I can see health

Chapter 208 Sudden Headache

Summer is slowly passing by, and the weather is getting cooler.

Walking on the path to the hospital, Lu Chen was in a happy mood.

After coming to Jinghua, he not only joined the elite group of the Electrophysiology Association, but also won the first place in the National Medical Skills Competition. Next, he will give a speech at the Electrophysiology Symposium.

More importantly, his clinical business ability is improving rapidly.

Everything is going in a good direction at the moment.

……

Come to the eighth district of the heart.

Yin Xinhua, the senior doctor on duty, has not yet arrived.

Lu Chen saw Fan Zhiping sitting in the doctor's office.

"Brother Fan, why are you here?"

Jinghua No. [-] Hospital does not arrange night shifts for trainee doctors.

Fan Zhiping was looking at the doctor's order, when he heard Lu Chen's words, he stood up, turned around and said, "I see you are on the night shift, so I wanted to take a look together."

Lu Chen smiled, but didn't speak.

Brother Fan is too active, he doesn't look like a trainee doctor at all.

He has an apple in his bag, the night shift should be fine tonight.

……

The night shift in the general ward of the Department of Cardiology does not need to admit new patients.

Patients who come at night will be sent to the CCU ward.

However, even if no new patients are admitted, the night shift in the cardiology ward is not easy to take.

Because many patients with heart failure have changes in their condition during the night shift.

At night, the human body is in a supine position, the amount of blood returning to the heart increases, and the vagus nerve is excited, so heart failure will be induced.

Lu Chen opened the doctor's order system, he needed to know the patients in the ward who were seriously ill.

……

25:[-] p.m.

With 5 minutes left before taking over, Yin Xinhua came to the ward.

"You're here." Yin Xinhua looked at Lu Chen, and at the same time she noticed Fan Zhiping beside him.

Good guy, the graduate student is on duty and also brings a deputy chief doctor for advanced training! !

"Lu Chen, let's take a look at the critically ill patient." Yin Xinhua cleared his throat.

"Okay." Lu Chen nodded.

Fan Zhiping heard the words, stood up and followed closely behind.

“2床、11床、16床、18床、25床、31床……这些都是告病重或者告病危的患者，我们要仔细在查看一遍患者，不能偷懒。”

Yin Xinhua took Lu Chen and Fan Zhiping to see all the critically ill patients in the ward.

It also included heart transplants and patients with aortic dissection received by Lu Chen's group in the past two or two days.

During the ward rounds, in addition to paying attention to the patient's health, Lu Chen would follow Yin Xinhua carefully and ask about the patient's specific situation.

"Lu Chen, this is your first night shift. Let me tell you some things to pay attention to during the night shift."

"First of all, all critically ill patients should be rounded up to find out whether there is any change in their condition in time."

"Secondly, we have to take a look at the new patients who came today to prevent any omissions from the day shift doctors."

"Finally, pay attention to the shift content of the day shift doctor, such as which laboratory values ​​to pay attention to..."

Yin Xinhua told Lu Chen all the precautions for the night shift.

In addition to some rigid requirements, there are some words of experience.

Lu Chen recorded them one by one. This is what he will do on the night shift in the future.

……

"There are so many patients in the big hospital." Fan Zhiping sighed, "In our county hospital, there are only [-] patients in the entire ward. But you are also a little bit better. You don't need to admit patients at night. Our county hospital has to admit patients every night. The patient couldn't sleep all night."

"We may not be able to sleep here." Yin Xinhua pouted.

Once the patients in the ward get sick, it will not be easy.

Lu Chen looked calm, the God of Night Shift will take care of him!
"Brother Fan, you should go back to the dormitory anyway." Lu Chen looked at Fan Zhiping, "If it's too late, it's not easy to walk at night."

"It's okay, since I'm here, I definitely won't leave." Fan Zhiping said with a smile, "There must be a beginning and an end. I have nothing to do."

Don't know how.

Fan Zhiping had an intuition that as long as he stayed by Lu Chen's side, he would be able to see some weird cases.

"Alright then." Lu Chen said helplessly.

It was the first time I met someone who wanted to work the night shift.

It's just that he felt a little awkward. Fan Zhiping was an associate chief physician no matter what.

Fan Zhiping stayed in the department, and Lu Chen couldn't direct him to work!

That Fan Zhiping stayed in the department did not benefit Lu Chen at all, on the contrary, it was a bit of a hindrance.

……

Seven o'clock in the evening.

The night shift has already passed almost 2 hours, and the doctor's office in the eighth district of the heart is very calm.

Lu Chen had nothing to do, so he began to look through some treatment guides.

In actual clinical work, the knowledge in internal medicine books can no longer meet the needs.

Many practical problems encountered in clinical practice require searching for answers in the guidelines.

Familiarity with various guidelines is the basic skill of an excellent clinician.

But the good times don't last long!

Dong Haimeng, a nurse on the night shift, suddenly walked into the doctor's office.

"Doctor Yin, the patient in bed 41 is complaining of headache, you should go see him."

Yin Xinhua glanced at Dong Haimeng and nodded: "Okay, I'll go right away."

Having said that, Yin Xinhua didn't get up.

After Dong Haimeng left, she said to Lu Chen, "Lu Chen, go and check on bed 41 to see what problems he has, and if you can solve it, let him solve it, if you can't, come back and tell me."

"Ah."

Lu Chen first read the patient's medical records.

This is a patient with high blood pressure, long-term high blood pressure, and does not take medicine regularly to control it.

This time, I came to the hospital this afternoon because of high blood pressure and head pain.

After understanding the basic condition.

Lu Chen walked out of the doctor's office, took a blood pressure monitor, and came to bed 41.

On the hospital bed, a male patient about 60 years old was sitting on the edge of the bed with a painful expression.

Lu Chen looked at his life first - 69.

"Master, do you have a headache?" Lu Chen stepped forward.

"Hmm." The patient nodded, pointing to his head with his right hand.

Lu Chen continued: "Is the pain severe? Are your eyes blurred?"

"It hurts. Except for the headache, there is no other discomfort for the time being."

Lu Chen immediately measured the patient's blood pressure, which was 180/110mmHg.

"What antihypertensive drugs did you take?"

"Nifedipine Extended Release Tablets."

On the side, a family member of the patient, a 40-year-old man frowned and said, "The pain started at about 6 p.m., and now it's 8 p.m., and the pain lasted for about 2 hours. The headache just got worse, so I asked you to come and see it."

An elderly man in his 60s, with a history of high blood pressure, suddenly had a headache and the pain was still severe. With such high blood pressure, the medicines did not work well. What is the most worrying thing?

The most worrying thing is cerebral hemorrhage or cerebral infarction, especially subarachnoid hemorrhage. Many patients with subarachnoid hemorrhage say they have unbearable headaches. (Subarachnoid hemorrhage is also a type of cerebral hemorrhage)

You know, cerebral hemorrhage itself will cause high blood pressure, and such high blood pressure may in turn lead to cerebral hemorrhage!

Although the patient's health did not drop below 60, Lu Chen still gave the patient a physical examination.

Observe whether the corners of the mouth are skewed, whether the nasolabial fold is symmetrical, etc., and even ask the patient to stick out his tongue to see if it can be centered.

If the patient has cerebral hemorrhage or cerebral infarction on one side, the tongue sticks out to one side.

In this patient, the tongue is centered, and there is no limb weakness or hemiplegia.

Cerebral hemorrhage and cerebral infarction were temporarily ruled out.

……

Go back to the doctor's office.

Lu Chen reported the patient's condition to Yin Xinhua.

After examining the patient, Yin Xinhua said, "Although there are no positioning signs, the patient is so old and has been suffering from high blood pressure for so many years. Sudden headache is definitely not such a simple headache."

After consideration, Yin Xinhua decided to ask the patient to have a head CT.

Be careful when sailing for thousands of years, especially in the tense relationship between doctors and patients.

Yin Xinhua would rather have an extra checkup than miss a diagnosis. This is fatal!
Even if the signs are not like cerebral hemorrhage, imaging results must be obtained.

Before the CT scan, Yin Xinhua routinely asked Lu Chen to take an electrocardiogram, and the results of the electrocardiogram were not too problematic.

"Take a piece of antihypertensive medicine first, and after the blood pressure has dropped a little, then push the cart out to take a CT scan."

Lu Chen asked the patient to take another Nifedipine Sustained Release Tablet.

The patient's family borrowed a wheelchair.

"Lu Chen, I'll accompany the patient for an examination." Fan Zhiping volunteered.

But Lu Chen quickly waved his hand and refused, "Brother Fan, let me go."

It is unreasonable to let a deputy chief physician accompany you for the examination.

Lu Chen measured the patient's blood pressure again.

The patient's blood pressure dropped to 160/90mmHg, so Lu Chen took him out for a head CT.

Because the head CT was done in time, the results came out soon.

CT showed a little brain atrophy and a little lacunar infarction.

Lacunar infarction is a cerebral infarction caused by the occlusion of very small blood vessels in the brain.

Go back to the doctor's office in the eighth district of the heart.

Yin Xinhua saw the CT results, frowned and said: "Elderly people with high blood pressure usually have lacunar infarction after a CT scan. Just control blood pressure and blood sugar well. It's not a serious problem. It may be the cause of this headache."

The most important information suggested by cranial CT is that no cerebral hemorrhage was found.

Fan Zhiping said from the side: "Then the cause of the patient's headache is related to the increase in blood pressure. Lowering the blood pressure may improve it."

"Yeah." Yin Xinhua nodded, "At present, it seems that the main cause of the headache is the sudden rise in blood pressure."

Lu Chen lowered his head in thought, but did not speak.

He felt that this patient was very strange, but he couldn't say what was strange about it.

At this time, the patient's family members walked into the doctor's office.

"Doctor, my dad feels a little stuffy in his chest and seems a little out of breath."

　What kind of review did the doctor do? I went home after 9 o’clock this evening and wrote a chapter.

　　
　
(End of this chapter)