Krafft's Notes on Anomalies

Many people who aspire to embark on the path of medicine will encounter a problem at a certain stage of learning, a problem often raised by their teachers about priorities and forced choices.

Suppose one day, you and your nemesis colleagues are unfortunately in a situation with limited time and manpower, but multiple patients come at the same time. The specific situation is as follows:

Option 1: Accompanied by a male friend, the young female patient complains of dizziness, headache, blurred vision, chest tightness and pain, difficulty breathing, abdominal pain and nausea, limb weakness, and has congenital heart disease, immune disorder, wind-heat attacking the lungs, spleen and stomach disharmony, and kidney yin deficiency, crying to you with tears in her eyes.

Option 2: A work-related injury patient who was sent by a coworker, found a random seat in the corridor to sit and smoke, silently holding a tissue and thinking about something, but the tissue contains two fresh fingers.

Option 3: A big brother who may have just fought bravely in an irregular drinking place, with several cuts on his head from a broken bottle, his skin and flesh turned outward, blood all over his head and face, crying and howling louder than the call number broadcast.

Option 4: A young child who was brought here by the elderly at home, without crying or making a fuss, "Everything was fine before, I didn't have any serious illness, I just coughed for a few days without fever, come to see", and now has a fast breathing and lips that are suspected to be a little dark.

Option 5: A middle-aged man who was brought here by his children, lying on the chair next to him without saying a word, with no obvious external injuries on his body, ignoring the noisy environment around him, and enjoying a baby-like sleep.

Option 6: Everything is fine, but the director's father.

Okay, the question stem and options are as above. It is forbidden to call for consultation or ask for instructions from superiors. Please independently select the object that should be checked and handled as soon as possible within ten seconds. You can select multiple options and sort them.

Time is up, and all well-trained doctors must have selected the best answer they think.

I believe that most people find it difficult not to laugh when asked, but their mentors usually don't interrupt their laughter.

Because they don't realize that they may really be in it one day. For example, the scene Kraft is in now.

The core logic of this outrageous question is to deal with the problems with vital signs and consciousness first.

"Quick, quick, quick!" Kraft dragged the injured who were too close to the wall away from the building where God knows whether a brick or a half tile would fall. "I'm a doctor, come and help!"

"Wait... No, don't move the patient first."

The unlucky guy who was scratched by the gargoyle fragments should only have a fracture, and his wailing was full of energy. Because it was in the center of the incident, the crowd dispersed from here, but avoided being stepped on.

After a simple inspection of the affected area, it was determined that it was a closed fracture of the left humerus. Kraft left him where he was and quickly ran to the injured who were enjoying "baby-like sleep".

It was right not to let non-professionals move the patient immediately. The second patient encountered was lying in a strange way, with a stiff neck, and he gurgled with difficulty when he saw someone coming over.

Still conscious, but unable to speak due to limited neck movement and pain.

The force and direction of the trauma he received were quite tricky, and it seemed that the cervical vertebrae were dislocated. If he was really moved casually and the cervical vertebrae were allowed to swing freely, he might have a high spinal cord injury.

"Leave this here, and I'll bring a flat plate to move it later!"

After quickly inspecting and skipping the injured who were holding their injured limbs and still howling, Kraft prioritized his time and invested in those key targets who had already quietly fallen silent, and quickly picked out those who needed special treatment.

"Those with broken ribs should move back a little. Wait, why is there a person with several broken ribs, flail chest? Wait for me to fix it." It can be treated and needs to be controlled as soon as possible.

"So many bleeding points, traumatic asphyxia. The heart is still beating, go slow, and remember not to hold your breath when you are squeezed next time." The special type of injury caused by the sudden increase in pressure in the chest cavity due to squeezing, fortunately it did not stop beating.

"No consciousness, but the heart rate and breathing are still stable, no external injuries, stay for observation!" It can be mild or severe, and there is no fatal sign for the time being.

"It seems to be a pneumothorax, closed. Apart from the pain, there is no difficulty breathing or anything. Let's wait for the needle from the clinic to come." After the assessment, decide whether to deal with it.

"Unconscious, with trauma on the head, breathing fast and slow. It's bad, Cheyne-Stokes respiration, and there is a problem in the brain." The problem is big, but it can't be treated for the time being.

Wading saw a confident professional temperament in this guy, instructing those who can still stand up in the square to do as required, and he was not shy at all.

His behavior was so natural that no one raised any objections or questioned his identity. Those who were a little hesitant also accepted this situation with doubts because others did not object, allowing a medical school person to sneak in.

There was no need to introduce where he came from. In the chaos, Kraft took over the command of the scene and sent Wading to the clinic to get tools and call people.

There were no labels and pens on the scene, so they relied on folding the patient's trouser legs to mark and classify. This method is sometimes not so effective. Some people wearing robes may not have trouser legs to fold, so they have to fold the sleeves instead.

Fortunately, there were not many patients who were seriously injured and needed immediate treatment. Most of them were just flesh wounds.

Kraft walked around the venue in a short time, sorting out the fractures that needed to be reset or fixed, those with suspected problems that needed to be kept for observation, and a few cases that might really be life-threatening.

When Brother Wadin arrived with Kupp and the toolbox, Kraft had already treated the first patient in the temporary indoor accommodation with a borrowed piece of cloth, and applied pressure bandage to the flail chest patient with multiple rib fractures. Although he was still grimacing in pain, at least he had the strength to grimaced.

"You came just in time. There is a patient with pneumothorax over there, and the lung compression is a bit severe." Kraft took the toolbox and assigned a task to Kupp who had just arrived. "You have done a lot of thoracentesis recently. Go and deflate him."

"Me?"

"Yes, you do it. I'm going to deal with that side first." The professor didn't waste a second and directly opened the box, letting him choose the tools on his own, and he walked towards the particularly quiet area.

Just now, he only had time to make a rough judgment, and now he entered the detailed examination step.

When there are a lot of patients, it is not so suitable to rely on the mental sensory substitution imaging department to make a diagnosis.

Fortunately, in an era when imaging technology was not so advanced, doctors also had to see patients, and a set of systematic physical examination methods were formed to indirectly reflect the degree and type of damage to the nervous system.

Their names are long and difficult to pronounce, such as Koenig's sign, Brudzinski's sign, Babinski's sign, Oppenheim's sign, Hoffman's sign, Chaddock's sign, etc., but all they do is raise the head, lift the feet, or scratch the instep or sole of the foot with a sharp object, and then observe the body's reflexes.

For those who are skilled in the operation, it only takes a few minutes to complete a set.

The one who was previously judged to be in a serious condition was indeed not in good condition. In addition to blurred consciousness, he had already shown quite obvious pathological signs, with low voice, language, and pain reactions, and a deep coma.

Even if he relied on mental sensory positioning and tried to solve the hematoma compression, it was estimated that there was no chance of pulling people out of the hands of death.

The church staff who helped brought a light source, and he turned over the patient's eyelids, ready to check the pupil condition for the last time.

Under the illumination of the lantern, the patient's eyeballs were repeating a small movement-slightly turning upwards and jumping back to their original position.

The amplitude of the movement was indeed not that obvious, and it only lasted for a few breaths. With the flickering firelight, it would have been missed if I hadn't looked carefully.

"Nystagmus?" It seemed to be a manifestation of intracranial injury. Combined with the abnormal breathing pattern, it should reflect that the injury involved the cerebellum and brainstem in the posterior position.

But is the nystagmus of intracranial injury like this? To be honest, he is not a neurologist and still has some doubts about this, but time is limited, so he can only go to other patients first and check everyone's pupil light reflex while the firelight is the brightest.

"Huh?" When turning over the eyelids of another deep coma patient who did not respond to pain obviously, Kraft said in surprise.

The patient's eyeballs also slightly rotated upward repeatedly, and then jumped back to their original position.

[What a coincidence? ]

Another nystagmus, and it was all in the upward vertical direction. It makes people a little self-doubting. Is it some unconventional clinical knowledge point that will not be taught in books, or is it a coincidence?

It could be a coincidence, but the knowledge he had learned told him that the probability of standard vertical nystagmus appearing in two deeply comatose patients at the same time was extremely small.

Kraft, who did not believe in superstition, opened the eyelids of another comatose patient and began to observe and wait.

When he was about to laugh at his inexplicable thoughts, the eyeballs that were staring at the ceiling jumped upwards a few times inconspicuously.