Brother Hua couldn't touch his head, so what was going to make a fuss? He quickly used a stethoscope to give it to the patient, and there was no pneumothorax.

I took another electrocardiogram at the bedside, but there was still no myocardial infarction. But after a closer look, it seemed that there were signs of pulmonary embolism!

Damn, this is not a joke. Brother Hua couldn't laugh or cry.

I quickly asked the superior doctor to come and take charge of the overall situation. Other doctors were also very curious and paid more attention. Everyone started a discussion.

There is no doubt that the patient had the first chest tightness and difficulty breathing was pulmonary embolism. CT pulmonary angiography confirmed that the thrombolysis treatment was also very effective. But this time the patient's chest pain and difficulty breathing was pulmonary embolism? Do you still need to have a third CT?

This is very possible.

I quickly contacted the patient's family and communicated again. Brother Hua told them that the patient could not be transferred to the ICU for the time being because pulmonary embolism might have occurred again.

When the two daughters heard this, they were shocked and asked why this was the case.

Brother Hua couldn't tell the reason for a while, so he had to say that it might be that the patient's pulmonary embolism had not been resolved yet, so the patient had pulmonary embolism again. Common symptoms of pulmonary embolism are chest pain, difficulty breathing, and hemoptysis.

Generally speaking, patients with tumors have a long-term bedridden, pregnancy, oral contraceptives, and other patients have a relatively sticky blood and have a higher risk of thrombosis. For example, venous thrombosis in the lower limbs. Once the embolism falls off, it may enter the pulmonary artery with the blood flow. However, the cause of thrombosis in this patient is not clear. Moreover, Brother Hua later performed color ultrasound of the lower limbs on the patient, but he did not see a vein thrombosis. Where did the embolism come from? It is difficult to evaluate. Maybe it was a deeper vein or somewhere. Anyway, I didn’t see a B-ultrasound.

There are generally three factors to form a thrombus, one is the viscosity of blood, one is the slow blood flow, and the other is the rupture of the endothelium of the blood vessel. It is easy to understand that the blood flow can easily lead to thrombus formation, and it is not difficult to understand that if the blood vessel endothelium is ruptured, some coagulation molecules will accumulate, and in the long run, it will easily form too many thrombus. Therefore, we recommend that patients not be bedridden for a long time, because it will lead to slow blood flow. It is also recommended that bus drivers not sit all the time and move around from time to time. This is all to prevent thrombus formation.

Why does this patient have thrombosis and pulmonary embolism?

have no idea.

Now that I can’t think of this, the most urgent thing is to do CT pulmonary angiography first to see if there is really a pulmonary embolism again. After all, the patient is hypoxia again.

It was a headache. I thought I could solve the problem by finding a pulmonary embolism, but I didn’t expect that this happened. Brother Hua was so angry.

I agreed to do it, and the family signed it again. Although I signed it, they must have some ideas. Brother Hua naturally knew this, so Brother Hua repeatedly emphasized to them that the cause of pulmonary embolism is not known, so we have to do our best and cannot guarantee that he will be cured.

This CT was indeed not unexpected.

The patient did have another pulmonary embolization, and several branches of the pulmonary artery were embolized.

In addition to pulmonary embolism, CT also saw a result that surprised Brother Hua: a rib on the left of the patient was broken.

Oh my God, why did the patient suddenly break a rib? Brother Hua was in a brainstorm again. The patient had no history of impact and had been in the ICU ward for the past two days. How could the rib fracture be broken? Could it be... Brother Hua was stunned. He was in the ward just now, and it seemed that the patient coughed a few times and then felt uncomfortable. Could it be that the cough broke the rib? It seems that the patient's chest pain this time was not only caused by pulmonary embolism, but also the components of the rib fracture. It was still not careful enough that the examination was missed. If the patient's chest wall was carefully examined at that time, he would definitely find a rib fracture. But he had preconceived thought about the pulmonary embolism. Fortunately, the fracture was not serious and did not puncture the blood vessels or lungs, otherwise it would be unimaginable.

Coughing causes rib fractures, which sounds horrible, but it is actually possible. Some patients with osteoporosis may have severe coughing, sneezing, or even sharp twisting of the waist may cause rib fractures, which is not rare.

Brother Hua contacted the thoracic surgery department and asked how to deal with this situation. The thoracic surgery department saw a film and said that the fracture was not very serious and could be treated conservatively. After discussion, the patient confirmed that he had pulmonary embolism again, so he was given thrombolysis again and continued anticoagulation treatment. The thrombolysis is to dissolve the already formed thrombus, and the purpose of anticoagulation is to prevent the formation of thrombus.

After dealing with the patient, Brother Hua went out again to communicate with his family.

When the family heard that the patient had a rib fracture, they cried again, saying that my father was so hard and had so many diseases. This was not life-threatening, but this was death-threatening.

The family members' words completely woke Brother Hua up. Brother Hua's messy thoughts seemed to have been pulled by someone, and they suddenly became clear!

Yes, how could a patient have so many diseases at the same time? In addition to pulmonary embolism and anemia, the patient also showed renal function abnormality and lung infection. This time, a rib fracture was added...

Is everything accidental? Is it all unrelated?

Is the patient's anemia really caused by hemorrhoids? Is the patient's renal abnormality really caused by hypertensive kidney disease? Is the patient's rib fracture really osteoporosis? Will a 60-year-old man have osteoporosis so much that he will get a fracture after a sneeze?

Too many questions.

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Several of our departments have been committed to treating patients' pulmonary embolism, thinking that the pulmonary embolism will be done after treatment. I never thought that a pulmonary embolism would occur for the second time. A rib fracture was also found. The bone density of the patient seen by CT was not very good.

Can a disease be used to explain all the above abnormalities? Isn’t monism we have always pursued? Why do we satisfy the diagnosis of pulmonary embolism? Are we not curious about why it causes pulmonary embolism? Where does the patient’s thrombosis come from? Why is the patient so easily embolized?

When Brother Hua thought of this, he felt cold sweat.

The blood is viscous, kidney function abnormal, fracture, anemia... All the information is superimposed, and Brother Hua is gradually getting eyebrows. Because it is not the first time they have encountered patients with abnormal renal function, fracture, and anemia. There was also such a patient last year, and he was finally diagnosed with multiple myeloma in the hematology department.

Yes, multiple myeloma. Multiple myeloma is not uncommon.

Under normal circumstances, our bone marrow will produce many normal plasma cells, and the daily job of plasma cells is to produce immunoglobulins. Immunoglobulins protect the body and can be considered special forces. However, under pathological conditions, the patient's bone marrow is confused and they develop...

Decreasing symptoms. These bad proteins accumulate in the renal tubules, causing kidney damage and abnormal renal function. These bad proteins accumulate in the blood
Chapter completed!