I took the patient's CT video and thought about it carefully.

This is a 60-year-old middle-aged man who was transferred from the hospital below and was a farmer. His son told me that no matter how much the price he paid, he would do his best.

The patient's surname is Chen.

Uncle Chen started to have fever, cough, sputum, and chest pain a month ago. I took a film in a local hospital. Considering that it was pneumonia, the effect was not good after several days of treatment, and shortness of breath later became short of breath. The local hospital issued a notice of serious illness, which scared Uncle Chen's son, Xiao Chen.

In fact, it is a normal diagnostic thinking for them to consider pneumonia, I told Xiao Chen.

But when the treatment effect is not good, we should be vigilant. Why is the effect not good? I looked at Xiao Chen and said.

After coming to our hospital, the patient's breathing was obvious. The emergency room was diagnosed with blood qi and showed respiratory failure. He was sent directly to me. I wanted to directly intubate the patient and ventilator to ventilate, but the patient's consciousness was still clear, so we tried to see if we could not intubate.

First give the mask oxygen inhalation. The mask oxygen inhalation is so comfortable compared to the tracheal intubation.

Fortunately, after the mask was inhaled oxygen, Mr. Chen's breathing could gradually ease.

I explained to him that I would treat it here for a few days first, and when the condition is cured, I would be transferred to the general ward to reunite with your son.

The patient is very afraid of living in the ICU because it is completely closed and there are no relatives. The instruments tickled by the bed next door, and people need to rescue them from time to time.

Too uncomfortable. For a patient with a clear mind.

After admission, we took advantage of the condition and arranged a review of the chest ct.ct.t. I saw pneumonia. At the same time, we were afraid that the patient would have lung cancer. TB treatment diseases, so we did ct enhancement. The results showed that there was no lung cancer and did not support tuberculosis.

But I saw a new problem. The patient had pulmonary embolism. The right middle lobe and lower lobe had pulmonary embolism.

In addition to pneumonia, the patient also has pulmonary embolism, which can explain all the current symptoms.

Pulmonary embolism refers to thromboembolism of the pulmonary artery. When there is thrombosis in the blood vessels of the body (mostly thrombosis of the lower limb veins), after these thrombus fall off, it will flow into the right heart with the blood flow and then enter the pulmonary artery. If the thrombus is large enough to embolize the main trunk of the pulmonary artery, the patient will quickly fall out of oxygen and die in an instant. Any rescue method is useless.

picture

Death is undoubtedly true!

If the thrombus is relatively small and cannot be truncated to the main trunk of the pulmonary artery, then it is fortunate that the thrombus will continue to flow, which may cause small branched vascular embolism. This is the case with Mr. Chen.

The reason why patients have difficulty breathing is definitely related to pneumonia and pulmonary embolism, I think.

In addition to using antibiotics to treat pneumonia, pulmonary embolism must also be treated so that the patient may get better.

If there is a very serious pulmonary embolism (the patient is in shock), we need to thrombolysis for the patient. This means that by injecting the drug into the body, these thrombolysis drugs can dissolve the blood clot that tie the blood vessels, thereby restoring blood flow and improving the condition. However, complications of thrombolysis may lead to cerebral hemorrhage. Therefore, thrombolysis is easily insoluble.

Although Mr. Chen was short of breath when he came, his blood pressure was still good, not the most serious pulmonary embolism, so we did not thrombolysis. Instead, we adopted anticoagulation methods. The purpose of anticoagulation is to prevent the re-formation of thrombus. As long as the thrombus does not continue to be generated, the condition will no longer worsen. Our body will activate the thrombolysis mechanism and dissolve the thrombus. This thrombolysis has no risk of cerebral hemorrhage.

picture

So we used warfarin anticoagulation. After several days of treatment, the symptoms did not significantly relieve. Uncle Chen still had shortness of breath and had difficulty breathing. He almost needed tracheal intubation several times.

The last time, I was on duty. After turning over, Mr. Chen's blood oxygen saturation continued to decline and his breathing was rapid. This would not work. I think it is necessary to first connect the tracheal tube to the ventilator, and saving his life is important.

After communicating with Xiao Chen, he agreed to tracheal intubation.

So I pushed a little midazolam (sedation medicine) to Mr. Chen, then quickly inserted the tracheal intubation and connected the ventilator to assist ventilation. The intubation process was quite smooth. After connecting to the ventilator, Mr. Chen's breathing gradually smoothed and his blood oxygen saturation could also be significantly improved.

No life is in danger for the time being.

The problem is that even though a patient with pneumonia and pulmonary embolism has undergone sufficient anti-infection and anticoagulation treatment, the effect is not good and still has fever. The infection index is not too high, but it has not been significantly reduced. What is the reason?

picture

Is it because antibiotics are not strong enough? This is unlikely. We have combined it with a wide spectrum of powerful antibiotics, and we can cover the most deadly antibiotics. Just like Dongfeng Express, the coverage area is very wide and there is no reason to be unable to control it.

Does the patient have other problems besides pneumonia and pulmonary embolism?

In fact, it is hard to imagine that such a farmer who works for a long time will have pulmonary embolism. How can pulmonary embolism be caused by no reason? The pulmonary embolism we usually see has causes, such as the patient may have just had surgery, had long-term bed rest, lower limb edema, blood hypercoagulation, etc., but he did not.

The patient is still suffering from fever. Is there any possibility of tuberculosis?

However, anti-tuberculosis antibodies, t-spot tests, and sputum smears were negative several times, and there was no evidence of tuberculosis.

On duty that day, I saw Uncle Chen lying quietly on the hospital bed. He was fully calmed and relieved, just like an animal hibernating, without obvious perception.

picture

When Xiao Chen visited, he saw his father lying motionless and cried loudly. He just held Uncle Chen's hand tightly and called his father, hoping that he could wake up early and go home to see the sugarcane together. The sugarcane can be sold again. Get up and go home quickly.

The patient has repeated fever, and the heat peak is not very high, and it has been around 38.5°C. It is not like an ordinary bacterial infection. Otherwise, it is unlikely that it will be so tenacious. If we continue to get so many antibiotics, there is no reason to remain motionless.

Is there really no special pathogen infection?

The most likely one is tuberculosis. I told myself. So I kept leaving phlegm in the next few days to find acid-resistant bacillus. If I could find acid-resistant bacillus, it basically means that it is tuberculosis. If I can't find it once, I will look for it twice. If I don't have it twice, I will look for it three times. If I look for it a few more times, the chance of finding it will be higher. When I look for it a few more times, I really don't, so forget it.

At the same time, sputum was also left to check for tuberculosis DNA, and a two-pronged approach was taken.

I hope to find clues. For ordinary tuberculosis, it is easy to diagnose, but I am afraid that some phlegm will find negative tuberculosis and chest X-rays are not typical, so it is relatively difficult.

picture

Fortunately, the patient is lucky.

The fourth sputum smear was found to have acid-resistant bacillus, which means that it is likely that it is tuberculosis.

Then the DNA results of sputum tuberculosis also returned. The DNA number of tuberculosis was very high, which was confirmed to be a tuberculosis infection.

The patient has tuberculosis!
Chapter completed!