My medical skills add experience

Chapter 613 The importance of inspection, a breakthrough discovery
On the day after admission, the patient had another headache, especially in the bilateral frontal and temporal regions.Finally, because the pain was too severe, vomiting occurred.

It can be so painful that the patient vomits, indicating that the pain level is very high.

The patient's body temperature was 38.4 degrees when admitted to the hospital, indicating the presence of fever.

After admission, the hospital gave her an intravenous infusion of antibiotics, which is also the basic package for most patients after admission.Especially for patients in gastrointestinal surgery, intravenous infusion of glucose or sodium chloride, coupled with corresponding antibiotics, has almost become a universal method.

Many people blame small clinics for the abuse of antibiotics. In fact, the buttocks of hospitals may not be clean.

It's just that large hospitals have stricter control over the dosage of antibiotics.

In order to pursue the maximum therapeutic effect, small clinics often choose to increase the dose.

After the female patient took antibiotics, her body temperature returned to normal on the third day of admission.

It has to be said that the efficacy of antibiotics is indeed very good.

That's why doctors and patients alike love it.

The course of disease recorded the progress of the patient's condition. On the third day of admission, although the body temperature dropped and the headache improved to some extent, the patient's condition did not abate.

Because she was still briefly unconscious on the third day, convulsing all over her body.

Each attack, the symptoms don't last for a long time, and it only lasts for about seven or eight seconds before resolving on its own.

Seeing this, Zhou Can felt that the patient's condition was a bit confusing, and it was difficult for people to figure it out.

When the cause cannot be identified based on symptoms alone, doctors can often infer the cause based on the test results.

The patient's current body temperature is 36.9 degrees, pulse rate is 74 beats/min, respiration is 29 beats/min, and blood pressure is 84/146mmhg.

All four major signs were basically normal.

In other words, as long as the patient does not get sick, his body is almost the same as that of a normal person.

No wonder she went to the neurology department.

In this case, the first suspicion must be neurological disease.

According to her symptoms, it is likely that something is wrong with the central nervous system.Such as brain lesions, or epilepsy and so on.

The nutritional status of the patient is acceptable, the skin and mucous membranes are free from yellow staining, the complexion is not pale, and there are no bleeding spots or spider veins on the body.Her thyroid was not enlarged, her thorax was not deformed, her breath sounds were clear, and no dry or wet rales were heard on auscultation.

The heart rate was 74 beats/min, the heart rhythm was regular, and there were no murmurs in each valve area on auscultation.

The abdomen was flat and soft when pressed, without tenderness and rebound pain, and no mass was felt.The spine and limbs were normal without deformities.

This series of physical examinations proved that the patient's body was basically normal, and no obvious lesions were found all over the body.

The diagnosis again points to the central nervous system.

The brain is the main object of suspicion.

The first doctor, Director Yin Hua, conducted a preliminary examination of the patient's brain.

Including talking with the patient, the patient's consciousness is clear, his thinking is clear, his speech is normal, his memory and calculation ability, comprehension ability, and judgment ability are normal.

The patient's visual acuity and visual field were also normal.

Except for double vision, headache, and twitching of the limbs during the onset, there are no other problems.

Director Yin also focused on the examination of the optic disc of the patient's fundus. The left eye moved flexibly in all directions, and there was no abnormality in the upsight and abduction of the right eye, which was obviously limited, and there was diplopia.

During the test, the diplopia is especially obvious with the center of the eyeball and the right eye.

Zhou Can couldn't help thinking of the child with high paraplegia.After the little boy fell, there were also obvious differences between the left and right sides of the body.

To overcome this case, we may be able to get some inspiration from it.

Although the conditions of the two are completely different, if they are both neurological diseases, they can definitely learn from each other.

Zhou Can decided to go to the ward to see the female patient in person.

Regardless of the description of the condition in the medical record, the record of the course of the disease, and various inspection reports, it is not as straightforward as the doctor seeing the patient with his own eyes.

Inspection has been a basic skill of doctors since ancient times.

It is also the diagnostic medical technique that ranks first among the four diagnostic techniques of traditional Chinese medicine.

In TCM diagnosis, inspection is not the core diagnostic skill, but it is the first diagnostic method after consultation.

Just like a day's plan lies in the morning, and a year's plan lies in spring.

It is a beginning of the doctor's diagnosis.

It has a great influence on the follow-up disease research and judgment.

The core diagnostic technique of Chinese medicine is pulse detection.

The development of western medicine is thousands of years later than that of traditional Chinese medicine, so it can be regarded as a rising star.Its diagnostic habits have somewhat copied traditional Chinese medicine.

Inspection is still the first item of diagnosis in Western medicine, alongside physical examination.

As for cutting the pulse, Western medicine does not recognize the theory of tendons and veins. Western medicine believes that pulse science is metaphysics, which is very illusory.It may also be felt that the study of pulse is too complicated, so Western medicine has developed a set of diagnosis and examination methods to replace the pulse.

That is ultrasonography, biochemical experiments, CT examination, MRI, endoscopy and so on.

It doesn't matter whether a cat is black or white, as long as it catches mice, it is a good cat.

The TCM pulse is very powerful. A good TCM practitioner only needs to touch the patient's body, which is equivalent to a patient going to the hospital for a full-body examination.Moreover, there may be diseases that cannot be detected by advanced equipment, but Chinese medicine can find the clues by checking the pulse.

However, Tengmai is very difficult to learn, and requires a high degree of talent, and it takes many years of study to achieve success.

Talent training cycle is too long.

Coupled with the decline of Chinese medicine nowadays, there are not many old Chinese medicine practitioners who really understand the pulse, and it is even more difficult to preach and teach.

It is easier to popularize various techniques of western medicine, and students with a little brain can learn medicine.

In this regard, medical students who are suitable for studying medicine can be screened directly through the college entrance examination.

Therefore, Western medicine is the world now, and there are many talents.

The inspection and operation of various instruments is really not good, and it is all possible to operate according to the instructions.

According to the information in the medical history, Zhou Can found the inpatient ward where the patient was located.

There are 37 beds in Shennei.

A beautiful female patient was lying on the hospital bed, accompanied by a middle-aged and elderly woman in her [-]s.It should be the patient's mother.

Even if a woman is married, the family members who accompany her when she is sick are either her parents, her husband or her children.

In short, very few father-in-law or mother-in-law go to the hospital to take care of their daughter-in-law.

"Excuse me, is this Ms. Zhao Caixiu?"

"Yes, I am."

Seeing the doctor coming, she sat up quickly.

"It's okay, I'm just here to find out about your condition, just lie down."

Zhou Can quickly comforted her.

Patients with such neurological diseases should try to keep them in a relaxed and natural state as much as possible.Otherwise, you will be nervous and easily get sick.

"Let me check your eyes."

"Ok."

She readily accepted.

The vast majority of patients are happy to have a doctor come to examine them and care about their condition.

Zhou Can stared at the patient's eyes, and the right eye was obviously slow to turn and difficult to turn up.

"Watch my fingers and don't move your head."

After Zhou Can finished speaking to the patient, he stretched out a finger and moved it up, down, left, and right in front of the patient's eyes.

The patient's right eye was more sluggish when turning.

Zhou Can first blindfolded the patient's left eye, and then stretched out two fingers.

"How many fingers do you see?"

"It seems to be four!"

Come on, the patient's right eye really has diplopia.

He covered the patient's right eye again, and asked, "How many fingers?"

"Two!"

The patient's left eye had normal vision.

Zhou Can's examination of her is not over yet. The examinations just now have been done by other doctors. He just wants to confirm the results again and see the patient's eyeball performance.

"Did your right eye hurt when you turned it just now?"

"It seems to be a little painful. When the right eye is turned, it seems to pull a certain nerve, and the head will hurt a little."

The patient answered truthfully.

"Okay. Let me touch your face and you relax."

Zhou Can touched the patient's left and right faces, especially the cheeks and cheekbones, and there was no obvious abnormality.

"Do you usually eat chewing gum?"

"Occasionally eat, rarely." The patient said a little embarrassed.

"Come on, I'll give you a piece of gum. Just keep your eyes open while chewing. I'll do a further check on both of your eyes."

Zhou Can took out a piece of Green Arrow chewing gum from his pocket and handed it to the patient.

This unique examination method immediately attracted other patients and family members in the ward.Everyone watched curiously.

After the patient took it, he opened the packaged aluminum tin foil, put it in his mouth and began to chew.

Although she didn't know what items Zhou Can wanted to check, she still felt that the young doctor's examination method was unique and novel.

Zhou Can stared at the patient's eyes and found that her corneal reflex was abnormally dull.

Chewing is very strong.

"Close your eyes."

She closed her eyes obediently, and Zhou Can tried to roll her eyelids, feeling that she had great strength when she closed her eyes.

He stared at her face carefully again. The corners of her mouth were not skewed, the depth of the nasolabial fold was normal, and there was light fluff on her lips.

Women don't have beards, but they have fluff, which is normal.

Some women will have elevated male hormones during a certain period of time. At this time, the hair on the lips will become thicker and longer, like a beard.Many women often feel panic, but in fact there is no need to worry, this is just a normal physiological phenomenon.

Especially in older women, it is especially obvious after menopause.

Just face it calmly.

If you really feel that it affects your appearance, and you are worried about being discriminated against or laughed at by others, you can use hair removal cream to remove the fluff on your lips.

In addition, when male compatriots are looking for a female partner, if they want to know whether the other party has a strong personality, there is a little trick for reference.

As long as you secretly observe the other party's lip fluff, if it is thick and long, such a girl is likely to have a strong personality.After marrying home, you must be prepared to be strict with your wife.

Of course, marrying such a girl is actually very happy.

This kind of girl is often very ambitious, loves and hates clearly, and has a big temper, which is a bit big, but she is very good to her husband and children.

If you can't get along with the elderly at home, just don't live together.

"Okay, please spit out the gum and try to drink some water."

Zhou Can's test on her is still going on.

When the patient spit out the chewing gum, he wrapped it in tissue paper and signaled his family to throw it into the trash can.Judging from her performance, she is quite accomplished.

She took a sip from her water glass.

Zhou Can found that she seemed to have difficulty swallowing.In fact, she had discovered this phenomenon just now when she was chewing gum.

The gag reflex is evident when swallowing.

But it didn't choke.

"Stick out your tongue and open your mouth a little bit wider."

Zhou Can said to her again.

Fortunately, the patient's husband is not here, and it is easy to misunderstand the female patient's husband when doing this kind of examination.

In fact, the doctor is just to find out the cause of the patient, and there is no other bad intentions at all.

Through observation, he found that the patient's tongue can be centered naturally, without tongue muscle tremor and atrophy.

"Okay, that's it."

Zhou Can continued to conduct other examinations on her.

The muscles of the patient's limbs were all normal, the muscle tone was normal, and no voluntary movement was found in the body muscles.The free-masking movement test was normal, there was no abnormality in the depth and depth of the limbs, and there was no hyperactivity or decrease in the tendon reflexes of the limbs.

There appears to be a positive Babinski sign bilaterally.

This is a new discovery.

The patient lies on the back, the hip and knee joints are straight, the examiner holds the upper part of the ankle with the left hand to fix the calf, and the right hand holds a blunt-tipped metal rod from the outside of the foot to the root of the little toe, and then turns to the side of the big toe. Test for bilateral Babinski sign.

Normal plantar flexion of the toes is negative.

The female patient was obviously abnormal, and the initial diagnosis was positive.

It seems that you still have to contact the patient in person.

If he hadn't come to the ward for an in-depth examination, it would have been impossible to discover so many details.

If you only look at the test results and medical records, as long as the patient's body doesn't get sick, everything is normal.

Who would have thought that there are so many abnormalities hidden under the seemingly normal performance?
"Let me touch your neck, try to relax, don't be nervous."

Zhou Can tried to touch and press the patient's neck, and the skin was smooth and silky.

On palpation alone, there is significant neck resistance.

"Relax, don't tense your neck, or the results of my examination will be inaccurate."

Zhou Can gently comforted the patient.

"Ok."

She closed her eyes and tried to relax.

But the phenomenon of neck resistance still exists.

Zhou Can tested her for Kellnig's sign and Bruluski's sign, and the results were both +.

Not particularly serious.

"Okay, thank you for your cooperation. We will tell you when we have a new diagnostic breakthrough." Zhou Can has gained a lot. Although there is no clear direction for the patient's etiological diagnosis, combined with the patient's experiment Laboratory examination and various instrument examinations should be able to diagnose her cause.

"Are you the patient's mother?"

He looked at the middle-aged and elderly woman accompanying the bedside and asked.

"Yes! I am her mother."

"If she is sick, try to put her on her side, preferably on her left side. It will be safer for her."

"Okay, thank you."

The family members nodded, expressing that they remembered.

Family members generally obey the doctor's orders.

There are also some suspicious family members, or family members who think they know a little medical knowledge, who will have doubts about the doctor's advice.

It can only be said that if you don't listen to the doctor's advice, you will suffer in front of your eyes.

Sometimes it is easy to suffer a big loss.

Zhou Can returned to Director Yin's office and found that Director Yin Hua had returned.

"I thought you were running away! How about it, have you read the information of that female patient?"

Director Yin asked.

"When did I slip by?"

Zhou Can couldn't help rolling his eyes strangely.Director Yin looked serious, with an old-fashioned pedantic personality, but after getting to know him well, especially after his strength was recognized by the other party, he was quite open-minded when talking.

(End of this chapter)