I Can See Health

Lu Chen glanced at the patient's elbow joint, calmed down, and muttered: "This may not be a rash!"

"Not a pinhole?" The nurse on duty frowned.

Lu Chen leaned over and continued: "Look carefully, this might be a pinhole! Some of the pinholes are infected, so they appear like a rash."

As soon as these words came out, everyone was shocked.

Li Qinghua was also surprised.

He stepped forward and took a closer look.

They were really pinholes, densely packed, right near the cubital vein in the patient’s left arm.

"The patient also has a lot of rashes like this on his right hand. They are really pinholes!" The nurse on duty opened the sleeve of the patient's right hand again.

She was changing the patient's hospital gown when she discovered these details.

"If it's really a pinhole, that would be serious." Lu Chen said slowly with a brow.

Li Qinghua also nodded in agreement: "Well, then thrombolysis cannot be used."

At this time, Yin Xinhua walked into the ward. Hearing the conversation between the two, he wondered: "Why can't thrombolysis be used again?"

Li Qinghua paused, looked around, and saw that the patient's family members were not there, and then said slowly.

"He is most likely a drug addict."

Lu Chen also strongly agreed with Li Qinghua's point of view.

With so many pinholes on the body, there is only one possibility, and that is drug addiction!

When the nurse on duty heard this, she immediately let go of the quilt on her hands, hurriedly washed her hands and changed her gloves.

Lu Chencai exposed the patient's pinhole part to Yin Xinhua.

Yin Xinhua's eyes showed surprise.

Upon seeing this, Li Qinghua immediately said: "Don't be too afraid, just take personal protective measures. If he is really a drug addict, he may have sexually transmitted diseases or AIDS, etc., but this possibility is not high. Please be careful That’s it.”

After finishing speaking, Li Qinghua looked at Yin Xinhua and Lu Chen, "So I think the patient may not have an ordinary pulmonary embolism!"

"Well, at least it's probably not pulmonary thromboembolism." Lu Chen nodded slightly.

Li Qinghua continued: "If the patient is really taking drugs, then the fever may be related to the infection. Our CCU had a similar case the year before last. Infectious endocarditis occurred in drug addicts, causing long-term Fever. Infective endocarditis will have cardiac vegetations. If there are vegetations on the right side of the heart, once they fall off, they may also cause pulmonary embolism.”

If the patient really has infective endocarditis, the dislodged emboli are bacterial clumps and tissue.

This is not a blood clot, so there is no need for thrombolysis!

Thrombolytic drugs target blood clots and are not helpful for bacterial clumps and tissue clumps. At this time, thrombolytic drugs may do more harm than good.

Although this possibility is very small, it is reasonable and can explain the symptoms the patient is currently experiencing.

Yin Xinhua frowned and said, "But Lu Chen and I have both auscultated the patient's heart and heard no obvious heart murmur. If the patient really has such obvious cardiac growths, he should be able to hear the murmur. "

Li Qinghua shook his head and said seriously: "That's not necessarily true!"

"First of all, the vegetation is not necessarily very large. In addition, the patient was breathing so rapidly at the time, and the auscultation was easily disturbed."

"We'd better call the cardiac ultrasound teachers to come over and let them take a look at the heart. After all, we are not as professional as them. They might be able to see cardiac vegetations and pulmonary artery emboli."

Yin Xinhua nodded: "Now we just have to wait for the teacher from the cardiac ultrasound room to come over."

Lu Chen took the portable ultrasound machine and looked at the patient's heart several times, but still could not see cardiac vegetations or pulmonary embolism.

There is no way, his cardiac ultrasound skill card is only elementary.

After understanding the patient's condition, Yin Xinhua immediately called the family member's sister.

"You know about the pinholes on his elbows? Does he have any bad habits..."

The patient's sister looked confused and almost cursed.

"How could my brother be taking drugs!"

Yin Xinhua comforted the patient's family: "We are just suspicious. Whether you have taken drugs can be tested. I want to ask you if you know."

The patient's sister didn't speak, and kept grabbing her sleeves with both hands.

After being silent for a long time, she continued: "Actually, we sister and brother haven't seen each other for more than half a year. It was absolutely impossible for him to take drugs before, and I can't guarantee it now."

Can’t guarantee it now?

As soon as these words came out, Lu Chen, Yin Xinhua and Li Qinghua looked at each other.

They found that the patient's sister looked a little panicked.

Li Qinghua spoke up: "Whether it's drug abuse, go to the laboratory or a testing agency outside the hospital for a toxicology test. Use the patient's hair for a test. Generally, anyone who takes drugs can be found out within six months. And your brother has symptoms on both arms." They are all pinholes, and we have reason to doubt this.”

When the patient's sister heard this, she almost collapsed on the ground, with a hint of crying in her voice.

"My eldest brother is a drug addict, but my younger brother is not... Doctor, I beg you to cure my younger brother..."

Seeing this scene, Li Qinghua whispered to Yin Xinhua: "The patient must be very addicted to drugs."

Yin Xinhua nodded calmly.

…

At this time, the doctor in the ultrasound room that everyone was waiting for finally arrived!

The cardiologist took a probe and looked carefully at the patient's heart several times.

"It's really a pulmonary embolism!"

Lu Chen and others immediately stepped forward.

The cardiologist pointed to a place on the screen.

"Look, there is an embolism in the pulmonary artery. Although it is not obvious, it is there, and there is a vegetation on his right heart valve. You really guessed it!"

When Lu Chen heard this, he was completely relieved and felt a slight chill down his spine.

It’s really dangerous!

If thrombolysis is performed directly, the consequences will be disastrous!

"In this case, the emboli should be a bacterial clump, not a thrombus." Yin Xinhua repeated.

Li Qinghua nodded and ordered at the same time: "Keep blood culture, monitor body temperature, and apply the strongest vancomycin, which will not dissolve thrombosis."

If the patient is really an intravenous drug user, then the infective endocarditis that occurred this time is likely to be related to intravenous drug use.

The most likely bacterial infection is Staphylococcus aureus, because this bacteria is most common on the skin and can cause infection at any time due to needle holes.

Staphylococcus aureus may or may not be drug-resistant.

But the patient ran out of time and had to cover it with the strongest vancomycin.

Vancomycin is a special class of antibiotics.

Applications must be submitted for this particular grade of antibiotics.

However, this is a special emergency situation.

Li Qinghua skipped the application and directly used vancomycin.

Soon, the nurse brought vancomycin from the pharmacy and gave it to the patient.

…

After Li Qinghua and the doctor in the ultrasound room left.

Lu Chen and Yin Xinhua looked at each other with lingering fear.

It's almost twelve o'clock in the evening. UU Reading www.uukanshu.net

Yin Xinhua invited consultations from multiple disciplines, including ICU, respiratory department, ultrasound department and CCU.

After comprehensive consultation from so many disciplines, the correct conclusion was finally reached.

This patient is full of pitfalls.

If you are not careful, you will be in trouble!

On the other side, the ICU and respiratory doctors heard that the pulmonary embolism was caused by infective endocarditis in an intravenous drug addict.

They couldn't believe it at first, and they even came to the eighth area of ​​​​the heart. They were convinced when they saw the patient's arms were densely covered with pinholes.

"Damn, it's really rare to see people taking drugs these days. Drug trafficking should really kill the whole family!"

The icu doctor muttered before leaving the eighth area of ​​​​the heart.

7017k