I can see health

Chapter 204 Embolism, Bleeding Again!

"If the patient is pretending, he will definitely have to go to the toilet later if he takes a furosemide," Fan Zhiping said.

"Well, that's a good idea." Cheng Peng nodded.

Lu Chen frowned, "I think something might be wrong."

"What's wrong with this?" Fan Zhiping asked suspiciously.

"There must be an indication to push furosemide." Lu Chen said, "We are currently considering that the patient is in a pseudo-coma, but we cannot be 100% sure, so we can't just use it casually. Because once the patient takes furosemide, what happens? Problems, such as malignant arrhythmia and so on, that is our responsibility, and the consequences can be serious."

"Then what should we do?" Cheng Peng looked helplessly at Lu Chen, "Just wait until the patient becomes impatient and wake up by himself?"

Lu Chen smiled, "No, have you forgotten that comatose patients have certain operations that must be done according to the principles of treatment."

Fan Zhiping frowned at first, then suddenly realized.

"You mean the catheterization and upper gastric tube?"

"Yes!" Lu Chen smiled.

Cheng Peng and Fan Zhiping glanced at each other.

It turns out that Lu Chen is the "bad" one...

……

"What kind of expression do you guys have..." Lu Chen glanced at the two of them angrily, "I'm just going to try it out. If I'm really comatose, according to the principle of treatment, the catheter must be inserted. If you're pretending to be comatose, listen When it comes time to insert a catheter, [-]% will wake up..."

"Then give it a try." Cheng Peng said.

A person pretending to be unconscious, even if you pinch him, he can grit his teeth and endure it.

Because of the pain of pinching, most people have psychological expectations, know what's going on, and can be mentally prepared.

But he couldn't bear it when the gastric tube and urinary tube were inserted.

Because the feeling of inserting a gastric tube and urinary catheter is something most people have never experienced, and they cannot make psychological expectations to endure it.

……

Come to the bedside.

Lu Chen was fully armed, wearing gloves, a hat and a mask.

Cheng Peng stood next to him on the platform, holding a catheterization bag in his hand.

On the hospital bed, a middle-aged woman was lying on the bed with a very calm face.

Lu Chen could see her HP - 74.

It seemed that, as Fatty Cheng said, the patient was pretending to be unconscious.

"Doctor, you are..." The patient's accompanying family member was a young woman, who should be the patient's daughter.

Cheng Peng quickly said: "We all need a catheter for comatose patients."

The face of the patient's daughter changed.

"This... shouldn't be necessary."

Cheng Peng shook his head, "A catheter must be inserted. For all comatose patients, this is the basic principle of treatment. We cannot violate it. And after the catheter is inserted, you will take better care of the patients."

The young woman still waved her hand to refuse, and stood up, standing in front of Lu Chen.

"Doctor, why don't you wait a little longer, my mother may wake up soon."

Lu Chen pretended to be puzzled and said: "We can't guarantee when we will wake up. If the condition changes and we don't have time to react, it will be bad."

"No, it won't." The young woman seemed very resistant to the catheterization.

The family members did not agree to insert the urinary catheter, so naturally Lu Chen and Cheng Peng would not force it.

"Then let's observe for another 10 minutes. If the patient does not wake up, the urinary catheter must be inserted, otherwise this does not conform to the principle of treatment."

Lu Chen's voice was so loud that he believed that the middle-aged woman lying on the bed could also "hear".

"This, this...well then."

The young woman looked back at the woman on the bed, and could only nod silently.

……

The catheterization bag was not even opened, so Lu Chen and Cheng Peng returned the same way.

Go back to the doctor's office.

Cheng Peng hesitated and said, "Lu Chen, is this really useful? Why don't you try Dr. Fan's method, I think it should work!"

"Don't worry." Lu Chen smiled, "I'll give her 10 minutes, she will definitely wake up later. Pushing furosemide seems to be a good way, but it doesn't conform to the principle of treatment. If the patient afterwards If you trouble us, it will be difficult.”

"Yes." Cheng Peng nodded.

Now we can only wait.

Waiting for the patient to wake up by himself.

……

The eighth district ward in the heart.

"Mom, if you don't wake up again, the doctor will insert a catheter for you!" The young woman looked around, and then whispered to the woman on the hospital bed, "I heard that catheterization is very painful, and there are many complication……"

The middle-aged woman on the hospital bed had her eyes closed tightly and her eyelashes fluttered slightly, as if she might wake up at any moment.

"Mom, it's almost over... It's frightened others. The neighbors won't dare to quarrel with you in the future. They've already paid for the medical expenses."

After the young woman finished speaking, the middle-aged woman on the hospital bed slowly opened her eyes, her voice sounded extremely weak, "Then I'll take a few more expensive bottles to replenish qi and blood!"

"Okay, then I'll go tell the doctor." The young woman was relieved, she was really afraid that her mother had played with fire.

……

While Lu Chen was chatting with Cheng Peng, Nurse Liu walked into the doctor's office.

"Doctor Cheng, your comatose patient has woken up!"

Cheng Peng showed joy and stood up quickly: "That's great! I'll go and see her."

Lu Chen smiled and teased, "Go, or you'll be unconscious again later."

Cheng Peng came back within 5 minutes of going to the ward.

"Hey, what kind of injection does the patient need to invigorate Qi and blood, and we don't have any Chinese patent medicine here, so we can't do it!" Cheng Peng said helplessly.

Chinese people, especially the older generation, are very superstitious about Chinese patent medicine preparations.

It cannot be said that Chinese patent medicines are useless, but the ones that really play a role in clinical practice are western medicine preparations.

Many Chinese patent medicines are placebos.

"Fatty, just give her a bottle of amino acids and a bottle of vitamins." Lu Chen suggested.

"That's the only way to go." Cheng Peng nodded.

Drugs such as amino acids and albumin have special magical powers for the older generation.

Many patients, no matter what the disease is or what department they are in, will come up and ask whether they can take amino acids or albumin.

For the treatment of diseases, amino acids are useless, and they are only a nutritional drug.

If albumin is not low, infusion of albumin will not only have no benefit, but will also increase the burden on the heart, leading to heart failure.

After Cheng Peng negotiated with the patient, most of the problems were solved.

Everyone turned a blind eye, closed one eye, and did not reveal the fact that she was pretending to be asleep.

The middle-aged woman asked to be discharged from the hospital after receiving the drip.

Compared with Fan Zhiping's "pushing furosemide", Lu Chen's "urinary catheterization" is more in line with clinical thinking of diagnosis and treatment.

Otherwise, in the process of promoting furosemide, if there is a real change in the condition, the loss outweighs the gain.

After the matter was over, Lu Chen also received a thank you value from Cheng Peng.

"Congratulations, I received a thank you value from Cheng Peng +1!"

……

After solving this little episode, Lu Chen continued to prepare his case report.

He looked through the medical records he had encountered before.

The more interesting cases are oleander poisoning and the recent case of heart transplantation.

Other cases are either too simple and common, or too out of clinical.

Lu Chen temporarily listed the two cases of oleander and heart transplantation as candidate cases.

……

After get off work, Lu Chen finished dinner in the cafeteria and returned to the dormitory very early.

As soon as he opened the bedroom door, he received a call from his uncle Lu Wenjun.

On the phone, Lu Wenjun thanked Lu Chen again.

His father-in-law is already in good condition and is about to undergo surgery. This time he came to ask Lu Chen for his opinion.

Lu Chen patiently explained it to Lu Wenjun.

After hanging up the phone, Wang Zihao and others also returned to the dormitory.

"Zihao, can you do PPT?" Lu Chen looked at Wang Zihao.

Wang Zihao shook his head and walked to Lu Chen's side.

"I can do simple things, but I can't do things that are too complicated. What's the matter, are you going to give a PPT lecture? Or do you do it for the boss?"

"I use it myself. I'm not familiar with some functions in PPT." Lu Chen said, "Time is tight, so learn slowly, it may be too slow, I want to find someone to guide me."

"Uh, I remember Lao Gu seems to be able to, he is an old driver." Wang Zihao thought for a while and said, "When he was an undergraduate, he gave speeches on stage a few times, and the PPT was very good-looking."

"Gu Xinyue?" Lu Chen wondered.

"Yes." Wang Zihao nodded, "He and I both graduated from Jinghua Medical University, so we know him better."

"it is good."

Lu Chen found Gu Xinyue on WeChat.

……

"You want to make a PPT?"

"Well, after I finish the first edition, can you review and proofread it for me?"

Lu Chen's words appeared in the dialog box, and Gu Xinyue showed a smile on his face.

He was finally in a field where he could overwhelm Lu Chen.

Lu Chen thought that Gu Xinyue was unwilling, and was about to let it go, but Gu Xinyue sent an "OK" gesture.

Lu Chen was overjoyed.

"Thank you very much. I will send you the first version in two days. You can review it for me. I will treat you to dinner next time."

"Okay, then I will remember."

Although Gu Xinyue didn't say much, she readily agreed.

After solving the problem of ppt production, Lu Chen returned to the case screening work.

……

And on the other side of the dormitory in Guipei Building.

After Gu Xinyue accepted Lu Chen's request, she received an email from Jinghua Electrophysiology Association.

He is now an ordinary member of the Electrophysiology Society, and he occasionally receives emails from the Society.

"Dear members, next Sunday, the Jinghua Electrophysiology Association will hold an academic exchange meeting. Members are welcome to participate enthusiastically. The fare is at your own expense, and you will have board and lodging."

"Electrophysiology seminar?" Gu Xinyue touched her chin, "I must go and see it."

This kind of academic exchange meeting is generally an exchange of academic cutting-edge knowledge.

For Gu Xinyue, this is definitely a good opportunity to gain knowledge.

He must go.

……

……

Silent all night.

The next day.

Lu Chen is on the night shift today.

So after he checked the room in the morning, he could go back to the dormitory to rest.

Recharge your batteries and prepare for the night shift at night.

When they came to the department, Sun Guoguo led everyone to check the room.

As soon as he returned to the doctor's office, Lu Chen saw people from the hospital's charity association.

The purpose of their trip was mainly to investigate the patient with aortic dissection.

If the patient's situation is true, then they will reduce the patient's part of the cost.

The entire review process was relatively smooth.

The information on patients with aortic dissection is very detailed, and the investigation by the Charity Association has passed!
Finally, about 30% of the fee can be reduced.

This should be a large proportion of the hundreds of thousands of surgical expenses.

However, it depends on whether the family members of the patient can make up the rest of the operation fee.

As long as the family members can collect the remaining expenses, the patient can be transferred to another department for surgery immediately!

……

After solving the affairs of the charity meeting, Lu Chen was about to leave the department.

Suddenly, Li Yao returned to the department.

She has been in the department much more recently than before.

She walked into the doctor's office and glanced at everyone who was working.

"The third district of the heart has invited a hospital-wide general consultation, Lu Chen, you can go with me to participate."

After speaking, Li Yao walked away.

Lu Chen was about to leave, but upon hearing this, he could only stay temporarily.

It seems that I have to wait until the general consultation is over before I can go back to the dormitory.

"Junior brother, hurry up, this is a good opportunity to learn." Sun Guoguo whispered, "The whole hospital has a general consultation, and there are eight districts in the heart, each of which will visit people, and there will be people from other relevant departments of the hospital. join."

Lu Chen nodded, but at the same time he was thinking in his heart, "What kind of patient with intractable diseases is this, who is so inspiring?"

In Jinghua Second Hospital, it was the first time that he met a patient who received a general consultation from the whole hospital.

While thinking about it, Lu Chen followed Teacher Li Yao downstairs.

……

The place for the general consultation of the whole hospital is in the demonstration classroom on the fourth floor.

This demonstration classroom can accommodate more than 200 people, and it is a classroom specially prepared for various meetings in the Department of Cardiology.

The entire floor on the fourth floor is very large, mainly divided into two areas, the cardiology CCU ward on the right, and the catheterization room on the left.

Between the CCU and the catheterization room, there is also a large classroom, which is the demonstration classroom of the Department of Cardiology.

Lu Chen put on his shoe covers and hat, and followed Li Yao into the classroom.

It shows that there are already many people in the classroom, and everyone's conversations are endless.

Lu Chen also met Gu Xinyue, who was sitting in the second row, with a good location.

Li Yao greeted teachers from other districts in her heart.

After 10 minutes, almost all the participants came.

Director Yang of the third heart district, who presided over the general consultation of the whole hospital, slowly walked onto the stage and began to speak.

"Thank you for taking the time out of your busy schedule to attend this hospital-wide general consultation. The case this time is very difficult. The patient has been admitted to the hospital many times with repeated illnesses. The current diagnosis is not clear and involves multiple disciplines. I think Again and again, I invited this hospital-wide general consultation."

"I hope everyone will brainstorm and come up with a feasible diagnosis and treatment idea for this patient in our department!"

"The following is the patient's bed doctor, Wang Peng, who will introduce the patient's medical history."

A young doctor steps onto the stage.

He is thin, about 1.7 meters, with a light beard on the corner of his mouth.

On the screen in front of the stage, the patient's medical history information is displayed.

Wang Peng's voice also sounded.

Patient, female, 54 years old.

He was admitted to the hospital due to "sudden chest tightness for 4 hours".

Three months before admission, he had undergone thrombolysis treatment in a local hospital due to "inferior wall myocardial infarction" (the specific diagnosis and treatment process is unknown), and then emergency coronary angiography showed proximal anterior descending artery occlusion.

On the third day after the operation, the patient had abdominal pain and released about 200g of tarry black stool, occult blood in the stool (+++), hemoglobin 97g/L, and was discharged after the symptoms improved.

Two months later, the patient was again admitted to the Department of Gastroenterology of our hospital because of "2 black stools".On the 2th day after admission, the patient began to experience headache, vomiting, and blurred vision. Magnetic resonance imaging showed hemorrhagic cerebral infarction in the right occipital lobe and hippocampus.

……

"From a monistic point of view, what are the possible etiologies of this patient's multiple arterial embolisms and gastrointestinal bleeding?"

After listening to Wang Peng's description, Lu Chen felt that this patient was not simple.

Embolism for a while, bleeding again for a while.

It seems that these are two completely contradictory things.

No wonder the whole hospital has to be consulted!

For a while, Lu Chen didn't think of any possible diagnosis or treatment.

(End of this chapter)