This doctor has a system

Chapter 188. 186. The Truth Comes Out——Tsutsugamushi

"Let me go and have a look." Dong Qianqian stepped forward. She has a carefree personality and is not shy of people like Hu Meili.

"I haven't taken a shower these days." Hu Meili frowned and said, "You guys have been thinking about how to treat me, what do you mean by coming here to pick me up!"

Dong Qianqian didn't bother to talk to her, so she called the patient's husband directly, "You're wearing gloves too, help me turn her over later, I'll take a look later."

No ulcers or eschars were found in the front groin and perineum. "Lift up your butt!" Dong Qianqian patted Hu Meili, who was a little embarrassed at the moment, but unfortunately, no problems were found in other parts.

"It's just nonsense." Hu Meili said dissatisfied.

"If not, upgrade or combine antibiotics." Li Huizhen suggested, "It may also be that piperacillin-tazobactam did not cover some atypical pathogenic bacteria."

"It's best to check the chest CT again and ask the infection department to take a look." Gao Feng suggested. For some reason, the system didn't issue a task for such a difficult patient, which surprised him.

"That's fine, let's do this first, let's take a look at it with levofloxacin today." Director Nie explained to Qin Hao.

At night, Gao Feng was reading literature, and Li Xinyao was lying on the bed with a small instrument the size of a palm: a simple fetal heart rate detector.

"Why can't I hear any sound!"

"It won't be until four months later, but now I'm afraid I can only hear your own heartbeat." Gao Feng was a little bit dumbfounded, "Why are you so anxious?"

"This is the only thing in my mind right now, can I not be in a hurry?" Li Xinyao said with a smile, "Now I hope that the time will pass quickly and I will see what the child looks like sooner."

The two were talking when Gao Feng's cell phone rang, and it was Dong Qianqian calling.

"Are you busy at the moment?" Dong Qianqian's tone was a little anxious, "That Hu Meili is not in a very good condition at the moment, her difficulty in breathing has increased a lot, and she keeps complaining about her stomach pain."

"I'll go take a look now." Gao Feng quickly stood up.

Hu Meili's condition changed around 7 o'clock in the evening. At that time, her difficulty in breathing suddenly worsened. She was sweating profusely.Dong Qianqian, the doctor on duty, was very nervous. The patient's unknown diagnosis was already a headache, but suddenly it happened again.

"Don't let anything happen!" she said worriedly.

When she came to the patient's bedside, Dong Qianqian saw that the patient's consciousness was still clear, but her forehead was full of sweat. She tightly covered her stomach with her hands, her breathing was short, and the ECG monitoring indicated that the blood oxygen saturation had dropped to 90%. The nurse brought the mask over and gave her oxygen through the mask.

The tenderness in Hu Meili's abdomen was obvious, and she was still fine in the afternoon, which made Monk Zhang Er confused.

After a careful physical examination, Dong Qianqian found that Hu Meili's right upper quadrant tenderness seemed to be more obvious, and Murphy's sign suggested a suspicious positive.

"Could it be cholecystitis?" Dong Qianqian thought, a positive Murphy's sign would first make people think of the disease, but the patient's color Doppler ultrasound did not suggest gallbladder stones.

Gastrointestinal perforation would also cause severe abdominal pain. Dong Qianqian hurriedly called the surgery department. No matter what, it was right to call them over to have a look.

Gao Feng also arrived at this time. After the physical examination, he didn't think much about cholecystitis and gastrointestinal perforation, but he didn't have a clear idea.

"Get an electrocardiogram." Gao Feng said to Gui Peisheng next to him.Whenever there is abdominal pain, myocardial infarction must be ruled out first. This is the express regulation of the hospital.

"Invite the doctor who is seriously ill. If her condition continues to worsen, she may have to go to the ICU."

The surgeon arrived soon and gave a consultation opinion after the physical examination: Although the patient had obvious abdominal pain, the abdominal wall was not tense and there was no rebound tenderness, so cholecystitis and gastrointestinal perforation were not considered.There are still bowel sounds, and it doesn’t look like intestinal obstruction. It’s hard to say whether there is pancreatitis or not. It is recommended to do an abdominal CT to clarify it first. If there are indications for surgery, then seek them for surgery.

The doctor who was seriously ill suggested that an abdominal CT should be done now. Dong Qianqian hurriedly communicated with Hu Meili's husband, who was so frightened that he had lost his mind.

Everyone was about to push the bed away, when Hu Meili's difficulty in breathing suddenly worsened, and her consciousness became a little blurred.

"Hurry up, don't do CT, turn to severe disease first." Gao Feng felt that the patient's blood pressure also tended to drop.

"Sissy, hurry up and tell the family about the serious illness! I will intubate her right now." The nurse ran to get the tracheal intubation kit.

The doctors in the ICU are also contacting the departments to make preparations there.

Hu Meili's husband's mind went blank at the moment, he only knew how to nod his head, and said while crying that he could spend as much as he wanted, so that he could treat the patient as soon as possible.

Gao Feng quickly put the endotracheal tube into the patient's trachea, and the whole ward was noisy. The nurse quickly connected the balloon and pressed the patient to inflate the patient, and then several people quickly pushed the patient to the ICU.

After leaving the ICU, Gao Feng felt very strange. Why did the patient suddenly appear in respiratory distress?Is the pneumonia getting worse?Or a pulmonary embolism?Pulmonary Edema?
"What are you thinking?" Li Xinyao was a little curious seeing him standing there in a daze.

"A rather complicated patient." Gao Feng rubbed his face, "I don't have any clues at the moment, and just now his condition changed and he was transferred to the ICU."

"Forget it, don't think about it, let's sleep." He got up and turned off the light.

The next day, Hu Meili's condition stabilized a little. The doctor in the ICU pushed her on a ventilator and took her for a chest and abdomen CT scan. Gao Feng thought he would find something, but the result disappointed him.

The patient had no pneumothorax, no pulmonary embolism, and even the original pneumonia was relieved a little.There is some pulmonary edema. As for how the pulmonary edema is caused, whether it is caused by pneumonia or heart failure, everyone's opinions are very different.

If the patient's heart function is not good, blood will accumulate in the lungs if the pump cannot go out, and pulmonary edema will occur at this time. The entire alveoli should be filled with air, but now they are filled with water, and the patient will appear hypoxic. , causing breathing difficulties.

But the problem is that Hu Meili should not have heart failure. She was in good health before, without coronary heart disease and other heart diseases. sick.

If it is really severe myocarditis, then the previous examination should reflect it, or it may have progressed from ordinary myocarditis to severe myocarditis all at once.So why does myocarditis occur?Is it caused by viral infection?

"I think the murderer is still on the heart side, and the pneumonia may just be a bystander." Ren Qinglin, the doctor in charge of the severe disease, said.

Seeing that nothing could be discussed, the director of the ICU decided to arrange a multidisciplinary consultation in the afternoon, inviting the Department of Respiratory Medicine, Department of Cardiology, Department of Infectious Diseases, Department of Hematology, and Department of Gastrointestinal Surgery to discuss it together.

Before the discussion started in the afternoon, everyone went to see the patient. With the support of the ventilator, Hu Meili was breathing smoothly, her blood pressure was stable, and her abdominal muscles were not tense.

Qin Hao whispered to Gao Feng: "I think it's not bad to work in a severe case. You can see that Dr. Ren won't be scolded by Hu Meili."

She wanted to scold, but now she was taking sedatives, she was in a sedative state, and she was still intubated, so she couldn't speak, Gao Feng thought.

The director of the Department of Infectious Diseases believed that infectious diseases such as dengue fever and scrub typhus should still be considered, but these related tests were all negative.

"I think a bone marrow biopsy can be done. The patient's platelets are declining progressively. If a hematological disease is suspected, such as leukemia and lymphoma, a bone marrow biopsy can give the answer." A director of the Department of Hematology said.

A director of the surgery also expressed his opinion. He still thinks that the patient is not an acute abdomen and probably has little to do with the surgery.This is the case with the surgeons, as long as they can't use a knife, it doesn't matter to them.

Gao Feng is also quite confused at this meeting. Judging from Hu Meili's blood routine recheck today, the number of white blood cells is still high, and she is still having repeated fevers.If bacterial infection is considered, it means that current antibiotics are ineffective.

But in fact, piperacillin-tazobactam combined with levofloxacin injection is already a strong anti-infection combination.

"No way, let's do a high-throughput gene sequencing of pathogenic microorganisms." The director of the infection department spoke.

This is a very expensive examination. Simply put, a tube of blood from a patient is taken and sent to a laboratory for examination. The laboratory can analyze all the gene fragments of pathogens known to humans in the blood.

Apart from being expensive, there seems to be no other disadvantages.

"It's a bit expensive." Doctor Ren, who was in charge of the bed, was a little embarrassed.

"Doctor Ren, are you new to work?" The director of the infection department asked curiously, "It's the first time I've seen an ICU doctor who thinks the examination is expensive."

"The cost of your day is almost 8000, right?"

Everyone laughed, Dr. Ren really just started working, and he was used to the poor life of a medical student, so the situation has been unable to open up for a long time.

Hu Meili's husband is very active, "If the man is gone, it's useless to keep more money, let's check!" He has no plans to change his wife in the near future.

As soon as the discussion was over, a nurse came in, "Doctor Ren, there is an erosion around the anus in bed 3, please come and see later." Bed 3 is Hu Meili.

"Perianal erosion?" Gao Feng, who was about to leave, was taken aback for a moment, "Let me go and have a look." He stood up.

Indeed, Hu Meili has a small ulcer focus of 0.5 cm x 0.5 cm on the perianal area. If the nurses did not take care of it carefully, it would be difficult to find it under normal circumstances.

Gao Feng was suddenly blessed. He hurried out and called Director Zhai of the Infectious Diseases Department, "Director, come and take a look. I think her erosion is like the eschar unique to scrub typhus."

"What?" Director Zhai immediately turned back, "Let me see!"

"It's true, very similar." Director Zhai stared at it for a long time, "But usually it should appear in the armpits and groin, and the perianal area is really rare."

The key is that the patient's Waifei test is still negative, and no one can be sure whether it is scrub typhus at the moment.

"I suggest using doxycycline directly against Rickettsia infection." Gao Feng said, "The Waifei test can be rechecked several times, didn't we also perform high-throughput gene sequencing of pathogenic microorganisms, Let’s wait for the results to come out.”

"I totally agree!" Director Zhai of the Department of Infectious Diseases looked at Gao Feng approvingly. She felt that this young man had a clear mind and dared to express his thoughts. What a talent!

After taking doxycycline, Hu Meili's condition improved significantly, and the peak temperature of her body temperature dropped, and it did not exceed 39°C.In the afternoon of the next day, the results of high-throughput gene sequencing came out. There were hundreds of gene sequences of rickettsia, and the truth finally became clear that the patient was a scrub typhus.

"Waifei's test was negative twice, so no one can blame it." Qin Hao said, "It must be her own bad luck."

What he said is actually not bad. The Waifei test also involves a problem of positive rate, and all tests are not 100% possible.This is also the case with scrub typhus. One week after the onset of the disease, the positive rate of the test is not high, but if it is two weeks later, the positive rate of the test will soar.

"You should check more times." Dong Qianqian said.

"Hehe, she scolded me as a black-hearted doctor every time blood was drawn." Qin Hao felt very wronged, "This woman even scolds Director Nie, I can't help her."

"Then she has been punished." Dong Qianqian smiled, "The experience of being in a severe illness will definitely make her unforgettable."

Hu Meili has suffered a serious crime. Now she has a urinary catheter, gastric tube, central venous catheter, and endotracheal intubation, and a lot of instruments are attached to her body.
In fact, 70% of patients transferred from severe illness will suffer from post-ICU syndrome, with symptoms such as inattention, fear, anxiety, and weakness.Many patients require specialized psychotherapy, sometimes for a long time, and some patients always recall this painful experience.

One week later, Hu Meili was transferred from severe illness. She is generally in good condition, but lost a lot of weight.However, his temper has also improved a lot. Qin Hao was not scolded even when he went to the ward rounds, which made him somewhat uncomfortable.

When she was discharged from the hospital, Hu Meili also sent a silk banner, "Doctor Qin, I apologize to you. It was because of my bad attitude that I caused you trouble." She said this sincerely. Although she is in a state of sedation, she can hear the voices from the outside world.

Qin Hao went to see her several times, and although he occasionally spoke ill of her by the bedside, she could feel that the doctor sincerely hoped that she would get better.

Hu Meili said that she is not a person who holds grudges, "I can't remember the 2 sentences you called me "serve it", 4 sentences "shrew", and 13 sentences "old woman".

Qin Hao
Hu Jiaran gave half a month's leave to his subordinates, and after working for nearly 5 months, the big guys couldn't stay any longer.Coupled with the fact that so much money has been issued recently, people have to go out to spend, otherwise my brother's promotion will not go up, and the country's development will be easily restricted.

He also went back to the provincial doctor today, planning to ask Gao Feng about his next work direction.Moreover, Li Youliang said on the phone that Zhao Xingye was very dissatisfied with his privately promised bonus, which made him feel a little uneasy.

"Stop! Why are you running a red light!" A traffic policeman stopped him, "Didn't you see the traffic light?"

"I see." Hu Jiaran said.

"I saw you and barged in?!" Comrade traffic police were very angry.

"I only saw the red light, but not you." Hu Jiaran confessed honestly.

The traffic policeman handed him a small flag, "You just stand here, and you can only leave when you catch the next one."

Hu Jiaran stood for more than 20 minutes before catching a passerby who had no eyesight, and the other party started having sex with the traffic police.

"Why are there so many things? I am responsible for the problems, so leave me alone!"

"I just want to control you!" The traffic policeman was unhappy now, "You are not allowed to leave until I catch two people today!"

　This chapter is for today, going to a meeting.

　　
　
(End of this chapter)