I can see health

Chapter 264 Veins
Lu Chen glanced at the patient's elbow joint, collected himself, and pondered: "This may not be a rash!"

"Not a rash?" The nurse on duty frowned.

Lu Chen moved his head closer and continued: "Look carefully, it might be a pinhole! Some pinholes are a bit infected, that's why it appears like a rash."

When this word came out, everyone was shocked.

Li Qinghua was also very surprised.

He leaned forward and took a closer look.

It's really pinholes, densely packed, just near the cubital vein of the patient's left arm.

"The patient also has a lot of rashes like this on his right hand, which are really pinholes!" The nurse on duty opened the sleeve of the patient's right hand again.

She was changing the patient's gown and discovered these details.

"If it's really a pinhole, it will be a disaster." Lu Chen said slowly, frowning.

Li Qinghua also nodded in agreement: "Well, then thrombolysis cannot be done."

At this moment, Yin Xinhua walked into the ward, and when he heard the conversation between the two, he wondered, "Why can't the thrombolysis be done?"

Li Qinghua paused, looked around, and said slowly, seeing that the patient's family members were not there.

"It is very likely that he is taking drugs."

Lu Chen also very much agrees with Li Qinghua's point of view.

With so many pinholes on his body, there is only one possibility, and that is taking drugs!
When the nurse on duty heard this, she immediately let go of the quilt on her hand, hurriedly washed her hands, and changed gloves.

Lu Chen only exposed the patient's pinhole to Yin Xinhua.

Yin Xinhua's eyes showed surprise.

Seeing this, Li Qinghua immediately said: "Don't be too scared, just take personal protective measures. If he is really a drug addict, he may have sexually transmitted diseases or AIDS, etc., but this possibility is not high. Be careful, everyone." Just do it."

After finishing speaking, Li Qinghua looked at Yin Xinhua and Lu Chen beside him, "So I think the patient may not be an ordinary pulmonary embolism!"

"Well, at least it might not be pulmonary thromboembolism." Lu Chen nodded slightly.

Li Qinghua went on to continue: "If the patient is really taking drugs, then the fever may be related to the infection caused by it. We had a similar case in our CCU the year before last. Infective endocarditis occurred in a drug addict, causing long-term Fever. Infective endocarditis will have cardiac vegetations, and if there are vegetations in the right heart, once they fall off, it may also cause pulmonary embolism."

If the patient really has infective endocarditis, then the shed emboli are bacterial clumps and tissue.

This is not a thrombus, so there is no need for thrombolysis!
Thrombolytic drugs are aimed at thrombus, and are of no help to bacterial and tissue clumps. At this time, thrombolysis does more harm than good.

Although this possibility is very small, it makes sense and can explain the symptoms that the patient is currently experiencing.

Yin Xinhua frowned, and said, "But both Lu Chen and I have auscultated the patient's heart, and we didn't hear any obvious heart murmurs. If the patient really has such an obvious heart growth, we should be able to hear the murmurs. "

Li Qinghua shook his head and said seriously, "That's not necessarily true!"

"First of all, the vegetation doesn't necessarily have to be very large. In addition, the patient's breathing was so short at the time that auscultation was easily disturbed."

"Let's call the echocardiography teacher over and let them look at the heart. After all, we are not as professional as them. They might be able to see heart vegetations and pulmonary embolisms."

Yin Xinhua nodded: "Now we have to wait for the teacher from the echocardiography room to come."

Lu Chen took the portable ultrasound machine and looked at the patient's heart several times, but he still couldn't see the heart vegetation and pulmonary embolism.

No way, his cardiac ultrasound skill card is only elementary.

After learning about the patient's condition, Yin Xinhua immediately called the family's sister over.

"The pinhole in his elbow, you know? Does he have any bad habits..."

The patient's elder sister was so dazed that she almost yelled.

"How could my brother take drugs!"

Yin Xinhua comforted the family members of the patients: "We are just skeptical. Whether there is drug use can be tested, and I will ask you if you understand."

The patient's elder sister didn't speak, and kept grabbing the cuffs of her clothes with both hands.

After being silent for a long time, she continued: "Actually, we haven't seen each other for more than half a year. It was absolutely impossible for him to take drugs before, and I can't guarantee it now."

Not sure now?

As soon as these words came out, Lu Chen, Yin Xinhua and Li Qinghua looked at each other.

They found that the patient's sister looked a little panicked.

Li Qinghua said: "Is it drug use? Go to the laboratory or a testing institution outside the hospital for a toxicology test, and use the patient's hair to send the test. Generally, anyone who has taken drugs within half a year can be found out. And your brother has both arms. It's all pinholes, and we have reason to suspect that."

When the patient's sister heard it, she almost collapsed on the ground, with a hint of crying in her voice.

"My elder brother is a drug addict, but my younger brother is not...Doctor, I beg you to cure my brother..."

Seeing this scene, Li Qinghua whispered to Yin Xinhua: "The patient must be a drug addict."

Yin Xinhua nodded calmly.

……

At this time, the doctor in the ultrasound room that everyone was looking forward to finally came!
The cardiothoracic doctor took a probe and carefully looked at the patient's heart several times.

"It's really a pulmonary embolism!"

Lu Chen and the others immediately stepped forward.

The cardiologist pointed to a place on the screen.

"Look, there is an embolism in the pulmonary artery, although it is not obvious, it is there, and there is a growth on his right heart valve, you really guessed it!"

When Lu Chen heard this, he was completely relieved, and at the same time his back was slightly chilled.

Really dangerous!

If thrombolysis is performed directly, the consequences will be disastrous!

"In this case, the embolus should be a bacterial mass, not a thrombus." Yin Xinhua repeated.

Li Qinghua nodded, and at the same time ordered: "Leave blood for culture, monitor body temperature, and administer the strongest vancomycin, which won't dissolve the thrombosis."

If the patient is really an intravenous drug user, then the infective endocarditis that occurred this time is likely to be related to intravenous drug use.

The bacteria most likely to be infected are Staphylococcus aureus, because this bacteria is the most abundant on the skin and may be infected by needle holes at any time.

This Staphylococcus aureus may or may not be drug resistant.

But the patient is running out of time and has to cover it with the strongest vancomycin.

Vancomycin is a special class of antibiotics.

An application must be submitted for this special class of antibiotics.

However, this is an emergency situation.

Li Qinghua skipped the application and used vancomycin directly.

Soon, the nurse brought vancomycin from the pharmacy and gave it to the patient.

……

After Li Qinghua and the doctor in the ultrasound room left.

Lu Chen and Yin Xinhua looked at each other with lingering fear.

It's almost twelve o'clock at night now.

Yin Xinhua invited consultations from multiple disciplines, including ICU, Respiratory Department, Ultrasound Department and CCU.

After comprehensive consultation of so many disciplines, the correct conclusion was finally drawn.

This patient is full of pitfalls.

If you are not careful, you will be in trouble!
On the other hand, ICU and respiratory doctors heard that pulmonary embolism was caused by infective endocarditis of intravenous drug addicts.

They couldn't believe it at first, and they came to the eighth area of ​​the heart, and they were convinced when they saw the dense needle holes in the patient's arms.

"Damn it, there are very few drug addicts these days, drug dealers should kill the whole family!"

The ICU doctor muttered something, and then left the eighth area of ​​the heart.

(End of this chapter)