I can see health

Chapter 192 The Truth About the Coma

"Brother, are there any problems with these test results?" Lu Wenjun asked nervously.

"I haven't found it yet." Lu Wenguo shook his head, "I still have to look at the results of the blood test. When the results of the blood test come out, I will ask Xiaohui to send them over."

"Okay." Lu Wenjun nodded.

At this time, Lu Chen took the phone from Lu Wenguo and found the photo of the electrocardiogram.

"Dad, look at this electrocardiogram, I think it's a bit strange." Lu Chen pointed at the electrocardiogram and handed the phone in front of Lu Wenguo.

"Electrocardiogram?" Lu Wenguo was taken aback, he hadn't read the electrocardiogram carefully yet.

As a general surgery surgeon, at most he would glance at the "machine-generated report" of the electrocardiogram.

That is the result of the automatic analysis of the electrocardiogram machine.

"Xiaochen, isn't this right bundle branch block? I remember that right bundle branch block should also appear in normal people, right?" Lu Wenguo looked at the electrocardiogram again, and then tentatively replied .

Although he was an old doctor for many years, he didn't dare to trust the electrocardiogram at all.

Lu Wenguo deeply remembered that Lu Chen once saw the electrocardiogram of "idiopathic ventricular tachycardia" at a glance.

This is a graphic that even the deputy chief doctor of the Cardiology Department misjudged.

Lu Wenjun on the side was stunned.

Why does he feel that his elder brother cares about Xiaochen's opinion?
Although Xiaochen is very good and won the championship in the skills competition, she is only a student after all.

However, my elder brother Lu Wenguo has been practicing clinically for so many years!

Is this my own illusion?
"Dad, this is indeed a pattern of right bundle branch block." Lu Chen touched his chin, "However, besides the right bundle branch, there are other abnormalities."

Lu Wenguo took the phone and carefully identified it again.

Half an hour passed.

He finally saw some abnormalities, and hurriedly said: "Axis deviation to the right, right bundle branch block, high voltage in the right ventricle, clockwise transposition. And s1q3t3, could it be a pattern like pulmonary embolism?"

Pulmonary embolism, some patients do have signs of coma.

At first glance, it sounds similar.

Lu Chen was stunned when he heard what his father said, but he didn't see the s1q3t3.

He picked up the electrocardiogram, then shook his head: "It doesn't look like lead III."

Lu Wenguo scratched his head, and after a closer look, this III really didn't look like it, it was because he was a little far-fetched.

"Dad, look at the test report later." Lu Chen said, "Only by combining the test report can we have a more accurate judgment."

……

Huzhong Province, H County near Jiangcheng.

County People's Hospital, Emergency Department.

Liang Hui nervously looked at the emergency doctor in front of him.

"Doctor Fu, can you take a picture of my dad's blood test results?"

Fu Shuo frowned, "Didn't I explain everything to you just now?"

"Well, a relative in my family is also a doctor. I'll take a picture and send it to him." Liang Hui quickly explained.

"Well, that's fine."

Fu Shuo was most afraid of people with relatives who had doctors. Not only did they want the reports of various laboratory tests, but they also sometimes gave instructions on the treatment plan.

"Where is your relative a doctor?" Fu Shuo asked casually.

"It's a surgeon from a county hospital." Liang Hui thought for a while.

"Oh." Fu Shuo nodded.

He really didn't believe that a doctor at a county hospital could remotely see the cause of a patient's coma.

So far, common causes of coma have been ruled out, such as cerebrovascular accident, hypoglycemia, diabetic ketoacid, cardiogenic, etc.

Liang Hui quickly took all the test sheets and passed them on to Lu Wenjun.

……

A neighborhood in Jiangcheng.

"Brother, I received the test sheet."

Lu Wenguo took the phone.

In the photos this time, there are not only the test sheets, but also detailed medical records.

The patient, a 64-year-old male, was admitted to the hospital mainly because of a coma for 2 hours.The family members told the patient that he is a "strict vegetarian" and does not eat eggs and dairy products, but he suddenly developed symptoms of fatigue and anorexia for no reason recently.The previous patients had no history of specific diseases.

Admission examination: coma, GCS score: 8–9 points. BP 132/67mmHg, HR 115bpm, R 24/min, BMI 16kg/m.Cardiopulmonary abdominal examination showed no abnormality.

Admission test report: urea 6.84 mmol/L, creatinine 263 mmol/L, calcium 4.17 mmol/L, phosphorus 0.14 mmol/L, alkaline phosphatase 189 U/L, albumin 38 g/L, globulin 37 g/L. The 24-hour urine calcium was 286 mmol/24h.

Blood routine, coagulation function, free thyroid function, prostate specific antigen (PSA), carcinoembryonic antigen (CEA), and CA19-9 showed no abnormalities.

……

After reading the test sheet, Lu Wenguo immediately said, "The patient's vital signs are temporarily stable, and his kidney function is abnormal, but this level of abnormality should not lead to coma, right?"

If there is severe renal failure and uremic encephalopathy, there is a possibility of coma.

However, the patient's creatinine is not particularly high, and this diagnosis is not supported for the time being.

At this time, Lu Chen added from the side: "He still has hypercalcemia."

Lu Wenguo checked the test results again, and nodded: "Well, the normal value of blood calcium is 2.25-2.75mmol/L, which is indeed a bit higher."

Lu Chen shook his head.

"Dad, it's not just higher. The electrocardiogram of this person just now shows that the right bundle branch is accompanied by a shortened QT interval of 120ms. Combined with the test results, it is completely in line with the performance of hypercalcemia."

"I have read all the medical records, and I have ruled out cerebrovascular accident, hyperosmolar coma, and hypoglycemic coma. I think the most likely coma is hypercalcemia."

"A coma caused by hypercalcemia?" Lu Wenguo frowned.

Lu Chen nodded: "When the blood calcium reaches about 3-4, the patient should have symptoms of mental weakness and fatigue, which can also explain why there was anorexia in the past few days."

"If the blood calcium reaches 4 or more, there may be delirium and mental confusion. If it is close to 5, there may be persistent coma."

After listening to Lu Chen's explanation, Lu Wenguo was still skeptical.

He has never seen a case of coma caused by high calcium.

Lu Wenjun on the side was even more surprised.

When Xiaochen talked about it, she was really clear and logical.

Although he didn't quite understand it, but judging by his elder brother's face, he didn't seem to have thought of it either.

The level of medical graduate students is so much higher than that of county hospital doctors?
At this time, Lu Wenguo thought for a while and said, "Xiaochen, just tell me briefly what caused the high blood calcium, so I can tell your aunt so she can remind the doctor over there."

Lu Chen blinked and continued: "The differential diagnosis of hypercalcemia includes distant metastasis of malignant tumors, multiple myeloma, primary hyperparathyroidism, sarcoidosis and vitamin D poisoning. That's all I can think of right now."

Lu Wenguo coughed lightly, "Xiaochen, can you speak more simply?"

The amount of knowledge reserves of surgeons is really not too much.

He knew all about these diseases, but upon closer inspection, he didn't seem to know much about them.

Lu Chen paused, didn't he make it clear?
"Dad, let the doctor at the county hospital over there do a chest CT. The most likely problem is the parathyroid gland."

"Okay." Lu Wenguo nodded, so he understood.

(End of this chapter)