I can see health

Chapter 719 A Seemingly Simple Physical Examination (Second)
The patient's stomach was so tense and hard, which greatly attracted Lu Chen's attention.

Tension in the abdomen often indicates inflammation in the abdominal cavity.

The inflammation irritates the peritoneum, causing the abdominal muscles to tighten, so the belly feels tight to the touch.

Lu Chen muttered to himself, "Could it be that the patient's myocardial infarction caused abdominal tension?"

This situation is rare!
At this time, the ECG of the patient's reexamination also came out.

Lu Chen took it over and read it carefully, but still didn't see the typical pattern of myocardial infarction.

At this time, it had been three or four hours since the patient had obvious chest pain.

If it is really acute myocardial infarction, there should be obvious changes in the electrocardiogram.

However, this graphic is almost the same as before!

"Is there another reason for the chest pain?" Lu Chen frowned.

In his mind, short-term life-threatening "chest pain" diseases such as aortic dissection, pulmonary embolism, and pneumothorax flashed across.

However, it is not quite like it!
Moreover, the emergency department also did a preliminary investigation of such diseases.

Lu Chen's head was spinning rapidly, thinking about various possibilities.

At the same time, his hand didn't stop for a moment, and he kept checking the patient's abdomen, hoping to find more useful information.

Lu Chen percussed the patient's liver area.

It is to make a fist with the right hand and lightly hammer the skin on the surface of the patient's liver.

Just like that, Lu Chen found that the patient suddenly frowned and showed a very painful expression.

There is only one possibility for a comatose patient to suddenly show a painful expression.

That's what really hurt him!
Normal people are unwilling to have percussion pain in the liver area, except for some acute inflammatory diseases, such as liver abscess, or cholecystitis, etc.

Seeing the patient's painful expression, the patient's wife thought he had woken up, and was busy calling his name loudly.

But there was no response at all.

……

Just then, the emergency doctor came back with a newly opened hospital certificate in his hand.

He said to the patient's wife: "Now take the hospital certificate and go to the CCU ward for hospitalization!"

The patient's wife was about to receive the hospital certificate, but was stopped by Lu Chen.

"Wait a minute!" Lu Chen said.

"President Lu, what's the matter?" The emergency doctor looked at Lu Chen who was beside him suspiciously. Wasn't he the one who asked him to issue a hospital certificate just now?
Lu Chen looked at the patient lying on the hospital bed, and said in a deep voice, "The patient may not have acute myocardial infarction, it is very likely that he has a gastrointestinal disease!"

"Ah?" The emergency doctor was slightly taken aback, not knowing why Lu Chen said that.

At this time, in order to further verify his idea, Lu Chen put his left palm on the lower right chest of the patient, and pressed the gallbladder area with his left thumb. If the patient has gallbladder inflammation, such a deep pressure will definitely cause severe pain to the patient.

Because the gallbladder is right under Lu Chen's thumb.

really!

When Lu Chen's left thumb pressed down deeply, the patient's brows frowned even more, and even crinkled into a ball!
Seeing this, Lu Chen took a long breath, and slowly said to the emergency doctor beside him, "It's true that the patient is in shock, but it's not cardiogenic shock, but septic shock!"

Seeing Lu Chen's physical examination, the emergency doctor was surprised and said loudly, "You mean acute cholecystitis?"

Lu Chen nodded slightly, "Cholecystitis, cholangitis, these are not ruled out!"

Cardiogenic shock refers to the shock caused by heart disease. If it is myocardial infarction, intervention or thrombolysis should be done immediately to restore the blood supply to the myocardium, so as to save the shock.

But if the gallbladder is severely infected and septic shock occurs, the treatment is completely different.

And the inflammation of the gallbladder and bile duct can also cause chest pain. Although it is rare, it is possible!

Conversely, a myocardial infarction is just as likely to cause abdominal pain rather than chest pain.

If the two are mistaken and the best opportunity for treatment is missed, the patient may really die.

……

"Do you have a bedside ultrasound machine in your emergency department?" Lu Chen turned to the emergency doctor and asked.

"Yes!" The emergency department nodded immediately.

"Hurry up and bring it here. I'll do an abdominal ultrasound on the patient to see if it's a problem with the liver and gallbladder." Lu Chen said.

The emergency doctor was a little surprised, Mr. Lu did the ultrasound himself?

He will also do abdominal ultrasound for liver and gallbladder?
Only one or two people in the emergency department can use this ultrasound machine.

However, he was only slightly taken aback, now is not the time to doubt these things.

He immediately ordered Gui Peisheng to push the ultrasound machine next door over.

Taking advantage of this time, Lu Chen asked the nurse to replenish the patient with fluids.

In fact, whether it is cardiogenic shock or septic shock, fluid supplementation is good at this time.

Only by increasing the patient's blood volume and blood pressure can the blood and oxygen supply of various organs be guaranteed.

Otherwise, the various organs of the human body will die one by one due to ischemia and hypoxia!
In order to be safe, Lu Chen did a detailed physical examination on the patient again, and there were not many abnormalities in the heart and lungs.

I pulled another ECG again, but I still didn't see the typical myocardial infarction performance!

……

At this time, Gui Peisheng from the emergency department came over pushing the ultrasound machine.

Lu Chen immediately sat next to the patient's bed and applied coupling agent to the ultrasound probe.

All the movements are done in one go.

Abdominal ultrasound is still very simple. Now Lu Chen is mainly looking at the gallbladder and bile ducts.

Under Lu Chen's operation, the image of the gallbladder soon appeared on the ultrasound screen.

"I'm going, the gallbladder is really big!" The emergency doctor can't do ultrasound, but he can still identify it.

B-ultrasound showed that the gallbladder was significantly enlarged, the walls of the gallbladder and bile duct were thickened, there were many stones in the gallbladder, and the bile duct was still obviously dilated!

The result was not beyond Lu Chen's expectation, it was really a gallbladder and bile duct problem!

Lu Chen said in a deep voice: "The patient's gallbladder and bile duct are inflamed, and it is very likely to be acute obstructive suppurative cholangitis."

Once stones block the common bile duct, bile cannot be discharged smoothly from the digestive tract, and it is bound to accumulate more and more.

Eventually, the pressure in the bile duct will increase, and the bile will flow back into the blood, accompanied by bacteria entering the blood, which will produce obvious manifestations of sepsis, and severe cases may have shock!
"Please consult with the hepatobiliary surgeon! Operate as soon as possible!" Lu Chen immediately put away the ultrasound equipment and said to the emergency doctor beside him.

The emergency doctor also knew the urgency of the matter, and immediately ordered the nurse to call the hepatobiliary surgery department for emergency consultation.

The surgeon came soon, and also confirmed the diagnosis of acute suppurative cholangitis, and quickly pushed him to the operating room for bile duct decompression and drainage.

As long as the bile duct is cut to let the gushing bile flow out, the condition will be significantly improved, and surgery will be considered to completely solve the gallstone problem later.

……

"Mr. Lu, thank you so much!"

Thanks to the emergency doctor repeatedly, Lu Chen left the emergency ward.

The system appreciation value and upgrade completion rate have increased by a bit.

The emergency doctor looked at Lu Chen's back, and sighed in his heart, thanks to Mr. Lu this time!

The emergency department was so busy that he didn't have time to give the patient a physical examination.

In fact, no matter how busy the doctor is, the necessary physical examination is still required!

(End of this chapter)