This doctor has a system

Chapter 565 628. Parrot Fever Again

Originally, they wanted to transfer him to the infectious disease department, but the doctor in the infectious disease department took a look at the old man’s heart, which was in a mess, and said that there were not enough beds, so they suggested finding someone else.

"Isn't this inappropriate?" The cardiologist expressed his dissatisfaction, "How can you refuse it just because the patient is troublesome!"

"The key is that we can't solve the heart problem." The infectious disease doctor had his own reasons, "Look, he was having atrial fibrillation yesterday."

If this case is reported to the infectious department, then if there are any problems, we will still have to consult the cardiology department.

"If it doesn't work, just continue the treatment here and we'll come over to check on you often." The infectious disease doctor suggested.

"That won't work." The cardiologist disagreed. Their department admitted very few patients with fever, and sometimes they were confused about the antipyretic drugs.

This is not an exaggeration. Due to the huge division of specialties in these large tertiary hospitals, many doctors have in-depth knowledge of diseases in their own field, but their understanding of diseases in other departments is not even as good as that of doctors in county hospitals.

In a word, the depth is sufficient, but the breadth is clearly insufficient.

"Then you should switch to respiratory medicine or general medicine!" the infectious disease doctor said, "Call Bu Zhengyang. They don't have many patients, so they probably won't refuse."

"That's right!" The cardiologist slapped his thigh, "With Director Gao in charge, treating a fever is a piece of cake!"

"exactly!"

When Bu Zhengyang learned about the situation, the patient was already on his way to be transferred to another department. There were indeed quite a few empty beds in the general department, so he didn't have any major objections.

"We are now using Tezhixing, q8h." Mao Wenhui reported, "but the old man still has repeated fevers."

Young people can't stand having a fever, let alone the elderly. The patient has had a poor appetite in the past few days, his body has been gradually losing weight, and his condition is getting worse and worse.

"But the family members are easy to communicate with, and the whole family respects the medical staff."

Meeting such a sensible family member, Mao Wen worked very hard, hoping that the patient would get better soon. He called Gao Feng yesterday.

Gao Feng took a quick look at the patient's test results. When he was admitted to the hospital, his temperature was 38.9℃, pulse was 110 beats/min, blood pressure was 124/78mmHg, white blood cells were 6.40*10^9/L, neutrophils were 4.9*10^9/L, and blood sugar was 19mmol/L...

Procalcitonin 2.84ng/ml, erythrocyte sedimentation rate 59mm/h.

CT showed bilateral lung inflammation and a small amount of pleural effusion on the left side.

"Let's go see the patient." Several people went to the ward together.

After entering, Gao Feng immediately smelled a fishy odor, which made him frown. What was going on?
"I caught this fish." The patient's son smiled and said, "It's big now!"

"Just stay here and take care of me, don't run around!" Mao Wen scolded him.

The patient's son is addicted to fishing and he would go fishing whenever he has nothing to do. This time when the old man came to the hospital, he prepared for a rainy day and brought a fishing rod with him.

"What a filial son," Li Youliang thought.

The patient's spouse takes care of him during the day, while his son goes out fishing. He comes back at night to work the night shift, so his schedule is fully scheduled.

"Aren't you tired?" Gao Feng asked.

"I won't feel tired as long as I can catch some fish." The patient's son replied, and he carried out a white bucket from the side, which contained several big fish.

"Do you want it?"

It can be seen that the other party's fishing skills should be quite good.

"Don't fish these days." Mao Wen said to him, your father is going to die, why are you catching so many fish? For the banquet?

The old man lay weakly on the hospital bed. His temperature was 38℃. The nurse gave him ice, but his temperature was still rising.

"How do you feel now?"

"I feel weak all over, have a headache, body aches, feel anxious, suffocated, and have a cough and phlegm," the old man replied.

Gao Feng listened carefully with a stethoscope and could hear some fine moist rales in the lungs. The heart rate was also a bit fast, which should be caused by the increased body temperature.

He performed a detailed physical examination on the patient and was able to feel some swollen lymph nodes in the armpits, but found nothing else special.

"Student, please tell me why this patient chose piperacillin-tazobactam instead of levofloxacin to control the infection." Gao Feng said to a yawning intern.

"Well, the patient has diabetes. Levofloxacin belongs to the quinolone class of drugs, which can affect blood sugar and may cause hypoglycemia." The resident trainee replied, "And there is no evidence of mycoplasma infection so far."

"Well said." Gao Feng thought that the other party must have yawned because he studied too late at night. "Do you think there are other things that need attention for this patient?"

This question is a bit beyond the scope, but this slightly older-looking intern performed very well.

"Diabetic patients should consider the possibility of Enterobacteriaceae infection, but I asked the patient and his family yesterday, he has no experience of long-term hospitalization, and has no history of ESBL colonization or infection."

"We are still waiting for the results of blood culture and drug sensitivity."

"Well, you can tell at a glance that he has read the book." Gao Feng praised, "But the patient has been treated in other hospitals before, so some of his symptoms may be masked. In addition, he has underlying diseases. We must pay close attention to his condition and treat the symptoms in a timely manner."

To be honest, this patient is quite strange. He had a fever more than half a month ago and was receiving intravenous treatment at the local county hospital. His family members did not explain the specific situation, but there was no major problem with the chest CT scan at that time.

This chest CT scan showed bilateral infection, but it was not specific and it was difficult to draw any valuable information from the imaging.

If the old man does not have any serious heart problems, it would be more appropriate to do a bronchoscopy and send the lavage fluid for inspection, which may yield something valuable.

"The anesthesiologist said the risk is too great and he won't give me anesthesia," Mao Wen said.

"Then let's try local anesthesia." Gao Feng suggested.

The risk of local anesthesia is relatively small, of course, this has a lot to do with the operator's skills. When doing bronchoscopy under local anesthesia, if the doctor's skills are not proficient, the patient will suffer a lot. Some paralyzed patients can jump out of bed.

Mao Wen asked the doctor from the bronchoscopy room to come over, but it was not going well. Not to mention irrigation, as soon as the scope was inserted, the old man started to pull the bronchoscope violently.

A bedside mirror costs 20 yuan. The doctor who performed the operation was scared to death and refused to continue doing it no matter what.

"Doctor, that's too uncomfortable." The old man said with a bitter face, "It's like choking on a chili pepper, I can't stand it!"

"Try it again. If it really hurts, just raise your hand and I will stop immediately." Gao Feng said.

After his and Mao Wen's strong persuasion, the old man finally agreed to try again.

The composition of the bedside bronchoscope is actually very simple. It is basically a fiberoptic bronchoscope and a movable light source. After arriving at the ward and plugging in the power supply, the light source starts working. After connecting the bronchoscope and then the negative pressure drainage bottle, the doctor can perform the operation.

However, the field of view of this mirror is not good, and the doctor needs to look through the eyepiece at the front end of the bronchoscope to see the real situation under the mirror.

The mirror can be inserted through the patient's mouth or nostrils, but the nostrils are generally chosen now. The reason is very simple: entering through the mouth is not very friendly to the mirror.

Some patients will bite the mirror when they are anxious. If the optical fiber of the bronchoscope breaks, it will cause heavy losses.

Moreover, it is difficult for patients to make corresponding compensation in this situation.

Gao Feng stood at the head of the bed and picked up the bedside mirror. Mao Wen stood by his side as he assisted him and injected lidocaine into the syringe.

This is the most economical method. The human glottis is very sensitive to external stimuli. The mirror, as a foreign body, will cause obvious discomfort to the patient when touched, leading to severe coughing.

Therefore, a lidocaine injection is usually placed above the patient's glottis to provide surface anesthesia.

After injecting lidocaine, Gao Feng paused for about ten seconds, and then decisively inserted the mirror into the airway while the patient's glottis was wide open when he inhaled.

The next step is easy. He manipulates the bronchus to push it forward and try to keep the endoscope in the center of the airway. This can reduce irritation to a certain extent and alleviate the patient's discomfort.

"There is some white purulent secretion." Gao Feng gestured to Mao Wen to connect a sputum collector so that the aspirated material could be sent for examination.

He suctioned out all the visible secretions and performed lavage on the left lower lobe bronchus, which had the most severe imaging findings.

"It's not uncomfortable this time." The old man gave Gao Feng a thumbs up, "You are very good!" "It's okay." In response to this compliment, Gao Feng wanted to cure the disease.
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Zhao Xingye was looking at the financial statements in his study. The operating conditions for this quarter had been summarized and analyzed by professional personnel, and he needed to sort them out again.

At his position, he doesn't need to do most things himself, but there are some things he must do himself. Otherwise, once the people below find out that you can be easily fooled, then there will definitely be problems next.

"The prospects are very bright!" After reading the report, Manager Zhao came to the living room in a happy mood. Today was the day to pay public grain, and he needed to ask his wife to see if she had any needs in this regard.

Zhao Xingye's wife had just finished helping her son with his homework and was having a heart-to-heart talk with him.

"What if your wife quarrels with your mother in the future and says bad things about her?"

"She has already said that you are not good, you should change quickly," said the son.

"What if it's not my problem?"

"If it's not your problem, then just don't take it to heart." The son said, "Why bother with a child?"

"Can't you take care of your wife? Don't you think about how hard it is for your mother?"

"It's your husband's problem that you have a hard time. It has nothing to do with me." The son said confidently, "Why, will your life be easier if I don't marry a wife?"

"When you quarrel with my grandma, why don't you think about how difficult it is for my grandma?"

"When have I ever quarreled with your grandma?" Zhao Xingye's wife said, "We are as close as sisters!"

The child's grandmother couldn't help but curl her lips and said, "Yes, yes, you are right."

"In that case, why did you quarrel with my wife?" Zhao Xingye's son was a little puzzled.

"I"

"Also, I can't control my wife," the son continued.

"Why?!"

"Can my dad control you?" asked the son.

"Wife, do I need to take a shower?" Zhao Xingye asked.

"Go wash it! Go wash it now!" the wife shouted, "The old one is useless, we must have another one!
The next morning, as soon as Gao Feng arrived at the department, Mao Wen came to him.

"Director, it's the same patient again. His condition got worse last night!"

The patient had a high fever again at night, 40℃, with obvious chest tightness and atrial fibrillation. The doctor on duty worked on him for most of the night before he felt better.

"The oxygen saturation has also dropped. I am breathing oxygen now, and my pulse oxygen is only 89%."

This situation was obviously not good, and Gao Feng was a little worried. If oxygen and blood could not be maintained, tracheal intubation or mechanical ventilation would probably be necessary.

There are many side effects of endotracheal intubation, including ventilator-associated pneumonia, multidrug-resistant bacterial infection, and difficulty in extubation.

Gao Feng has always been cautious about tracheal intubation unless it is necessary.

“When will the results of bronchoalveolar lavage fluid NGS be available?”

"They said it would be tomorrow." Mao Wen said.

"Is it so slow?" Gao Feng was a little dissatisfied, but he also knew that this could not be rushed.

"Please bring up the chest CT scan so I can take another look."

Still unable to see anything, Gao Feng frowned. No abnormalities were found in the patient's sputum culture, blood culture, fungal culture, and virus-related screening.

Mycoplasma pneumoniae, Chlamydia pneumoniae, Coxsackie virus, Epstein-Barr virus, respiratory syncytial virus, and Legionella pneumophila were all negative.

Mao Wen, as the attending physician, was also a little anxious.

"Director, do you think we are heading in the wrong direction?"

"Does the patient actually have a non-infectious fever? Or is it tuberculosis or pulmonary embolism? The patient keeps saying he has a headache, so maybe it's a neurological problem?"

Gao Feng was also a little hesitant at this time. Could it be that the fever was really caused by non-infectious factors?

Non-infectious factors can indeed cause fever, common ones include drug fever, tumor fever, hyperthyroidism, dermatomyositis, rheumatoid arthritis, systemic lupus erythematosus, and leukemia.
But overall, this patient does not quite meet the criteria.

Based on the chest CT and yesterday's bronchoscopic findings, Gao Feng felt that infectious factors should still be considered.

"What should we do then? Wait for the NGS results?" Mao Wen.

It seems that this is all we can hope for, Gao Feng sighed. Fortunately, the results will be out tomorrow, and the patient should not have any major problems in one day.

"Why not go and take another look at the patient?" Mao Wen suggested.

The old man looks better now, with a heart rate of 98 beats per minute and oxygen saturation of 93%. His wife is feeding him an apple.

Seeing the doctor coming in, the patient's son quickly came forward and said, "Doctor, can I have a word with you for a moment?"

"Will my dad make it this time?" He looked very serious. "I still have two older sisters. Should I ask them to come over now?"

"It's hard to say." Mao Wen glanced at Gao Feng when he said this, "It's okay to let them come. If there is any accident, there will be no regrets, right?"

"That's right." The patient's son immediately ran to make a phone call.

"Grandpa, do you have any poultry at home? For example, chickens, ducks, cows, sheep, pigs, etc." Gao Feng asked.

"No, we don't have any animals at home," the patient's spouse replied. "We live in the county town, and we don't have a place to keep these things."

Gao Feng was not too disappointed with her answer. He had actually asked this question when collecting the medical history before. He just wanted to confirm it again.

Just as I was about to go out, the old man suddenly said, "The neighbor does have one."

"Oh?"

"The pigeons are on the roof." The old man said, "What a lack of manners!"

"What are you raising?!" Gao Feng stopped suddenly.

"Pigeons, just the common kind."

"We can't usually dry our quilts!" the old man complained. "If we're not careful, they'll be covered in shit."

"I understand!" Gao Feng pulled Mao Wen over and asked, "How did you collect the medical history?!"

"Ah?" Mao Wen.

"What?" Gao Feng said to him dissatisfiedly, "You didn't even ask for such crucial information!"

If anyone who has had contact with pigeons develops a long-term fever, psittacosis should be ruled out immediately.

Parrot fever is sometimes called bird fever and is usually transmitted through contact with birds.

It is a zoonosis caused by infection with Chlamydia psittaci. The disease mainly occurs in birds or poultry such as parrots, seagulls, ducks, and turkeys, and often manifests as diarrhea or asymptomatic latent infection.

Humans are usually infected by inhaling gases or dust containing pathogens or by close contact with sick animals. Patients often have symptoms related to respiratory infections, such as chills, fever, cough, and chest pain. A few have symptoms of severe pneumonia, such as dyspnea and hypoxia.

"I asked, but he didn't say that." Mao Wen felt a little aggrieved. He actually asked the patient if he had ever come into contact with any birds, and the other party's answer was: no.

"There is indeed no contact. When I see pigeons, I always walk around them from a distance." said the old man.

(End of this chapter)