This doctor has a system

Chapter 303 292. Acute myocardial infarction

"That's nonsense. What does it have to do with my socks?" Ma Chengjin was a little embarrassed. "Doctor, it's actually not that smelly. My wife is a dog and has a sharp nose."

Bu Zhengyang picked up the patient's chest CT and looked at it, then frowned.

"Doctor, is it serious?" Ma Chengjin panicked.

"No, the quality of this film is too bad." Bu Zhengyang said dissatisfied, "Why are the lung window and mediastinal window still on the same film?"

"Can you see this?"

"The community hospitals below are like this, and the price of CT scans there is also low." Wang Wenhao said, "There are advantages and disadvantages."

"Let's make another one." Ma Chengjin, a family member, said proactively. His wife's illness affected his heart. You just have to spend some money, and it's not enough if you don't spend enough.

"Just do a plain scan plus enhancement." Bu Zhengyang quickly wrote out the examination form for Teng Junxia, ​​"Wait a while after the nurse draws your blood, then you can go to the imaging department and line up to do it."

Teng Junxia didn't waste any time, but her appointment at the imaging department was still scheduled for tomorrow.

"Their business is so good!" she said with envy, "If there were even half as many people like this in my store, no! Even if it was 1/10 of the people, we would have distributed it long ago!"

"Isn't this nonsense?" Her husband Ma Chengjin rolled his eyes at her, "Where is this? The consumption level in the province is at the top, so there is no shortage of customers."

There were a few twists and turns during the enhanced CT scan. After the CT scan, Teng Junxia had a lot of red bumps all over her body, which were itchy and painful.

"It should be an allergy to iodine." The doctor in the imaging department frowned and said, "Do you have any other symptoms? For example, difficulty breathing?"

Different from ordinary CT, enhanced CT requires the injection of contrast agent into the vein when doing it. Generally, non-ionic iodine agent is used.

Some patients experience allergic reactions, with mild symptoms such as rash, nausea, vomiting, etc., and severe symptoms that may lead to severe allergic reactions, even laryngeal edema, respiratory and cardiac arrest.

"That's not the case." Teng Junxia felt a little irritated by the itch, "It's just the irritation, nothing else."

"Then go back to the ward and drink more water." The imaging doctor explained, "I'll call your doctor and ask him to give you some anti-allergic drugs."

"Drink more water. I'll give you a dose of dexamethasone and promethazine. If you feel any discomfort, please tell me in time." Bu Zhengyang explained.

Teng Junxia's allergic symptoms went away as quickly as they came. By the afternoon, her rash and itching symptoms had been completely relieved.

"There is a hole here." Bu Zhengyang pointed to the chest CT and said.

It is not uncommon for cavities to appear on CT scans, such as tuberculosis, lung abscess, fungal pneumonia, lung cancer, Staphylococcus aureus pneumonia, and Klebsiella pneumonia may sometimes cause patients to have cavities in the lungs.

"Smell the smelly socks?" Gao Feng asked.

"Yes, the patient said he felt a little uncomfortable after smelling it and developed a fever the next day." Bu Zhengyanghui reported.

"It should be pulmonary fungal disease." Gao Feng pointed to the chest CT and said, "Look, this area has halo signs, uneven density, and multi-room necrosis in the center..."

"Let's get a bronchoscopy and send the lavage fluid to NGS to identify the pathogenic bacteria!"

From the imaging point of view, the possibility of pulmonary Aspergillus infection is very high.

The follow-up results came out quickly. The results were nothing special. The bronchoalveolar lavage fluid ngs suggested pulmonary Aspergillus infection.

"Doctor, what is the reason why I have this disease?" Teng Junxia asked, "I also checked on the Internet. Don't people say that pulmonary fungal diseases are only contracted by the elderly and infirm?"

"At my age, I shouldn't be considered an elderly person, right?"

"It is indeed relatively rare for young and middle-aged people with no underlying diseases to suffer from this disease, but it is not uncommon." Gao Feng explained, "As for why you suffer from this disease, it may be related to smelly socks."

"Look! I knew this was the reason!" Teng Junxia shouted to her husband, "I told you before that I asked you to practice some personal hygiene. Now it's better!"

"Almost beat me to death!"

"I didn't let you smell it," Ma Chengjin said weakly, "It's still because your physical fitness is not good enough. I smell it every day and I haven't seen anything happen."

According to statistics, more than 90% of people like to smell their socks before throwing them away after taking them off. Some people even put their smelly feet in front of their noses to smell them.
But how can I put it, as long as you are happy, it is actually acceptable to smell it
If the feet are infected with pathogenic fungi, socks and shoes will be more likely to breed and multiply. Fungi on "stinky socks" are likely to enter the upper respiratory tract through smelling and inhaling.

Studies have shown that sweat (moisture, salt, lactic acid and urea), Staphylococcus aureus, fungi, waste keratin, etc. will remain on worn socks. People with athlete's foot may also have odorous metabolites such as white moss, so they usually In this case, socks and shoes are prone to fungus growth.

A single sock belonging to an athlete's foot patient may contain over [-] fungi!
When you inhale the gas emitted by smelly socks, the fungi on the socks will enter the lower respiratory tract through the mouth and nose along with the air. If you stay up late, are tired, have low immunity, etc. at this time, the fungi will take root in the lungs. Causes infection, leading to fungal pneumonia pneumonia!
However, pulmonary mycosis develops very rapidly. If not detected in time, the mortality rate is relatively high, and the treatment cost is relatively expensive.

Usually, if you are lucky, you will need to spend tens of thousands. If you are not lucky, you will spend half a house or a house.

No matter how bad his luck is, he will be a good man again after 18 years.

If any rich man wants to challenge his boring and boring life, he can usually smell his stinky feet.

Then some patients may ask, Comrade doctor, I usually have some special hobbies and like to play with things.
How to protect yourself in this situation?

Here, Dr. Gao warns everyone that they must do a good job of cleaning. Regardless of whether the bare feet are black, shredded or other colors, it is recommended not to play with them immediately after taking them out of high heels.

Wash them and put on a new pair of stockings. If you want to play, don't worry.

Of course, some patients have said, I just like the smell!

go away!

Then just pretend that Dr. Gao said nothing and you are happy.

The antibacterial drug Gao Feng used for Teng Junxia was voriconazole, which is a broad-spectrum triazole antifungal drug and has a good effect on invasive aspergillosis.

The disadvantage is that it is expensive, but after waiting for more than ten years, this drug will become a cabbage price after the drug procurement. As for the effect, that is another matter.

"Doctor, I have pain in my chest, and I have been coughing for the past few days." A patient hurriedly walked into the general clinic.

General practice outpatient clinics are currently positioned as general internal medicine departments. The nurses in provincial medical triage are generally more professional. Most patients are assigned to the corresponding departments, but some patients are always selected for general practice every day, which is regarded as special care.

After all, apart from some old patients, it is quite rare for patients who come here to see a doctor to sign up for a general medicine department on their own initiative.

It is also common to see a large number of patients in outpatient clinics, and some patients with milder conditions will be diverted to general practices.

In fact, ordinary patients do not need special professional doctors. They suffer from common diseases, and doctors in the community can also treat them.

"Where does it hurt? Point to me." Gao Feng motioned for the patient to sit down.

"It hurts right here, and my back hurts too." The patient pointed to his chest and back, "It hurts right here on my shoulder, too." "How long has it been hurting?"

"It's been more than an hour. In the middle, it was so painful that I couldn't breathe, but it's getting better now." The patient's face looked very pale, and his expression looked a little painful.

It can't be a heart attack!Alarm bells rang in Gao Feng's heart.

Severe pain is the main symptom of acute myocardial infarction. The pain mostly occurs in the early morning and is severe pain in the precordial area. It lasts for a long time, which can last for several hours or longer. It cannot be relieved by rest. The patient is usually restless, sweating, fearful, chest tightness or There is a sense of impending death.

The pain sometimes radiates to the shoulders and back, and some people even experience abdominal pain.

"Let's do an electrocardiogram." Gao Feng quickly made an order.

"Doctor, does it cost a lot?" the patient asked softly.

Only then did Gao Feng notice that the patient's financial situation was probably not very good. He was wearing a brown coat that was not commensurate with his figure, and there was a patch on the side. The person who repaired it must have worked hard and embroidered a few patches on the side. A small flower.

The patient's face is relatively old. Although he is only 52 years old on the electronic medical card, he looks almost like an old man in his 60s.

But what makes people feel good is that although the patient's clothes are shabby, he is clean and tidy.

"It's not expensive, just a few dozen yuan." Gao Feng handed the order to the patient, "Go and do it quickly, and come back as soon as you're done."

When the patient went out, Gao Feng still felt a little uneasy. He thought for a moment and called Li Youliang. He was at the clinic right now. Director Zhao had set up a smoking cessation clinic and he would help sort out the data if he had nothing to do. What.

"You should take this uncle with you. I think he may have a heart attack."

Li Youliang was startled, "Want to push a wheelchair?"

"No, no!" The patient waved his hand, "I can just walk, it doesn't have to be so troublesome."

"Let's push one." Li Youliang was a little worried. Myocardial infarction is a serious disease, and it is best not to allow the patient to move.

The electrocardiogram room is busy at the moment, but very orderly. Everyone queues up at the door obediently. When it's their turn, they come in, lie down on the bed, and then start to lift their clothes.
Streamlined work.

"Do it to our patient first. It may be myocardial infarction." Li Youliang shouted.

"Ah?" The fat female doctor sitting in front of the computer and giving out the electrocardiogram report suddenly became excited, "Myocardial infarction?"

"Quick, lie down!"

She grabbed the electrocardiograph from the doctor's hand and began to press the skin on the patient's body.

Several doctors gathered around, all staring intently at the electrocardiograph interface.

"Anteroseptal myocardial infarction!"

"Which clinic are we from? What's the phone number? I need to report a critical value." The fat female doctor grabbed Li Youliang and asked.

Li Youliang quickly called Gao Feng to report the situation.

"I'll tell the cardiology department that you push the patient up first, and then let the family members get admitted to the hospital as soon as possible." Gao Feng instructed.

"Old man, you have myocardial infarction and need hospitalization." Li Youliang said to the patient, "Where are your family members? Are they here? If not, tell them to come quickly!"

"My family members can't come." The patient struggled to stand up from the wheelchair. "I don't want to be hospitalized. Can you prescribe some medicine?"

"No! Your situation is quite serious. You may need interventional surgery or thrombolysis." Although Li Youliang no longer works in clinical practice, he still has basic clinical knowledge.

"I have no money," the patient's voice lowered, "I am a sanitation worker nearby, and my family doesn't have much money."

"Where is your family? Where are your children?"

"My son and daughter-in-law had a car accident early in life." The patient seemed to have tears in his eyes when he mentioned this. "My wife is also in poor health and has a grandson who is now in junior high school."

"I'll go back and discuss it with my wife first." The patient used some strength to stand up.

"Why so fast?" Gao Feng was a little curious when he saw Li Youliang pushing an empty wheelchair back. The Department of Cardiology is not close to this.

"Well, the patient said he wanted to go back and discuss it with his parents." Li Youliang hesitated and said.

"What is there to discuss about myocardial infarction!" Gao Feng was puzzled, "What's going on?"

"It's because my family has no money." Li Youliang was a little depressed, "I probably won't come again."

"What?!" Gao Feng was stunned for a moment.

"Hurry up and chase him back. He is only 52 years old. The key is he is still suffering from chest pain!"

Li Youliang quickly ran out of the consulting room.

Thanks to his speed, the patient would be on the bus soon.

"You will not be delayed for long if you come to our director. If you go back like this, you may die." He held the patient's hand and didn't let go.

The patient was a little helpless, but still followed him back to the consulting room.

"Your condition is very serious. If you don't go to hospital, your life may be in danger at any time." Gao Feng advised, "Let's go to the hospital first and talk about the money later."

"I really have no money." The patient's eyes turned red. "My family is in a bit of trouble and I don't have any extra money."

"It's okay, it's okay." Li Youliang consoled him, "Treat the disease first, and the rest will depend on the situation."

Gao Feng reprinted the hospitalization certificate. Originally, he wanted to receive it from the cardiology department, but the patient had no money, so it might not be appropriate to accept it again. After thinking about it, he changed the hospitalization department to the general medicine department.

"Zhengyang, we will be visiting a patient with myocardial infarction in a moment. You should receive the patient first and complete the necessary examinations as soon as possible. I will contact Director Qu of the Department of Cardiology and ask him to see the patient."

"His condition is short-lived and can be used for emergency intervention." Qu Mengqi carefully assessed the patient's condition and said, "He can be pushed to the cath lab now."

"I'll report to the leader." Bu Zhengyang quickly called Gao Feng, who told him to listen to Director Qu's instructions.

"Why did your department still treat myocardial infarction?" Qu Mengqi asked, "Didn't Lao Chen clearly say before that we don't want such patients?"

Wang Wenhao on the side curled his lips, how long has Lao Chen been working on the sewing machine, and Lao Chen is still here.

(End of this chapter)