This doctor has a system

Chapter 386 451. The towering peak formed the day after tomorrow

For this kind of cerebral hemorrhage, even if they undergo surgery, many people will remain in a coma for a long time.

Sometimes family members will ask, our family can open its eyes, but cannot understand speech and cannot communicate. Will this situation get better over time?

Most likely it is not possible. This is essentially a coma, medically called coma with open eyes.

The most common cause of cerebral hemorrhage is hypertension combined with arteriosclerosis. We may not be able to intervene in advance for arteriosclerosis, but blood pressure can be detected and controlled early.

Unfortunately, many patients know that their blood pressure is abnormal and very high, but they do not control it with medication.

As soon as you said it, he said he was fine.

What about "I'm not dizzy!" "It's medicine that's 30 percent poisonous." "Once you take it, you become dependent."

The main theme is that a person can do whatever he wants, but he will start to regret it when he is paralyzed on the bed due to cerebral hemorrhage. At that time, he can't help but pull his trouser pockets.

If the family members didn't find out, the feces and urine would have been dried by Nuan.

Does a normal electrocardiogram and cardiac enzymes mean there is nothing wrong with the heart? Gao Feng didn't think it was necessarily the case. After thinking about it for a while, he called the acting director here. After all, the other person was from the Department of Cardiology, and his depth of knowledge on the cardiovascular system was definitely better than his.

My son was very nervous and took him to the hospital for various examinations. The doctor formulated a plan. Once he took the antihypertensive medicine, his blood pressure was very well controlled, so he was told to go back and take the medicine on time and monitor his blood pressure regularly.

After checking the relevant guidelines, Gao Feng found that this situation is not uncommon and has been described in many case reports.

It is generally said that if you can eat, it means you are in good condition.

After my cousin bought a blood pressure monitor, he went to work in other places with peace of mind. During this period, I called my father to ask about his blood pressure and was told that everything was normal.

Although the diagnosis of such patients is difficult, the prognosis is not bad.

You should know that even people with normal blood pressure have a certain probability of cerebral hemorrhage.

However, after detailed questioning, it was learned that the patient did not take the medicine on time at home.

"Currently, we are still thinking of pleurisy." He said to the man, "I'll call a doctor from the pain department to come over for a consultation later to see if they have any good ideas."

2. Small infarct area: The myocardial infarction area is too small, the infarction thickness is insufficient, and the ECG vector is too small to be detected by the instrument.

"Old Coconut, where is your pain?" Gao Feng asked.

Dr. Ye was also helpless. The man was the son of the chest pain patient that morning.

However, although patients with myocardial infarction with normal electrocardiograms have a relatively good prognosis, there is still a certain mortality and adverse event rate.

Before Gao Feng, a cousin in the village was like this. During the physical examination, his blood pressure was 170/110mmHg and he was diagnosed with grade 3 hypertension, which is high risk.

That was a patient in his 50s who was admitted to the hospital because of episodic chest tightness and chest pain for 12 years, which worsened and was accompanied by profuse sweating for 4 hours.

Electrocardiograms were recorded immediately, 6 h, 20 h, 50 h and 68 h after admission, and all were normal. Testing of serum myocardial marker concentrations immediately upon admission was negative.

After listening to his words, Gao Feng suddenly felt enlightened. He felt that this patient might also be in the same situation.

When Gao Feng and the others returned to the department, they found that Dr. Ye was communicating with a patient's family about his condition.

"Dr. Ye, the patient still has pain?" he asked.

Li Youliang, who followed Gao Feng, found it quite funny, but he didn't dare to laugh at this time.

After the family members left, Gao Feng walked up.

The doctor felt very puzzled, how could he still have cerebral hemorrhage if his blood pressure was so well controlled? Could it be just bad luck?

Fortunately, the cousin's bleeding was not heavy. After recovery, he was only paralyzed on one side of his limbs. It was not a problem to move around on his own with crutches.

He felt that he was not dizzy and that taking medicine would hurt his body, so he stopped taking the medicine without telling his son, and the blood pressure monitor was not turned on a few times.

Sure enough, there was another hidden cause of this patient's illness.

"I think we still need to review the electrocardiogram and myocardial enzymes." Gao Feng said to Dr. Ye after returning, "It shouldn't be pleurisy. I feel that there is a high probability that there is something wrong with the heart."

Dr. Ye now began to wonder whether the diagnosis was wrong or whether there were other reasons.

Gao Feng immediately went to see the patient again. The latter was sitting on the bed and crying. His wife peeled an apple for him, and he took it and gnawed it while crying.

Speaking of this man, he felt a little helpless. In fact, his father usually cried a lot, but this time it must have been severe pain. He had never seen him cry for so long at home.

Now he is fine. Not only does he have to take antihypertensive drugs, but he also takes a lot of other drugs every meal. At this time, he is no longer afraid of harming his body by taking medicine. He is very honest and takes medicine on time more than eating.

"Yes," Dr. Ye sighed, "I have been depressed for a long time. Whenever I come to the department these days, patients or family members come to see me."

"What's going on with my dad?" The man in a black shirt was a little anxious. "It still hurts. He keeps crying in the house."

Antibiotics and painkillers were administered, but without any relief.

The myocardial marker concentration test turned positive two days later, and the patient was finally diagnosed with acute myocardial infarction based on the patient's clinical history of ischemic chest pain and the dynamic changes in serum myocardial marker concentration.

"Strange pain: Huo Jianguo's tears in the past few days have wetted several towels. His condition does not seem to be that simple. Please help him find the cause of the pain. Completing the task will earn you 15 skill points. Failure will not be deducted. Skill points." The system issued the task.

The chest pain was accompanied by radiation to the arms and back, and it felt like it was a heart problem. However, the patient's electrocardiogram and cardiac enzymes were normal, which was puzzling.

As a result, 4 months later, my cousin suffered a cerebral hemorrhage.

"But there's nothing wrong with the electrocardiogram." Doctor Ye frowned.

The normal ECG after myocardial infarction is likely to be due to the following reasons: 1. The recording time is too early: ECG changes in the hyperacute phase of AMI occur within minutes to hours. Due to the short time, all indicators of ischemia, damage and necrosis have not yet appeared. At this time, ST-T may have no specific changes.

"That's not necessarily the case," the acting director said, "The last time I had a patient, the electrocardiogram was normal when he was admitted to the hospital, but he was later found to have a myocardial infarction."

"This is it." The patient pointed to his chest, "But now my left arm and back are also a little painful."

This patient also experienced radiating pain today. Gao Feng felt that he should be more cautious. He could review the electrocardiogram and myocardial enzymes regularly to see if there would be any changes.

Dr. Ye felt that what he said made sense, so he asked the students to do an electrocardiogram on the patient every two hours and check myocardial enzymes every four hours.

Six hours later, at about 6 p.m., a graduate student received a call from the electrocardiogram room just after performing an electrocardiogram on the patient.

"Report the critical value, considering acute inferior wall myocardial infarction."

"Strange pain: Although the process is not perfect, you still played a part in the patient's clear diagnosis. You have obtained 5 skill points."

This is too little! Gao Feng was a little dissatisfied. Should I do the electrocardiogram on the patient myself? What is my current status?
There is nothing smart about this system.

But he had other thoughts at the moment, so he called the acting director over the next day.

He was very positive about his call as acting director. Gao Feng was the noble man in his destiny. "I have an idea." Gao Feng said straight to the point, "Can we do a retrospective study and statistics on this myocardial infarction patient with normal electrocardiogram performance?"

"Based on the first ECG taken at the time of treatment, see what proportion of patients had normal ECG performance at that time."

The acting director was very interested in this and said that we would discuss what to do after returning.

But not long after, he called Gao Feng and said that this statistics was not easy to make.

Because the first department where such patients go to see them is often the emergency department, and the emergency department used to have old-fashioned electrocardiogram machines.

"Without archiving, it will be difficult to find out any information over time." The acting director said to Gao Feng, "The new electrocardiograph can find previous data, but it has just been used for more than a year."

Hearing this, Gao Feng was a little disappointed.

"Forget it, it's not too late for you to start now." He said to the acting director, "We can combine it with other hospitals. If there are enough cases, publishing a good article will not be a problem."

"Moreover, the reasons for this situation can be studied in detail."

In addition to the premature recording time and small infarct area mentioned earlier, will there be infarction in multiple or corresponding parts of the myocardium? Because the infarction vectors cancel each other out, an electrocardiogram without pathological Q waves will appear.

Or the location of the infarction is special. It has been recorded in the literature that in some cases of left circumflex artery occlusion, there is no change in the 12-lead ECG, and in simple posterior wall myocardial infarction and right ventricular myocardial infarction, there is no obvious change in the conventional 12-lead ECG.
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Thursday morning, respiratory medicine clinic.

"What's wrong with you?" Gao Feng asked.

He now also attends the outpatient clinic alone. The reason is that Director Ma learned that he often attended the outpatient clinic with Zhang Zhengye, so he even arranged a day for him.

"My chest feels uncomfortable and I always feel itchy." The patient is a 26-year-old male who is very handsome and works as a fitness instructor. With him was a middle-aged woman who still retained her charm.

In fact, the patient just came for a visit. He mainly came with his girlfriend for medical treatment. Naturally, my girlfriend is the charming middle-aged woman next to me.

Li Youliang, who was typing on the keyboard, looked at the patient's name: Zhang Wei.

Zhang Wei's girlfriend is always worried that she has breast cancer and has to come to the hospital for check-ups every once in a while.

Looking at the towering mountain peaks, Gao Feng felt that it was not surprising that she was worried in this regard. When a person has a relatively perfect thing, he always holds it in his mouth for fear of melting, and holds it in his hands for fear of breaking.

But it is a pity that these two towering peaks were formed the day after tomorrow, which is what we often call man-made landscapes.

But how should I put it? Man-made landscapes are also landscapes. If you pay attention when playing with them, they are not much different from those formed by natural development.

This is true, Zhang Wei can testify.

The breast surgeon checked carefully and asked the patient to do a color ultrasound of the breast. If there was no problem, he sent the patient home.

Zhang Wei and his girlfriend both walked to the door of the hospital, and his girlfriend, who was still charming, suddenly stopped.

"My dear, haven't you been saying that you feel a little uncomfortable in your chest recently? Why don't we take a look together?"

Zhang Wei was actually not very happy, because the two of them planned to go to the Hilton Hotel next. The waterbed room had been reserved, and the stockings and other items were also in the bag.

"My dear, spring nights are so short," he said, "I shouldn't have a big problem with this."

He was still quite impatient. Gao Feng and Li Youliang expressed their understanding of his mood. After all, the eldest sister looked really interesting.

Some women are a little older, but they have an extra charm. Otherwise, why do we always talk about young girls seducing people and young women seducing people?

Zhang Wei had long wanted to release himself with his girlfriend, and both of his heads were filled with anger.

You have to ask, are you so depressed? When can't you release yourself? Just today?

Then you are a typical man who is full and doesn’t know how to be hungry. Zhang Wei cannot meet his girlfriend often.

The reason is very simple: the eldest sister who is still charming has a husband.

She knows very well that she should spend time with her husband. She only comes to see Zhang Wei when her husband is on a business trip.

Keep fit and applaud.

The eldest sister is still more concerned about her little boyfriend. He is caring but not clingy, which suits her needs very well.

And as a fitness instructor, she has good physical fitness and amazing waist strength. The eldest sister is in a daze a lot of the time when she is with Zhang Wei, flying up to the clouds and falling rapidly.

This feeling is something my husband cannot give me.

Zhang Wei first went to the cardiology department, but the doctor told him that nothing was wrong and asked him to go to the respiratory medicine department or general surgery department.

"Did I have a muscle strain? I usually exercise a lot."

"Expose your chest area and I'll check your lower body." Gao Feng stood up.

Zhang Wei's pectoralis major muscles are very strong and he looks very stylish, which makes Li Youliang on the side very envious.

"Where does it hurt?"

"It's right here. In fact, it can't be said to be painful, it's just that tingling feeling." Zhang Wei pointed to his left pectoralis major and said.

Gao Feng carefully palpated it and soon made a discovery.

"You need to do a breast ultrasound to check this."

Li Youliang immediately started typing on the keyboard.

"Ah?" Zhang Wei was stunned for a moment, "Why would a man like me do a breast ultrasound?"

"There is a problem." Gao Feng considered it, "Let's do it and have a look."

"Doctor, please tell me what you have to say." The eldest sister, who still retains her charm, felt that something was wrong. Why did the doctor's expression suddenly become serious.

"Then let me tell you bluntly, it is very likely that you have breast cancer." Gao Feng said.

The scene fell silent for a moment, and then Zhang Wei and his girlfriend couldn't help laughing.

"Ha ha ha ha."

"Doctor, are you mistaken? He is a man!"

"Breast cancer?! Hahaha!"

"Who told you that men won't get breast cancer?" Gao Feng said.

"

(End of this chapter)