I can see health

Chapter 200 A Doctor Without Medical Ethics

Lu Chen came to bed 18.

Fan Zhiping and his little follower Yao Jie followed behind him.

A male patient about 40 years old was lying on the hospital bed.

Lu Chen froze when he saw his health.

His health is only 51.

Another critically ill patient!

However, the patient does not seem to be in any discomfort now.

Lu Chen patiently began to ask about the medical history.

It is impossible for him to run up immediately and tell the patient that your condition is very serious.

You still have to follow the procedures when seeing a doctor, but Lu Chen's heart is tightened, and he always pays attention to changes in the patient's condition.

……

After the routine medical history inquiry, Lu Chen collected the patient's brief information.

The patient, male, 46 years old, complained of chest pain and was admitted to the hospital for 2 days.

Another chest pain patient!

Most of the patients in the Department of Cardiology are patients with chest pain or tightness in the chest.

"Where is the pain? Show me the exact location." Lu Chen said to the patient.

The patient raised his right hand, paused, and then pointed to his chest: "It hurts here, the whole piece hurts."

This location is at the bottom of the sternum.

"What kind of pain do you feel? For example, is it like a needle prick, or a stone is pressing, or is it like a tearing pain?"

"This..." The patient couldn't find the words to express for a while, "It looks like something is pulling my chest."

"When did it hurt the most?" Lu Chen continued.

"I started to have pain 2 days ago when I was working, and it started to hurt again at 4 o'clock this morning. The most painful time should be around 5 o'clock this morning. After taking painkillers in the emergency department, the pain stopped."

"Did you sweat when you were in pain?"

The patient nodded quickly and said, "Sweating!"

Lu Chen's heart sank.

In cardiology, there is an empirical talk.

If a patient with chest pain sweats from pain, it is generally not a good disease!

In addition, combined with the patient's life value, his situation is not optimistic.

……

Next, Lu Chen asked about other situations.

It turned out that the patient had a history of herpes zoster in the first half of the year.

This chest pain occurred, and I went to the local hospital to consider intercostal neuralgia.

After symptomatic treatment, the symptoms of chest pain were alleviated while taking the medicine.

However, at 4 o'clock this morning, the patient suddenly woke up from his sleep with pain. After being seen at the local hospital, the pain continued and did not relieve, so he came to Jinghua Second Hospital. "

Next is the physical examination for admission.

The patient was conscious, with soft neck, negative cardiopulmonary and abdominal examination, and no edema in both lower extremities.There were no obvious positive signs.

Because of the patient with broken heart syndrome yesterday, Lu Chen also specifically asked about the patient's mental state, and there was nothing wrong with it.

"Junior Sister, check the patient's electrocardiogram again."

Although the patient brought an ECG from the local hospital and had an ECG done in the emergency department, both ECGs were normal, but Lu Chen adhered to the principle of caution and re-examined an ECG for the patient.

"Zizzizi..."

The EKG machine runs out of paper.

Lu Chen picked up the electrocardiogram, and Fan Zhiping came over.

"Sinus rhythm, roughly normal ECG."

There is no difference from the ECG done before.

At this time, Yao Jie said from the side: "Brother, the patient's blood pressure is a little high, 172/90mmHg."

"This is the blood pressure of the right hand, what about the blood pressure of the left hand?" Lu Chen frowned.

"Oh, I haven't measured it yet. I'll measure another one for my left hand." Yao Jie took out the blood pressure monitor again.

Patients with high blood pressure must measure blood pressure in both hands.

Yao Jie took the stethoscope and tied the cuff tightly on the patient.

Press the airbag to inflate.

Then slowly deflate, when you hear the first beat, it is the systolic blood pressure; when the pulse disappears, it is the diastolic pressure.

"What's the blood pressure?"

Lu Chen saw Yao Jie re-measured several times, but did not report a prepared value.

Yao Jie took off the stethoscope, frowned and said: "Brother, I don't know if I heard it wrong, or what, the blood pressure of the patient's left hand is only 140/72mmHg."

Lu Chen was shocked.

"Let me measure it."

Put on the stethoscope and fasten the cuff.

Inflate, deflate.

The first beating sound did sound at 140.

"That's right, the systolic blood pressure is 140." Lu Chen put down his stethoscope and glanced at Fan Zhiping who was beside him.

Both of them could see the seriousness in each other's eyes.

Chest pain persists without relief and has high blood pressure.

And the blood pressure on both sides is not equal.

The diagnosis of aortic dissection is coming soon!
The aorta is composed of three layers, from the inside to the outside are the intima, media and adventitia.

Long-term high blood pressure, not well controlled.The intima is easily torn. Once the intima is torn, blood flows between the intima and the adventitia. In mild cases, a local false lumen is formed, and in severe cases, the false lumen can affect the entire aorta.

If the blood pressure is too high or the activity is violent, the adventitia ruptures, and the blood in the false cavity will evacuate thousands of miles, and the patient has almost no chance of survival.

This is one of the most dangerous killers in cardiology - aortic dissection!

如果病人得不到及时的救治，24小时内死亡率为25％，48小时内死亡率为50％，1周内死亡率为70％。

At this time, Lu Chen almost confirmed the diagnosis of "aortic dissection".

Because not only the symptoms and signs of the patient are consistent, but his life value is also lower than 60, and he is in a very critical state.

……

Go back to the doctor's office.

Lu Chen immediately reported all the patient's conditions to Sun Guoguo.

"Aortic dissection?! I'll go see the patient first." Sun Guoguo stood up abruptly.

If it is really aortic dissection, then this is a ticking time bomb!

Sun Guoguo came to the ward and checked the patient again.

"It's probably a dissection." Sun Guoguo said to Lu Chen, "But we still need to do CTA of the aorta for diagnosis."

No matter how similar the clinical manifestations are, to diagnose any disease, evidence must be produced.

For aortic dissection, that is aortic enhanced CT.

"Okay." Lu Chen nodded.

The patient was accompanied by a family member, his wife.

The conversation went well, and the family members agreed to go out for an inspection.

Because the patient's condition was critical, Lu Chen personally took him out for an examination.

Ready to go out to check the monitor and the first-aid kit, when Lu Chen was about to go out, he was stopped by Nurse Liu.

"Lu Chen, after the examination, the patient will be in arrears. After that, the medicine money will be paid on credit first, so you just want to urge the family members to pay the money."

Lu Chen nodded in agreement.

Patients are covered by medical insurance in rural areas, and need to pay first, and then reimbursed after returning.

……

Push the patient to the CT room.

When the image results appeared on the computer, the patient's aortic arch all the way to the thoracic aorta were tears.

There was no suspense, it was an aortic dissection, Stanford type A, requiring emergency surgery.

"Congratulations, the completion of the system upgrade has increased!"

At this time, Lu Chen didn't feel happy at all.

He immediately called Sun Guoguo and informed him of the test results, then carefully moved the patient back to the hospital bed and escorted him back to the ward.

Lu Chen was afraid that something would happen on the way.

However, nothing happened along the way, and he returned safely to the eighth district of his heart.

Sun Guoguo has already requested an emergency consultation with the vascular surgery department.

This kind of operation involves surgery, and ordinary medical intervention has been unable to solve it.

……

The vascular surgeon arrived shortly after.

"Director Zhang, transfer the patient to your department?" Sun Guoguo looked at the cardiac surgeon who came for consultation.

"If you need surgery, you can transfer to our department. If you don't have surgery, it's meaningless to transfer to another department. It's just to reduce blood pressure and treat symptoms. Your internal medicine department is more professional than our surgery department."

The consulting doctor's opinion is very clear.

This type A dissection requires emergency surgery.

Without surgery, it is like carrying a time bomb on your body, which may explode at any time!
Director Zhang of the Cardiac Surgery Department finished his consultation opinion and explained the condition to the patient's family before leaving.

……

The antihypertensive drugs have been used, and the next step is to communicate with the patient about the operation.

Lu Chen followed Sun Guoguo to the ward, and called the patient's family members out of the corridor.

Sun Guoguo repeated the conversation with the family members countless times before.

"It is necessary to have an operation, if you don't do it, you will die at any time!"

The patient's wife, who also looked poor in the countryside, asked Sun Guoguo with tears in her eyes: "Doctor, we are covered by rural medical insurance. How much does the operation cost?"

Sun Guoguo paused, and said slowly: "Rural medical insurance, you have to pay for it yourself before going back to reimbursement. If everything goes well, the overall hospitalization fee will be 20w, but you pay 10w first, enough for the operation fee, and we can start Do surgery to save your life."

The patient's wife burst into tears. She fumbled in her pocket for a long time and found a few ten-to-five pieces: "After two days of tossing around, this is all we have at home."

Lu Chen looked at it and found that it was not enough to add up to 100 fast, and it was too far away.

Sun Guoguo was also a little anxious: "Don't you have a card or something? Wechat and Alipay are also fine!"

The patient's wife fumbled in her pocket for a long time, and took out a bus card.

Sun Guoguo was stunned for a while, seeing that she was crying into tears, and gritted her teeth: "Well, you hurry up to raise money, as long as you have 5w, I will report to you here, find a way to transfer you to another department, and help you Done!"

The patient's wife may really have no money, so she kept shaking her head and crying.

Lu Chen and Sun Guoguo's hearts tightened. This was the best they could do.

If that doesn't work, there's really nothing I can do to help.

……

It may be that the crying of the family members was too sad, which attracted a middle-aged woman from the next ward.

The woman listened to the general idea, probably thinking that her relative's condition was also critical, so she stepped forward, shed a few tears with her, and said harshly, "The current doctors really have no medical ethics!"

Lu Chen and Sun Guoguo were a little confused.

For no reason, it was suddenly hammered.

I only heard the woman continue to say: "The doctors in the past always did the surgery first, so it doesn't matter what money you have."

Before Sun Guoguo recovered, Lu Chen calmed down, and said slowly, "There is no money in the account, I can't get anesthesia, and I can't get anesthesia. He can lie here and hang water for treatment, and he has already used the head nurse. Authorization, let him treat on credit."

The woman acted as if she hadn’t heard, and while comforting the patient’s wife, she continued to exhale: “The doctors nowadays are all for money! In the past, the old doctors in our village used to advance their own money to see patients. Now How can there be such a good person, everyone is full of bad water!"

Lu Chen's heart sank to the bottom.

He stood directly in front of the woman and took out his mobile phone.

The woman was startled, thinking that Lu Chen was going to hit her.

But thinking that this is a hospital, with so many people around, and cameras, he didn't show weakness and glared.

At this time, Lu Chen held up his mobile phone and opened Alipay's Yu'e Bao.

After looking at the balance, I quickly exited and reopened the loan.

Lu Chen gritted his teeth and said, "Sister, you are right, I really should be a doctor with medical ethics. Do you think this will work? I am a poor doctor and I don't have much money. There is a loan amount of 3 yuan here. Lend it all out and put it on for her. You are so caring, let’s make up the remaining 2w, let’s do a good deed to save people, shall we?"

After hearing this, the patient's family members widened their eyes and looked at the woman hopefully.

The woman's mouth trembled, and her steps stepped back.

The patient's family took a step in front of the woman, wiped away their tears, and wanted to speak.

The woman was so frightened that she pushed her hard, cursed and quickly disappeared into the corridor of the ward...

(End of this chapter)