Doctor Song, are you married?

Chapter 200 200. Could it be pulmonary embolism?
The second case is presented in the form of a video.

This case comes from the Respiratory Department of the Central Hospital. She is also a 40-year-old female. She was transferred to the hospital by emergency ambulance. When she was admitted, the patient was panting and sweating profusely.

At that time, the emergency doctor immediately arranged for oxygen inhalation and ECG monitoring for her. However, the oxygen inhalation patient's asthma was still wheezing and there was no sign of relief at all.

The doctor quickly asked about the medical history, and the patient's family members said that she had a history of asthma in the past.For more than ten years, I have had one or two attacks every year. I am afraid this time it is an old disease.

The doctor asked about the onset of the disease again. The patient reported that she had been having asthma for several days. However, when she was getting ready to go to bed after taking a bath that night, she suddenly felt that there was phlegm in her throat that she could not spit out, and she became asthmatic. Suddenly it got worse, so the family members called 120 urgently.

The doctor quickly issued medical instructions. Considering that it was bronchial asthma, in addition to oxygen inhalation, he also prescribed atomized anti-asthmatic drugs.

This is also a routine treatment for asthma.

However, the situation is not optimistic. After using atomized medicine, the patient's asthma has not improved at all.

The doctor had no choice but to give her the hormone drug, methylprednisolone!
It is generally not recommended to use corticosteroids for mild asthma, but if the asthma is severe and persists and cannot be relieved, corticosteroids must be used as soon as possible.

According to the doctor's past experience, as long as it is asthma, the fastest time to use methylprednisolone is 5 minutes, and if it is slower, it will take effect after 15 minutes. However, this patient still showed no signs of relief 20 minutes after taking the medicine.

The doctor initially thought the dose was not enough, but after increasing the dose, there was still no effect!

The first doctor was also a little panicked at this time. He always thought there was something wrong, but he couldn't find the problem.

The worried doctor had to conduct a physical examination for her again.

He was conscious, breathing rapidly, speaking intermittently, pupils of equal size and roundness on both sides, sensitive to light reflection, blood pressure and body temperature were normal, pulse was fast, breath sounds in both lungs were coarse, rales could be heard, and rales were not heard. sound.Her rhythm was smooth, and no murmurs were heard with the stethoscope in each heart valve. Her abdomen was soft, without tenderness or rebound tenderness, and there was no edema in both lower limbs.

This is a very typical sign of asthma.

However, this time the doctor also made a different discovery, that is, when the patient inhaled, there was an obvious depression in her supraclavicular fossa.

This is an obvious abnormal sign, and normal people do not have this depression.

Immediately afterwards, there were also obvious depressions in her suprasternal fossa and intercostal spaces.

Typical three-concave sign!

This is a typical manifestation of upper airway obstruction!
So, the doctor urgently contacted the otolaryngology department and applied for a laryngoscope to see if there was really any problem with the upper airway.

Due to the special nature of this case, the otolaryngology department immediately performed a laryngoscopy on her.

However, unexpectedly, the patient did not have any upper airway obstruction lesions, including upper airway tumors, polyps, or even inflammation!

This case has been very strange so far.

The attending doctor had no choice but to convene a consultation from various departments.

However, just as he was preparing for the consultation, the patient's condition suddenly worsened and he became drowsy and couldn't open his eyes!
The family members were also very anxious and kept calling her name loudly, but she could only barely open her eyes, making a slight "um" sound in her mouth, and then quickly closed her eyes again.

At this time, the family members were also a little excited.

"It's obviously just a simple asthma, why is it getting more and more serious?" "In the past, I would be cured quickly after going to the hospital and taking medicine. Will you take it seriously?"

"If it doesn't work, please transfer us to another hospital quickly."

The doctor also wants to transfer him to another hospital, but the patient's current condition is critical and it is really not suitable for transfer. Moreover, the respiratory department of the Central Hospital is also the most famous in the island city. Even if he is transferred to another hospital, where can he be transferred?
The family had no choice but to continue to let the patient stay for treatment.

At this time, the nurse hurried over and said that the patient's blood gas analysis results came out and they were very pessimistic!
The doctor takes a look!I was dumbfounded, the partial pressure of carbon dioxide was as high as 130mmhg.

This is an astronomical figure!

Carbon dioxide partial pressure, also known as carbon dioxide tension, refers to the pressure generated by dissolved carbon dioxide in the plasma.Because carbon dioxide molecules have strong diffusing ability, blood carbon dioxide partial pressure basically reflects the average alveolar carbon dioxide partial pressure.

Generally, the partial pressure of carbon dioxide in a normal person is 35-45 mmHg, and when the partial pressure of carbon dioxide reaches 55 mmHg, type II respiratory failure can be diagnosed.

In other words, this patient is already in severe respiratory failure!

Moreover, the patient has already developed symptoms of drowsiness, which means he has impaired consciousness, which is a manifestation of pulmonary encephalopathy. There is a risk of respiratory arrest and death at any time!
As a result, the patient was rushed to the intensive care unit and put on tracheal intubation.

After the patient entered the intensive care unit, she was intubated and put on a ventilator. Normally, her hypoxia symptoms should be relieved soon, but in fact her blood oxygen saturation was only 80%!
When a normal person does not inhale oxygen, the blood oxygen saturation must reach above 95% to be normal!
However, when the patient was given 100% pure oxygen by the ventilator, her blood oxygen saturation was only 80%, which is obviously very unconventional.

In addition to the failure of the blood oxygen saturation to rise, the cyanosis on the patient's lips and skin was not significantly relieved, and the patient did not wake up. The disorder of consciousness became more serious, and there was no response to calling her.

This shows that even after being admitted to the intensive care unit and put on a ventilator, the patient's condition is still deteriorating rapidly!

Faced with such a situation, several department directors were also helpless.

So the case was reported to the city's expert consultation group.

While the expert team was working hard to find a breakthrough in diagnosis, they also included this case into the competition.

Moreover, in addition to being included in the competition, this video material was also sent to the respiratory departments of several tertiary hospitals in neighboring cities at the same time, in order to make a definite diagnosis for this patient as soon as possible.

Seeing this video, Song Qi was a little confused. Traditional Chinese and Western medicine in the district basically had no chance to encounter such complex cases. When he was an intern, the most common cases he saw in the respiratory department, besides upper respiratory tract infections, were various types of pneumonia. .

However, now that I'm here, there's no reason to be a deserter. At least I have a good grasp of theoretical knowledge. Let's analyze it slowly.
If that doesn’t work, isn’t there a system auxiliary diagnostic function?

Song Qi just took stock and found that there was still one system-assisted diagnosis stored previously.

If it doesn't work, just summon it and use it!
"In view of the complexity of this case, teachers will have two opportunities to connect to the intensive care unit when making diagnosis." After the host explained the rules, the second round of the competition officially began.

Song Qi sorted through the cases again.

What we can know from various examinations is that there is a high probability that the patient will not have bronchial asthma.

And it's not upper respiratory tract obstruction.

Could it be pulmonary embolism?
Song Qi suddenly remembered a clinical case.

(End of this chapter)