When doctors have a simulated operating room

The patient was diagnosed with asthma.

Chest pain? ?

Or chest pain and tightness after exercise.

A normal doctor's way of thinking would definitely consider heart problems first, to see if the child has heart disease.

Is myocardial ischemia caused by heart disease?

In addition to heart disease, asthma is considered next.

But the patient does not have asthma...

Zhang Yi fell into deep thought.

It was not until the electrocardiograph was brought over that Zhang Yi came back to his senses.

Let's do the electrocardiogram first.

There must be clues from other tests.

Zhang Yi's eyes can indeed see the most intuitive blood, bones and even every organ of the patient.

But Zhang Yi is still unable to see some microscopic components in the blood.

Just like taking blood for routine blood tests.

Blood components such as white blood cells and neutrophils can only be analyzed by professional machines.

The electrocardiograph is a small square machine that is easy to use.

Generally, the electrocardiograph used in emergency departments is available at the bedside.

Take it as you need it, press the lead, and then pull it, and the electrocardiograph paper will come out.

The 18-year-old boy still has chest pain, but fortunately he knows how to cooperate with the doctor.

"Lie down and don't move. I'll take an electrocardiogram for you to see the situation."

Sizzle~

Soon, the paper with heartbeat ripples slowly extended from the other side of the machine.

The nurse also hurried over to draw two tubes of blood for examination.

After Mao Xiaoyuan took the electrocardiograph paper and took a look at it, she handed the result to Zhang Yi:

"Look, the ST segment is slightly elevated, but it's not a big problem. Chest pain may be myocardial ischemia."

Zhang Yi took the paper and observed it for a while.

"More than that, this ECG has some early recurrence."

"Hmm? Early recurrence? Let me take a look."

Mao Xiaoyuan took the result back from Zhang Yi.

After carefully watching it for a while, he raised his head and said, "It seems so, but early recurrence is not a big problem. It is impossible for an early recurrence to cause such severe chest pain."

Mao Xiaoyuan's analysis is also correct.

Early recurrence means normal variation of the ECG, which generally does not require treatment.

It is an ECG manifestation and basically does not cause any discomfort in clinical practice.

So this early recurrence should have nothing to do with chest pain.

So what is the reason?

Why does ST segment elevation occur? ?

Is it just because of exercise? ?

At this time, the boy lying on the bed suddenly took two long breaths, touched his chest and said:

"Doctor... my chest feels better..."

"Hmm? Doesn't it hurt anymore?"

The boy nodded: "Hmm... much better than before, it doesn't hurt much now."

Zhang Yi glanced at the time on his watch.

From the time the ambulance was taken to the hospital, the child had chest pain for about 23 minutes.

Chest pain that can be relieved by itself in 23 minutes?

No heart disease or asthma? ?

Suddenly, the name of a disease flashed through Zhang Yi's mind! !

"Wait! Li Miyan? Did you send away the blood you just drew?" Zhang Yi suddenly asked the nurse on duty.

"Ah? Blood? It's gone. I asked the nurse to send it up right after it was drawn. Doesn't the patient have chest pain? I thought it was an urgent check, so I asked him to go first. What's wrong? Is there something wrong with this blood?"

Zhang Yi shook his head: "No, the blood is fine. I just want to ask if you have drawn the biochemistry tube?"

The standard blood test for patients admitted to the hospital is routine blood test, biochemistry and infection.

Routine blood test generally checks the white blood cell and red blood cell counts to see if there is infection, anemia, etc.

Biochemistry includes more, such as liver and kidney function, cholesterol, blood lipids, coagulation function, etc.

"Biochemistry? No biochemistry, he had breakfast this morning, so the biochemistry can't be drawn."

"Okay, hand over to the night shift. This person has to stay in the hospital today, and a biochemistry test will be added tomorrow morning."

"Okay, no problem!"

The most important test that Zhang Yi needs to confirm is in the biochemistry test.

After a while, the boy returned to normal.

In just a short while, the hospital did not take any rescue measures, and the boy recovered on his own.

This symptom is really strange.

After he recovered, the boy did not care and clamored to be discharged from the hospital.

The family members could not persuade the boy, so they had to discuss with the doctor to go home.

After hearing this, Zhang Yi immediately rejected the family members.

"No

! We made your son stay in the hospital tonight for your consideration. The examination has not been completed yet, and the specific cause of the chest pain has not been found. We cannot take it lightly. "

The family members also looked embarrassed:

"But... my son said that he is fine now? He insisted on being discharged from the hospital... I..."

Another mother who dotes too much...

Alas!

Zhang Yi sighed and continued to persuade:

"Chest pain is not a small problem. Although your son has no heart disease and no other infection, he has inexplicable chest pain, and it occurs after exercise. As a parent, you should be more vigilant!

Anyway, I strongly recommend that you must stay in the hospital and it is not too late to go home after finding out the cause.

Now your son has inexplicable chest pain and then heals on his own. Do you think he is really well?

It is very likely that he has re-entered the incubation period! "

Zhang Yi's words were very serious, which scared the family members.

In desperation, the family members had to agree with Zhang Yi's opinion.

But the boy disagreed unexpectedly.

Before the family members went in and said a few words, the boy started to make a fuss.

"I'm fine, mom! I don't want to be hospitalized! I'm fine now! Why can't I go back?

This hospital is not a prison? What's wrong? Can't I go out after entering?"

"Oh, son, the doctor is also for your own good. He said that the cause of your illness has not been found. Let's stay in the hospital for a few days first, so that it's safer."

"I won't! I won't stay! I'm fine now, mom, don't you believe what I said?

I'm fine now, I don't have an IV or chest pain, and the doctor said that there is no problem with the test results. Why can't I leave?"

The boy didn't understand, and he jumped several times after getting out of bed.

In the office, Mao Xiaoyuan also looked at Zhang Yi in confusion and asked:

"Zhang Yi, why don't you agree to let him leave the hospital? Early relapse is not a big problem, and no abnormalities were found in color Doppler ultrasound, electrocardiogram, blood routine and thyroid.

This child is likely to have ventricular arrhythmia induced by exercise, and may have mild myocardial ischemia after exercise, but the heart is fine. Rest more, try to avoid strenuous exercise, and it is not impossible to go home. "

Mao Xiaoyuan is the person who has seen all the test results of this patient.

Except for the early relapse and sinus rhythm on the electrocardiogram, no abnormalities were found in other tests.

The most likely is a series of chest pain induced by exercise.

Plus, this person can relieve it on his own, which means that the problem is not particularly serious.

But Zhang Yi narrowed his eyes slightly: "Can't go out, biochemistry has not been checked yet, wait until the biochemistry results come out tomorrow to see if he can be discharged."

"Biochemistry? Oh, yes, this person hasn't had a biochemistry check today, but what are you going to check for biochemistry? Liver and kidney function? Blood lipids? Coagulation? Or...

Hmm? ? ! Wait! Biochemistry? ? ! You...you mean...? ? ! "

Mao Xiaoyuan said, and suddenly opened his eyes wide! !

"Are you suspecting that he is..."

Damn!

Yes!

Sudden chest pain after exercise... there is indeed a very rare reason!

Combined with the premise that the electrocardiogram is early re-graded and the patient induces chest pain after exercise.

Then...

This disease can indeed be considered!

Zhang Yi looked at Mao Xiaoyuan and nodded:

"Yes, you finally think the same as me, and we must check the cholesterol. ”

The patient has a family history of coronary heart disease. Although he is only 18 years old, since there is this family history, it can be suspected in the direction of inheritance.

First of all, the heart has been checked. The patient does not have coronary sclerosis or heart disease.

But hypercholesterolemia can also cause chest tightness and chest pain.

Especially if there is a coronary heart disease in the family history.

Coronary heart disease is also called coronary atherosclerosis, and the main causes of this disease are high blood lipids, high blood pressure, and high cholesterol.

The blood is so thick, so the fat in the blood vessels blocks the blood vessels, causing Atherosclerosis.

Now, the boy has a family history of coronary heart disease.

But the test results showed chest pain, but the cause was not in the heart.

Then, it is entirely possible to consider whether the chest pain was caused by hereditary hypercholesterolemia.

Hearing Zhang Yi say this, Mao Xiaoyuan suddenly had an epiphany!

Yes, yes!

Hypercholesterolemia!

Damn, why didn't I think of this!

Just thinking about chest pain and chest tightness, I considered heart disease.

I actually forgot about this.

"Thank you for reminding me, Zhang Yi, if you hadn't said it, I would have almost forgotten it."

Mao Xiaoyuan laughed twice.

In the emergency room, the boy was still yelling.

Zhang Yi had to go in and repeat the seriousness of the matter.

Seeing several doctors coming in, the boy instantly became much quieter.

Look

The doctor got serious, but he was still afraid.

"Stop it, young man. We are really keeping you in the hospital for your health.

Your grandfather has a history of coronary heart disease, and the main cause of coronary heart disease is high blood lipids and high cholesterol.

Now, your test results do not show any major problems.

But considering your family history, we have to wait for your last test last night before we can let you go home.

This test is very important, and it checks your blood lipids, cholesterol, and triglycerides.

These tests must be done on an empty stomach, and blood can only be drawn the next morning.

So do you understand now? Why don't you leave now? Do you understand?

If you are diagnosed with hypercholesterolemia, then the cause of your chest pain can be found."

"Ah? Hypercholesterolemia?"

The boy didn't say anything, but her mother was nervous.

"Yes, it's just a suspicion at the moment. We wanted to wait until the test results came out tomorrow morning before telling you, but you were so uncooperative. We can only tell you our speculation first.

Everything has to wait until the results come out tomorrow morning before we can make a diagnosis."

Sometimes it's better not to tell the patient and family members about the doctor's suspicion and speculation right away.

Avoid causing panic among them, especially for some rare and terminal diseases.

Mood is also an important factor that affects the patient's ability to recover smoothly.

So most of the time, doctors wait until the test results are confirmed and it's set in stone before telling the patient the results.

After Zhang Yi said this, the boy really stopped making trouble.

But when they heard that it was related to the coronary heart disease inherited from the family, the boy and his mother were instantly depressed.

The main reason is that the child is only 18 years old.

In his prime...

What kind of blood disease did he get? Hypercholesterolemia?

Who else can accept it?

Oh!

After everything was done, Zhang Yi washed his hands and went to the cafeteria to eat.

When we arrived at the cafeteria, almost everyone had left.

In the huge hall, only a few doctors and nurses were left eating.

Zhang Yi got his meal and went to a corner to eat.

Unexpectedly, there was a flurry of discussion behind him.

"It was him, who boasted that he would be on the Lancet at the annual meeting!"

"Oh~ I know him, his name is Zhang Yi, a new doctor, and he was said to be parachuted in."

"Oh, Tang Wei, you don't know, you didn't come to the annual meeting that day, he was so arrogant! He said he would be on the Lancet in front of the whole hospital, hahahaha... I laughed to death, I've never seen such a boastful person in my life, haha..."

Bang!

As the two were talking and laughing, they saw a dinner plate slammed on the table on their side.

Looking up, wasn't this person Zhang Yi?

Zhang Yi looked down, smiled at the man who had just spoken, and asked:

"Which department are you from?"

I don't know if Zhang Yi's condescending way of speaking is very imposing.

The male doctor who had just complained was instantly scared.

But he was only scared for a second!

He then straightened up and smiled with a provocative look:

"What? What department do I belong to? "

"Huh? What? Don't dare to say?"

"Don't dare to say? What can I not say? Listen carefully, I am Wang Ziwei from the Department of Neurosurgery!"

The two people's voices were getting louder and louder, and it was difficult for the few medical staff who were eating in the cafeteria not to notice them.

"Wang Ziwei? What? What can't you say to your face? Do you have to laugh at others' boasting behind their backs?"

Their conversation was neither small nor loud, and Zhang Yi could hear it just right.

There were obviously several tables between them.

But Zhang Yi could hear it, which meant that the two of them did not intend to speak in a low voice.

Well, since I heard it, I can't tolerate it!

Who likes someone to say bad things about them behind their back?

So Zhang Yi came over with a plate of food.

If you have anything to say, say it to their face. Don't say one thing in front of them and another behind their back like an old sow.

Wang Ziwei's expression froze slightly, as if he didn't expect Zhang Yi to be so direct.

He just wanted to say a few words to satisfy his desire to talk.

Unexpectedly, Zhang Yi came over...

"Hehe, I'm not laughing at you! I'm telling you the truth. Do you think it's so easy to get published in The Lancet? You can publish your paper in The Lancet within the next year?

Hahaha, you're bragging! Only Dean Jin and his team worked together to publish the main journal of The Lancet in our hospital.

Who do you think you are?

You don't think the world has to revolve around you just because you've done a few surgeries??

Don't be silly, brother. I see that your skills are pretty good, so I'm giving you a sincere suggestion.

I suggest you improve yourself first.

First take the postgraduate entrance examination, read more about the quality of other people's papers, and then think about how to enter SCI Zone 2. "