I Can See Health

Lu Chen came to bed 18.

Fan Zhiping and his little follower Yao Jie were following him.

Lying on the hospital bed was a male patient about forty years old.

Lu Chen was stunned when he saw his health value.

His health points are only 51.

Another critically ill patient!

However, the patient does not look uncomfortable now.

Lu Chen patiently began to ask about the medical history.

It is impossible for him to rush up immediately and tell the patient that your condition is serious.

You still have to follow the procedures when seeing a doctor, but Lu Chen's heart tightened and he paid attention to changes in the patient's condition at all times.

…

After a routine medical history inquiry, Lu Chen collected the patient's brief information.

The patient, a 46-year-old male, was admitted to the hospital complaining of chest pain for 2 days.

Another patient with chest pain!

Most patients in the cardiology department suffer from chest pain or chest tightness.

"Where is the main pain? Point me to the specific location." Lu Chen said to the patient.

The patient raised his right hand, paused, and then pointed to his chest: "It hurts here. It hurts all over."

This location is at the lower end of the sternum.

"What kind of pain do you feel? For example, is it like a needle pricking, or a dull pain when a stone is pressing on it, or is it a tearing pain?"

"This..." The patient couldn't find the words to express it for a while, "It feels like something is pulling on my chest."

"When does it hurt the most?" Lu Chen continued.

"I started to feel pain while I was working two days ago, and it started to hurt again at 4 o'clock this morning. The worst pain was probably around 5 o'clock this morning. After taking painkillers in the emergency department, the pain disappeared."

"Did you sweat when you were in pain?"

The patient nodded quickly and said, "I'm sweating!"

Lu Chen's heart sank.

In cardiology, there is an empirical statement.

If a patient with chest pain is so painful that he or she sweats, it is generally not a good disease!

In addition, combined with the patient's vitality, his situation is not optimistic.

…

Next, Lu Chen asked about other situations.

It turned out that the patient had a history of herpes zoster in the first half of the year.

This time I had an episode of chest pain, so I went to a local hospital and was diagnosed with intercostal neuralgia.

After symptomatic treatment, the chest pain symptoms were relieved while taking the medicine.

However, at 4 o'clock this morning, the patient suddenly woke up from his sleep with pain. After seeing the local hospital, the pain continued to not be relieved, so he came to Jinghua Second Hospital. "

Next is the physical examination on admission.

The patient was conscious, had a soft neck, negative cardiopulmonary and abdominal examination, and no edema in both lower limbs. There are no obvious positive signs.

Because of the patient with broken heart syndrome yesterday, Lu Chen specifically asked about the patient's mental state, and there was no problem.

"Junior sister, review the patient's electrocardiogram."

Although the patient brought an electrocardiogram from the local hospital and had an electrocardiogram done in the emergency department, and both electrocardiograms were normal, Lu Chen adhered to the principle of caution and still reviewed the patient's electrocardiogram.

"Zizzizi..."

The electrocardiograph ran out of paper.

Lu Chen picked up the electrocardiogram, and Fan Zhiping also came over.

"Sinus rhythm, approximately normal EKG."

There is no difference from the electrocardiogram done before.

At this time, Yao Jie said from the side: "Brother, the patient's blood pressure is a bit high, the blood pressure is 172/90mmhg."

"This is the blood pressure of the right hand. What about the blood pressure of the left hand?" Lu Chen frowned.

"Oh, I haven't measured it yet. I'll measure the left one again." Yao Jie took out the blood pressure monitor again.

Patients with high blood pressure must measure their blood pressure in both hands.

Yao Jie held the stethoscope and tightened the cuff on the patient.

Press the air bag to inflate it.

Then slowly deflate. When the first pulse is heard, it is the systolic blood pressure; when the pulse disappears, it is the diastolic blood pressure.

"What's your blood pressure?"

Lu Chen saw that Yao Jie had re-measured several times, but did not report a prepared value.

Yao Jie took off the stethoscope and frowned: "Brother, I don't know if I heard it wrong or what happened. The blood pressure of the patient's left hand is only 140/72mmhg."

Lu Chen was shocked.

"Let me measure it and try it."

Put on the stethoscope and tie the cuff.

Inflate and deflate.

The first pulse sounded indeed at 140.

"Yes, the systolic blood pressure is 140." Lu Chen put down the stethoscope and glanced at Fan Zhiping aside.

Both of them saw the solemn look in each other's eyes.

The chest pain persists and does not relieve, and there is high blood pressure.

And the blood pressure on both sides is not equal.

The diagnosis of aortic dissection is almost here!

The aorta is composed of three layers, namely the intima, media and adventitia from the inside to the outside.

Long-term high blood pressure that is not well controlled. The intima is easily torn. Once the intima is torn, blood flows into the space between the intima and adventitia. In mild cases, a local false lumen may be formed. In severe cases, the false lumen may involve the entire aorta.

If the blood pressure is too high or the activity is strenuous, causing the adventitia to rupture, the blood in the false cavity will plummet, and the patient will have almost no chance of survival.

This is one of the most dangerous killers in cardiology—aortic dissection!

If the patient does not receive timely treatment, the mortality rate is 25% within 24 hours, 50% within 48 hours, and 70% within 1 week.

At this time, Lu Chen had almost confirmed the diagnosis of "aortic dissection".

Because not only did the patient's symptoms and signs match, his health value was also below 60, making him in a very critical state.

…

Back to the doctor's office.

Lu Chen immediately reported all the patient's conditions to Sun Guoguo.

"Aortic dissection?! I'm going to see the patient first." Sun Guoguo stood up suddenly.

If it really is an aortic dissection, then this is a time bomb!

Sun Guoguo came to the ward and checked the patient again.

"It's most likely a dissection." Sun Guoguo said to Lu Chen, "But we still need to do aortic CTA for diagnosis."

No matter how similar the clinical manifestations are, evidence must be produced to diagnose any disease.

For aortic dissection, that is enhanced CT of the aorta.

"Okay." Lu Chen nodded.

The patient is accompanied by a family member, his wife.

The conversation went smoothly, and the family members agreed to go out for a check-up.

Because the patient's condition was quite critical, Lu Chen personally took him out for examination.

Lu Chen prepared the monitor and first-aid kit for out-of-town inspection. When Lu Chen was about to go out, he was stopped by Nurse Liu.

"Lu Chen, after the patient has completed this examination, he will be in arrears. All subsequent medicines will be paid on credit, so you can urge the family members to pay."

Lu Chen nodded in agreement.

The patient has medical insurance in a rural area and needs to pay first and then be reimbursed after returning.

…

Push the patient to the CT room.

When the imaging results appeared on the computer, there were tears all the way from the patient's aortic arch to the thoracic aorta.

There is no doubt that this is aortic dissection, Stanford type A, requiring emergency surgery.

"Congratulations, the system upgrade completion rate has increased!"

At this time, Lu Chen didn't feel happy at all.

He immediately called Sun Guoguo and informed him of the examination results, then carefully moved the patient back to the hospital bed and escorted him back to the ward.

Lu Chen was afraid that something would happen halfway.

However, nothing happened along the way and we returned safely to the Eighth District of the Heart.

Sun Guoguo has already requested emergency consultation from the vascular surgery department.

This kind of operation involves surgery, and ordinary medical intervention can no longer solve it.

…

The vascular surgeon arrived soon after.

"Director Zhang, transfer the patient to your department?" Sun Guoguo looked at the cardiac surgeon who came for consultation.

"If you need surgery, transfer to our department. If you don't need surgery, there's no point in transferring. It's just about lowering blood pressure and treating symptoms. Your internal medicine department is more professional than our surgery department."

The consulting doctor's opinion was clear.

This type A dissection requires emergency surgery.

Without surgery, it would be like carrying a time bomb that could explode at any time!

Director Zhang from the Department of Cardiac Surgery finished writing the consultation opinions and explained the condition to the patient's family before leaving.

…

Antihypertensive drugs have been used, and the next step is to communicate with the patient about the surgery.

Lu Chen followed Sun Guoguo to the ward and called the patient's family members out of the corridor.

Sun Guoguo repeated the conversation with her family members countless times before.

"I have to do surgery. If I don't do it, I will die at any time!"

The patient's wife also looked like she was very poor in the countryside. She asked Xiang Sun Guoguo with tears in her eyes: "Doctor, we are a rural medical insurance company. How much does the surgery cost?"

Sun Guoguo paused and said slowly: "For rural medical insurance, you have to pay for it yourself first and then go back for reimbursement. If everything goes well, the total hospitalization cost will be 200,000, but if you pay 100,000 first, it will be enough for the operation fee, and we can start Do the surgery to save your life.”

The patient's wife burst into tears. She fished in her pocket for a long time and took out a few ten-and-five-dollar bills: "After two days of struggling, this is all we have at home."

Lu Chen took a look and saw that the total speed was not even close to 100, which was too far behind.

Sun Guoguo was also a little anxious: "Don't you have a card or anything? WeChat and Alipay are also fine!"

The patient's wife fumbled in her pocket for another long time and took out a bus pass.

Sun Guoguo was stunned for a while, and saw that she was already crying. She gritted her teeth and said, "Well, hurry up and raise money. As long as you have 50,000 yuan, I will help you report and find a way to transfer you to another department and help you." Done!"

The patient's wife may really have no money. She kept shaking her head and crying.

Lu Chen and Sun Guoguo's hearts tightened. This was the best they could do.

If that doesn't work, there's really nothing we can do to help.

…

Perhaps the cries of the family members were so sad that they attracted a middle-aged woman from the next ward.

The woman listened carefully, probably thinking that her relative's condition was also very critical, so she stepped forward, shed a few tears with her, and then said sternly: "Today's doctors really have no medical ethics!"

Lu Chen and Sun Guoguo were both confused.

For no reason, he was suddenly hammered.

Just listen to this woman continue to say: "In the past, doctors always performed the surgery first, and they didn't care whether you paid or not."

Before Sun Guoguo could recover, Lu Chen calmed down and said slowly: "There is no money in the account, we can't get anesthesia, and we can't get anesthesia. He can lie here with water for treatment, and he has to use the head nurse." With his authority, he was allowed to receive treatment on credit.”

The woman seemed not to have heard. She comforted the patient's wife while continuing to spit out the fragrance: "Doctors nowadays are obsessed with money! In the past, the old doctors in our village used to advance their own money to treat others. Now, How can there be such good people? They are all full of evil!"

Lu Chen's heart sank to the bottom.

He stood directly in front of the woman and took out his cell phone.

The woman was startled, thinking that Lu Chen was going to hit her.

But thinking that this was a hospital, UU Reading www.uukanshu.net there were so many people around, and there were cameras, so he didn't show any weakness and glared angrily.

At this time, Lu Chen held up his mobile phone and opened Alipay's Yu'E Bao.

After looking at the balance, I quickly exited and reopened the loan.

Lu Chen gritted his teeth and said: "Sister, you are right, I should really be a doctor with medical ethics. Do you think this will work? I am a poor doctor and I don't have much money. There is a loan limit of 30,000 yuan here. I Lend it all out and give it to her. You are so caring, why don’t we put in the remaining 20,000 and do a good deed together to save someone?”

After hearing this, the patient's family members widened their eyes and looked at the woman with hope.

The woman's mouth trembled and she stepped back.

The patient's family member took a step towards the woman, wiped away her tears, and wanted to speak.

The woman was so frightened that she pushed her hard, cursed and quickly disappeared into the corridor of the ward...

7017k