This doctor has a system

Chapter 217 215. Drug-induced lung injury county hospital experience

"Doctor, is my wife's condition serious?" The patient's husband was very nervous. "Will something unexpected happen to her?"

Sang Hui was trembling on the side
"How can you say this in front of a patient!" Dong Qianqian was a little unhappy. This man looked like a fool.The man also felt that what he just said was a bit inappropriate, "Shall we go to the corridor to talk?" He pulled Gao Feng and was about to go out.

"Don't!" Sang Hui said, "Just say it here. You can scare me to death if you talk behind my back."

...

"It's not that serious." Gao Feng was a little dumbfounded.

"It should be drug allergy." He said aloud. "The cause of difficulty breathing is lung damage caused by drugs, that is, drug-induced lung injury."

"You have completed the Bourne Identity mission and you have gained 20 skill points."

"Then why is the application of methylprednisolone sodium succinate ineffective?" Dong Qianqian expressed her puzzlement, knowing that the effect of hormones on drug allergies is still very good.

"It's hard to say. It's possible that the patient is not sensitive to hormones." Gao Feng guessed, "If that doesn't work, let's change the medicine and use epinephrine instead."

Adrenaline is a hormone secreted by the human body.When a person experiences certain stimuli (such as excitement, fear, tension, etc.), this chemical is secreted, which can speed up breathing (providing a large amount of oxygen), accelerate heartbeat and blood flow, and dilate pupils, providing more energy for physical activities. make the response faster.

Epinephrine is a hormone and neurotransmitter released by the adrenal glands.It increases the contractility of the heart, dilates the blood vessels of the heart, liver, and muscles, and constricts the blood vessels of the skin and mucous membranes. It is a must-have to save dying people or animals.

The drug of choice for anaphylactic shock is epinephrine.

But this patient hasn’t reached this stage yet, right?Dong Qianqian was a little suspicious, but she was convinced by Gao Feng, and immediately ran to give a doctor's order.

Adrenaline is a high-risk drug. Unless it is a rescue situation, you have to give oral medical advice at ordinary times, and the nurse will not give you any trouble at all.

"0.3mg epinephrine subcutaneous injection?" The bed nurse confirmed the doctor's order, and Gao Feng nodded.

About 15 minutes later, Sang Hui's dyspnea symptoms were significantly relieved, and her breathing rate also dropped, which made everyone smile.

However, half an hour later, the patient had difficulty breathing again. Dong Qianqian's face sank, "What should I do? Is there something wrong with the diagnosis?"

"Probably not." Gao Feng pondered for a moment, "Maybe the dose of the drug is too small, which has a lot to do with the patient's constitution."

He pondered for a moment and decided to give the patient a continuous intravenous infusion of epinephrine 0.2 micrograms/minute for 12 hours, and at the same time, give the patient 80 mg methylprednisolone sodium succinate intravenously for 3 days.

Soon, Sang Hui's symptoms of dyspnea were relieved. Three days later, Dong Qianqian stopped using the above-mentioned drugs. The patient no longer had symptoms of dyspnea and was successfully discharged after 3 days of observation in the hospital.

Drug-induced lung injury accounts for 5%-7% of systemic adverse drug reactions. Common drug-induced injuries include drug-induced pneumonia, drug-induced asthma, drug-induced pulmonary edema, and drug-induced pulmonary fibrosis.

"Her symptoms are progressive dyspnea, and wet rales can be heard in the lungs during physical examination, which is consistent with the diagnosis of drug-induced pulmonary edema." Gao Feng said to Dong Qianqian, "When the situation is more serious, the electrocardiogram will also change, such as Generalized ST-segment depression."

However, it is obvious that Sang Hui's situation is not that serious.

Gao Feng was quite busy in the next week. Director Shen assigned him a task and asked him to cooperate in recording the routine operations of bronchoscopy, including lavage, brushing, and biopsy.

At present, bronchoscopic technology is relatively popular, and many city-level and county-level hospitals want to take advantage of this shareholder wind to fool hospital leaders into purchasing equipment for routine development in the future.

Director Shen asked people to collect bronchoscopy reports from many hospitals and found that there were many problems. Almost every hospital's respiratory department had its own various "original" templates.
"Youliang, you can do the bronchoscopy report specification." Gao Feng put down the pick, "I can't do it."

Li Youliang smiled and agreed. He was a bit of a thief and directly copied the template of Xiehe Hospital. At the same time, he also incorporated part of the template of the Provincial Hospital's bronchoscopy room.

"You are very efficient!" Director Shen was very happy. "This template is very well done, and it clearly shows the capabilities of our large tertiary hospital." She talked for a long time, and then left with the template.
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"Is this a county hospital?" Li Youliang was a little shocked. The county hospital in their hometown was like a town health center compared with this one.

The brand new and tall hospital building even had dry-hanging stones on the outside. The two of them roughly counted it and found that it was 16 stories high. The hospital area was very large, spanning two streets. Gao Feng even felt that it was a bit provincial. up.

He was invited to come to Pingshan County Hospital today to guide the operation of bronchoscopy, and Li Youliang drove to accompany him.

"Welcome Professor Gao to come to our hospital to guide our work!" Vice President Ma of Pingshan County Hospital was very enthusiastic. He was a little surprised to see such a young Gao Feng at first, but he quickly adjusted.

"Let me show you our new hospital area first." Vice President Ma looked very proud. He was lucky to catch up with the opportunity of the country's strong support for the county hospital. The layout of the emergency building is completely copied.”

No wonder there was a sense of familiarity, Gao Feng and Li Youliang suddenly realized.

"We are going to build a lake here," said Vice President Ma. "If the scenery in the hospital is beautiful, the patients will feel better. The hospital is their warm home."

Just fart, Li Youliang thought, no matter how beautiful your hospital environment is, patients spend most of their time in the hospital bed. If their condition improves, they will be discharged directly. How can they have time to relax and play by the lake?

And this sweet home...

How much money can you spend living at home?
"Oh, this lake is the finishing touch!" He echoed, "It just connects the park here to the rockery and bamboo forest over there. There are mountains, water, flowers and forests! I have to praise us. The leaders of the hospital have great taste, you have put real effort into planning, wonderful!"

"Yeah, right!" The smile on Vice President Ma's face suddenly became a little brighter. Good guy, I met someone who knows the goods!

No wonder he is an expert at such a young age. Just by looking at the people around him, he can tell that he has several skills.

"Teacher Gao!" Yang Guanghui from the Respiratory Department finally spoke to Gao Feng. He had just returned from the bronchoscopy room of the provincial hospital for two weeks. Gao Feng's visit this time was also the result of his urging the director of the department to facilitate it.

When I was in provincial medical school, I felt that I had learned almost everything, but when I came back to work on my own, I felt that it was not easy.The other doctor studied at the First Affiliated College, and his level was much worse than him.

"We have a few patients, and we would like to ask you to teach us step by step." Yang Guanghui was a little embarrassed, "We had a massive hemorrhage after we came back, and now everyone is not in the mood to do anything."

The head of the department here, surnamed Liao, also paid great attention to Gao Feng's arrival. He said a lot of polite words and kept his attitude very low.

The bronchoscopy room of Pingshan County Hospital is simply a replica of the bronchoscopy room of the Provincial Hospital. The placement of their main computer, anesthesia machine, flat car, and computer is exactly the same as that of Room 1 of the Provincial Hospital’s bronchoscopy room.

The first patient had a foreign body in the trachea. The patient had a green dragon on his left and a white tiger on his right. He looked like a social person at first glance.

My eldest brother accidentally choked on a peanut while drinking. He was scared to death and came to the hospital crying. Chest CT examination has now been improved.

From the film, it can be clearly seen that peanuts have fallen into the basal segment orifice of the right lung.

The anesthesiologist saw that everyone was here, asked for instructions, and quickly turned the patient over.

"You have frozen ones, how easy it is." Gao Feng signaled Yang Guanghui to get started.

"Pull the probe out a little further, otherwise the freezing will easily damage the mirror."

With so many people watching, Yang Guanghui was a little nervous at first, but as soon as he heard Gao Feng's voice, he inexplicably relaxed, just like he did in the bronchoscopy room of the provincial hospital.

"Okay, come out." Peanut was lifted and slipped out smoothly.

"This seems very simple." Vice President Ma was very happy. "It is effective for the hospital to send them out to study."

"That's right, it all depends on the leader's foresight!" Director Liao instinctively flattered him.

Net fart!Yang Guanghui thought to himself that when he and his colleagues went out to study, Vice President Ma's tone was neither yin nor yang.

"Are you able to learn new technologies?"

"Can you recoup the cost of buying such an expensive instrument?"

"You're so ambitious, you guys can't recognize yourselves!"

The second patient was an elderly male, 68 years old, diagnosed with lung mass.

Gao Feng looked at the film and felt that he should be able to see it directly under the microscope. The mass was most likely to be in the lumen.

Sure enough, after bronchoscopy, a cauliflower-shaped new organism was seen at the bronchial tube opening of the left lower lobe, and it was covered with a layer of pus. This situation is almost like lung cancer.

Yang Guanghui gently touched the new cauliflower-like creature with biopsy forceps, and blood immediately seeped out, which made him feel nervous.

"What are you stunned for? Clamp!" Gao Feng was a little strange, why was he hesitating?

"Why don't you come?" Yang Guanghui was a little embarrassed, "I'm afraid of too much bleeding."

Gao Feng was a bit dumbfounded. How could a biopsy not bleed? The tumor itself had a rich blood supply, and all the tumors could grow were blood vessels.

"It's okay, just do it, I'll watch it for you." He encouraged.

Yang Guanghui calmed down, adjusted the angle, and signaled the nurse to open the pliers, "Okay, clamp!"

Then more blood seeped out.

"This" Director Liao couldn't sit still. He is a conservative person and is most afraid of medical disputes.

Vice President Ma was uncomfortable seeing such a bloody scene, so he said hello and left.

The sentence he is most afraid of hearing now is: A good living person went to the hospital to be treated for life and death.

Although there is a high probability that this patient has lung cancer, he walked in by himself when he was admitted to the hospital. If he gets here, the family members may not accept it.

"It's okay. Inject some thrombin and rinse with ice-cold salt water." Gao Feng said softly. In fact, the bleeding was not much, but because the camera was close, the magnification effect gave people the feeling that blood was pouring out instantly.

Yang Guanghui quickly signaled the nurse to do as he was told, and soon the bleeding stopped.

“Continue clamping and take at least 3-4 pieces of tissue.

The nurse quickly handed the forceps to the operator Yang Guanghui, who continued to adjust the angle. The subsequent operation was relatively smooth. Although there was bleeding every time the forceps were removed, the specimen was taken very well.

We should do this less often in the future, Director Liao thought to himself. Seeing the blood coming out of his trachea, he felt very anxious.

The behavior and handling style of a department doctor is closely related to the personality of the department director. When the department director is conservative, most of the doctors below are like this; when the department director has a strong desire to explore new knowledge and technology, other doctors in the department will also like to try new ones. stuff, and taking risks.

The last patient was relatively simple. On imaging, he was considered to have tuberculosis, but the acid-fast sputum smear was always negative. The purpose of having a bronchoscopy was to collect the lavage fluid for examination.

To be honest, Gao Feng was a little disappointed. It was too simple and did not reflect his level at all.

"Don't you have patients who can be treated under the microscope?" he asked.

"No, it's all transferred to you." Yang Guanghui replied honestly.

high wind
It seems that it is a bit difficult for county-level hospitals to provide endoscopic treatment. The current bronchoscopy technology here is just in its infancy, and it is really not appropriate to aim too high.

A group of people came out of the bronchoscopy room. Director Liao had already booked a restaurant. "The local chickens we have here are excellent. You can try them later. If they taste good, I will have them packed and taken back."

Just as he was about to go downstairs, the system suddenly rang.

"Race against time: Liu Fengnian's condition cannot be objective. Please help him get a clear diagnosis quickly to facilitate subsequent treatment. You can get 15 skill points by completing the task."

Damn it, who is Liu Fengnian?Gao Feng was dumbfounded.

He quickly looked around and saw that there were quite a few patients. This was the outpatient clinic building, with a sign for the Department of Otolaryngology hanging opposite.The benefits of being mentally strong were now revealed. Gao Feng quickly spotted an elderly man who was being supported by someone, and depending on the situation, he was going to take the elevator downstairs.

"What's your name, old man? Are you feeling uncomfortable?" He walked up quickly.

"My name is Liu Fengnian. He said he was dizzy early in the morning, maybe rhinitis." Liu Fengnian's son subconsciously replied, "Hey, who are you?" When he saw Gao Feng not wearing a white coat, he immediately felt a little wary. Heart.

Isn't it a medical assistant?He usually watched a lot of short videos, but this person didn't look like him. It would be a pity for such a handsome man to be a doctor. Wouldn't he make more money by being like that?

Director Liao and a group of people gathered around him, "Professor Gao, do you have any questions?"

"I feel like there's something wrong with this patient." Gao Feng didn't know how to start.

"Is this your dad?" Director Liao asked, "What's wrong with him?"

"No, what are you doing?" Liu Fengnian's son asked.

"We are all doctors here." Director Liao said, "Which doctor did you see just now?"

Soon Director Dong from the ENT Department rushed over, and Gao Feng learned from his words that Liu Fengnian had severe rhinitis and had been to the ENT Department many times.

Early this morning, he began to have obvious symptoms of nasal congestion, dizziness, and headache. After applying budesonide nasal spray at home, there was no relief. Bian came to the hospital for treatment under the leadership of his son.

"I checked his head CT and found nothing abnormal." Director Dong of the Department of Otolaryngology said, "At first I was worried that it was a cerebrovascular disease."

"I just have rhinitis." Liu Fengnian also said at this time, "When I had the attack before, the symptoms were exactly the same as now."

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(End of this chapter)