This doctor is great

Chapter 92 First, get rid of the four emergencies!

Zhou Mo could tell that the patient in front of him was suffering from chest pains.

Because he was covering his heart and frowning, as if he was suppressing it.

Patient, Cheng Wenle, 33 years old

Time was urgent, and Zhou Mo's speech speed accelerated a lot.

"I'm your bed doctor, what's wrong with you now?"

"Chest pain." The patient Cheng Wenle groaned in pain.

"What kind of pain method? Crush pain, dull pain, sharp pain from being pricked, tearing pain?"

"I can't tell, it just hurts anyway..."

"Is it continuous, or in bursts?"

"A burst of..."

"When did the chest pains start?"

"Two hours ago, when I was working in the company, I suddenly had a chest pain, and then I panicked, so I asked my colleague to take me to the emergency room..."

At this time, the patient Cheng Wenle's chest pain seemed to have eased a little, and his speech became smoother.

At this time, Zhou Mo saw the patient's friend carrying a bag in his hand, revealing a corner of the medical record.

"Is this the inspection report?"

"Yes, yes..." The friend of the patient Cheng Wenle was a little cautious.

"give me……"

Zhou Mo took the inspection report and read it.

While watching, stroke.

For this kind of disease, the dangerous ones should be ruled out first.

The first is acute myocardial infarction and aortic dissection, both of which are very urgent.

Acute myocardial infarction is myocardial necrosis caused by acute and persistent coronary ischemia and hypoxia.

Once the course of the disease progresses acutely, a large number of myocardial cells are necrotic, the heart is severely damaged, and the scope expands, leading to cardiogenic shock and malignant arrhythmias (such as ventricular fibrillation), and death at any time.

Its diagnosis is simple.

A large area of ​​myocardium is necrotic, so the electrocardiogram, which measures the electrical activity of the heart, will naturally be very sensitively reflected.

In addition, when a large area of ​​myocardial necrosis occurs, myocardial fibers will degrade and release a large amount of troponin, so troponin with poor blood pumping will soar rapidly.

Troponin is a marker of myocardial injury and necrosis (gold standard), which has important clinical significance for the diagnosis and risk stratification of acute myocardial infarction, with a diagnostic sensitivity of 100% and a specificity of 91%.

Summary method: ECG + troponin
Zhou Mo quickly pulled out the patient's long ECG drawing and glanced at it.

Fortunately, the EKG is normal.

I looked at the patient's blood troponin again, it was all normal!
"Whoo~~~~"

Zhou Mo finally breathed a sigh of relief.

The patient has had chest pains for two hours. If there is a real myocardial infarction, troponin should have responded long ago.

Exclusion: acute myocardial infarction!
Big crisis, rule out one!
(Extra-topic: This derivation cannot be reversed. Elevated troponin does not mean myocardial damage. It may also be renal insufficiency.)
However, just to be on the safe side, Zhou Mo still asked the nurse Xiaomei Liu to draw blood, continue to do troponin testing, and dynamically monitor whether it will improve.

In addition, Xiaomei Zhao, a night shift nurse who just took over the shift, was busy taking electrocardiograms and sticking electrodes on the patients.

Next, what Zhou Mo needs to rule out is——

The second danger: aortic dissection!
Aortic dissection is also very dangerous. Once it ruptures, it will be aortic hemorrhage, spraying water like a faucet, and life is at stake.

"Miss Liu, after you have drawn your blood, help me measure his blood pressure on his left and right arms..."

"Ok."

Little Miss Liu was busy and crying in a storm.

This time it is estimated that I will not get off work until 6 o'clock!
……

Zhou Mo began to stroke:

Aortic dissection, how should this disease be ruled out and judged.

The first is pain.

Almost all patients with acute dissection present with severe chest pain.

It is characterized by an immediate peak in a short period of time, often with symptoms of exhaustion due to intense pain.

Its tearing (pain) process: It starts from the ascending aorta, passes through the aortic arch, and extends to the descending aorta, causing pain to spread from the front chest to the back, between the shoulder blades on both sides.

(Boss, give me a picture?)

For the sake of clarity, Zhou Mo made a gesture on purpose:
"The progress of your pain in the past two hours, has it started from here (in the chest) and then all the way to here (between the shoulder blades behind)..."

The patient Cheng Wenle watched Zhou Mo's gesture seriously, and then thought about it.

Shaking his head.

"No...it's just heartache all the time, no pain in the back shoulder (shoulder blade)..."

Zhou Mo breathed a sigh of relief.

Fortunately not.

At this time, the nurse Xiaoliu Meimei had already completed the blood pressure measurement of the patient's arms.

"Doctor Zhou, the blood pressure is out. The blood pressure of the left upper extremity is 150/93mmHg, and the blood pressure of the right upper extremity is 152/95mmHg..."

Zhou Mo was stunned for a moment.

It's even symmetrical!
"Do you usually have high blood pressure?"

"Have……"

Patients with aortic dissection may have asymmetric blood pressure in the left and right arms, with a large difference.

If it exceeds 30-50mmHg, it is highly suspected that there may be aortic dissection.

Why is there a difference in blood pressure?

(Boss, continue to give pictures?)
Of course, a huge blood pressure difference can infer aortic dissection, but aortic dissection does not necessarily have a huge blood pressure difference.

Zhou Mo pondered for a moment.

"Or, let's go for a CT..."

Although the blood pressure in both arms is symmetrical, although the pain is not tearing from the chest to the back, several possibilities of aortic dissection (such as abdominal aortic dissection) cannot be ruled out.

After all, the condition is dangerous, and a CT is only a few hundred yuan. You can try it, after all, it is life-threatening.

As for why not use color Doppler ultrasound?
Color Doppler ultrasound can also be used to see aortic dissection, but its accuracy is not high, and there is a possibility of false negatives and false positives.

So to be on the safe side, ask for CT!

Zhou Mo informed the patient of his considerations.

"Do! Do it!"

The patient Cheng Wenle nodded decisively.

The income of programmers is quite high, so at such a critical moment, naturally they will not save money.

Zhou Mo nodded: "Okay, before I go, I have to do other checks for you..."

Currently,

In addition to the previous acute myocardial infarction and aortic dissection, what other dangerous and fatal causes of the patient Cheng Wenle's symptoms may exist?
The third danger: pulmonary embolism!
(I wrote this earlier, probably due to the formation of thrombosis in the lower extremities, which flowed back to the pulmonary artery and capillaries, and then blocked)
In addition to occupations of standing for a long time, programmers are sedentary, which can also be regarded as occupations with frequent occurrence of thrombosis.

but,

When Zhou Mo checked the patient Cheng Wenle's calf, there was no sign of varicose veins.

But Zhou Mo still asked the nurse to help push the bedside color ultrasound.

Then he performed a color ultrasound on the patient Cheng Wenle.If there is a pulmonary embolism, it is difficult for the right ventricle to pump blood into the pulmonary artery, which will lead to a rapid increase in the pressure of the right ventricle, which can be seen from the color ultrasound of the heart.

At last,
"Heart ultrasound is fine..."

"That means pulmonary embolism has been ruled out..."

So apart from acute myocardial infarction, aortic dissection, and pulmonary embolism, what else is more dangerous?
The fourth danger: pneumothorax.

A pneumothorax is when the lung ruptures and air accumulates in the chest cavity, compressing the lungs and restricting the expansion of the lungs.

(Boss, continue with the picture?)

However, Zhou Mo looked at the patient's condition. Although his breathing was a little anxious, the finger pulse oxygen and blood oxygen of the ECG monitor was still 98 (the normal range of finger pulse oxygen is 94-100).

When you have a pneumothorax, you will have difficulty breathing, and your blood oxygen should be lower.

Holding a stethoscope, Zhou Mo listened to the patient Cheng Wenle's heart and lungs.

Pneumothorax is naturally limited breathing, so the sound heard by the stethoscope will be very weak.

So it's easy to identify.

Upon hearing it,
Pneumothorax was directly ruled out.

So far,

Ruled out: acute myocardial infarction, pulmonary embolism, pneumothorax,
Finally, aortic dissection awaits further investigation...

"Go, go to CT!"

At this time, all departments of the hospital were off work, but CT was staffed 24 hours a day.

There is no need to make an appointment in advance. After all, the condition is urgent, so you can just push it to the imaging department.

Zhou Mo called and said hello to the other side.

Gollum~~~~
The patient lay on the car and was pushed out of the ward.

"Doctor, how about I walk over..."

The patient Cheng Wenle was lying on the car, blushing like a monkey's butt, feeling very embarrassed about this kind of 'treatment'.

Zhou Mo said seriously: "Lie down, don't get up."

.

(End of this chapter)