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

Yin Liang also doubted:

"It's just suppurative pancreatitis, and the area of ​​the vitreous density shadow in the lungs is also very small. The patient has no symptoms, neither hypoxia nor cough. How can you be so sure?"

Seeing their doubts, Lin Yi was also prepared, he said:
"It might sound a little silly, but it's true.

The uncle did not show symptoms of shortness of breath or hypoxia, probably because it was still early.

If you come to the hospital a little later, or one day later, the shadow of the lung CT may become denser.

Another point is that the cause of interstitial pneumonia is actually related to pancreatitis.

During the pathogenesis of pancreatitis, the body will produce a large number of inflammatory cytokines and inflammatory mediators.

Its degradation products are likely to cause severe contraction of capillaries in the lungs, resulting in increased permeability of vascular endothelial cells, resulting in poor lung perfusion, resulting in cell damage and dysfunction in the lungs.

It's just that it's an early stage, and the patient's symptoms are very mild, or there are no obvious symptoms.

In addition, pancreatitis is also included in the many etiologies of ARDS.

And its mechanism of occurrence is similar to that of interstitial pneumonia.

All are lung injuries caused by inflammatory cytokines and inflammatory mediators.

But the reason why I ruled out ARDS is because ARDS must have respiratory symptoms.

However, interstitial pneumonia will not occur in the early stage, so in addition to octreotide and omeprazole, which are used to treat pancreatitis, glucocorticoids and diuretics are also used. "

The words fall.

Everyone in the office stared at Lin Yi blankly.

Especially Wu Jiang and Yin Liang.

This guy……

How did Brother Yi realize so quickly that the lung inflammation was caused by pancreatitis? ?
and also!

Regarding the auscultation of the lungs, I think Wu Jiang has been practicing medicine for so many years and he has not heard any abnormalities.

In the end, Brother Yi recognized it as soon as he heard it! !

For a moment, Wu Jiang felt goosebumps all over his arms! !

Brother Yi's observation and judgment skills are really too strong!
In patients with severe pancreatitis or immunocompromised patients, it is true that this kind of inflammatory cytokine damages the lungs.

But the odds are very, very small.

It is so small that it is difficult for ordinary doctors to find that the cause of lung problems is pancreatitis.

Either it is suspected to be the sequelae left by the previous lung disease, or it is suspected to be a viral infection of the lungs.

In short, it is difficult to associate those shadows on lung CT with pancreatitis.

Hey……

I have to say, Brother Yi is really powerful.

After a while of silence, Lin Yi gave the doctor's order under the watchful eyes of all the doctors.

At this time, the nurse in the emergency room also ran over and said:

"The patient with pancreatitis just now didn't know what happened. I felt that he was panting a little urgently? And the fingertip oxygen saturation was measured to be 85%. Do you need oxygen?

Also, he still has a low-grade fever, with a body temperature of 38.1°C, and other vital signs are normal. "

Lin Yi quickly replied:

"To get on, first give oxygen at high flow for an hour, and then switch to low flow oxygen when the oxygen saturation reaches 90%."

"Ok!"

After the nurse responded, she turned her head and went to work.

In the office, all the doctors in the hospital looked at Lin Yi with admiration.

I just said that I have no symptoms, but the symptoms of this patient came soon!
Soon, the migrant worker's body temperature dropped after the infusion.

The index of amylase has also been checked again.

Surgery should be scheduled next.

Suppurative pancreatitis and free fluid has appeared, it is necessary to drain and remove the purulent and necrotic pancreatic tissue.

Soon, the migrant workers were sent to the operating room.

He didn't have much money, and it was all collected by the guys who came together.

In addition, the family members also notified that a boy wearing a high school uniform and a middle-aged woman who looked a little demented came over.

The middle-aged woman should be the patient's wife...

I feel like a disabled person who can't speak or walk very well.

No wonder patients keep saying they have no money.

Before entering the operating room, Lin Yi tried his best to explain the patient's main problems and surgical plan to the two family members.

The expression on the high school student's face was very flat, as if he understood, but also as if he didn't understand.

Let alone a middle-aged woman, she kept holding Lin Yi's hand and wanted to speak excitedly, but she couldn't say a complete sentence for a long time.

Lin Yi nodded and looked at them:

"Don't worry, the operation is not difficult and it will end soon."

The two family members nodded in unison.

"Doctor, wait!"

Just as Lin Yi was about to enter the operating room, the high school student suddenly stopped him.

Lin Yi looked back at him.

But the boy stammered and said:

"Doctor... I... our family's condition is not good, I don't have money to give you a gift... But... But if you cure my dad...

I... I can be your cow or horse, thank you! "

After finishing speaking, the boy bowed at [-] degrees to Lin Yi.

Lin Yi was quite moved when he heard this.

Although this child is only in high school, he seems to be much more sensible than students of the same age.

Hey, yes, which poor family's children didn't become home early?
Lin Yi stepped forward and pulled the boy up and said:
"Child, do you know that we doctors don't need you to give gifts?
It is our duty to cure diseases and save lives, and no additional conditions are required from you.

If you really want to thank me, you should study hard and get admitted to the best university. Your future success is the best way for you to repay me.

Think about it, your dad is so tired working on the construction site all day, isn't it all because of you? "

The boy raised his head, his eyes twinkling with starlight.

"I... I will! Thank you doctor, please make sure to cure my father."

"Ah."

Lin Yi gave an affirmative answer.

In the operating room, disinfect, prepare skin, and spread surgical towels.

Lin Yi is the chief surgeon.

The operation is performed in a minimally invasive way, that is, two holes are made in the abdomen.

While placing the laparoscope, place the operating tools.

Inhalational anesthesia, general anesthesia, the patient quickly closed his eyes.

Song Borui helped clamp the skin with round forceps, and Lin Yi took a scalpel to make an incision around the hole.

After the incision is made, place the multi-channel single-hole PORT.

Song Borui helped Lin Yi hold the mirror, and when the camera first penetrated into the abdominal cavity, the position of the pancreas was not fully exposed.

However, part of the tissue of the abscess can already be seen.

Pulling the liver and stomach aside, the entire pancreas was completely exposed to everyone's eyes.

"The area of ​​necrosis accounts for more than half."

Song Borui sighed, and put the flushing tube in.

Rinse and suction first to clean the operative field for easy operation.

On Lin Yi's side, he held the bipolar coagulation forceps and started blunt dissection.

When the bipolar coagulation forceps are closed, they can be used as a live blunt knife.

When opened, it is a charged scissors.

It is a very commonly used surgical instrument in clinical medicine.

Nourishing~
The operating room was very quiet, and the sound of electrocoagulation forceps working could be faintly heard.

Lin Yi first clipped the large blood vessels of the pancreas.

Then start to remove the necrotic part of the abscess in turn.

The treatment of suppurative pancreatitis is mainly anti-inflammation, drainage, and removal of abscess.

In the sight of others, Lin Yi held the electrocoagulation forceps and separated the abscess tissue very cleanly.

There was a lot of blood everywhere.

Song Borui was also attracted in a timely manner, and he always maintained a relatively clear vision of the operation.

After the separation is complete, the necrotic part of the abscess is clamped out.

Hemostasis, opening of pancreatic vessels.

The entire abdominal cavity was cleaned again to remove the purulent fluid.

A drainage tube was placed in the laparoscopic hole on the other side.

Drain the residual blood out of the body in time.

The entire operation took less than 10 minutes.

The operation time is only 10 minutes.

"Okay, it's over, pay attention to the patient's drainage, and be careful of secondary infection."

"okay, got it."

After a while, a patient came from the emergency center.

Zhou Chao hurried out of the hall to pick up the patient, and Lin Yi followed.

"Male, 48 years old, previously healthy. Severe chest pain for one hour. In the community hospital, sublingual nitroglycerin did not relieve, no dyspnea, no nausea and vomiting."

The doctor on the ambulance hurriedly briefed Zhou Chao on the patient's condition.

The patient was lying on the first aid stretcher, his face was slightly pale, his head was sweating profusely, he was clutching his chest, and his face was full of pain.

A middle-aged woman, holding a stretcher, asked worriedly: "Doctor, please show my husband quickly, what is wrong with him? His chest pain is unbearable."

Hearing what the emergency doctor said, Zhou Chao already had a general direction in his heart.

He hurriedly used his stethoscope to listen to the patient's condition.

It was found that the patient's heart rate was regular, there was no murmur, and the breath sounds of both lungs were also normal.

Using the stethoscope alone, no obvious problems were found.

The pain of the patient is so severe, it is no wonder that he is not sick.

Stethoscope auscultation is only a preliminary screening.

Only a small part of the disease can be judged.

For example, arrhythmia, atrial fibrillation, premature beats, heart valve insufficiency, and dry and wet lung rales, etc., can be judged with a stethoscope.

But in this case, if the patient complains of severe chest pain and there is no abnormality in cardiopulmonary auscultation, further examination of other conditions is required.

Zhou Chao hurriedly asked the patient's lover, "Has your husband ever had this kind of situation before?"

"No, he is in good health, this is the first time he has an illness!"

"Do you have any history of high blood pressure, diabetes, etc.?"

The patient's wife shook her head hastily.

"Without these diseases, the blood pressure he measured a few years ago was still normal!"

No useful information was obtained from the patient's family.

The patient has now been pushed into the emergency room, and Zhou Chao immediately gave him an electrocardiogram.

Given the patient's age and severe chest pain, Zhou Chao's first thought was acute myocardial infarction.

Acute myocardial infarction is a very serious heart disease.

Ventricular fibrillation and cardiac arrest can occur at any time in the patient, seriously endangering the patient's life.

While Zhou Chao was performing an electrocardiogram on the patient, he also gave other medical orders to the nurse.

"Electrocardiographic monitoring, oxygen inhalation, routine blood tests, liver and kidney function, electrolytes, and 5 coagulation items and myocardial enzymes."

The patient's EKG came out.

Zhou Chao took a closer look and found that there was nothing wrong with the electrocardiogram.

There is no problem with the electrocardiogram, and acute myocardial infarction can generally be ruled out.

In the case of this patient, there is no obvious problem in the ECG, and acute myocardial infarction can basically be ruled out.

Then the risk of the patient will be greatly reduced.

It stands to reason that Zhou Dynasty should relax.

But the patient's chest pain did not ease at all, and Zhou Chao's brows frowned even tighter.

He had a bad feeling.

At this time, the nurse had already connected the leads of the ECG monitor to the patient, and the monitor quickly displayed the patient's blood pressure.

Blood pressure actually reached 200/120mmHg.

Zhou Chao couldn't help taking a deep breath.

A normal person's blood pressure will not exceed 140/90mmHg, but this patient's blood pressure has reached a very high risk level.

The bad premonition in his heart became stronger and stronger.

Lin Yi couldn't help but frowned slightly.

If there is no problem with the patient's ECG, there is a high probability that acute myocardial infarction can be ruled out.

So why does the patient still have such severe chest pain?
Lin Yi suddenly thought of that, very serious cardiovascular disease.

In his mind, the patient's aortic vessel and other conditions have already emerged.

Sure enough, as he expected, the patient suffered from aortic dissection.

Aortic dissection is a relatively rare fatal disease, and its occurrence is related to many diseases.

Hypertension is an important risk factor for aortic dissection.

About 70% of patients have a history of hypertension, distal aortic dissection, and hypertension is more common.

The most common symptom of this disease is sudden onset, sudden severe pain.

It is usually in the chest area, sometimes pain, but also pain in the back, abdomen and lower limbs.

Its symptoms are similar to those of acute myocardial infarction.

Sometimes, the electrocardiogram of patients with aortic dissection will also show myocardial ischemia, which is more likely to confuse doctors.

This is a very dangerous cardiovascular disease. A patient's aortic aneurysm can rupture at any time, causing massive bleeding, and the patient can die instantly.

The mortality rate of this disease is relatively high.

Once the aneurysm ruptures, even if the patient is lying on the operating table, the doctor cannot save his life.

Because the pressure on the aorta is very high, once the aneurysm ruptures, the blood in the whole body will soon flow out.

Even lying on the operating table, the doctor has no time to rescue him.

Obviously, the Zhou Dynasty also considered the possibility of this disease.

Without waiting for Lin Yi to remind him, he hurriedly said to the nurse:
"Hurry up, first inject a dose of pethidine to relieve pain, then add 50 ml of normal saline, add 50 mg of sodium nitroprusside, and inject 4 mg per hour intravenously, and quickly lower his blood pressure."

Then Zhou Chao said to the patient again: "You must relax now, and you must cooperate with my treatment. Don't be overly tense and don't move around. I will give you a painkiller in a while, and you won't be in so much pain. I still need to take you to do a few tests to confirm the diagnosis."

This patient is simply a ticking time bomb, which may detonate at any time.

Zhou Chao's heart also reached his throat.

He just guessed in his heart that this patient had an aortic dissection aneurysm.

But without a test, she can't be 100% sure.

Lin Yi already knew about the patient's illness, but he couldn't stop it. Zhou Chao went to examine the patient.

This patient definitely needs immediate surgery.

But without those tests to confirm the diagnosis, surgery is not possible.

Zhou Chao has already considered this dangerous disease, and he also knows that it is very dangerous to take the patient for examination.

During the examination, the aneurysm may rupture, and the patient will die in the examination room.

However, she has nothing to do, even if it is dangerous, she has to take this patient for an examination.

Otherwise, the following operations and treatments cannot be performed.