This doctor has a system

Chapter 436 501. A dark and bright future
"Did you receive rabies vaccinations at that time?" Ma Liang asked.

"No, I went to the dog injury clinic and she thought it was expensive."

What does hydrophobia mean? Others may not know it, but Ma Liang himself is frightened.

He has been working in the emergency department for a long time and has already encountered two patients who were afraid of water. Both of them were eventually diagnosed with rabies and both died.

Rabies, once developed, is fatal.

Ma Liang had no doubt about this, so he was afraid.

He reluctantly told the patient's husband that the patient might have rabies.

The patient's husband turned blue when he heard the news. He was not a doctor, but he had probably heard of rabies. You probably also know that once rabies occurs, no one will survive. I was speechless for a long time.

"It's not confirmed yet. I'm just suspicious, highly suspicious." Ma Liang said.

"Also, I need to tell you in advance that the patient is now having difficulty breathing. If it is really rabies, the difficulty breathing will continue and gradually worsen." Ma Liang tried to keep his tone gentle.

"He's around." Li Youliang said.

"What should we do? Admit him to the ICU directly?"

It has been almost a day now, and the paralysis period will begin next. By then, the patient will have respiratory and circulatory paralysis. If he is not put on a ventilator, he will definitely die.

"Are you sure?" Gao Feng was a little unconvinced, "I just heard you say that she was bitten by a friend's dog."

"Take it up first. I estimate that the patient will need to be intubated soon." Gao Feng pondered for a moment and said.

Why are rabies patients afraid of water?
This mechanism seems to be complicated. It is speculated that the virus invades certain parts of the brain, which control the patient's throat and swallowing movements.

How does pneumonia explain hydrophobia? cannot.

Gao Feng listened and could only agree with Ma Liang's interpretation. After all, hydrophobia is a really important trait.

"That's the female patient." Ma Liang pulled Gao Feng aside, and he explained the patient's condition in detail.

Rabies explains everything.

"What else are you reporting? Hurry up and push them over!" Director Dong Zhida's slightly irritable voice came from the receiver, "Hurry up! We can't let the patient die in our emergency department anyway!"

"She may need tracheal intubation and ventilator-assisted ventilation later. Do you agree? If not, she may die soon due to lack of oxygen."

Just as he was hesitating, his cell phone rang.

Dr. Guipei, the male doctor next to him, did not speak and listened quietly. He had just read a book. The book said that the characteristic of hydrophobia is very important, and it can basically be equated with rabies. After all, rabies also has a name called hydrophobia.

Seeing this situation, Ma Liang didn't know what to do.

However, Ma Liang’s personal experience is that most of the patients whose chest CT scans are not severe but have severe symptoms are elderly, and few young people have such a situation. Therefore, Ma Liang himself does not agree that pneumonia causes patients to have difficulty breathing.

"Where's your boss?"

Director Dong had drunk a little wine and was a little confused, but when he heard it was rabies, he woke up on the spot.

"I have to report to my superiors." Ma Liang called the director while asking people to prepare.

Ma Liang hurried to communicate with the patient's husband. The other party's brain was completely shut down now, and he kept begging him to save his wife.

"Invite him over quickly!" Ma Liang said urgently, "I have a patient here who may have rabies. Ask him to come over and take a look at it for me."

"The patient has typical symptoms of hydrophobia." Dr. Guipei interjected at this time.

"Brother Liang, let's go have a drink after get off work tonight." Li Youliang's voice came over, and Ma Liang was instantly overjoyed.

If the patient is really rabid, then it should be the excitement phase. During the excitement phase, patients will have hydrophobia, hallucinations, etc., which will last for 1-2 days.

The patient's breathing is a bit rapid now, and the oxygen saturation is still barely adequate. This is because of high-flow oxygen inhalation, and he may have to be intubated and put on a ventilator in 10 minutes.

Ma Liang understood Gao Feng's suspicion, so he reanalyzed his condition.

For a rabies patient with laryngospasm, swallowing water is tantamount to suicide, because the water may accidentally enter the trachea and cause suffocation. So people with rabies are afraid of water.

Gao Feng still didn't believe it. Could it be that he had encountered another case of rabies? You're not that lucky when buying lottery tickets.

Ma Liang nodded and acquiesced to this statement. Moreover, the patient had not been vaccinated after being bitten by a dog.

Ma Liang's brain was spinning rapidly. The task tonight was to save his life, and he had to be intubated and put on a ventilator first.

The patient has difficulty breathing, fatigue, fear of water, and seems to be afraid of light. I hope he can turn off the lights. He also has a history of being bitten by a dog, and the diagnosis is already mixed.

More and more people are bitten by dogs every year, but few get sick. Domestic dogs are still very safe, especially if they are vaccinated.

Of course, if you are put on a ventilator, you will definitely die.

"Don't cry yet. I'm just suspicious. The diagnosis requires some tests, such as checking for some antigens, etc. It will take some time. She may not have rabies. It may just be severe pneumonia." Ma Liang comforted the patient's husband.

The patient's husband was so frightened that he immediately squatted in front of a stool and cried in his arms.

The patient will have throat spasm and difficulty breathing. Once the patient thinks of water, he will think of the action of swallowing water.

No matter what the cause of dyspnea is, as long as it is severe enough, there are indications for intubation and ventilator placement. Unless, of course, it’s a pneumothorax. However, the patient obviously did not have a pneumothorax, which was also confirmed by chest CT.

The evidence for pulmonary embolism is insufficient.

In fact, he was really just comforting. In his own heart, he has basically determined that the patient is rabid.

What's more, the patient ruled out cardiac causes of dyspnea, and no obvious pneumonia was found on chest CT. Although the respiratory physician said that the chest X-ray was not serious, the symptoms could be serious. Ma Liang believed this.

The patient is so young. If the family members make a fuss in the future and say that the emergency department is not doing a good job in rescuing the patient, what will happen?

"It's a pity that this patient is only 30 years old, hey!" Gao Feng is not a sentimental person, but every doctor who encounters rabies will become compassionate because he is powerless.

This feeling is the most helpless.

"The family demands active rescue at all costs." Ma Liang's tone was heavy, and the latter followed the patient's husband, who was crying and red-eyed.

One night, I thought it was ordinary pneumonia, but I didn't expect it to be rabies. This kind of separation between life and death came so quickly that no one else would be able to bear it.

"When was the dog bitten?" Gao Feng couldn't help but ask, "Where was the bite?"

"Last year, at our friend's house, he seemed to have bitten his lower left leg." The patient's husband wiped his tears.

"Is there any bleeding?" Gao Feng asked again.

"It doesn't seem like... I don't remember much. I drank some wine at the time." He was very upset. Gao Feng then thought, it would be better to ask the patient directly. So I returned to the emergency room, walked to the patient's bedside, and said hello to the patient.

He lifted up the quilt and pants and repeatedly checked both sides of the patient's calves, but found no obvious bite marks or scars.

Gao Feng's actions made the patient a little dissatisfied, but when he saw Gao Feng's face clearly, his expression changed from dissatisfaction to unnaturalness.

"What are you checking for?"

"My husband said you were bitten by a dog at a friend's house last year. Where was the bite? Was there any bleeding at the time?" Gao Feng asked directly.

The patient was still conscious at this time. Although his breathing was fast, he could barely speak a word or two.

"The bite was not severe at the time, and the skin was not broken. It was blocked by my clothes," she recalled.

The patient also tried to lift up his trouser legs, but it seemed that his hands were not strong enough to lift them up.

Ma Liang was confused when he heard this. Then several people looked at each other.

This information is so important. It is a fact that you are bitten by a dog, but if the skin is not bitten, it is absolutely impossible to contract rabies.

"Have you ever been bitten by a dog in the past few years?" Ma Liang asked.

The patient took a breath and shook his head slightly with certainty.

"No more. Just that one time, the bite wasn't serious." After saying that, his eyelids were about to droop, as if he was about to close his eyes and sleep. She spoke in a very low voice and seemed unable to even raise her head.

Gao Feng immediately became vigilant. Could it be that he was severely hypoxic and his brain was suppressed? When he looked up at the ECG monitor, his blood oxygen saturation was still 97%, which was better than before.

The plot is reversed.

The patient's words were so impactful that even Ma Liang himself began to doubt the diagnosis of rabies.

If the patient clearly remembers that he was not bitten by a dog, and the skin was not even bitten, how could he have rabies?

His husband said he was bitten by a dog, but he was drunk at the time and was confused, so it is possible that he could not remember clearly. Medical history is more reliable if told by the patient himself.

Of course Ma Liang knew this.

But if the patient is not rabid, why does he show fear of water? Ma Liang was a little confused.

"The patient's pneumonia is not serious, and the difficulty in breathing should not be caused by pneumonia." Gao Feng agreed with Ma Liang's judgment.

The patient looked very weak, had no strength all over his body, and was about to fall asleep while talking.

"Is there a neurological problem?" he thought for a moment and said.

"But neurological problems are unlikely to cause breathing difficulties." Ma Liang spread his hands.

"Is there a possibility of cerebrovascular accident? A small number of cerebrovascular accidents can cause pulmonary edema, which is a neurological reflex. Patients may also have difficulty breathing and hypoxia..." Gao Feng realized it before he finished speaking. This inference is not valid.

Because no signs of pulmonary edema were seen on the patient's chest CT, a chest CT already provided a lot of ironclad evidence.

The two of them stood next to the patient's bed, watching the patient's ECG monitoring and breathing, wondering whether they should intubate the trachea and put him on a ventilator to make the patient more comfortable.

But after all, the cause of the disease was not yet known, so both of them were hesitant. Moreover, the patient's current indicators are still barely adequate, which does not mean that he must be ventilated.

"Your husband said that you had been feeling unwell before, but nothing was wrong with you. Where did you feel unwell?" Gao Feng suddenly asked the patient.

The patient's eyelids almost drooped. Hearing Gao Feng ask this question, he raised his head slightly again, as if he was trying hard to raise his head and open his eyes, but he could only raise his head slightly, and his eyes were very blurred.

"I just don't have any energy in my body and I feel very tired. I want to sleep. I will feel better in two days..."

There was something strange in Gao Feng's eyes, which was caught by Ma Liang. He realized that Gao Feng must have thought of something, so his eyes lit up.

"Do you feel better in the morning and worse in the afternoon?" Gao Feng asked.

The patient nodded slightly and seemed unwilling to speak.

Gao Feng observed the patient for a while and found that the patient's limbs were weak and had difficulty breathing. He could not even raise his head, open his eyes, or move his limbs.

Most people would think that the patient was weak due to hypoxia, but at this moment, he suddenly thought of a disease that others might not have thought of.

"Myasthenia gravis!!" Gao Feng blurted out.

The diagnosis was imminent.

The patient is very likely to have myasthenia gravis and a myasthenic crisis.

When a myasthenic crisis occurs, the most serious thing is respiratory muscle weakness and difficulty breathing. There are many types of myasthenia gravis, and almost all muscles in the body may be affected, including respiratory muscles, neck muscles, eyelid muscles, etc., so patients will be unable to lift their heads or open their eyes...

"Request a consultation from the neurology department quickly." Before Ma Liang could finish speaking, the male follower Pearson had already run towards the phone.

"Hello, neurology department? I'm in an emergency, please call for an emergency consultation!" "Yes, come take a quick look, the patient is dying!"

This trainee is very smart. He learned Ma Liang's big trick just once, and he also learned and applied it, directly changing from consultation to emergency consultation.

He is simply teachable!

Such people are naturally suited to emergency medicine.

Ma Liang and Gao Feng stared at the patient in the emergency room. After discussing it, they decided to take the first step and intubate the patient and put him on a ventilator. Otherwise, the patient would be passive if he stopped breathing.

Ma Liang went out to sign the patient's name, while Gao Feng, with the assistance of the nurse, put the patient down in a few clicks, successfully inserted the tracheal intubation, and connected the ventilator.

Seeing the patient lying quietly on the rescue bed, with the ventilator pumping air, everyone felt extremely safe. Because the patient's blood oxygen saturation rose to 100%.

Is hydrophobia not a specific manifestation of rabies?
It's really not.

For patients with myasthenia gravis, if their throat muscles are weak and their breathing is weak, they will choke and cough if anyone gives them a drink, and it is difficult to drink. When they see water, they will have a fear of drowning and suffocation, so they are very thirsty. But still dare not drink water.

The neurologist came over breathlessly. After understanding the condition, he said that it might indeed be myasthenia gravis. Patients with myasthenic crisis often suffer from respiratory failure, which is not uncommon in neurology departments.

But no matter what, the patient can be admitted to the ICU before further treatment. After all, the patient is already on a ventilator.

"You've all been intubated, why are you asking for emergency consultation?" Before leaving, the neurology doctor expressed his dissatisfaction slightly.

"Teacher, a large group of us can't understand it." The male standard Pearson said with a smile on his face, "So I can't wait to invite professionals like you to come over and take a look."

"Haha." The neurologist suddenly became less dissatisfied, "That's right. Myasthenic crisis is still very dangerous. I understand. I understand."

"What is this student's academic qualifications?" Gao Feng asked, "If he is a graduate student, he can stay with us as a general practitioner in the future."

(End of this chapter)