This doctor is great

Chapter 48 Be a doctor, be careful...

"That's the way it is..."

"Now I don't know what's going on. I can only ask your cardiology department if you have any ideas."

"Why do diuretics have no effect?"

"Nitroglycerin, the effect is average?"

Zhang Yang told everything about the situation.

He looked at Chen Bing and Zhou Mo with inquiries.

After all, he is in the Department of Respiratory Medicine, and there is still a specialist in Cardiology, so maybe the Department of Cardiology can see what the problem is.

Chen Bing: "What are the diuretics used for?"

Zhang Yang: "Furosemide..."

Chen Bing nodded, there is no problem with the medicine.

Furosemide, a loop diuretic commonly used in congestive heart failure and edema.It is a classic drug for acute heart failure.

Chen Bing: "How long has it been used?"

Zhang Yang: "It's been more than 4 hours now..."

Chen Bing raised his eyebrows: "For more than 4 hours, the diuretics didn't work at all?"

This is very strange.

At this time, Zhou Mo said: "Is it possible that it is a pulmonary embolism?"

He expressed his guess.

Then he analyzed: "The patient has been bedridden for the past few years. The blood flow in the lower limbs is definitely not very good, and it is easy to form a thrombus. Once the thrombus falls off, it may flow into the pulmonary artery, causing a pulmonary embolism, which will lead to asthma, hypoxia and other symptoms."

Zhang Yang shook his head: "It is indeed possible, but I have already ruled it out, because half an hour ago, a CT-enhanced CT was performed and no pulmonary embolism was found."

Zhou Mo nodded.

CT enhancement can judge pulmonary embolism, so if there is no CT enhancement, it must not be there.

Chen Bing said: "The possibility of heart failure still exists, and the matter of diuretics does not rule out heart failure... Have you checked the patient's heart failure markers?"

Zhang Yang: "I've already checked, the value of heart failure markers is not too high, unlike heart failure..."

Then use the ipad to pass the inspection results to Chen Bing and Zhou Mo.

- N-terminal pro-B-type natriuretic peptide, 143 (normal value <125 ng/L)

Not too high.

So the possibility of heart failure is not high.

Zhou Mo: "Can I check him personally?"

Zhang Yang: "Yes..."

Zhou Mo came to the patient's bedside with a stethoscope.

I saw that the patient and the elderly were still panting and sweating profusely.

The bedside ECG monitor showed blood pressure was 150/95mmhg and heart rate was fast.

The blood oxygen is only 96%, which is still in the case of oxygen inhalation.

Zhou Mo took a stethoscope and listened to the old man's lungs.

Sure enough, there are dry rales and wet rales...

(ps: dry rale: the sound of gas turbulence...)
This is a typical manifestation of heart failure.

At this moment, Zhou Mo noticed that the old patient, struggling with panting, kept saying "uh uh uh~~~" to Zhou Mo, and pointed his hand under him with difficulty.

Zhou Mo: "?????"

Elderly: (o↓-↓o)

Eyes down, pointing.

Zhou Mo: "........."

Lifting off the quilt of the patient and the elderly, and then exposing the legs...

A smell came.

I saw that the calf of one of the legs had festered.

It was bed rest for a long time, which led to ulceration and formed a pressure sore.

Zhou Mo: "Here?"

Old man: "Uh uh uh~~~~~"

Zhou Mo felt that the old man didn't mean that, so he subconsciously lifted the quilt again.

This time, it hit the abdomen directly.

"I go!"

Zhou Mo was taken aback because he saw the old man's abdomen, which was as distended as if she had been pregnant for several months.

Quickly take off the hospital gown.

The bulging belly was exposed.

The lower abdomen, at this time, has been stretched without any wrinkles.

This is the bladder!

"Urine retention!!"

Zhou Mo flashed the word all of a sudden!

Zhang Yang also saw this situation, and his expression changed immediately, just like the face changing in Sichuan opera.

Bladder so big, it should be urinary retention.

How can urinary retention happen?Has a urine tube?
The only possibility is that the catheter is blocked!

A series of inferences flashed through Zhang Yang's mind.

There was a mess in the wind!
In my heart, I scolded the nurse half to death, and I also scolded myself half to death!

At this time, Zhou Mo tapped lightly on the patient's lower abdomen, and there was a dull sound. It seemed that there should be liquid in the lower abdomen.

It's urine, that's right!
So much urine obviously comes from here.

Especially when diuretics are used, more urine is required.

Zhou Mo and Chen Bing looked at each other, speechless.

Both of them figured it out, it wasn't heart failure or pulmonary embolism at all, but the simplest and most common urine retention!
As for why urine retention?

In the case of a urinary catheter, the biggest possibility is that the urinary catheter is blocked, resulting in the inability to discharge urine.

As for the patient's shortness of breath, profuse sweating, and high blood pressure... it is probably caused by the pain of holding back urine.

Chen Bing and Zhou Mo made eye contact:
"It feels like Zhang Yang has overturned..."

"Let's not talk anymore..."

"Great embarrassment..."

With a sullen face, Zhang Yang called the nurse over.

When the nurse saw the patient's bladder, her expression changed, and she knew something was wrong.

After tidying up the urinary catheter, there is no trace of bending or pressing in each section.

Obviously, it was blocked by urine sediment.

The nurse hurried back to push the treatment trolley over, and then flushed the patient's bladder again.

A rush!
The urine tube will pass.

Then Zhou Mo and the others could clearly see that the urine in the urine collection bag rose rapidly.

"It's a bit fast, slow down!"

"Stop at 600!"

For urinary retention, it is ideal to urinate 400-600ml for the first time. Exceeding this amount may lead to hematuria or even hypotensive shock.

It took a lot of time,

One bag of 1000ml is full.

Then I put a lot in the urinal.

This time,

The patient's parents let out a long sigh of relief.

comfortable.

1 minutes later,
The shortness of breath of the patient and the elderly gradually eased, and the blood pressure also came down...

Zhang Yang: "..."

He smiled awkwardly at Chen Bing and Zhou Mo, and forced a smile.

This kind of car rollover accident, and it was the first time that the car rolled over in front of other departments.

Chen Bing coughed: "Ahem... I have something to do in my ward, so I'm leaving first."

Then he pulled Zhou Mo and left.

Zhang Yang pulled Chen Bing back: "Don't talk about it, I'll treat you to dinner tonight..."

Chen Bing suddenly smiled: "Yes, I have been trying to kill you but failed, this time I have the opportunity..."

……

Chen Bing and Zhou Mo left the respiratory department.

He let out a long sigh of relief.

Senior Brother Chen Bing: "This time, Zhang Yang has a doctor on duty, and nurses in charge of two shifts. They may be scolded..."

Zhou Mo sighed: "This kind of thing feels a bit wronged. If you look carefully, you will find that the urine is retained..."

Senior Brother Chen Bing shook his head: "It's hard to talk about clinical things, I've been overturned before..."

"Ah? Brother, have you ever overturned your car?"

"Too many rollovers..."

Then Senior Brother Chen Bing shared with Zhou Mo an incident where he overturned his car...

"A year ago, I was on duty in the middle of the night, and the emergency department called me to go to the consultation. The patient complained of chest pain, which was severe and unbearable. He complained of sudden pain under the xiphoid process 6 hours ago, and then gradually spread to the chest area. After the physical examination, left and right Extremity blood pressure was asymmetrical, aortic dissection was considered at the time, aortic CTA was checked in the emergency department - the aorta was normal, there was free gas under the diaphragm... At this time, a lot of time was wasted... Do you know what the final cause is?"

Zhou Mo shook his head.

Brother Chen Bing said: "We all forgot to check the abdomen carefully. Yes, at that time the night shift was full of young doctors. They were in a hurry, so they didn't check the body carefully. We didn't find any problems with the patient's abdomen, flat abdomen, full abdominal tenderness, rebound Pain,... More importantly, we forgot to trace the patient's medical history, the patient's history of abdominal pain lasted for several years..."

Zhou Mo: "........."

Senior Brother Chen Bing smiled: "Is it a very low-level mistake?"

Zhou Mo nodded.

It is indeed a very low-level mistake.

Very low level!

Even if the doctor present at the time glanced at the patient's abdomen,
Or even ask about the patient's medical history,
They can find out what is wrong with the patient's stomach, instead of focusing on myocardial infarction and aortic dissection.

I will not run to do aortic CTA.

Waste of money, waste of time.

Chen Bing finally sighed: "Being a doctor is like walking on thin ice. You must be careful, professional, and not sloppy. Every new doctor is prone to make such low-level mistakes... From now on, try to be more careful..."

Zhou Mo nodded.

Been taught a lesson!
"Ring ring ring~~~~"

At this time, a call came to Brother Chen Bing's mobile phone.

"Dr. Chen, there is a patient in the emergency department who needs to go to the cardiology department for consultation. The director arranged for you to go. Are you free?"

Emergency Department……

Without saying a word, Chen Bing and Zhou Mo turned and went downstairs to the emergency department.

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ps: I'm late, sorry...

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(End of this chapter)