I can see health

Chapter 314 He is not in the Jianghu, but there are legends about him everywhere in the Jianghu!
"Hiccup?" Lu Chen frowned.

Because he looked at the HP on the old man's head, it was only 57!

The health value is below 60, this is definitely not such a simple hiccup!
"Besides hiccups, is there any other discomfort?" Wang Xueyang asked immediately, "For example, headache, dizziness, bad habits, vomiting, difficulty breathing, cough, chest pain, or palpitations?"

The old man thought for a while, then shook his head, "No, it's just a hiccup."

As soon as the words fell, there was another "uh".

The middle-aged man sighed, "Hiccups are not a disease, but they can be fatal! My dad has been hiccupping for the past four days, and basically can't sleep at night. The symptoms of hiccups have worsened tonight, basically for four or five seconds. just one time."

Wang Xueyang frowned: "Master, did you have any other illnesses before?"

The middle-aged man on the side replied: "Well, my dad used to have three highs, high blood pressure, diabetes, and hyperlipidemia."

"Other than that? For example, have you ever hiccupped like this before?" Wang Xueyang asked.

The middle-aged man turned his head to look at the uncle.

The uncle shook his head, and then said "uh" again.

"We searched a lot of methods on Baidu, such as holding our breath, drinking water, and diverting attention. We tried all kinds of methods, but nothing worked." The middle-aged man shook his head slightly.

This is where it gets a little tricky.

Wang Xueyang didn't think of any good solution for a while.

Lu Chen also frowned.

This uncle must not be as simple as a hiccup, otherwise his life value would not be so low.

The technical term for hiccups is hiccups.

This is due to paroxysmal spasms of the diaphragm, accompanied by sudden closure of the glottis during inspiration, with a distinctive short loud sound

Hiccup is a reflex activity, and the afferent branch is composed of vagus nerve, phrenic nerve, and thoracic sympathetic trunk.The hiccup center is located at C3-C5, connecting the central nervous system, respiratory center, phrenic nucleus, medullary reticular formation and hypothalamus.

The efferent branches (vagus, phrenic) have connections with the glottis and accessory respiratory muscles, intercostals, and anterior scalene.

Stimulation anywhere along the afferent branch of the reflex arc can cause hiccups.

In other words, almost any chest lesion can stimulate the thoracic branch of the vagus nerve to cause hiccups.

"Doctor, the doctor at the clinic near our community said that the hiccups are benign and don't need special attention. They will get better gradually, but we are not getting better now. You can help my dad figure out a solution." The young man said.

Wang Xueyang explained patiently: "In fact, if hiccups generally last for a few seconds or a few minutes and disappear slowly, they can be considered benign."

"However, once the hiccups last for several days or months, they are frequently repeated and aggravated, leading to insomnia, weight loss, and fatigue. At this time, it may be caused by some underlying diseases, such as central nervous system lesions, lung diseases, gastrointestinal diseases, Abnormal metabolism."

"Is there still so much to pay attention to?" The middle-aged man wondered, "But my dad didn't have these diseases before, so he couldn't suddenly get such a disease, right?"

Wang Xueyang paused, and said to the uncle: "Let me check it for you first."

Asking the middle-aged man to help the uncle onto the physical examination table, Wang Xueyang began to perform physical examination on the patient.

half an hour.

Wang Xueyang finished the physical examination with a look of confusion, but she still did not find anything abnormal.

Heart and lung auscultation were also normal.

"Let's check the plain film of the chest and abdomen first." Wang Xueyang said.

"Huh? Hiccup still needs to be filmed?" The middle-aged man asked suspiciously.

"I told you just now that any chest disease may cause hiccups. The purpose of taking this film is to rule out a disease called hiatal hernia," Wang Xueyang said.

"Oh." The middle-aged man half understood.

Lu Chen immediately gave the patient a checklist.

Afterwards, the middle-aged man took the uncle to go for an examination.

As for this hiccupping uncle, because there is no inspection at present, Lu Chen has no clue.

However, the red 57 on the uncle's head is particularly dazzling.

Lu Chen didn't dare to take it lightly.

……

The speed of X-ray examination is very fast, and as soon as it is completed, the imaging department will issue the results.

About 10 minutes later, Lu Chen and Wang Xueyang saw three more ordinary emergency patients.

The middle-aged man came back with his uncle.

"There is nothing wrong with the chest and abdomen plain films." Wang Xueyang was unable to judge the patient's condition for a while.

"Doctor, you should take some medicine first to stop my dad's hiccups." The middle-aged man was a little anxious, "As for what caused the hiccups, I will investigate slowly later."

Wang Xueyang said in a deep voice: "That's all right, first take it to the emergency observation room, use some medicine, and observe it overnight."

"Okay." The middle-aged man agreed.

He took the uncle to the emergency observation room on the second floor.

Lu Chen watched the uncle leave while staring at the red health value, feeling a little uneasy.

Although the uncle went to the emergency observation room, there were many patients in the emergency observation room at night.

Lu Chen was worried that the doctor on duty might not notice the changes in the uncle's condition in time.

If the uncle really had some kind of dangerous disease attack, it would be too late to rescue him again!
After thinking about it, Lu Chen still sent Cheng Peng a WeChat message, asking him to pay attention to the uncle in the observation room on the second floor.

……

On the second floor, the emergency observation room.

Cheng Peng received Lu Chen's WeChat.

"Hey, this night, I really don't worry, if I meet Lu Chen next time, I still have to change classes!" Cheng Peng thought to himself.

As soon as this thought flashed through his mind, the uncle Lu Chen mentioned came to the emergency observation room.

"Let me pay attention to this uncle, and make more rounds..." Cheng Peng carefully looked at the hiccup uncle, "Is there something special about this uncle, isn't he just a hiccup patient?"

At this time, Wang Xiaodong quickly received the uncle.

Hiccup, a seemingly simple problem, but it is not so simple to cure it.

Subsequently, Wang Xiaodong gave the patient two conventional medicines for treating hiccups.

"Administer lorazepam 2mg and chlorpromazine 50mg intramuscularly."

Lorazepam and chlorpromazine are psychotropic drugs that can treat hiccups caused by mental factors.

After using the medicine.

Cheng Peng observed for 5 minutes, and the uncle's hiccups eased!
"It's time to use this medicine!" After the uncle calmed down, a relieved smile finally appeared on his face.

In the past four days, hiccups have tortured him terribly.

Cheng Peng immediately sent a WeChat message to Lu Chen, telling him about the uncle's situation.

"Is it really just a hiccup caused by mental factors?" Lu Chen frowned, "Will mental factors make the life value so low? It shouldn't be!"

……

However, after only 2 minutes, the uncle's hiccups started again.

And compared with before, the symptoms of hiccups have not been relieved in the slightest.

"What's going on here?" Cheng Peng was quite surprised.

Chlorpromazine and lorazepam can only provide temporary relief, but cannot fundamentally solve the problem.

It is impossible for patients to use these two drugs all the time!
Wang Xiaodong also looked puzzled.

He was also the first patient to encounter such intractable hiccups.

At this moment, Cheng Peng received another WeChat message from Lu Chen.

"Fatty, did the patient do any tests on your second floor?"

"There's no need for a blood test for this kind of hiccup patient." Cheng Peng wondered, "It's just a routine electrocardiogram."

Admission electrocardiogram, which is mandatory for all patients.

"What about the ECG result?" Lu Chen asked.

"I took a look, and the electrocardiogram should be normal. Brother Wang also looked at it, and there was nothing wrong with it." Cheng Peng replied.

"Normal?" Lu Chen paused, "Send me the electrocardiogram."

Without thinking too much, Cheng Peng sent the electrocardiogram to Lu Chen.

Lu Chen's ability to read pictures is much better than him, and he even entered the national finals of the electrocardiogram competition.

He didn't feel that Lu Chen was looking down on his ability to read pictures, because the level of reading pictures between the two was too different, and Cheng Peng had no such idea at all.

……

On the first floor, the emergency internal medicine clinic.

Just as Lu Chen finished watching a patient with a fever, he received an electrocardiogram from Cheng Peng.

At present, the patient has not undergone any examination, only this electrocardiogram.

Click on the original image to enlarge it.

At first glance, Lu Chen did not find any problems.

Hiccups generally have nothing to do with the heart.

Lu Chen thought for a while, and just wanted to turn off the picture.

He suddenly caught a glimpse of the lower wall leads of the electrocardiogram, it seemed a bit strange!

The inferior leads are leads II, III, and AVF.

At this time, in Lu Chen's eyes, the ST-T segment of the inferior wall lead seemed to be raised a little.

However, when I regained my senses and took a closer look, it seemed that I hadn't elevated it!

This……

Lu Chen hesitated.

Clinically, the ECG is not black and white.

The electrocardiogram in front of me, most doctors will definitely think it is normal when they see it.

Even, Lu Chen thought it was normal in his heart, there was only a trace of strangeness.

However, I thought of the red life value of 57 on the uncle's head.

Lu Chen felt that he couldn't let go of the possibility of "abnormal electrocardiogram" just like that!

He quickly sent a wechat message to Cheng Peng.

"Fatty, take another electrocardiogram for the patient. If the family members agree, it would be best to check the myocardial enzymes for him."

Cheng Peng, who was in the observation room of the emergency department, froze.

"Recheck the electrocardiogram, and also check the myocardial enzymes? Lu Chen, do you suspect that the uncle has angina pectoris or a myocardial infarction?"

"Yes." Lu Chen simply replied.

Cheng Peng frowned, and carefully read the uncle's electrocardiogram again.

He still didn't see anything unusual.

If you suspect myocardial infarction, you have to show evidence!
The patient did not have any symptoms of myocardial infarction...

No chest pain, no abdominal pain, and no toothache!
Although Cheng Peng admired Lu Chen very much, at this time he always felt that Lu Chen was restricted by his own profession and misunderstood the patient's diagnosis.

Clinically, many doctors have narrow thinking due to their own professional limitations.

For example, doctors in the Department of Cardiology think of coronary heart disease when they have chest pains, but do not consider gastric ulcers, hiatal hernias, etc.

However, Cheng Peng did not make his own claim, but told Wang Xiaodong Lu Chen's opinion.

……

"Suspect it's a hiccup caused by a heart attack?" Wang Xiaodong was slightly taken aback, "This... I've never seen it anyway."

Wang Xiaodong also checked the uncle's electrocardiogram several times, but found nothing abnormal.

His thoughts were the same as Cheng Peng's, the patient did not have any symptoms of myocardial infarction!
"Well, I'll go talk to the patient, and I can check another ECG." Wang Xiaodong paused, "As for myocardial enzymes, I definitely can't do it for the time being."

If other graduate students proposed this possibility, Wang Xiaodong probably would not accept it.

But Lu Chen is different. Wang Xiaodong is well aware of Lu Chen's abilities, and he will never aim at nothing.

Moreover, he also knew about Lu Chen's entry into the finals of the electrocardiogram competition.

What if there is really something they didn't see in this electrocardiogram?

……

Wang Xiaodong communicated with patients and their families for most of the day.

Finally, the patient and his family agreed to review the ECG.

After all, no one would ever consider that hiccups and heart disease are linked!
"Zizzizi..."

Cheng Peng pushed the electrocardiogram machine to review an electrocardiogram for the uncle.

Wang Xiaodong was watching from the sidelines.

After the electrocardiogram was finished, he immediately picked up the blueprint.

"It seems that there is still no problem!" Wang Xiaodong frowned.

An electrocardiogram that looks normal, no matter in terms of the speed or rhythm of the electrocardiogram, no abnormalities were found!
"Junior brother, please compare the electrocardiogram with me." Wang Xiaodong said to Cheng Peng.

"Okay." Cheng Peng quickly took out the first ECG from the office.

Whether it is angina pectoris or myocardial infarction, there is an important feature, that is, there must be changes in the electrocardiogram!
That's why Lu Chen asked Cheng Peng to review the electrocardiogram for the uncle.

Wang Xiaodong took the two ECGs and compared them carefully.

From P waves, QRS waves, T waves...

Wang Xiaodong carefully compared each paragraph.

"Hey, Junior Brother, look at the ST segment of the lower wall lead, isn't it a little different!"

Wang Xiaodong suddenly noticed a change in the electrocardiogram.

In the second ECG, the ST segment of the inferior wall lead is slightly elevated compared with the first ECG.

After the comparison, looking back at the first ECG, Wang Xiaodong felt that in the first ECG, the ST segment of the lower lead seemed to have been elevated!

Upon discovering this, Wang Xiaodong was not happy at all, but broke out in a cold sweat.

Fortunately, I found it. If I didn't find it, the patient had a heart attack. I really can't imagine...

Cheng Peng also compared the electrocardiogram again, and after Wang Xiaodong reminded him, he also noticed it.

In fact, the electrocardiogram is like this.

If there is no reminder, you can't see many details.

Once someone mentions something, you can immediately notice the abnormal place.

"Senior brother, it seems that I have really elevated a bit."

At this time, both Wang Xiaodong and Cheng Peng were amazed.

From the first electrocardiogram, you can peel off the cocoons and see the abnormalities in it.

Lu Chen is too powerful!

……

However, now is not the time to lament.

Wang Xiaodong immediately took the electrocardiogram to communicate with the family members of the patient, and at the same time invited an emergency consultation from the Department of Cardiology.

The patient and his family members were informed of the whole story, and the family members agreed to check the myocardial enzyme spectrum.

At this time, Li Qinghua, chief resident of the Department of Cardiology, also came.

After checking the two ECGs, he said in a deep voice: "It is indeed lifted. The second ECG is a little more obvious, but the first ECG is not so obvious. Your emergency department can see this clue, and give the patient a reexamination." Taking an electrocardiogram is really not easy!"

Wang Xiaodong scratched his head, "I didn't see it, but a graduate student in your cardiology department saw it."

Li Qinghua looked at Cheng Peng, who was on the side, with a rather surprised expression: "It's you? I remember it's a graduate student from District [-] in your heart."

Cheng Peng quickly shook his head: "Teacher, it's not me, it's Lu Chen. He's working in the emergency department on the first floor today."

Li Qinghua was taken aback, then smiled, "It's Lu Chen!"

That's understandable.

This kid's ability to read pictures was proved by the electrocardiogram competition.

It's no worse than these old guys!
Li Qinghua said with a smile: "It's rare that I didn't meet him in an emergency consultation, but it still has something to do with him!"

"How do you say those few words, people are not in the Jianghu, there are legends about him everywhere in the Jianghu!"

"Xiaodong, you can check the myocardial enzymes. If it is really a myocardial infarction, then you will receive the CCU."

"Okay, Teacher Li." Wang Xiaodong nodded.

Afterwards, Li Qinghua left.

After Wang Xiaodong gave the doctor's order, the nurse on duty checked the uncle for the rapid myocardial enzyme in the emergency department.

After 2 minutes, the myocardial enzyme results came out.

Uncle's troponin exceeds 20 times the normal value!
"I'm going, it's really a heart attack!"

Wang Xiaodong and Cheng Peng looked at each other.

Although the two were prepared, they were still shocked for a few seconds.

Heart attack diagnosed!
……

First floor, emergency room.

Wang Xueyang looked at the chat records in the emergency WeChat group in surprise.

The hiccup patient just now had an acute inferior myocardial infarction!
She quickly looked at Lu Chen who was at the side.

"Lu Chen, do you know what was the final diagnosis of the hiccup patient just now?"

Lu Chen replied lightly: "Have a heart attack?"

As soon as the words fell, Wang Xueyang's expression became even more astonished.

This wechat group is the wechat group of doctors in their undergraduate department, but no students have joined it!
Lu Chen, how did he know this diagnosis?
"Yes... your classmate on the second floor told you." Wang Xueyang suddenly thought of this.

Lu Chen smiled, neither denying nor admitting.

Just now, he received a notification from the system.

"Congratulations, the thank you from Cheng Peng is worth +1!"

"Congratulations, I received Wang Xiaodong's thank you value +1!"

"Congratulations, the completion of the system upgrade has increased by 1%!"

Seeing these reminders, he knew that his guess was correct.

But when Wang Xueyang saw Lu Chen's smile, he only knew it from what Cheng Peng said.

Wang Xueyang said slowly: "This is the first time I have seen stubborn hiccups caused by myocardial infarction!"

"Me too." Lu Chen said, "But the patient has a medical history of three highs in the past, which is indeed a risk factor for myocardial infarction."

"But no one would think about that!" Wang Xueyang sighed, "The doctor on duty upstairs tonight is good, and he can actually consider the disease of acute myocardial infarction..."

……

Speaking of this stubborn hiccup uncle.

After the diagnosis of myocardial infarction, Wang Xiaodong immediately transferred him to the intracardiac CCU.

After an emergency coronary intervention operation, the patient's hiccups disappeared after the heart vessels were opened...

　A real case encountered during the second research period.However, at that time, no one could see the changes in the first ECG. Afterwards, the patient had a myocardial infarction, and when he looked back, he found that there were actually changes in the admission ECG.Although the patient was fine in the end, everyone sounded the alarm. ps: I haven't read any other medical novels.As mentioned before, cases come from personal experience, or case reports in the literature.

　　
　
(End of this chapter)