My medical skills are a billion points

But Gao Yingjun shook his head.

"I don't think it's that simple. When this patient had a high fever of 39 degrees, he didn't have convulsions, and when he came to our department, his body temperature had already dropped. The possibility of febrile convulsions is not great."

Several people were discussing the patient's condition, when the critical doctor on duty walked in and said, "The patient admitted just now has frequent convulsions, and I have given him continuous sedation! Director Xiao, do you think we need to further examine him?"

"Again?"

Gao Handsome frowned.

"Ok!"

The intensive care doctor nodded.

According to the film, it really looks like a lung infection, and the patient also has a fever, which can be matched!

But why does he keep having frequent twitches?

Lung infection will not appear neurological symptoms ah!

Gao Yingjun couldn't figure out the man's condition for a while.

He couldn't help looking at Xiao Chu for help.

Ask Xiao Chu if everything is uncertain.

"Xiao Chu, what do you think about this patient?"

Xiao Chu didn't answer directly, but asked: "When you gave this patient a physical examination, what abnormal signs did you find?"

Gao Yingjun thought for a while and said, "I auscultated his heart rate to be fast, and he could hear moist rales in his lungs. There seems to be nothing else."

Xiao Chu shook his head slightly.

This tall and handsome man has high eyes and low hands, the physical examination was not meticulous, and the observation of the condition was not in place.

"Didn't you find the patient stiff in the limbs, stiff in the neck, and sensitive to sound?"

Gao Yingjun was stunned for a moment, his face turned slightly red.

He really didn't find out the symptoms of the patients that he told Xiao Chu about.

If he does a careful physical examination of the patient and can find these abnormalities, it will also be of great help to the judgment of the disease.

It's a pity that when he was doing the physical examination of the patient, he just took a general look, and then pushed the patient to do the examination.

Therefore, some abnormal signs were ignored.

Now being brought up by Xiao Chu, Gao Yingjun was somewhat embarrassed.

Xiao Chu didn't look at Gao Yingjun, but said to Wang Panpan: "You go and call the patient's co-workers, there are some things we need to understand."

Soon, Wang Panpan called the patient's co-workers into the office.

Xiao Chu asked: "Has the patient been injured these days?"

This is the most critical information for diagnosing a disease.

Hearing Xiao Chu's question, Gao Yingjun's eyes lit up.

Is the patient...

Combined with the patient's neurological symptoms, Gao Yingjun's answer is ready to come out.

He is also a worker who is staring at the patient, looking forward to his answer.

The patient worker hastily replied:

"Yes, yes, his right foot was pierced by a nail a few days ago. We don't care about this kind of minor injury, and of course my workmates don't care about it."

Understood!

Gao Yingjun instantly understood the patient's condition!

I only blame myself for not being careful in the physical examination.

Xiao Chu said: "The information you said is very useful. Your worker is seriously ill and needs to be notified of critical illness. You should notify his family members as soon as possible."

When he heard that he was going to be critically ill, the worker was so frightened that he hurried out to make a phone call.

Gao Yingjun scratched his head, and said weakly: "Xiao Chu, I didn't expect this patient to be injured, why don't I go and check him carefully."

"Go ahead!"

It is easy to misdiagnose the disease because of omissions caused by careless physical examination.

When Xiao Chu came to this patient, he had already checked him in detail.

Already found the patient's right foot, there is a wound, but he did not make a sound.

Instead, I want to see what Gao Yingjun has to say.

What he didn't expect was that Gao Yingjun didn't notice.

As a senior resident doctor, it cannot be said that Gao Yingjun's level is low.

It can only be said that the physical examination of the patient is indeed a bit sloppy.

Soon, Gao Yingjun returned to the office.

"Xiao Chu, there is a relatively deep hole in the sole of the patient's right foot, which already shows signs of inflammation."

"I already have a rough judgment on this person's condition!"

"Tell me."

Xiao Chu said.

"This patient should have had a tetanus attack"

"I blamed me for not checking carefully before, but now combined with his feet being pierced by nails and not treated, there are signs of infection now,

Coupled with neurological symptoms such as convulsions, tetanus can basically be diagnosed. "

Chapter 294 A disease with a high fatality rate

"tetanus?"

Wang Panpan was stunned for a moment.

Of course, she had learned about tetanus in textbooks.

But working in a county-level hospital, she has not seen any symptoms of the disease.

Looking back at the various signs of the patient and the clinical symptoms in the textbook, Wang Panpan gradually got it right.

Xiao Chu came to the final conclusion.

"The patient was infected with tetanus."

"He had typical muscle rigidity and muscle spasms, and was very afraid of stimuli such as light and sound."

"Handsome, you should give him a thorough debridement first. You must culture the wound secretion for Clostridium tetani, and then transfer him to the intensive care unit. You must keep the ward quiet and protected from light."

"it is good!"

Gao Yingjun agreed.

The reason why this patient had tetanus was mainly because the tetanus antitoxin was not timely after being pierced by a nail.

Especially nails that have rusted in the soil are most likely to be infected with tetanus.

Therefore, all trauma patients encountered in the emergency department now have to be injected with tetanus antitoxin, just to prevent tetanus infection.

Tetanus is a critical disease with a fatality rate of 20.00% to [-]%.

The mortality rate of critically ill patients is as high as 70.00%.

Neonatal and elderly mortality rates are higher.

And this is a young guy in his 20s, so far he is not considered heavy.

But the condition is not optimistic.

After all, he had more frequent convulsions now.

In severe cases of tetanus, muscle rigidity and muscle spasms are most likely to occur.

It can be said that the muscles of the whole body will be affected.

It is easy to have opisthotonus or opisthotonus.

If the larynx is affected, breathing difficulties and coughing will occur.

Some also induce respiratory arrest.

Patients like this need analgesia and sedation, and a tracheotomy should be performed early to prevent the patient from having throat obstruction and difficulty breathing.

Seeing Wang Panpan on the side looking thoughtful, Xiao Chu asked: "Panpan, do you know how tetanus occurs?"

Wang Panpan immediately came back to his senses, thought for a while and replied:

"Tetanus is a specific infection in which Clostridium tetani invades the human body through skin-to-skin wounds, grows and reproduces in a hypoxic environment, produces toxins, and causes muscle spasms.

Tefentoxin primarily attacks motor neurons in the nervous system.

Therefore, primary disease is clinically characterized by trismus, paroxysmal spasm and tonic spasm. "

I remember the definition very clearly.

Xiao Chu stopped Wang Panpan from continuing, but asked: "Since the diagnosis of tetanus, do you know how to deal with it?"

Wang Panpan put his hands in the pockets of his white coat, like a pupil answering questions.

"Well, the first step is to thoroughly debride the wound without leaving sinuses and dead space. Even if the tetanus attack has occurred, it is still necessary to inject tetanus antitoxin.

Antibiotics mainly use high-dose penicillin or cephalosporin, and metronidazole is also needed. "

"Well, because the patient's muscles are tense, an absolute quiet environment is required. Continue to sedate if necessary to prevent the patient from muscle spasms and cause respiratory depression.

In severe cases, tracheotomy should be performed as soon as possible. "

"Definition and treatment are not bad."

Xiao Chu nodded.

"Since I remember it so clearly, why didn't you think of the typical symptoms of this patient just now?"

Wang Panpan was taken aback for a moment, and his face turned red.

I thought to myself: Don't talk about me, didn't even Gao Yingjun think of it?Who can be like you, an all-rounder in the emergency department!

However, Wang Panpan replied truthfully: "Mr. Xiao, I have never encountered such a case in our county hospital. Even if I know the clinical symptoms in the textbook, I still cannot combine it with the actual situation.

I have seen this case now, and if I encounter it again in the future, it should be possible to diagnose it. "

Although this Wang Panpan is a bit showy at times, in general, he is pretty good for diagnostics and clinical experience.

After all, she came from a county-level hospital, so it is understandable that she has never seen such a rare case.

So Xiao Chu asked: "Can you do a tracheotomy?"

Wang Panpan shook his head hastily.

"I haven't done it."

"Okay, let's go and perform a percutaneous tracheotomy on this patient later."

"Percutaneous tracheostomy?"

Wang Panpan blinked and blinked, a little confused.

"Ms. Xiao, what does percutaneous tracheostomy mean? Isn't it a conventional tracheotomy?"

Xiao Chu shook his head.

"For a conventional tracheotomy, the surgeon usually makes a longitudinal incision in the neck.

This kind of tracheotomy is very traumatic for the patient, easy to be infected, and difficult to heal.

The percutaneous tracheotomy we will do later is a transverse incision.It only needs an incision of [-] cm. I will take you to do it again in a while, and you can feel it slowly. "

Because this patient has a high fever and obvious muscle tension.

Intensive care doctors have sedated him.

In order to prevent the patient from breathing difficulty and suffocation,