This doctor has a system

Chapter 514 577. Fulminant Myocarditis
“Those quack doctors said I wasn’t sick and refused to give me an IV,” Third Grandpa said dissatisfiedly.

He had long become a celebrity in the village and the town's clinic, and every doctor shook his head when he saw him.

Some people are curious about him. Isn't it said that overusing antibiotics can cause health problems? Why is this old man still alive and well despite taking so many antibiotics every year? He seems to be fine.

"Then it's no use for you to come to me." Gao Feng said, "The control of antibiotics here is quite strict. You can't use drugs without indications."

Gao Feng wanted to send him away quickly.

"I understand. You mean I have to get sick, right?" asked Third Grandpa.

Looking at his calm face, Gao Feng was a little puzzled.

"Xiao Gao, why don't you give him some transfusion?" The third grandfather's son was a little helpless, "Otherwise he will deliberately not wear clothes and catch a cold, and then..."

high wind
Are you so stupid?
Gao Feng remembered that he had been beaten by such a person when he was a child, and he felt a tightness in his chest.

"You can find someone else." He turned and left. Behind him, he heard his third uncle scolding him, as if saying that he was an ungrateful bad boy.

Gao Feng made an appointment with Director Lu to have dinner today, and Director Zhou Shuming of the General Surgery Department was also present.

The latter is also well-known in the hospital. He has a hot temper and is known as "the workaholic".

He had previously fought with the anesthesiologist in the operating room, then ran to the office building and cursed his superiors, and even had a physical fight with patients and their families in the outpatient building.

It's because he has high skills and long experience, otherwise he would have been dismissed from the hospital long ago.

Leaders don't like such troublemakers either.

This is also why Director Zhou has a lot of honorary titles and is highly capable, but is just an ordinary team leader.

"I don't care about being the director. It's just a bunch of shit." Although he said that, Gao Feng still felt that he was a little aggrieved.

How could a man not aspire to a higher position?

Director Zhou’s temper has improved a lot over the years, but he is also old, so it can only be said that he woke up a little late.

"Director Gao, please take a look at this film."

Director Zhou also had other purposes for coming to eat. "The hospital downstairs said they couldn't rule out malignancy and asked for a biopsy."

He consulted several directors of the imaging department and found that their opinions were not unanimous.

"My mother-in-law is old and her mind is a little confused." Director Zhou said helplessly, she might not be able to cooperate with CT-guided puncture.

The doctor at the hospital below suggested doing it under anesthesia, but the old man had a lot of underlying diseases and his children were worried about the risks.

Another thing is that the old man is old, and even if it is a malignant tumor, there may not be much that can be done. Director Zhou does not agree with the puncture.

"It's too much trouble to ask them to bring the old lady to the provincial hospital."

Gao Feng looked at it carefully. "What are the symptoms? Fever, cough?"

"Yes, I have fever, cough, and blood in my sputum. It has lasted for 7-8 days. I was treated with cefuroxime sodium at the hospital downstairs."

"It should be Legionnaires' pneumonia." Gao Feng said, "You can adjust the antibiotics, maybe macrolides or doxycycline."

The patient's imaging features are quite obvious, but the doctors in the hospitals below probably rarely see them.

The conditions of the laboratory departments in primary hospitals are not good. There are not enough equipment, and some projects can only be carried out with difficulty. The positive rate of bacterial culture is extremely low, and there is nothing that can be done about it.

Sometimes, even if the patient's disease is cured, the attending physician cannot tell what pathogen caused the disease.

Anyway, it’s okay to be confused, the purpose has been achieved.

Director Zhou quickly wrote down Gao Feng's words and prepared to communicate with the doctor over there later.

As they were chatting, Director Lu's cell phone rang.

He frowned and took a look, "What are you doing? I'm not a second-tier player."

Although a little dissatisfied, Director Lu still picked up the call.

After hanging up the phone, he sighed, "Hey, there's work, I have to pick up a patient."

When he stood up, he glanced at Gao Feng and said, "Director Gao, why don't we go together? The patient will probably need ECMO transfer."

Ms. Liu comes from the hometown of Liang Shanbo and Zhu Yingtai and is a teacher by profession.

Her fate is the same as Zhu Yingtai's, which is also a bit tragic.

One day last year, she developed symptoms such as chest tightness, palpitations, shortness of breath, and dizziness. She was diagnosed with "fulminant myocarditis and acute coronary syndrome" by the local hospital. She was put on ECMO at the time and was eventually successfully removed from the machine, and her body returned to normal.

Although it cost a lot of money, she still felt very fortunate.

After all, money is just external things, and life is the most important.

Six days ago, Ms. Liu developed symptoms of coughing and general fatigue after catching a cold. She was diagnosed with "respiratory tract infection" at the local community hospital and did not see any improvement after oral medication.

After going around the county hospital, he was told to go to the city center hospital immediately.

After arriving at the City Center Hospital, he was again diagnosed with fulminant myocarditis.

The second bout of fulminant myocarditis was much more serious than the first. Ms. Liu's blood pressure plummeted and large doses of active drugs could not maintain it. Local hospital experts urgently used ECMO to save her life.

But even so, her condition is not optimistic. Her vital signs have not stabilized and her life is now hanging by a thread.

Local hospital experts immediately sought help from higher-level hospitals.

"I was invited to the consultation last time." Director Lu said to Gao Feng, "This female patient is very tenacious. At that time, I thought there was little hope."

But unexpectedly, the patient’s condition stabilized quickly after being put on ECMO, which was a relatively good outcome.

According to the attending physician this time, the situation seems to be more serious and there is a high probability that relatives and friends will have a feast.

"Xiao Ma, drive faster." Director Lu urged, "I know this is not your limit."

"Director, this is indeed not my limit." Xiao Ma said with a look of "you know me well", "But this is the limit of this car. Don't you think it's a little floating?"

He was really a little bit arrogant. Director Lu didn't dare to urge him this time.

The ambulance quickly arrived at its destination.

The patient's consciousness was blurred and his limbs were cold. Even someone who didn't know much about medicine could tell that he wasn't going to live long.

"Oh, this." Director Lu was in a dilemma. The risk of transportation was too great. What should he do if the transportation was interrupted halfway?
"Director Gao, what do you mean?"

Gao Feng took a look at the conditions in the intensive care unit here. It was not bad, but it was definitely not comparable to the provincial hospital.

“It’s in very bad condition, but you can try.”

Ms. Liu's husband was very positive about the treatment, after all, his wife was still very young.

"Transfer is risky." Director Lu communicated with him.

“But if he is not transferred, he will just be waiting to die.” The patient’s husband was a little desperate. The doctor from the CCU of the City Central Hospital had talked to him before, and the doctor said in one sentence: there is little hope.

"Let's switch it." He regarded the experts from the provincial hospital as his last straw. "No, there's something wrong with the machine." Gao Feng went forward and adjusted the parameters of the ECMO machine, and soon found the cause. The machine was not faulty.

Rather, there was a problem with the placement of the tube, which may be the reason why the patient did not achieve good results after using ECMO.

But it was a remarkable achievement for the hospitals below to be able to use ECMO, a high-end technology. In addition, Gao Feng didn't know much about the situation at the time, so he didn't have any opinions about the doctors here.

He thought about it and called Director Lu over.

"Re-insert the cannula?"

"Yes, there is a problem with the tube. It would be too risky if we don't re-install it." Gao Feng explained. It would take at least three hours to get to the Provincial Hospital from here, which is still too long.

Director Lu called the familiar director aside, and the other director felt a little embarrassed.

"Director Lu, this is a pipeline problem." He said in embarrassment, "You know, we don't have much experience."

They don't do even one case a year. If the patient couldn't do it, they really wouldn't want to do it.

"It's okay. The main reason is that the machine we transported needs to be re-inserted. Director Lu said, "You can communicate with the family members."

"Okay!" The other party breathed a sigh of relief.

Soon the bedside was filled with people. Knowing that the expert from the Provincial Hospital was going to re-intubate the patient, everyone wanted to learn on the spot as this was a rare opportunity.

Fang Yanghui is also one of them. He and the director had used ECMO on the patient before. It is said that the experts from the Provincial Hospital thought there were some flaws, which made him very concerned.

Director Lu consciously assisted Gao Feng and checked the necessary items.

Fang Yanghui had fried pork with chili peppers for dinner, but maybe it was too spicy, so he felt a little uncomfortable in his stomach now.

If you pull it at the critical moment, you will miss the live demonstration of the experts.

Thinking of this, he hurried to the bathroom. He thought that he would be able to come back in time in a few minutes at most.

In his impression, the average operation time for ECMO implantation is at least 20-30 minutes, and 5 minutes is the maximum for the beginning.

After I finish unloading the goods and get ready, I will definitely learn all the superb skills of these provincial medical experts without missing a single detail. He fantasized while unloading the goods.

When I returned to the ward, just 6 minutes had passed.

But the scene at the scene made him a little overwhelmed. A bunch of people were whispering to each other, and the director surnamed Lu was fixing the pipeline.

"Why don't you do it?" he asked. "Is there something wrong?"

"Done," a colleague said to him with a complicated tone.

"That's nonsense!" Fang Yanghui said, "It's only 6 minutes. Can we get on the plane in 6 minutes?"

"I thought it was a joke before," said the colleague, "but didn't you see it was like playing a video game? It was too fast!"

He was dazzled by what he saw and now felt a little dizzy.

"Director Lu, you guys..." The director of the City Central Hospital didn't know what to say, "You're awesome!" He said this twice in a row.

"Professor Gao Feng is the fastest to use ECMO in our hospital," said Director Lu with a smile. "It would take me at least 20 minutes."

"Oh, I see." The director of the City Central Hospital felt better. He had been doubting his life just now.

Is the gap between us and provincial hospitals so big?
Ms. Liu was lifted onto the ECMO transfer vehicle. The driver, Xiao Ma, drove at full speed this time and arrived 20 minutes ahead of schedule.

Although the patient's vital signs were relatively stable on the way, her condition still required urgent treatment.

The mortality rate of severe fulminant myocarditis is very high and it is very difficult to treat, not to mention that it was the second time the patient had the disease. The patient was pushed to the cardiac intensive care unit as soon as he got off the car.

The CCU was immediately filled with tension. Faced with such a dangerous disease, several directors with rich experience in treatment had already been on high alert and began to instruct medical staff to carry out a series of effective treatments.

The patient's condition had just improved a little, but at this moment the perceptive Gao Feng discovered something unusual.

"The blood pressure seems to be dropping." He said, "Nurse, take a look at her pants. Is that blood?"

"Blood?" Director Lu was stunned for a moment. Where did the blood on the pants come from?

The nurse lifted it up and took a look, and immediately exclaimed: the patient's lower body was bleeding heavily.
"The medical record says that she had a uterine curettage two months ago." Gao Feng said quickly, "Hurry up and ask the obstetrics and gynecology department to take a look. It seems that it was not cleaned up properly!"

Now there was chaos again. Director Lu called the ultrasound doctor to perform bedside color ultrasound, and the results confirmed Gao Feng's judgment.

A director of the obstetrics and gynecology department hurriedly performed a uterine curettage on the patient.

"Oh, this is my first time to perform uterine curettage on a patient in the CCU!" she said depressedly, "It's really... Oh!"

It is a huge challenge to perform uterine curettage for patients with fulminant myocarditis under ECMO support.

What is even more worrying is that the patient woke up at this time and was struggling in a daze.

The two nurses quickly held the patient down. Gao Feng looked very anxious. After thinking for a moment, he also went up.

With a little effort from both hands, the patient immediately calmed down.

"Doctor, can you be gentler?" the patient said, "Is it okay if I don't move? Woo woo woo."

To ensure the smooth progress of the operation, a nurse held the patient's hand tightly, giving her comfort and encouragement.

As the operation went smoothly, a large amount of blood clots and residual tissue were cleared out, and the director of obstetrics and gynecology finally breathed a sigh of relief.

It was already past 8 o'clock in the morning when all this was done. Gao Feng didn't feel anything yet, but the elderly Director Lu could no longer bear it.

"No, I need to go to sleep for a while." He said hello to Gao Feng and went straight into the duty room.

Just as I was hesitating whether to go home, Bu Zhengyang called and said he needed to see a patient.

No wonder doctors are prone to sudden death, Gao Feng thought.

The patient is an old patient of the general practice. This time he suddenly developed chest pain at home, so his family members brought people directly to the hospital.

"It just suddenly started to hurt here." The old man pointed at his stomach and said, "I haven't eaten anything in the past two days."

"Doctor, why don't you do a gastroscopy for my dad?" the patient's son suggested. "It hasn't been done in several years. He had a gastric ulcer before and had bleeding."

"Is the stool black this time?" Gao Feng asked.

“It’s not black.” The family member replied.

"Director, look at this film, I think something is wrong." Bu Zhengyang pulled up the abdominal CT scan that the patient had just undergone.

He compared the CT scan of the patient one year ago and felt something was wrong, but he couldn't put his finger on it, so he thought of calling Gao Feng.

Gao Feng took a closer look and his expression changed immediately.

"Zhengyang, go take the old man to do an aortic CTA first, and push the wheelchair!"

"Then please consult with the cardiothoracic surgery department urgently."

(End of this chapter)