Back in 2002 as a doctor

False alarm, Zhou Congwen's pace suddenly slowed down.

The patient was pushed to the emergency room and placed on ECG monitoring with a heart rate of 100 beats/min.Blood pressure: 80/50mmhg.However, the electrocardiogram showed sinus rhythm, and the blood oxygen saturation was fine.

"I told him to lie down on the bed for an injection, but he insisted on standing up, and said it was just one injection, nothing wrong." The nurse complained, "I haven't had the injection yet, the needle just touched him, and his whole body looks like It's as soft as noodles."

Zhou Congwen took a look and saw that there was a piece of gauze on the patient's hand.According to the size of the gauze and the condition of the dressing, it should be just an abrasion.

In this case, a shot of tetanus and 15 minutes of observation will allow the patient to go home.

It doesn't matter whether I take anti-inflammatory drugs or not, but I didn't expect to meet a patient who didn't even know he fainted.

Fortunately, the patient did not hit his head when he fell down, and the matter was still under control.

"Congwen, I can't figure it out. You said why many old men fainted from needles and blood."

Chapter 0704 What's so good about coughing

Before Zhou Congwen could answer, Shen Lang said self-consciously, "A few days ago, a buddy accidentally scratched his girlfriend's foot."

"It's a small hole, not big. I guess it will take two stitches. The emergency room was so busy that day, so I'll help sew it up."

"I didn't know that buddy was dizzy. When I sent the patient in, I didn't see any abnormality in him. But when I opened the gauze, the buddy's face was not right. When I debride the wound, I didn't wait for the patient to shout. All of a sudden it was as white as paper."

Zhou Congwen smiled, there are indeed many such things, and it is impossible to guard against them.

"Congwen, this is the first time I saw a face as white as paper, and it changed color just by brushing it right in front of me."

"Well, there were many similar situations. What happened next?" Zhou Congwen asked Shen Lang while watching the patients in the emergency room being hung up with a bottle of liquid and no other rescue measures.

"Just go out and sit for a while. I asked his girlfriend, and his girlfriend said that he didn't know that he would faint." Shen Lang laughed, "It looked fine, but suddenly passed out, which scared me to death."

"Needle dizziness and blood dizziness refer to the short-term loss of consciousness and mobility caused by mental stress or other factors during the process of receiving acupuncture treatment and seeing blood."

Zhou Congwen explained professionally.

"You don't need to be so serious." Shen Lang was surprised.

"You asked me why, I'm not explaining to you."

"Then go ahead and pretend I didn't say anything." Shen Lang was also very curious about what explanation Zhou Congwen could give.

"Generally speaking, these patients are in a sitting or standing position, and syncope rarely occurs in a lying position."

Shen Lang wanted to argue, but after thinking about it carefully, what Zhou Congwen said seemed to make sense.

"Because the blood gathers to the pelvis and lower limbs due to gravity when the treatment is performed in a standing or sitting position, resulting in a decrease in blood return to the heart, a decrease in cardiac output, and a drop in blood pressure.

Because blood pressure drops, it causes the reflex effect of carotid sinus and aortic arch baroreceptors, which increases the activity of sympathetic nerve and inhibits the activity of vagus nerve.

Then the sympathetic and vagal nerves become unbalanced, the tone of the sympathetic nerves decreases, the tone of the vagus nerves increases, blood pressure and heart rate decrease, and syncope occurs. "

"..."

Shen Lang was speechless.

Do you want to be so professional!

I just came to the emergency department to watch the fun and chat a few words, why bother to be like a university professor giving a lecture.

"Poor autonomic coordination is the basis for needle and blood dizziness, and nervousness is the cause. Therefore, it is best to lie on the treatment bed when doing treatment. However, the emergency department is too busy, and the probability of similar things happening is not high. So what..."

"Uh, there are so many opinions about getting an injection while lying on your stomach?" Shen Lang was startled.

"Of course, every detail of clinical diagnosis and treatment norms is summed up in decades and countless treatments. So, the techniques I teach you now may seem boring, but they can prevent you from..."

Zhou Congwen switched to the state of the boss unconsciously, and began to instill values ​​in Shen Lang.

What is the use of standardized procedures and every detail of the treatment of patients received.Words like these kept coming out of Zhou Congwen's mouth, as if they would never stop.

Shen Lang was dumbfounded.

Zhou Congwen is really annoying.

Within a few minutes, Shen Lang started to feel sleepy, but fortunately, Zhou Congwen's cell phone rang.

"Hello, Qingyao, what's the matter so late?" Zhou Congwen asked after answering the phone.

"Brother Zhou, I have a friend who has been coughing recently, can you help me take a look?"

"Cough? Okay, tomorrow or now?" Zhou Congwen asked casually.

"I'm in the department, and they're all there, is it convenient for you?"

"It's convenient, I'm just going home and I'm still in the hospital." Zhou Congwen and Yuan Qingyao said a few words, seeing that the blood pressure of the patient who just fainted from the needles rose and his heart rate dropped after lying down, he should be fine.

There is no big problem in itself. Hanging a bottle of liquid is also to reserve a vein channel, so as not to be overwhelmed during the rescue, and to avoid extremely rare situations.

Moreover, the main purpose of hanging the liquid is not to cure, but to make people feel more comfortable. Don't let the patients faint, and the doctors and nurses in the hospital don't even care about it.

Although it is good to lie down for a while, it is more appropriate to hang a liquid.

"Let's go." Zhou Congwen said, "I'm going to see Qingyao's friends, are you going?"

"What's so good about coughing? It's a cold. Or it's cold in winter, and you have tracheitis or bronchitis." Zhou Congwen said that Shen Lang was sleepy, so he took a breath and became listless again, "I'll go back to rest, you go .”

Zhou Congwen smiled, sent Shen Lang away, and turned back to the ward by himself.

Yuan Qingyao stood in the corridor of the ward waiting for Zhou Congwen. When he saw him come back, he hurried up to meet him, "Brother Zhou, you have worked hard."

"Why didn't you come home?"

"I was also brought here." Yuan Qingyao said helplessly.

Seeing Yuan Qingyao wearing a mask, Zhou Congwen immediately thought of his eight small white teeth and smiled.

"What about people?"

"In the duty room." Yuan Qingyao introduced, "For about half a year, I had repeated fever, cough, and expectoration, but it didn't get better."

"Have you been hospitalized?"

"No, I watched the film, but I didn't understand it." Yuan Qingyao said.

Zhou Congwen was taken aback.

I don't understand what the hell it is?

Yuan Qingyao's level is not low, no matter what, he has a Cleveland degree. I have seen a few operations he and Chen Houkun cooperated with recently. It can be said that although this young man's technical level cannot be compared with his own rebirth, he can already Said it was very old fashioned.

Moreover, Yuan Qingyao received a world-class professional education, and his level of film reading is far superior to many people.

He didn't understand?

"What's going on?" Zhou Congwen asked cautiously.

"Brother Zhou, take a look, I don't know what to say." Yuan Qingyao looked confused, "The CT looks weird, and there are large, localized shadows in the bronchi on the plain film."

Listening to Yuan Qingyao's description, Zhou Congwen was even more interested.

When he came to the duty room, he saw a man and a woman standing up. The woman was pale, with an unhealthy blush on her cheeks, and was coughing continuously.

Without pleasantries, Zhou Congwen asked about the medical history directly.

Yuan Qingyao briefly introduced that besides this, the patient started coughing and went to the local hospital to see a doctor, but nothing was found, only antibiotics were given intravenously.

With intermittent treatment, the condition is getting worse.Some doctors also suspected tuberculosis, and the patient went to the tuberculosis hospital for examination. The sputum bacterial culture was negative for tuberculosis.

So it can only be treated with antibiotics continuously.

However, as time went by, the symptoms became more and more serious. The local hospital suggested to go to the provincial capital to see the registered department is Rheumatology, Immunology and Respiratory Medicine.

Only then did he contact Yuan Qingyao.

Chapter 0705 Zhou Congwen can not understand the film

There are a lot of video materials, but Zhou Congwen is not satisfied.

At first, there was a chest plain film, which looked fine; after that, it was all lung CT. On CT, a high-density shadow can be seen from the right main bronchus to the atelectasis of the right lower lung, but there is nothing to prove.

Even with Zhou Congwen's rich clinical experience and film reading level, there is no diagnosis for this yet.

After inquiring about the medical history, Zhou Congwen felt that something was a little abnormal-the patient seemed to be hiding something, but it was not the typical situation of concealing the medical history and talking about him.

Except for a certain point and after that, everything else is very detailed.

But Zhou Congwen didn't know exactly which point.

This is Zhou Congwen, who has rich clinical experience and has asked countless medical histories in his previous life, so he has an instinctive suspicion.If it was another person, it is estimated that there is no problem at all.

Yuan Qingyao looked expectant, but seeing Zhou Congwen's face getting more and more serious, Yuan Qingyao was also a little confused.

In Yuan Qingyao's cognition, Zhou Congwen is synonymous with omnipotence.

But there was still no answer when Zhou Congwen moved out this time, which made Yuan Qingyao a little confused.

Incomplete atelectasis in young people is very rare clinically. After excluding tumors, tuberculosis and other diseases, repeated anti-inflammation relapses, the local hospital suggested that there is nothing wrong with rheumatism immunity.

Undecided, rheumatism immunity? It seems that the doctor in the area where the patient is located is also an experienced doctor. At least he knows how to let the rheumatism immunity doctor take a look to determine if it is a rare disease.

Zhou Congwen gradually became serious after watching the film and other materials.

Exactly as imagined, this is not a simple pneumonia at all, a disease of atelectasis caused by poor phlegm discharge.

"Brother Zhou..." Yuan Qingyao called out in a low voice.

"I'll watch the film again." Zhou Congwen picked up the film bag, turned and walked out of the duty room without saying hello to the patient.

"Qingyao, is such a young doctor reliable?" Seeing Zhou Congwen going out, the patient's family members grabbed Yuan Qingyao and asked.

"Brother Zhou is very skilled. If he can't solve it, I don't know who can." Yuan Qingyao said firmly.

"So young, is there an older doctor?"

"Older doctors, I can take you to the outpatient clinic tomorrow, but the level is definitely not as good as Brother Zhou." Yuan Qingyao emphasized again, then hurriedly turned and went out.

When he came to the office, he saw Zhou Congwen standing in front of the film reader, with his right hand tucked up in a crew cut, concentrating on a few CT images.

Yuan Qingyao didn't bother Zhou Congwen, he just didn't understand that CT images are supposed to be not difficult, the right lower lung is atelectasis accompanied by a large area of ​​inflammatory infection in the right main bronchus, why Brother Zhou would look at it repeatedly.

What the hell is he looking at?

Time passed bit by bit, Zhou Congwen was immersed in the video data without saying a word.

In the end, the patient and the patient's family were anxious, but they did not interrupt Zhou Congwen's reading of the film out of politeness and out of respect for Yuan Qingyao.

When seeing a doctor, it is usually the patients who dislike the doctor for too short a time to see a doctor; but this time it is the opposite, it is the patient who begins to dislike the doctor for a long time.

Yuan Qingyao didn't know what Zhou Congwen was thinking. After 42 minutes, Yuan Qingyao finally couldn't bear the curiosity in his heart and asked in a low voice, "Brother Zhou, did you find anything?"

"No." Zhou Congwen told Yuan Qingyao an answer with certainty.

"..." Yuan Qingyao was stunned for a moment.

"I haven't seen a similar case, it's very strange." Zhou Congwen then clicked on the video data with his hand, and the film viewer was beeping, and he began to state the differential diagnosis.

Twelve categories of diseases, 180 three branch diseases that may cause atelectasis were excluded one by one in the differential diagnosis.

When all the impossible is ruled out, what remains, however improbable, is the truth!Yuan Qingyao thought in his heart.

But Zhou Congwen shook his head at the end.

"This disease is very strange. Generally, there will be one or two vague diagnoses at the end of the analysis, and then just do an examination. But now there is no one disease that can be relied on. It has absolutely nothing to do with blood and rheumatic immunity. Strange, what is it? What's the problem?" Zhou Congwen asked suspiciously.

Under the whole world, Zhou Congwen believes that his diagnostic level is definitely among the top five people in the world, and this is still a modest statement.

The reason why he can't get ahead is that there is still a boss after all.

This is not Zhou Congwen's subjective conjecture or respect for his boss, but an objective fact.

The level of boss diagnostics is unfathomable, which has long been proved in the master-student dialogue exercises time after time.

Similar to the kind of sparring in the northern market, it has been practiced more than 1000 times. The boss has not made a diagnosis error, but Zhou Congwen has fallen once.

This thing in front of me...

Zhou Congwen was very distressed. If it really didn't work, he could only do bronchoscopy for diagnostic treatment.

Go in under the bronchoscope, take a look at the condition of the right main bronchi while sucking sputum, and even take pathology or do alveolar lavage.

Yuan Qingyao faintly sighed in his ears, and Zhou Congwen patted him on the shoulder, "A little disappointed?"

"Ah?" Yuan Qingyao was startled, thought about it embarrassedly, and finally sighed, "It's not disappointment, but because there are so many medicines, and even Brother Zhou can't give a diagnosis, I feel a little afraid of difficulties."

"Hahaha." Zhou Congwen smiled, tidied up the films on the table in chronological order, and finally put the chest plain film on top.