This doctor has a system

Chapter 442 507. Super double

The test and pathology results came out the next day, and the diagnosis of tuberculosis was clear.

Lin Tingran was quickly transferred to the infectious disease hospital, where it was not known whether she could make any waves.

"Director Gao, am I not at high risk?" the patient whose lung occupied the space asked cautiously.

"It's not big." Gao Feng looked at his blood pressure of 190/100mmHg and consoled him, "Trust me."

"Yeah" the patient took a long breath.

"You are so cowardly." Anesthesiologist Zheng Xinglong laughed, "Director Gao's bronchoscopy skills are widely recognized by colleagues in the medical field. There is really no need to be nervous."

"I'm not nervous, I'm not nervous." The patient said, but the heart rate of 120 beats/min betrayed him.

"Forget it, let me start taking the medicine." Zheng Xinglong felt that it was useless to comfort him, so he pushed the anesthetic immediately. After the patient fell asleep, his heart rate and blood pressure quickly dropped to normal values.

Gao Feng picked up the bronchoscope and took a look inside. The airway was very clean, as expected.

In this case, TBNA can be performed, which is transbronchial needle aspiration, but this is a blind puncture with a low positive rate, so it is no longer the first choice.

The more popular EBUS-TBNA now is a small ultrasound probe added in front of the bronchoscope.

Don't underestimate this small probe, it can guide the operator to find diseased or enlarged lymph nodes while avoiding large blood vessels.

If the TBNA is regarded as an ordinary rifle, then the EBUS-TBNA is upgraded to a sniper rifle with a scope added to it, and its accuracy is greatly improved.

The nurse who set up the stage quickly put on the ultrasound bronchoscope and prepared the puncture needle.

"it is good."

"Yes." The nurse was very happy. Something came out of the first puncture needle. It seemed that she could get off work early today.

The next second, third, and fourth injections all brought out something, and some of the onlookers' trainee doctors couldn't help but widen their eyes.

luck?

"The main thing is the operation method." Gao Feng said, "First of all, the mirror must be stable when wearing it."

"The probability of something happening will be higher this way."

"Teacher, come here and give it a try." He said to a training doctor who should be older than him.

"Oh, forget it." The training teacher waved his hand, "I just came out to gain knowledge, and my boss won't buy me a machine when I go back."

"No more wasting everyone's time."

The main unit of ultrasonic bronchoscopy costs more than 500 million yuan, and a mirror costs more than 100 million yuan. How can ordinary county-level hospitals have such strength? Most people just come to have a look and know that this technology is available.

"Let me try." A younger doctor in training was very enthusiastic.

"How long have you been here? Which group are you in now?" Gao Feng asked while correcting his movements.

"I've only been here for half a month, and now I'm washing the mirror in the bathroom." The young training doctor replied.

However, he was quite talented, and under Gao Feng's guidance, he managed to get the first needle through.

"Hey, there is something." The nurse glanced at him and said, "You're lucky."

"I knew I had this talent." The young doctor in training was very happy. "When I study hard, I will persuade the leader to buy a machine when I go back and try to become the director as soon as possible!"

The young man was very energetic and everyone laughed out loud.

There were many family members sitting at the door of the bronchoscopy room. Because muscle relaxants are used during bronchoscopy, they can selectively act on the N2 receptors on the motor nerve end plate membrane, blocking the transmission of nerve impulses to skeletal muscles. , leading to muscle relaxation.

Gastrointestinal endoscopy generally does not require this drug.

This is why patients who undergo bronchoscopy wake up slower than those who undergo gastroenteroscopy. Patients who undergo gastroenteroscopy can even walk back by themselves after the procedure, but it is impossible for patients who undergo bronchoscopy.

He will feel that his limbs are limp and weak, and it usually takes about 2 hours to recover.

"Oh, it's done!" The patient's wife was staring at the exit. "How are you? Do you feel uncomfortable anywhere?"

"It's okay, but I feel dizzy." The patient tried to open his eyes, "A little sleepy."

"Don't sleep yet. The family will talk to him later." The uncle who was transporting the patient said, "You can't eat or drink anything until two hours later."

"When will the results be available?" the patient's son asked.

"It's 4: in the afternoon the next day." The nurse said.

I hope it’s not a tumor. The patient’s son didn’t dare to say anything and could only pray silently in his heart.

When Gao Feng returned to the ward, someone was waiting for him.

"Are you done?" Director Liu from the Department of Vascular Surgery said with a smile, "I've been waiting for you for a long time."

"Do you have any advice, Director Liu?" Gao Feng asked, looking relaxed as if there was something urgent.

"A relative of my hometown in the countryside is hospitalized and wants you to come and have a look." Director Liu explained his purpose.

"Is the condition complicated?"

"It's a bit complicated, but it's not particularly complicated." Director Liu said, "Hey, I can't understand it either. You can go over and have a look."

When he arrived, Gao Feng learned that the patient was now in the intensive care unit.

The patient, a 64-year-old female, complained of persistent gum bleeding for 5 days.
You must be thinking, does a person with bleeding gums need to be admitted to the intensive care unit?

Of course, ordinary gum bleeding is not necessary, but this patient had other causes. Her prothrombin time was as high as 184.5 seconds.

Prothrombin time is the time required to detect blood coagulation by artificially simulating the exogenous coagulation mechanism in vitro. It is commonly used in coagulation tests. This indicator reflects whether the exogenous coagulation function of the blood is normal and can be mainly used to evaluate whether the patient has coagulation function. disorders or bleeding disorders.

Normal range: generally 11~13 seconds.

That is to say, the blood of ordinary people can coagulate in the outside world in about 11-13 seconds, but this old lady's blood needs 184.5 seconds.

Some people may think this is something? Isn’t it just over 100 seconds longer? Is it necessary to be so nervous?
Of course it is necessary. A high prothrombin time can lead to bleeding of skin and mucous membranes, bleeding gums, nosebleeds, blood in urine and other symptoms. In severe cases, it is easy to cause internal bleeding and even cerebral hemorrhage, which is very dangerous at this time.

"So high?" Gao Feng was also stunned for a moment, "Has the test been retested? Is there something wrong with the specimen or the testing process?"

But then he realized that he had said nonsense.

Director Liu even dragged him over, so this result must have been verified.

"The test was retested, and the patient's test result in his hometown was also the same."

Seeing that the coagulation function was like this, the hospital in his hometown county quickly discharged the patient and recommended that he be transferred to a higher-level hospital for continued treatment.

The current doctor-patient environment is not very good. Many doctors in county hospitals are unwilling to spend too much energy on patients who seem a bit complicated at first glance.

Otherwise, it would be nice to find the reason, but if the reason cannot be found, the patients and their families will definitely have opinions. It's acceptable to say that your level is poor, but it's not uncommon for someone to ask you to refund the hospitalization fee and to blackmail you for delaying your illness.

Of course, such patients and their families are in the minority just like unscrupulous doctors. But often a few people can have a huge impact on the reputation of the entire industry. Commonly known as: One rat droppings spoils a pot of soup.

Moreover, the county hospital now has no shortage of patients at all. With this energy, they can look after 3-5 other types of patients.

"The patient has taken warfarin orally before." The bedside doctor reported to Gao Fenghui, "She has a history of atrial fibrillation."

"Overdose of warfarin?" Gao Feng asked.

Warfarin is a coumarin oral anticoagulant drug and is mainly used to prevent and treat venous thrombosis, pulmonary embolism, embolism caused by cardiac valve surgery or atrial fibrillation, and local transient ischemia.

When overdose is taken, gum bleeding and prothrombin time increase may also occur.

"Probably not." said the doctor in charge of the bedside. He had also considered this at first. Many patients would not go to the hospital to review their coagulation function when taking these anticoagulants. They found it too troublesome and would just immerse themselves in taking drugs.

"Her son bought the bottle of warfarin in March last year and has not finished it yet."

This shows that the patient did not eat too much, she probably did not eat at all.

Gao Feng was also confused now. If it wasn't this, what other reasons could it be?

He carefully looked at the test results and found that the patient not only had problems with the prothrombin time, but also had a significantly prolonged activated partial prothrombin time.

This indicates that there is a problem with internal and external coagulation and common pathways, the most common of which are severe liver disease and warfarin overdose.

Severe liver disease will inevitably reduce all coagulation factors, but the single fibrinogen test in this test is 3.04, which is normal, which is obviously inconsistent. That leaves the 2.7.9.10 factor of vitamin K dependence caused by dicoumarol overdose or poisoning, but the patient did not take warfarin on time at all.

Now both factors are eliminated.

Gao Feng took a closer look at the patient and learned that she lived alone. Physical examination: The patient was in a calm state of mind, and his verbal responses were to the point. Continuous bleeding was seen in all the gums, and there were many bruises all over the body. There were no obvious abnormalities in the cardiopulmonary examination, and there was no edema in both lower limbs.

"By the way! Rat poison poisoning can also cause this problem."

At this moment, Gao Feng suddenly remembered that the patient was from a rural area. If Baoqi was not exposed to rat poison, could he have ingested it by mistake?

"I'm not stupid. Who would eat that stuff?" The old lady shook her head, but Gao Feng keenly noticed a hint of panic in her eyes.

"Where are the family members?"

The old lady has two sons who are at the door of the intensive care unit during the day. They live in the corridor at the front corner at night.

"Is there anything unusual about your mother recently?" Gao Feng asked.

"No, she's still the same as before," the eldest son replied. "She has a bad temper and scolds everyone she sees."

"Yes, we don't even live together with her, and the conflict between mother-in-law and daughter-in-law is very serious." The second son also agreed.

It turns out that the old lady had a hot temper when she was a little girl, and she didn't change at all after getting married. She had a very strong personality. She controlled her parents-in-law at the top, bossed her husband around in the middle, and the two children below were also trained by her to be obedient.

I have been here all my life, and the family can get along pretty well.

But as time went by, the two sons grew up and started their own families.

This is not the most important thing, the most important thing is that she is getting older.

Her father-in-law and mother-in-law passed away more than 10 years ago, and her husband died of liver cancer the year before last. Although her two sons are very filial, they cannot still listen to her in everything.

He has his own wife.

The daughter-in-law is even less likely to listen to her, and if she offends others, she will immediately call her "old and immortal".

"So you want to commit suicide by taking rat poison?" Gao Feng asked.

"No! You kid, don't talk nonsense." The old lady was anxious.

"Have you eaten yet?" Gao Feng

"No!" The old lady

"Er Gouzi, get rid of this kid." The old lady turned to Director Liu of the Vascular Surgery Department and said, "I don't like him."

"Auntie, why are you still calling me by my nickname?" Ergouzi Director Liu looked embarrassed, "Didn't I tell you everything? I will never stop you."

Gao Feng waved his hand to Ergouzi to go aside first.

"You can't lie to me, I'm a doctor." Gao Feng said to the old lady, "Not only do I know you ate it, I also know how many days you ate it!"

"Then tell me how many days." The old lady couldn't bear to see him like this. What a jerk!
"Eat for five days." Gao Feng said.

"I've been taking it for more than half a month." The old lady blurted out, "What you said is not accurate!"

"Oh, my aunt, why are you so confused!" Ergouzi Director Liu came over, "Okay, why do you think you are eating this?"

"What can I do? I don't want to live anymore." The old lady said, "It's boring. No one in the family pays attention to me."

Her fiery temper when she was young was backfired. Not only did her daughter-in-law not want to see her, but old ladies of the same age were also unwilling to play with her.

Her family was short-lived and they didn't even take her with them when they danced square dances.

She couldn't stand it anymore, so she simply bought a few packs of rat poison, which is the rat poison bromadiolone we often call it.

"Every time I fry dried meat, I put some in it." The old lady told the reason why she hadn't died after eating it for half a month. Her younger son worked in the town's slaughterhouse and got it for the old lady last month. Half a fan of pork.

She was worried that after she died, the pork would be wasted, so she thought about not putting in so much at one time, and she would double it after the pork was finished.

As a result, her eldest son came to see her and found that she was vomiting blood, so he quickly took her to the hospital.

"Don't tell them." The old lady said, "I don't want to die now."

Although the two daughters-in-law usually didn't want to see her, they were very nervous when they saw her sick. The old lady suddenly changed her mind when she saw her ignorant grandchildren.

"Er Gouzi." She asked, "Can I still be cured?"

"It can't be cured." Ergouzi replied, "I'll bury it for you tomorrow."

After the cause was found, the treatment had a clear direction. The doctor in charge immediately gave the patient vitamin K1 and infused plasma at the same time.

The coagulation index was rechecked that day and dropped again.

At this time, relevant examination results also came out, indicating that the patient had combined gastrointestinal and urinary tract bleeding!

"Oh, thank you so much." Director Liu thanked Gao Feng, "Director Zhou also said it might be rat poison poisoning."

He came over specifically to ask, but was easily fooled by the old lady. Poor Director Zhou might still be looking up literature in front of the computer right now.

A true and objective medical history is really important. Sometimes deliberate concealment can make the doctor’s diagnosis deadlock.

However, in clinical practice, such cases are often rare.

(End of this chapter)