illnesses, there shouldn't be any serious illnesses.

But this man insisted on thinking about lung cancer, which is weird enough!
No one would imagine that they have cancer!
As for Lin Yi's medical skills, that's right there. In recent months, everyone in the emergency department has witnessed his surgical ability and rich clinical experience.

But now Lin Yi said that this man is really sick, and she also wants to know what kind of illness this man is.

Therefore, the head nurse couldn't help pricking up her ears, waiting for Lin Yi's next words.

Seeing that Lin Yi kept silent, the middle-aged man became even more nervous.

The muscles of the whole body seemed to tremble a little, and the lips trembled a little.

"Doctor, why don't you talk? Is it true that I have lung cancer? I'm rich, and I'm not afraid of spending money. You give me all those imported medicines, and you must cure me."

Lin Yi couldn't help sighing secretly.

This man also looks like a rich man.

He was very curious, how could a man earn so much money with such an IQ?
"You are sick, but not lung cancer."

Lin Yi pointed to his heart, and continued, "You are sick here."

"Heart disease!"

"What?"

"Heart disease?!"

The middle-aged man suddenly widened his eyes and raised his voice: "You said that I am not lung cancer, but a heart disease? Heart disease, why do I cough and vomit blood? Will you see a doctor?"

The head nurse was also speechless.

Saying that you are not lung cancer, you are still impatient!
Are you happy only if you get lung cancer?
You can meet all kinds of people in this hospital, and there are even some people who hope that they will get lung cancer.

She had never seen such an idea in her life!
Lin Yihuan put his arm on the table, looked directly at the middle-aged man, and said slowly:

"You do have a little trouble with your lungs. But it's not lung cancer, it's just bronchitis.

It may be caused by you catching a cold a while ago.But bronchitis, which caused your severe cough, caused the rupture of capillaries in the lungs, so it caused cough with blood in the sputum, not lung cancer! "

"Don't suspect that you have lung cancer just by searching for some symptoms on the Internet.

I can tell you clearly now that you have some bronchitis in your lungs, and there is no major problem. "

"What Dr. Wang told you before is correct. Now you only need to take some antibiotics and medicines to relieve cough and reduce phlegm, and you will recover slowly."

"However, if you insist on thinking of your illness as lung cancer, it's not a heart disease, what is it?"

Lin Yi explained in detail, explaining clearly the reason why the middle-aged man coughed with blood.

Even the nurse on the side nodded secretly.

I feel that Lin Yi is serious and careful in seeing a doctor, and he is also very patient.

For such a wonderful patient, he is not in a hurry.

Can't help but praise Lin Yi again and again.

Although Lin Yi explained in detail, the middle-aged man didn't buy it.

"I used to catch a cold, cough and spit, but I never had blood in the sputum. Why this time, I coughed and had blood in the sputum after catching a cold?"

"And other people in my family also have a cold and a cough. Why don't they cough with blood? Why do I have it?"

"And it's also said on the Internet that if you cough with blood in your sputum, you must be alert to lung cancer. I have blood in my sputum, and you still say that I am just a minor problem, and you can take some medicine. Will you see a doctor?"

"Or, you saw that I had lung cancer, so you didn't tell me on purpose, and you want me to call my family?"

"You are irresponsible to the patient, you young doctor is really unreliable!"

The real cause of this man was indeed caused by bronchitis, capillary rupture and bleeding.

It is not a big problem to cough with blood in the sputum, and it will be cured after taking some medicine in a few days.

But this person, who did not know where he saw the blood in the sputum, considered lung cancer.

Therefore, he stubbornly believed that he had lung cancer, and thought that the doctor lied to him.

For this kind of paranoid and stubborn patient, it is impossible for Lin Yi to explain patiently to him all the time.

Even if you explain it to him, he won't believe it. He would rather believe what he sees and hears than the doctor.

And such patients are not rare.

Lin Yi said solemnly again: "According to all your current examination results, you only have bronchitis, not lung cancer at all. If you don't believe it, you can choose to go to another hospital to have a look."

The middle-aged man stood up suddenly, his voice raised again.

"You can't see the problem, so let me go to another hospital to see it. Is your central hospital at this level?"

"What a quack! Wasted my whole morning."

After the middle-aged man finished speaking, he rushed out of the door.

Looking at the middle-aged man who hurried out, the head nurse was stunned.

"Director Lin, why is this person like this? You told him that there is nothing serious wrong with him, but he didn't believe him. He insisted on believing that he had lung cancer. It's really weird!"

"I've explained everything to him. If you don't believe me, there's nothing you can do about it. Since he's not short of money, let him do whatever he wants."

The middle-aged man left the emergency department and did not go to other departments to register. Instead, he cursed all the way to the parking lot.

He came to a domineering car, opened the door, and got into the cab.

He took out a Huazi, stuffed it into his mouth, took out the lighter, and prepared to light it.

After thinking that he was still coughing and bloody, he stuffed Huazi back again.

"Hmph, this hospital is full of quack doctors. I saw a few doctors, and they all said that I have no major problems. What the hell, when I cough up sputum, there is blood, and they say I'm fine.

The cough is bloody, is this okay? "

"No, the level of this hospital is not good, and neither is the doctor. I have to go to a big hospital for an examination tomorrow."

While muttering, the middle-aged man turned on the ignition, kicked the gas pedal, and walked away.

My own home had just been demolished, and I was allocated 2000 million before I bought Dabadao and married a young wife in her twenties.

You can't get lung cancer yourself!
Not long after Lin Yi sent him away, another doctor in charge of the emergency department came over and said that there was a patient who wanted to be seen by Lin Yi.

Lin Yao took the medical records and read them.

He complained of bloody stools for more than a month, and he was admitted to the hospital a week later with aggravated foreign body sensation in the perianal area.

All vital signs and various examinations were normal when admitted to the hospital. The admission diagnosis was mixed hemorrhoids, so a suture operation was performed.

But on the third day, bloody stools started again, and the amount of bleeding was about [-] milliliters.

A simple hemostatic bandage was done.

Three days later, he bleeds again, and the amount of bleeding is [-] milliliters. It is found that the sigmoid colon vascular malformation ruptures and bleeds.

Surgical removal of malformed blood vessels followed by sutures.

Less than six hours later, the wound was bleeding again.

Intestinal resection and interventional hemostasis were performed.

Three surgeries back and forth.

The amount of bleeding is also bigger and bigger every time.

Lin Yi flipped through the medical records and doctor's orders.

But I looked around and found no suspicious problems.

All medical orders and records are treated according to bleeding, so what is the problem?
Lin Yi frowned, he also felt a little strange.

Then, Lin Yi looked through all the patient's checklists, including B-ultrasound, blood routine, CT and angiography results.

I looked around and saw nothing unusual.

It is equivalent to saying that this patient only found hemorrhoids when he came to the hospital.

Although the bloody stools lasted more than a month, he didn't even appear anemia.

Still came to the hospital to cut the hemorrhoids, bleeding and then underwent three operations to cause anemia, and the hemoglobin was as low as 98g/L.

Hemoglobin was always above 110.

Ah shit.

What's wrong with this medical record?
Not to mention, it really aroused Lin Yi's curiosity.

Simply, Lin Yi sat on a chair and read the medical record again and again.

While watching, Lin Yi combined the patient's physical condition in his mind.

Apart from a few bleeding spots in the intestines, the patient had no other physical injuries.

No heart disease, tumors or anything like that.

"The white blood cells and eosinophils in the blood routine are not high, and the four blood coagulation tests are normal for three times.

There are no infectious diseases such as AIDS, syphilis, and hepatitis B.

Strange, this guy is really weird..."

Lin Yi said to himself.

Suddenly, Lin Yi set his eyes on the four blood coagulation items.

The knowledge points in my mind are also quickly tumbling, trying to find the most correct point!
The four blood coagulation items are must-check items for every admitted patient.

Including prothrombin time, thrombin time, quantitative fibrinogen and activated partial thromboplastin time.

These indicators are the comprehensive coagulation factors of this patient.

Generally speaking, as long as the result of this test is normal, it means that the person does not have a coagulation disorder.

It is possible to go to the operating room, and there will be no major bleeding during the operation.

But this patient had inexplicable bleeding after the operation? ?
According to Lin Yikan's records, on the day of admission, on the fourth day, and this morning, he had three urgent blood coagulation checks.

There should be no problem with the inspection results, and it has been checked three times.

Moreover, anticoagulant drugs were also used in the doctor's order, but none of these anticoagulant drugs were effective for this patient...

What the hell is going on? ?
Lin Yi frowned and thought over and over again watching...

suddenly!

Lin Yi's eyes lit up!
correct!

And genes!

This patient did not check the coagulation gene! !
It is true that all patients must check the four blood coagulation items when they are admitted to the hospital, but this is the general public!
Ordinary people can basically find out how his blood coagulation function is, whether he has blood coagulation disorder, etc. by checking the four blood coagulation items.

But this is only for ordinary patients!
There is also an extremely rare possibility that this patient may have a disease that cannot be detected by the four blood coagulation items!

It's called hemophilia!

It is an X-linked recessive hereditary hemorrhage!

It is caused by a loss of the gene for clotting factor VII (in hemophilia A) or factor IX (in hemophilia B) in the patient.

This disease can only be detected by genetic testing!

A deficiency of VII is called hemophilia A, and a deficiency of IX is called hemophilia B.

This disease is not easy to be detected because it is rare, and the four routine blood coagulation items admitted to the hospital are most of the general surveys.

As long as this result is OK, it means that the patient does not have a coagulation disorder.

But this patient is a rare hemophilia patient.

That's why I have been treated for so long, and I have lost so many anticoagulants to no avail.

Because the medicine didn't go to the point.

Hemophilia A lacks the VII gene. If this patient wants to stop the bleeding, he can only transfuse blood containing more VII genes to treat the bleeding.

Hemophilia B lacks the IX gene, and the treatment is the same as for hemophilia A.

This kind of patient can only stop the bleeding if he lacks something and loses something.

Other conditions certainly cannot be treated.

Thinking of this, Lin Yi suddenly became enlightened.

This must be the reason!
My guess should not be false!
Just at this time, there was a burst of cursing outside the office.

"The patient's father is here."

The attending doctor couldn't help frowning and said.

"Bleeding again? Is your hospital okay? My son has undergone three operations in your place, so his body is getting worse and worse, right?!"

Then, a middle-aged man walked into the consulting room.

The attending doctor lowered his head slightly, and the scolding from his family really made him uncomfortable.

But at this moment, as a doctor, he can only suffer:

"Don't get excited, I asked Dr. Lin to show your son."