This doctor has a system

Chapter 187 185. Patient with Headaches

At the hospital, Qin Hao from the Respiratory Department encountered some trouble.

Hu Meili, a 57-year-old woman, had a fever 4 days ago. She bought some antipyretics at home, but the effect was not very good.She still had recurrent fevers, with a maximum body temperature of 39.4°C, accompanied by cough, chest tightness, and muscle aches.

Even so, Hu Meili didn't want to go to the hospital. A smart person like her wouldn't go to a place where money was cheated.

After 4 days at home like this, she felt that she was okay, but her husband couldn't sit still, watching his wife's temperature soared to 40°C, and her spirit was getting worse and worse. He was finally a man with a strict wife. Back, Hu Meili slipped directly to the hospital.

On such a hot day, Hu Meili, who was shivering all over while wearing a mink, caught everyone's attention.

"Do you have a fever?" Ma Liang from the emergency department asked, and Hu Meili's husband hurriedly explained the situation to the doctor in detail.

Ma Liang listened with a stethoscope and found some moist rales in the patient's left lower lung. Combined with the patient's fever, cough, and chest tightness, the possibility of pneumonia is very high.

The so-called moist rale is the sound produced by the vibration of the liquid or the rupture of the blister when the airflow passes through the bronchi with thin secretions.To put it simply: when the lungs are inflamed, water will seep out, and moist rales will be heard when inhaling.

When the doctor hears this sound, he usually asks the patient to do a chest X-ray or chest CT, so that it can be seen at a glance.

Before asking Hu Meili to go for CT, Ma Liang also routinely performed an electrocardiogram for her. Fortunately, no typical myocardial infarction or severe arrhythmia was seen, but the heart rate was a little fast, 120 beats per minute.

This is normal for Hu Meili, as the heart rate will be faster when there is a fever. Generally speaking, for every 1°C increase in body temperature, the frequency will increase by about 15 beats per minute.

The results of chest CT came out soon, suggesting left pneumonia.Seeing that Hu Meili's spirit was very poor, Ma Liang suggested that she be hospitalized for treatment, but the latter showed obvious resistance.

"You can't go home in this state. If something happens, you will regret it." Ma Liang persuaded. Fortunately, the patient's husband is better at communicating, and he also tried his best to persuade his wife to be hospitalized.

"It's not that serious. I'll just go home and take the medicine. If it's really impossible, I'll go home after getting the needle in the emergency department, and come back when I need to get the needle." Hu Meili is not willing to be hospitalized. Spending money here is like running water. Wouldn't it be delicious to have that money to buy some pork ribs stew?

"Don't bargain with me!" Ma Liang was a little unhappy, "If you don't want to be hospitalized, just sign and refuse, and you will be responsible for the consequences."

Ma Liang's words made Hu Meili's husband anxious. He said to his wife angrily: "When you come to the hospital, you have to listen to the doctor. You see that you have burned like this. Isn't it difficult to go home? I can't even cook. Yes, but I can't take care of you!"

Now Hu Meili was silent.

Ma Liang contacted the respiratory department, "Although the patient is not in good spirits, his vital signs are still stable, and his blood pressure is normal."

"Okay, let her come over." Qin Hao, who was on duty, said.

"Doctor, do I need to be hospitalized in this situation? I think I just have a cold." Hu Meili, who came to the respiratory ward, regretted again, "No, you can prescribe me some medicine and go back to take it."

"The chest CT clearly shows inflammation. It's not a common cold." Qin Hao said, "You have such a high fever right now, you have to be hospitalized for observation, and we'll have to draw blood later."

"Look, let the blood be drawn as soon as you come in!" Hu Meili lost her temper at her husband, "Don't you know how hard it is to make money?"

"Oh, it's only a few dollars!" The husband became a little impatient, "I'm in a hurry right now, don't do it."

All the results of the blood test came out in the afternoon of the same day. The number of white blood cells was slightly increased, the platelets were slightly lower, the liver function showed that the transaminases were a little higher, and the myocardial enzymes were also partially elevated.

Although the result of such an examination is abnormal, it is not serious. Qin Hao communicated with the family members and told him that the patient must have pneumonia. As for whether it is caused by bacteria or viruses, further observation is needed.

"Also, beware of heart problems." Qin Hao's words frightened Hu Meili's husband.

"Don't worry, I mean it's possible, not sure. Her myocardial enzymes are a little high. It may be due to inflammation of heart cells, such as myocarditis, or damage to muscle cells or inflammation of the liver. It's easy to say, you can observe it, maybe nothing happened." Qin Hao quickly explained.

Normal people's heart muscle cells, limb skeletal muscle cells, liver cells and other tissues have many proteins, some of which we call enzymes, such as transaminases and cardiac enzymes.After cells are destroyed, these enzymes are exposed and abnormally elevated.After these enzymes are elevated, we have to consider whether these liver, heart, skeletal muscle cells, etc. have inflammation.

Qin Hao is quite experienced. He vaguely feels that the patient is not necessarily ordinary pneumonia, or it is not just pneumonia.But no other major problems have been found so far. He decided to treat it as bacterial pneumonia and give the patient antibiotics first.

Pneumonia refers to infectious inflammation of the alveoli, distal airways, and lung interstitium.Pathogenic microorganisms, such as bacteria, viruses, fungi, and rickettsia, can cause pneumonia, and acid reflux and reflex injuries can also cause pneumonia.The most common of these is pneumonia caused by bacteria, among which Streptococcus pneumoniae, Mycoplasma, and Haemophilus influenzae are the most common.

After taking sputum culture from the patient, Qin Hao empirically applied the antibiotic piperacillin-tazobactam to control the infection.

Hu Meili expressed her dissatisfaction again at this time, "Why don't you wait for the results of sputum culture to come out before taking medicine! Isn't that better for the treatment effect?"

It's over, and Qin Hao feels a little headache when he encounters this kind of patient whose bottle is not full of half a bottle.

"Using the medicine in advance will help to control the infection in time." He explained patiently, "Besides, the positive rate of sputum culture results is very low, and it may not necessarily produce anything."

And the results are also slow, sometimes the patient has been cold for a few days before the laboratory department calls to report the results.
"If you can't train me, what will you do for me?" Hu Meili was very angry, "Can you stop wasting our money! What a black heart!"

MMP, what a weird thing this is, Qin Hao cursed inwardly, he really wanted to kick Hu Meili out of the hospital right now.

It has been three days and Hu Meili is still running a fever, with a maximum body temperature of 40°C.

"How did you communicate?" Director Nie, Qin Hao's superior doctor, was very angry. He was scolded by Hu Meili when he went to make the ward rounds. It has been many years, and this is the first time that a patient pointed his nose at a quack doctor .

Qin Hao is also very wronged, she is not very good, what can I do.Besides, you were scolded only once, but I was tortured every day.

"Have you considered myocarditis? In case of severe myocarditis, the patient may disappear immediately. We must communicate well before the accident. One sentence at this time is more useful than ten thousand sentences after the accident." Director Nie explained, "If it is myocarditis, it is usually caused by a virus. Do we have better antiviral drugs? We can try it."

Director Nie said that the possibility of myocarditis cannot be ruled out, but even for viral myocarditis, there is currently no good antiviral drug.

But Qin Hao didn't dare to refute, he just wanted to be criticized honestly.

The most common cause of fever is infection, but the infectious disease itself can write a book of several thousand pages, and it is still difficult to determine the infection site and the infected bacteria.In addition, connective tissue diseases should also be considered, that is, rheumatism and immunity have dozens or hundreds of diseases.

Tumors can also generate heat, but tumor-like fever rarely reaches a high temperature of 40°C. Qin Hao has completed the detection of tumor-related markers in patients, and the results are all negative.

"No, let's call everyone over to discuss it." Director Nie said.

In fact, Gao Feng had noticed this patient a long time ago. Hu Meili scolded him every day during the ward rounds. He had a bad impression of him. In addition, he stayed in the bronchoscopy room in the morning, so he didn't bother to ask about the specific situation. .But seeing Qin Hao's headache, he sat down and looked through the medical records and examination results.

"Qin Hao, have you considered infectious diseases?"

Strictly speaking, an infectious disease can also be considered an infectious disease, but it is just a special pathogen infection, such as leptospirosis, scrub typhus, dengue fever, hepatitis A, AIDS, etc.

"It was quite hot the day before, so we should be vigilant against dengue fever." Gao Feng said.

"The patient's dengue fever antibody was checked and it was negative, and there was no rash on the patient's body, and no one at home gathered to get sick, so I don't support dengue fever." Qin Hao said.

"What about scrub typhus? This disease is not uncommon." Gao Feng suddenly thought, "Patients with high fever, pain in the limbs, chest tightness, and cough should be considered routinely. This is not a rare disease in southern Hunan, and it is misdiagnosed every year. .”

"That's right! Have you done the Wai Fei experiment?" Director Nie asked.

You may know less about scrub typhus, it is an acute infection.Small rodents, including many species of rodents, can carry Orientia tsutsugamushi asymptomatically for long periods of time.

These rodents infeste grasslands overgrown with weeds. If humans are doing farm work in the fields or resting in the field, they may be bitten by scrub typhus, which will cause scrub typhus. fever.

If it invades the respiratory tract, there will be cough and chest tightness. If it invades the heart, it will cause myocarditis. If it invades the liver, it will cause elevated transaminases.Patients have fever, chills, and it is inevitable that there will be pain in the limbs.

"Waifei's test was done and it was negative." Qin Hao whispered.The Pey's test uses known Proteus bacterial antigens to detect the titer of the corresponding antibody in the patient's serum to assist in the diagnosis of febrile diseases caused by Rickettsia infection.

"Ah?" Director Nie was disappointed for a while, he thought he had found the cause of the disease just now.

Gao Feng was a little confused now, "Have you checked carefully? Is there any ulcer in the patient's armpit and groin?"

There is a typical feature of scrub typhus, that is, red dots will first appear on the site where scrub typhus rickets bite people, and then it will turn into ulcers and eschars, and it is not painful or itchy. It is very special. The bite The most common parts are often fine skin and tender meat, moist and dark places, such as perineum, groin, armpits and so on.

"I checked the armpits, but nothing." Qin Hao said, "I didn't check the groin and perineum. This patient is not of high quality. I am a male doctor, how dare I look at her parts."

"This is not the old birthday star hanged himself - impatient to live!"

Director Nie didn't say much now, Qin Hao is still very responsible at work, busy in the department all day, he has no reason to criticize him.

(End of this chapter)