My medical skills are a billion points

But in Zhao Fangshu's heart, she couldn't help but admire Xiao Chu even more.

No wonder Xiao Chu was favored by the director and recruited as a full-time employee of the hospital.

It seems that he is really talented.He didn't even see the patient, and he could tell it was oral bleeding just from the patient's description and vomiting of blood.

Really amazing!

When the young man saw the doctor, he refused to let his grandfather go for a checkup, and he was a little undecided.

Hesitantly asked: "Doctor, my grandpa started to vomit blood quite badly. Is it really not necessary to go for an examination?"

Zhao Fangshu shook her head and said: "For the time being, there is no need to go for an examination, because his tongue was bitten off and is still bleeding, you should go to the stomatology department for treatment first.

The possibility of the patient's upper gastrointestinal bleeding can basically be ruled out.If you are really worried, you can do liver color ultrasound and blood routine to see. "

The young man looked at Xiao Chu again.

Because it was Xiao Chu who discovered the problem, he wanted to hear Xiao Chu's opinion even more.

"Don't worry, you just need to go to the dentistry department to treat the wound on your tongue. You don't need to do other examinations. Your grandfather is fine."

If it were another doctor, he would definitely not be so sure.

But Xiao Chu dared to say this.

Because he has already seen clearly that apart from biting his tongue, this old man is not sick at all.

Why let people spend this wronged money again?

Seeing that the two doctors said so, the young man took his grandfather to the dental department for an examination.

Seeing the two walking away, Zhao Fangshu let out a sigh of relief.

"Xiao Chu, thank you! If you don't remind me, I really didn't find out that the patient was caused by tongue bleeding. Sigh, it seems that I need to learn more from you in the future!"

Xiao Chu smiled and said: "Senior sister is joking, I haven't been working for a few days, and I still have a lot to learn from you. You can't hide your secrets!"

Zhao Fangshu waved her hand and said, "Okay, let's stop bragging about each other here. It just so happens that we're not too busy this morning, so hurry up and fix our case!"

Xiao Chu immediately stopped Zhao Fangshu from talking.

"Senior sister, don't say that, don't say that you are not busy in the emergency department, we will be busy soon!"

"That's right, that's right, I forgot about this, I finally had a little free time, but I can't let my crow's mouth get it right!"

You can't say you're not busy in the emergency department, and even if you are, you can't say so.

As long as you say it, the patient will come immediately.

This is already the experience summed up by countless people.

There is no way, the hospital is so evil!

The two were about to go back to the office to check the medical records, when suddenly, the sound of an ambulance sounded outside the gate.

The two looked at each other and smiled helplessly.

"In the emergency department, you really can't say you're not busy!"

Zhao Fangshu hurried out of the hall to pick up the patient, and Xiao Chu also followed.

"Male, 46 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 introduced the patient's condition to Zhao Fangshu.

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, Zhao Fangshu already had a general direction in his heart.

She hurriedly used her 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.

Zhao Fangshu hurriedly asked the patient's lover, "Has your husband ever had this 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 Zhao Fangshu immediately gave him an electrocardiogram.

Given the patient's age and severe chest pain, Zhao Fangshu'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 Zhao Fangshu was taking an electrocardiogram for the patient, she 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.

Zhao Fangshu 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.

Logically speaking, Zhao Fangshu should relax.

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

She had a bad premonition.

Chapter 51 Time Bomb

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.

Zhao Fangshu couldn't help taking a 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 her heart became stronger and stronger.

Xiao Chu 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?

Xiao Chu immediately 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, Zhao Fangshu also considered the possibility of this disease.

Without waiting for Xiao Chu's reminder, she hurriedly said to the nurse: "Quickly, first inject a dose of peperidine to relieve pain, then inject 50 ml of normal saline, add 50 mg of sodium nitroprusside, and inject 4 mg of sodium nitroprusside intravenously. Blood pressure drops."

Then Zhao Fangshu said to the patient: "You must relax now, and you must cooperate with my treatment. Don't be overly nervous, don't move around, and give you a painkiller in a while, and you won't be in so much pain. I 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.

Zhao Fangshu's heart also rose to her throat.

She just guessed in her heart that this patient had aortic dissection.

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

Xiao Chu already knew about the patient's disease, but he couldn't stop it. Zhao Fangshu went to examine the patient.

This patient definitely needs immediate surgery.

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

Zhao Fangshu has already considered this dangerous disease, and she also knows that it is very dangerous to take the patient for an 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.

Zhao Fangshu stared at the monitor, feeling agitated, hoping that the patient's blood pressure would drop as soon as possible.

Only by lowering the blood pressure of this patient to the normal range.

Then the risk of his aneurysm rupture will be reduced. Only in this way can Zhao Fangshu dare to take him for CT and cardiac ultrasound examinations.

However, ten minutes later, the patient's blood pressure was still 200/120mmHg.

On Zhao Fangshu's forehead, there was a layer of sweat involuntarily.

Sodium nitroprusside is the most powerful drug used to lower blood pressure.

For most patients, blood pressure will drop after taking medicine for three to five minutes, not to mention taking medicine for 10 minutes.

However, this patient has used it for more than ten minutes, but his blood pressure has remained stable.

Due to the application of pethidine analgesic drug to him, the pain was relatively relieved a lot.

But because the blood pressure didn't drop, Zhao Fangshu didn't dare to touch him at all.

Not to mention taking him to check.

The blood pressure is so high, so take him for a checkup. If the aneurysm ruptures on the way to the checkup, the patient will undoubtedly die.

Then Zhao Fangshu himself will have an inescapable responsibility.

"Adjust the sodium nitroprusside to 8 mg per hour and pump it intravenously."

Zhao Fangshu asked the nurse to increase the dose.

Even if the patient's blood pressure drops to the normal range,

Zhao Fangshu had already taken a great risk by taking him for an examination.