This doctor has a system

Chapter 435 500. The best place to learn is in the emergency department
The patient's husband seemed relieved that they were now in the hospital.

"Did you see a doctor or take medicine yesterday?" Ma Liang asked.

"I didn't go to the doctor and bought some medicine myself."

Ma Liang glanced at it and saw a box of amoxicillin, a box of ambroxol, a box of cold medicine, and several Chinese patent medicines.

The patient's husband told him that his wife asked him to buy it.

"Has she studied medicine before?"

"No, it's from Baidu." The patient said weakly on the bed.

Needless to say, the medicines I bought are quite complete. It seems that I can still get some reliable knowledge from Baidu.

Ma Liang nodded without saying anything else. He wrote the bill and asked the patient's husband to pay.

He took the order and looked at it, slightly hesitant.

This sentence is not directed at readers.

Ma Liang
"Brother, you're too much." Ma Liang was a little aggrieved. For a man whose pocket is cleaner than his face, what's the point of living?

"My wife asked me to put it all together." The man said a little helplessly, "I put in another 200 yuan myself."

"Teacher, how old is the youngest patient with myocardial infarction you have ever seen?" Dr. Guipei asked Ma Liang while pulling an electrocardiogram.

"Didn't I just give you 500 last month?" The patient was a little dissatisfied.

At this time, the blood test results also came out. The blood routine was normal and the white blood cells were not elevated.

"The ambulance fare was more than 300 just now," her husband said. "You have to pay me later."

This is even less like hypoxia and dyspnea caused by pneumonia.

The electrocardiogram results came out and there were no obvious abnormalities. I just took a blood test and the troponin test was normal. This made Ma Liang completely relieved.

"That's not a lot." Ma Liang said.

Ma Liang did not blame the patient for not coming to the hospital earlier. Blaming no longer meant anything. The most important thing at the moment was to first determine whether it was pneumonia and then deal with it accordingly.

Most pneumonia is mild, and a few can become severe. The female patient tonight probably has severe pneumonia.

"Yes." Ma Liang was very satisfied with his performance. This boy was very eye-catching and sometimes reminded him of Hu Jiaran.

The male standard Pearson curled his lips. It was probably another cheap buffet. He was very interested in it at the beginning, but now that he has eaten too much, he is not interested at all.

"I don't have any money." The patient's husband was a little embarrassed. "Please transfer some to me." He turned to the patient and said.

This gave Ma Liang a headache.

"No, you can take her home." Ma Liang said, "I don't think your wife's illness requires treatment."

"The patient's dyspnea and fatigue can be explained by heart diseases, such as arrhythmia, heart failure, myocardial infarction, etc., but at her age, it is unlikely." Ma Liang told the young doctor Guipei.

Ma Liang felt something was wrong.

Simply looking at the patient's symptoms, it seems that pneumonia is serious. But what he saw on the chest X-ray was unexpected, because such a small amount of pneumonia is unlikely to cause such obvious symptoms.

There is a certain advantage when going to the imaging department for urgent chest CT prescribed in the emergency department, that is, you can jump in line.

Could it be a heart problem?
Ma Liang's eyes just glanced at the electrocardiograph machine at the corner, and Gui Peisheng on the side immediately stepped forward and pushed the machine over.

The patient was quickly pushed over, and the results came out quickly. There was a little inflammation in the left lung.

The patient had already had an electrocardiogram on the way to the hospital, and no abnormal findings were found. Nearly an hour had passed by this time, and a review of the electrocardiogram was necessary.

"Yeah, you're the same age as me." Dr. Guipei said, "I've been feeling flustered and chest tight lately. Could it be that there's something wrong with my heart?"

Pneumonia is a very common disease, and it is not uncommon for young people to suffer from pneumonia. They usually have symptoms such as cough, sputum, chest pain, fever, hemoptysis, etc. In severe cases, shortness of breath may occur.

"Then let me tell you the truth, I want to rest tomorrow." Gui Peisheng said as he took the Pichu off the patient's body.

But no matter what, let's take oxygen first, add some fluids, and use some antibiotics. As long as the vital signs are stable, there is time to diagnose and observe slowly.

"Teacher Ma, do you want to do it again?"

"I agree, but the director doesn't agree." Ma Liang said, "There is bad news. There will be a meeting tomorrow. You all have to go and listen. The good news is that you are in charge of the meal."

"The electrocardiogram is normal and the troponin is not high. In addition, the patient said there was no obvious chest pain and only difficulty breathing, which does not support acute myocardial infarction." Ma Liang told Dr. Guipei.

"23 is old."

"That's not the case," the man said. "She is also picky about herself. It's just because she was afraid of being poor before."

But the young female patient in front of me has no history of bed rest, pregnancy, long-term oral contraceptives and other high-risk factors. Her blood is not very sticky, so it is unlikely to be a pulmonary embolism.

Ma Liang did not consider this aspect. If necessary, he could improve the enhanced chest CT examination and it would be clear at a glance.

"Last month I paid 7800 yuan," the man said.

"If you want to rest tomorrow, just say so. How can I not let you go?" Ma Liang glared at him.

"Go quickly." Ma Liang urged, "Why are you in such a daze?"

After the man left, Ma Liang looked back at the patient again. The patient was still half-sitting and listless. Ma Liang told her not to be nervous, she would be much better with some medicine.

But there probably won't be any big problems, Ma Liang thought to himself, because the ECG monitoring can also roughly see that the ECG situation is basically stable, but the ECG monitoring is very rough and definitely not as good as the ECG. Therefore, the ECG Still gotta do it.

Generally speaking, in addition to pneumonia, patients with dyspnea should also consider lung cancer, pulmonary embolism and other lung diseases.

"Will there be myocarditis?" Dr. Guipei asked. Severe myocarditis can also cause difficulty breathing and even sudden death.

"Do you think it looks like it?" Ma Liang asked him without raising his head, while carefully studying the patient's reports.

"I think it is still possible. The patient has a history of upper respiratory tract infection." Guipeisheng analyzed. "At this time, dyspnea, fatigue and other symptoms appeared. We took a CT scan and it showed that the pneumonia was not serious. At this time, we still need to be alert to heart problems. , if it is not myocardial infarction, then myocarditis still needs to be considered.”

"If it's myocarditis, the patient's troponin should also be elevated." Ma Liang said with squinted eyes.

"Teacher, I have seen myocarditis with low troponin and sudden death." Dr. Guipei's eyes widened and he looked at his teacher and said seriously.

Ma Liang wanted to say a few more words, telling him that a low troponin level could basically rule out myocarditis, but thinking that there were no absolutes in the world, it was possible that some patients might have symptoms before the abnormal test results, so he didn't say anything more. The cause of the patient's dyspnea is not clear. Although the pneumonia is not serious, the only thing that can be found so far is pneumonia. There is insufficient evidence of myocarditis. Myocardial infarction has been basically ruled out. There is no basis for heart disease in the past, and it is estimated that he will not have heart failure.

Generally speaking, cardiac causes are less likely, while pulmonary causes are more likely.

"Next, I'm going to increase my skills." Ma Liang said to the two trainees following him, "If you want to do emergency medicine in the future, you must study hard."

The two trainees were shocked when they heard this, and they quickly watched attentively what he would do next.

"You have just been here two days, so you may not be familiar with it yet, but let me tell you, once this technique is used, there is an 80% chance of solving the patient's problem if it succeeds."

"What if it fails?"

"Don't be afraid if you fail, because this move has no cooldown, no CD time, and can be used repeatedly."

The two students looked at each other, a little excited. They say that you can learn the best things in the emergency department. Look, this is where it comes from!

Ma Liang raised his arm, quickly walked to the triage table, and then picked up the phone.

"Hello, cardiology department? I'm in the emergency department. I need a consultation." "Yes, come and take a look. The patient is in trouble."

"Hey, respiratory department? I'm in the emergency department, please call for a consultation." "Yes, there is inflammation in the lungs. The patient is feeling very uncomfortable right now. Come and have a look quickly."

"Did you learn it?" He turned to the two students.

"Teacher Ma, some students said you were a joke before." said the male student, "I didn't believe it at first."

"Do you think this skill is easy to use?" Ma Liang asked.

Although the skill is useful, it is not without side effects.

The side effects of activating this skill during the day are relatively small, and people usually complain about it, such as: What level are you at? Is this a disease in our department? Or is there something wrong with you? Do you need to call me over?
The side effects of activating this skill at night, especially late at night, will be severe, and the eighteenth generation of your ancestors may be insulted.

The respiratory physician and cardiologist came one after another, and the emergency department requested a consultation, which they had to get. And when they heard that it was a patient who had difficulty breathing, they usually rushed there as soon as possible.

After seeing the patient, the respiratory physician believed that the diagnosis of pneumonia was established. Some patients' chest CT does not look serious, but their symptoms may be very serious, which is understandable.

In other words, the patient may have difficulty breathing and hypoxia caused by pneumonia. In addition, pulmonary embolism cannot be ruled out. If possible, a chest CTA is still required to rule out pulmonary embolism, but it seems unlikely at the moment and is only a consideration.

The typical pulmonary embolism is the triad of dyspnea, chest pain, and hemoptysis. The patient currently only has dyspnea, no chest pain, and no hemoptysis. In addition, the electrocardiogram results show no signs of pulmonary embolism, so it is not very supportive of pulmonary embolism.

The cardiologist came and said that it was unlikely to be myocarditis or myocardial infarction because there was insufficient evidence.

The patient's electrocardiogram showed a fast heart rate, which was a sign of hypoxia and was not necessarily a heart problem. There are too many reasons that can cause the heart rate to increase. Fever, anxiety, tension, pain, fear, lack of oxygen, and dehydration can all cause a fast heart rate.

In addition, the electrocardiogram is basically normal, and no cardiac hypoxia process can be seen, so myocardial infarction can basically be ruled out. However, there is no absolute, and dynamic observation can be performed. If necessary, the electrocardiogram, cardiac enzymes and other indicators can be reviewed.

"I don't think it's a heart problem." Ma Liang said.

"Then you still let me come!" The cardiologist said speechlessly, "You are sick!"

"Then he will be admitted to the Department of Respiratory Medicine and treated as pneumonia for the time being." Ma Liang told Dr. Guipei. As for whether to do chest CT enhancement, it depends on what they want and let them do it.

After all, there are specialties in the art industry.

At this time, the patient waved to indicate that he wanted to drink water and said he was thirsty. Her dyspnea seemed a little better at this point, but not much.

After struggling all night, it was normal to feel thirsty. Ma Liang was afraid that she might have a heart problem, so he didn't dare to drink too much fluid, so she must be short of water.

Ma Liang asked Dr. Guipei to pour her a glass of water.

The patient took the cup, pulled off the mask, paused, and then raised his head to take a sip of water. She had just taken half a sip when she suddenly spat it out with a whoosh.

With a bang, the cup fell to the ground.

This frightened Dr. Guipei and also frightened Ma Liang.

The two of them looked back at the patient, but saw that she looked extremely frightened, her lips were trembling, and there were still water stains on the corners of her mouth. The water spilled on the ground, making it wet.

"What's wrong?" Dr. Guipei stepped forward and asked the patient with concern, "Is it hot to the touch?"

After saying that, he himself was puzzled. It was obviously warm water, not hot.

The patient did not speak, his throat moved a few times, and he seemed to have swallowed a sip of water. He looked panicked and his eyes were blurred. My breathing became more rapid, and my blood oxygen saturation dropped to 88%.

Doctor Guipei quickly helped her put the mask back on and increase the oxygen flow.

Ma Liang saw all this.

This is really too bad!
A nurse rushed in after hearing the noise. She thought something had happened. Seeing that the ground was wet, I quickly came over with a mop to clean it up.

Dr. Guipei told the patient to get her a glass of water, since there was plenty of water anyway.

The patient didn't know where the strength came from at this time, and grabbed him.

"No, no, no more, I'm not thirsty anymore," she said.

When she said this, her lips were dry, and any fool could see that she really needed moisture.

As soon as the patient moved, his heart rate increased faster, approaching 140 beats/min, and the ECG monitor sounded a sharp alarm.

Ma Liang got a little closer to the patient and asked her if she found the light irritating and whether she would like to turn off some of the lights so that she could have a good rest.

The patient was frowning, breathing heavily, and seemed to have difficulty lifting a breath, which was extremely laborious.

"It would be best if you can turn off the light." After finishing speaking, she paused, "It doesn't matter if you don't turn it off."

Ma Liang signaled her to stop talking and take oxygen.

Ma Liang motioned to Dr. Guipei to look at her, while she walked out of the emergency room and found the patient's husband. Ask him if the patient has been bitten by a dog recently.

The patient's husband was very confused about Ma Liang's question and thought about it for a long time.

"No, I haven't heard her say anything about this."

"If you think about it carefully, in the past few months, or in the past few years, have you had a dog in your family, or have you come into contact with dogs at neighbors' homes, on the roadside, etc., or have you ever been accidentally bitten..."

"When you say that, it seems like there was really one time..." the patient's husband tried to recall, "Last year at a friend's house, she was startled by a puppy and seemed to be bitten, but it didn't seem serious at the time..."

(End of this chapter)