Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Soon, the two bags of pale yellow plasma gradually bottomed out.

The patient's pale complexion improved a little because of the [-]ml of plasma.

In the drainage bag, the drainage fluid starts to slow down on the 150ml scale.

This shows that the bleeding has really stopped! !

The attending doctor immediately took a long breath:

"Phew... stop it, stop it! The bleeding has stopped!"

Doctor Liu also shook his head and sighed:
"That's right, this person has hemophilia, luckily it's subclinical.

If it is medium and heavy, it is estimated that people will die long ago. "

Finally, after waiting another 15 minutes, the blood in the drainage bag did not increase any more.

This shows that the bleeding has really stopped.

The attending doctor called in the family members waiting outside the door.

Because I cried just now, the eyes of the family members are still red.

Originally, he wanted to point at the doctor's nose and scold him as soon as he came in, but when he heard that the patient was rescued and the cause of the bleeding was found, the family immediately changed their faces.

The family member asked with a friendly face when he was just admitted to the hospital.

It's a completely different person from the staring eyes and wanting to eat people just now.

Doctor Liu breathed a sigh of relief:

"Yes, it's stopped. Now we are temporarily out of danger, but we still have to wait for the results of the last and most important test before we can diagnose what disease your son has."

The family members looked at the patient on the hospital bed and called him twice.

The patient will be very weak, but conscious, he opened his eyes and looked at his father, then closed his eyes and fell asleep.

"Doctor, what's the matter with my son? When will the examination come out?"

The family members were very anxious, and after looking at their son, they hurriedly asked about the situation.

Doctor Liu became serious and asked the family members:
"Let me confirm with you again, no one in your family has ever had teeth bleeding? Or have you bruised when you bump it?

Or is there any abnormal bleeding? ?

Not only your relatives, but also your grandparents, and even the relatives of the patient's mother. "

The family members frowned and thought carefully for a while.

bleeding?

No?
The grandparents have been quite healthy for generations.

Except for the patient's grandfather who died of stomach cancer, he had no serious illnesses.

but……

"The patient's mother... actually left when she gave birth."

After thinking for a long time, the family members came up with such a sentence.

Doctor Liu immediately raised his voice a few degrees:

"Why didn't you say it earlier?? I asked you a long time ago if you have any relatives with abnormal bleeding in your family. Why didn't you say it!"

The family member scratched the back of his head in a daze and said:
"No... Didn't you ask me about abnormal bleeding? The patient's mother died of dystocia. I remember the doctor said that it was because of a lot of bleeding and the blood vessels were blocked, so he couldn't be rescued.

But I wonder if it is normal to have bleeding after childbirth?
Which woman gives birth without bleeding?
So...so I don't think this is abnormal bleeding...I didn't say..."

"I……"

Dr. Liu rolled his eyes, almost fainted by this family member.

After taking a deep breath, Dr. Liu tried to explain to the family in a calm tone:
"Forget it, let me tell you first, we now suspect that your son has a rare genetic defect of blood clotting disorder, that is, hemophilia.

Because of the lack of a blood clotting factor in the gene, he continued to bleed after cutting a small hemorrhoid.

Under normal circumstances, it is impossible for hemorrhoids to cause such serious consequences

But that's because of your son's special circumstances.

Just now your son was bleeding again, but we tried to treat it with the two gene factors that your son may lack, and now the effect is remarkable.

So we can basically be sure that your son has hemophilia.

It should be related to her mother. Hemophilia is generally a recessive inheritance from the mother, and most of them will be passed on to the son.

I guess, the patient's mother should have left after bleeding too much and not stopping when she gave birth. "

After hearing this, the family members nodded with a look of enlightenment.

Although he didn't quite understand it.

But as long as his son can be rescued, he has nothing else to ask for.

"Then doctor, can my son's disease be cured?"

Doctor Liu shook his head:

"Not yet, but your son's condition is relatively mild. In the future, as long as there are no major accidents or entering the operating room, he will basically not bleed."

"Huh... that's good, that's good!"

After the family members patted their chests, they looked at the doctors and nurses in the emergency room with embarrassed smiles and said:

"I'm sorry, everyone, I've been too worried about my son these days, so sometimes I may speak a little aggressively, sorry, I apologize to you."

Several doctors and nurses quickly waved their hands, indicating that it was okay.

Doctors and nurses can understand the emotions of family members.

Doesn't everyone who comes to the hospital want their family members to go out safely?

This time, this patient was sent to the operating room several times. If any of them encountered this kind of thing, they would be angry.

So the medical staff were not angry.

After waiting for another half an hour, the amount of bleeding in the patient's drainage bag was still 150 ml.

Only then did Dr. Liu feel relieved and prepared to go home.

Lin Yi is sitting in the office.

Several migrant workers came outside the door of the emergency department.

As soon as he came in, he yelled:
"Doctor! Is the doctor there? Come and have a look!"

In the office, they didn't look at the case anymore, they all went outside to inquire about the situation.

"What's wrong? What's wrong?"

Several migrant workers supported the old man in the middle who looked the weakest.

He should be in his 60s, with a thin body and dark skin. At this moment, he is sweating profusely all over his forehead.

Lin Yi hurriedly pulled out a platform car from the side and came over and said:

"Hurry up, get the person onto the flat car first! Also, Nurse Li, come over here to set up the intravenous access first, and bring the ECG monitoring too!"

"Ok!"

Before everyone could react, Lin Yi had already taken the lead in dealing with it.

After lifting the patient to the flat car, Lin Yi continued to ask:

"Where does it hurt?"

The migrant worker next to him said:

"His stomach hurts, it hurts so much that he has no energy all over his body, and he is sweating a lot, and his forehead feels a little hot, I don't know if he has a fever.

It started to hurt at noon yesterday. He went to the clinic to buy some stomach medicine, but it still hurts when he wakes up today. We asked him to come to the hospital to have a look, but he couldn't bear the money.

The result is like this, I fainted while working on the construction site.

He woke up after pinching him, and then we brought him to the hospital immediately. "

Lin Yi took out the small flashlight in his hand and stimulated the uncle's pupils.

Fortunately, sensitive to light reflection.

He checked his whole body carefully.

It turned out that there was something wrong with the pancreas.

He quickly put on a glove and opened the clothes on the migrant worker's abdomen.

While pressing, he asked:
"Master, where does it hurt? Does it hurt to press here?"

Lin Yi pressed on the upper abdomen near the pancreas.

As a result, the uncle was still groggy, but suddenly he yelled!

"Ouch... it hurts, it hurts right here."

"What about here?"

Lin Yi pressed to the center of the pancreas.

As a result, the uncle's expression became even more painful.

"It hurts, doctor, it hurts..."

"What about the chest? Does it hurt here?"

"No chest pain."

"What about here?" Lin Yi pressed on the appendix again.

"No pain……"

"Did you have diarrhea?"

"There is no diarrhea... it's just the pain here... I can't stand the pain..."

At this time, watching Lin Yi's series of palpations, basically all the doctors present could have a direction of suspicion.

There is no pain in other parts, only the stomach and pancreas.

That means either gastric ulcer or pancreatitis.

Combined with the fact that the patient did not have diarrhea, blood in the stool, and digestive tract reactions, the result was closer to the pancreas.

Before Lin Yi could speak, Wu Jiang took the lead to ask:
"Did he eat anything greasy before the stomachache yesterday? Or drank a lot?"

The other migrant workers nodded quickly:

"That's right, the boss had a treat on our construction site the night before, and we went out for a dinner party, and we did have some wine for the hot pot.

But hot pot is not too greasy, right?It's just more spicy. "

"Master, let me ask you a few questions." Wu Jiang approached the patient again to ask.

The uncle on the flat car nodded: "Okay...Okay."

"Does your stomach hurt all the time or did it just start yesterday?"

"Just...just yesterday..."

"Come to a nurse and take his temperature."

After Wu Jiang finished speaking, he lowered his head and asked:
"Master, do you feel sick when your stomach hurts? Do you feel acid reflux in your stomach?"

"No... just a stomachache... There is no discomfort in the stomach."

Wu Jiang's question basically ruled out stomach problems.

Now the finger is directed at pancreatitis.

Wu Jiang turned to look at Lin Yidao:

"I initially suspected pancreatitis. Let's check B-ultrasound, abdominal CT, blood and urine amylase."

Lin Yi nodded:

"Ah."

After finishing speaking, Lin Yi did not rush to give a doctor's order, but took a stethoscope and listened to the migrant worker's lungs for a while.

Everyone is puzzled.

Now the result is obvious, it is probably pancreatitis.

Check the amylase and then control the infusion, and the person will be fine.

What chest does he still listen to?

Qian Zhenggang only thought that Lin Yi wanted to check more, so he didn't say anything.

After putting down the stethoscope, Lin Yi said:

"Lung auscultation does not seem to be voiceless. I suggest adding a lung CT."

Wu Jiang became curious when he heard it. He took the stethoscope in Lin Yi's hand and listened.

embarrassed...

Why can't he hear anything?
Isn't this a normal unvoiced sound?

Where is it different?
At this time, the uncle lying on the flat car heard that more inspections were needed and complained:

"Doctor... I... I'll do less checkups, I don't have much money..."

But Lin Yi shook his head and insisted:
"Master, I am doing this for your own good. A CT scan of the lungs must be done."

"But the doctor... I don't have any money... Can I do abdominal surgery?

Did you do it with your lungs? "

"I'm afraid it won't work. Each part is separate."

"But... my family... There are old and young in the family, so I save as much as I can, doctor...

You can do it, okay, can I not do this CT? "

The patient lying on the flat car was very weak, but he felt very helpless when he thought that going to the hospital would cost a lot of money.

Lin Yi frowned and looked at his lungs.

"No, lung CT must be done! 300 yuan... Let me help you out. Hurry up and draw blood first, and then send it to the imaging department."

As soon as Lin Yi said this, the surrounding doctors cast him surprised looks.

Actually offered to help patients pay for CT?

They feel that if this person really doesn't have the money to do lung CT, then he won't do well.

If pancreatitis is found out, there is no need to do lung CT.

At this moment, Deng Wei also stood up and asked:

"Lin Yi, why do you insist on having him do a lung CT scan?"

Lin Yi explained: "The sound of auscultation of the lungs is not right, just in case, so do a CT scan."

Deng Wei frowned, and listened carefully for a while with a stethoscope.

Didn't hear anything wrong.

He thought to himself, is Lin Yi a bit unnecessary?

The patient lying on the flat car heard that Lin Yi was willing to pay, and gratefully wanted to sit up and bow to Lin Yi.

But Lin Yi pushed him on the flat car:
"You don't need to thank me, you can lie down first, whoever is a family member of you, come to the office with me to sign first, and the other people should send him for examination first."

Several migrant workers have no family members, but there are colleagues who are willing to help sign.

Half an hour later, all the patient's test results came out.

Blood amylase: 378U/L
Urine amylase: 3974U/L
Blood and urine amylase were all found to be higher than normal.

Such a high value can basically confirm that it is pancreatitis.

In addition, the detected blood sugar is not high, and the three blood lipids are also normal.

Explain that pancreatitis is not caused by blood sugar and hyperlipidemia.

No bile duct and gallbladder stones were seen on the B-ultrasound, indicating that it was not caused by gallbladder blockage.

And finally CT.

The CT of the upper abdomen showed that the shadow of the pancreas was enlarged, which should be edema.

And there is free fluid around.

It should be inflammatory exudate.

It seems that the old man's pancreatitis has developed into suppurative pancreatitis.

Finally, another CT scan of the lungs.

It doesn't matter if you don't look at it, when you look at it, everyone's eyes are full of doubts!

"This...how did this pancreatitis lung CT appear like this??"

Yin Liang stared at the film for a while and said.

At this moment, the gray-black film was stuck in front of the light film.

The migrant worker's film showed diffuse ground-glass density shadows in both lungs, with fine grids inside.

Wu Jiang also thought to himself:
"This person doesn't cough, and there are no dry and wet rales in his lungs. Why does this appear on the CT scan??"

In fact, from the very beginning, Lin Yi had already noticed the abnormality of this patient's lungs.

That's why he insisted on having a CT scan of his lungs.

At this moment, while everyone was wondering, Lin Yi stood up.

"During auscultation, I noticed something was wrong. It sounded like a voiceless sound, but it didn't sound like it, but it wasn't dry and wet rales either.

That's why I insisted on doing the inspection.

Now the results have come out, which shows that my persistence is indeed correct.

The patient's lungs were auscultated without dry and wet rales, and pancreatitis was evident.

It also further explained that the shadow on this CT film is a lesion of the lung interstitium, not the alveoli.

Therefore, I think this patient should have interstitial pneumonia in addition to the diagnosis of pancreatitis! "

"Huh? Interstitial pneumonia?"

"Pancreatitis combined with interstitial pneumonia? It's rare."

After Wu Jiang hesitated for a moment, he asked:

"It's not that serious, is it?! If you say it's interstitial pneumonia, why doesn't the patient have any respiratory symptoms?"