Chapter 546: Asymptomatic is dangerous, a diagnosis of fog through the clouds

Author: Fisherman by the River

Chapter 546: Asymptomatic is dangerous, a diagnosis of fog through the clouds

When various acute and severe patients are sent to the hospital, the situation is often particularly scary.

At least when Zhou Can first went to the emergency department for internship, he admitted five acute and severe patients in a day who were near-death.

"I remember your name is Xie Yu, right?" Zhou Can talked to her while following the little nurse to the emergency hall.

"I didn't expect you to remember my name, so moved!" The little nurse was a little flattered.

Now the doctors and nurses in the emergency department know that Zhou Can is a powerful figure in the department. He has strength, status and a bright future. Not to mention that everyone respects him, at least everyone has formed a consensus and treats Zhou Can as a heavyweight figure in the department.

"I tell you, patients with severe symptoms like this are not scary. What you really need to be wary of are those patients who don't seem to be very serious. For example, pulmonary embolism has a very short onset time, and death occurs within one or two minutes."

Zhou Can guided the newcomer.

In the hospital, because medical staff are a common interest body. Especially for members of the same department, if something happens to one person, it may drag down the entire department. Therefore, even a doctor or nurse with an introverted personality will give appropriate guidance to newcomers as long as you have the opportunity.

Medicine can be passed on continuously, and it is precisely because of everyone's spirit of being a good teacher.

"Doctor Zhou said it is not an exaggeration at all. I still remember when I was a nurse in the first year, I was examining a patient who was hospitalized for observation. The patient was very cheerful and talkative, and took the initiative to chat with me. His children were also accompanied by the bedside. I just took his blood pressure to measure him, and found that his blood pressure was falling. The patient was still able to chat and laugh, but there were no obvious symptoms, so why was his blood pressure so low? I was going to change his arm to measure it again. As a result, the patient suddenly twitched, fell on the bed, his eyes rolled up, and the patient died soon. Later I found out that the patient had an aortic dissection in his body and it was ruptured."

Jiang Wei also shared her growth experience next to her.

During the formation of aortic dissection, different degrees of pain will generally occur.

However, some patients have strong tolerance for pain and do not care about some less intense pain, and are easily overlooked.

There is also a kind of aortic dissection that is the most terrifying.

The time from formation to rupture is extremely short, and this mortality rate is basically 100%.

Unless it can be detected in advance and then intervened, such as placing a blood vessel stent to block the torn part of the inner wall of the blood vessel. Otherwise, the miraculous doctor will not be able to save it.

"After being taught, I will be more cautious in the future! I really didn't expect that asymptomatic patients are the most terrifying."

The young nurse agreed with the words of these two seniors.

The three of them had already arrived at the triage desk at this time and saw a man of 34 or 35 years old lying on the first aid bed with a pale face.

At a glance, you can tell that it was the emergency patient brought back from the ambulance.

The patient covered his chest tightly, his face turned pale, his forehead was already sweating, and his hair was wet.

The expression is also extremely painful.

Breathing seems to be very laborious.

Seeing Zhou Can coming, the doctor on duty seemed to have found a savior. He quickly made aside and asked Zhou Can to check the patient.

"Where does it hurt?"

Zhou Can first explored the patient's carotid artery.

When encountering such patients with suspected chest pain or patients who suddenly fall into the ground, exploring the carotid artery can obtain a lot of diagnostic information.

For example, by the strength and presence of the carotid artery, the working state of the heart can be roughly inferred.

Some patients may also develop cervical ankylosing, which has certain diagnostic significance for diseases such as meningitis and neuropathy.

"This part hurts so much! It seems that there is still the left shoulder and the back part, which is also painful."

The patient's voice seemed weak and he looked scary as if he could die at any time.

After hearing this, Zhou Can tried to press the patient's chest position.

The patient just hummed twice, and the tenderness reaction was not obvious.

Some patients are already numb because of the pain, so they don’t know where the pain is. They only know that the large piece is very painful.

At this time, the doctor needs to use his own experience and medical knowledge to identify it, and finally lock in the real pain area.

As we all know, pain is actually a kind of protection for the body.

Which place of pain means that the organs or body tissues in that part are undergoing serious lesions. The more severe the pain, the more serious the lesions are.

In addition, if there is only a little pain at first and lasts for a long time, the pain will increase a little bit. Or intermittent complications can basically be said to be a chronic disease.

There is only the kind of pain at the beginning that people can't bear it quickly. The progression from slight pain to severe pain is very short, so you have to be careful.

Basically, they are all acute lesions, and the degree of danger is often very high.

Needless to say, chest pain and chest tightness are needed, even if it is acute and severe abdominal pain or headache, you must be very careful.

For example, the most common cerebral infarction, cerebral hemorrhage, acute appendicitis, acute intestinal perforation, etc. If the treatment is not done in time, it is easy to lose precious golden rescue time, eventually die and become disabled.

Zhou Can pressed the patient's chest, and after the tenderness reaction was not obvious, he felt at ease.

It's probably not a heart disease.

The doctor on duty may have heard that the patient had chest pain and vomiting, so he was a little panicked.

Since the pain area is not on the chest, it means that chest pain is radiation pain.

When the pain is severe, it can continuously spread to a certain area around it, and it can even spray to a very distant area.

For example, if you treat your feet with headaches, you may have foot lesions that cause head pain.

Zhou Can began to press the patient's abdomen.

"Ao... it hurts, it hurts..."

When Zhou Can pressed his fingers to the middle of his upper abdomen and a little above his navel, he didn't react much at the beginning. He pressed the pressure a little bit, and the patient suddenly let out a change in tune. His body also tightened suddenly, and blue veins on his neck appeared.

"It seems that the real pain area is here. It is not in the superficial surface in the middle of the upper abdomen, but in the deep abdomen. This position is the area where the stomach and pancreas are located. The stomach is in the superficial upper abdomen, and the pancreas adjacent to it is deeper behind. From his symptoms, the problem with the pancreas may be greater."

While analyzing the patient's condition, Zhou Can turned to look at Dr. Xie on duty.

"Have the patient's body temperature and blood pressure exceeded?"

When examining the patient's body, blood pressure and body temperature are two very important reference points.

"I've taken it over, my body temperature is 37.8 degrees, my blood pressure is a bit low, and my systolic blood pressure is only about 80."

Dr. Xie has been working in the emergency department for more than a year, and compared with when he first came in, he has made great progress. At least after receiving the patients, these details have been done well.

However, this person is a dull doctor. He is relatively dull when diagnosing diseases. He has a lot of medical knowledge, but he cannot use it flexibly.

The patient's body temperature is moderate.

The systolic blood pressure is even lower than 80 mm tribute column, no wonder Dr. Xie is very panicked.

Chest pain and hypotension are the first to think of aortic dissection.

The normal range of systolic blood pressure is between 90 and 140 mmHg. Below this value, it is considered hypotension in clinical diagnosis. Above this value, it is called hypertension.

Relatively speaking, there may be many reasons for hypotension in clinical practice.

For example, long-term malnutrition, hypothyroidism, or taking antihypertensive drugs, etc.

Hypotension with chest pain is the most scary. Almost all emergency doctors will immediately suspect aortic dissection rupture and heavy bleeding in the body.

Zhou Can has a sixth-level hemostasis and a sixth-level pathological diagnosis, which has certain advantages in the diagnosis of various in vivo bleeding.

After preliminary diagnosis, he believed that the patient's possibility of heavy bleeding was relatively low.

Many symptoms of aortic dissection rupture are highly consistent with this patient, but it does not mean that it is aortic dissection.

Clinically, there are many diseases with overlapping symptoms.

To measure a doctor's diagnosis level, we can see whether the doctor can quickly and accurately combine many symptoms, conduct targeted examinations on the patient step by step, and then screen out some suspected diseases with high overlap in the symptoms, and diagnose the real cause.

It's simple to say, but it's extremely difficult to do this.

Almost all doctors have been working hard in this direction all their lives, constantly learning and accumulating diagnostic experience. But there are less than one in ten doctors who can truly reach a high level in the end.

With the advantages of the system, Zhou Can can use one or two years to reach a level that others will take twenty or thirty years or even longer to reach. This is his biggest advantage at present.

Many doctors may have only improved hemostasis to level 6 after spending 20 or 30 years, but they cannot raise all other medical skills to this level at the same time.

This leads to a certain one-sidedness in their diagnosis.

Knowledge is destined to be very narrow.

Zhou Can broke this routine and could upgrade multiple medical skills to level 6 or above at the same time. It is equivalent to combining multiple chief physicians with more than 30 years of diagnosis and treatment levels into one at the same time, which is quite terrifying.

It's definitely not as simple as one plus one equals two.

In fact, since recently, he has been in the emergency department, pediatrics, and cardiothoracic surgery departments, he has cracked many difficult cases that the chief physicians could not solve after consultation. This is enough to show how awesome he has multiple sixth-level medical skills at the same time.

Learning is endless.

He did not stagnate because of this.

On the contrary, he is still working hard to improve various medical skills and strive to push them to level seven.

By then, not to mention the number one in the world, it should be difficult to find an expert who can match him in China.

Dr. Xie looked at Zhou Can checking the patient, but he didn't dare to urge him, but he was so anxious that he stamped his feet secretly.

My mother, the patient's condition is so urgent, and the symptoms are also highly coincident with the rupture of the aortic dissection. What is Dr. Zhou still thinking about?

He is really not in a hurry!

No matter Dr. Xie or the nurse next to him, no one dared to urge Zhou Can.

Without the chief physician present, Zhou Can is the absolute leader.

Zhou Can knows that the mortality rate of acute pancreatitis is quite high, so he will never dare to be careless.
Chapter completed!