Gou is practicing medicine in the clinic
Chapter 367: Four sources of air for pneumothorax, and one more is broken
Chapter 367: The four sources of pneumothorax, and another one is broken
In addition, there were no cases of caseous pneumonia or hematogenous dissemination in the chest X-ray.
These lesions must be very typical in a patient with tuberculosis that has progressed to such an advanced stage.Therefore, the possibility of tuberculosis is almost slim.
Since it is not tuberculosis, how does pneumothorax form?
Based on the symptoms and disease progression described by the patient, it can be determined that the patient first developed pneumomediastinum and then developed pneumothorax. So where did this gas come from?
Inferred from this direction, it is no longer possible to support the idea that bullae rupture or emphysema will lead to pneumothorax.
Under normal circumstances, the air in pneumothorax must come from the lungs, trachea, bronchi or esophagus.
Recall that the patient mentioned that it started with pain when swallowing food, and then gradually progressed to chest pain and difficulty breathing.
Li Jingsheng believes that the air that causes pneumothorax probably does not come from the lungs.
Then its only source is the esophagus.
Because there are only so many channels through which the human body can inhale gas.
Whether it is inhaled through the mouth or nose, it enters the body through the trachea or esophagus.
The normal path for air intake is through the trachea and then through the bronchi into the lungs.
But when you eat, open your mouth to swallow, or talk, you may ingest gas through your esophagus and into your stomach.
In this case, as long as the digestive tract is not broken, the gas has two places to go.
One is farting through the intestines, which is called gas or flatulence in medical terms.
Normal people actually excrete a lot of farts in a day, more than 1.5 liters.
And spanking is not a bad thing, it is actually good for the intestines.
There is also gas that passes through the upper gastrointestinal tract and then out of the esophagus.
A common way to do this is through hiccups.
This patient's pneumothorax should not come from the trachea, bronchi, or lungs.
The symptoms of air leakage in the trachea or bronchus will be different. When listening to lung sounds, experienced doctors may even hear a whistle or a sound similar to a tire leak.
It would be even more serious if the bulla ruptured.
The patient should not be able to delay going to the hospital for so many days.
In addition to the rupture of lung bullae to form pneumothorax, there is also a relatively rare situation that may also lead to the occurrence of pneumothorax.
The lung abscess penetrates backward into the chest cavity.
This situation can actually be ruled out.Because the patient first developed dysphagia, then chest pain, and finally dyspnea.Especially difficulty breathing.
Li Jingsheng believed that the patient's difficulty in inhaling was caused by the compression of the left lung by more than 30 degrees.
If the lungs cannot open, it also means that the alveoli cannot open, and fresh air cannot be sucked in.
In fact, after our lungs relax, we breathe fresh air into our bodies.Then it shrinks again to expel the waste gas from the body.
This is the basic working principle of the lungs.
If the patient's left lung has a severe abscess from the beginning, he should first have symptoms of difficulty breathing and painful breathing.
You may even cough up pus or blood.
Therefore, just by inferring from the symptoms, we can rule out the possibility of lung abscess penetrating the chest cavity.
After ruling out all the possibilities, the only possibility left was esophageal perforation and leakage.
He concluded that the patient's esophageal rupture should be small.
Otherwise, let alone more than a month, or less than a week, the person would send him away directly.
The food eaten leaks out of the broken esophagus and then enters the chest. The consequences are terrible to think about.
A large amount of food chewed through the mouth, mixed with saliva and soup, is rich in bacteria in the mouth.They get into the almost undefended chest cavity and it's an absolute disaster.
The patient did not have a high fever at the beginning, but the fever started after painful swallowing.
This is also consistent with Li Jingsheng's inference.
The esophagus may be broken, but the hole is very small.
"Have a good rest! From now on, don't eat anything, including drinking water. Because your condition is very serious, we will try to arrange a check-up on you in the evening."
Li Jingsheng's diagnosis already has a relatively clear result.
What we have to do now is to convince Director Lian Tao to perform a fiberoptic laryngoscopy on the patient.
Li Jingsheng was about to go back to Lian Tao's office, but he didn't expect that Lian Tao came out of the ward and happened to see him.
"Jingsheng, did you come to the patient in person to inquire about the situation? I like your down-to-earth style. How is it? Have you found anything?"
"I just asked about the patient's general condition and there are some diagnoses. It may be necessary to arrange for him to have a laryngoscopy overnight to check the esophagus. I think his condition is quite serious. I am afraid that the condition is still progressing rapidly. The sooner we can find out problem, the less damage he will suffer.”
That is to say, the relatively euphemistic word injury was used in front of the patients and their families.
Li Jingsheng actually knows very well that if the cause of the patient's disease cannot be identified in time, the probability of death is extremely high.
The current situation is already very bad.
"I knew that asking you to come over would help me share my worries. The patient with the esophageal tumor had just been scheduled for a puncture. There were only two people on duty at the anesthesia department, and I finally called one. I watched these difficult patients being promoted one by one. , I'm quite happy. Come on, let's go to the office and talk."
Lian Tao went to the office with him.
This scene was seen by the nurses and doctors on duty in the gastroenterology department, and they all looked at Li Jingsheng in surprise.
Some people have seen Lian Tao walking alongside him, like old friends.
But because Li Jingsheng came here very rarely, most people didn't know him. "Director Lian, who is this handsome guy?"
"It's my good friend, Dr. Li from the Second Hospital."
"I feel so young! Dr. Li, if you are still single, there are several girls in our gastroenterology nursing station who are still single! Sweet, salty, cute, there are all kinds of styles you want."
The short-haired nurse must be 27 or [-] years old. She has a diamond ring on her left ring finger and a necklace around her neck. She must be a married young woman.
When she said this to Li Jingsheng, her main intention was to show her kindness.
After several years of training in the workplace, highly educated girls have improved their emotional intelligence, and after getting married, they are no longer so shy about the topic of love, but become more open and generous.
At this time, all of them are elites in the workplace.
The only way to control a man is within a few inches.
"Okay, thank you, I already have a girlfriend."
Li Jingsheng responded with a smile.
Perhaps in this girl's view, if he can sit on an equal footing with Director Lian Tao and talk like old friends, he must have considerable strength.
It is an excellent potential stock.
That’s why I was willing to take the initiative to help Zhang Luo.
"Oh, why are all the outstanding men these days being taken over by women! Dr. Li is welcome to visit us often!"
"Haha, that's a must. You have so many beauties, all of them are a beautiful sight. I will definitely come and see you often when I have time."
Li Jingsheng didn't have any airs, and he never pretended to be aloof.
After chatting with the nurses and becoming familiar with each other, he and Lian Tao returned to the office together.
"Tell me, why did the patient just need a laryngoscope?"
"Based on the current examination results and the patient's symptoms, I initially diagnosed that there may be a small rupture in the patient's esophagus, and then a pneumothorax will form. Now that it has progressed to so many complications, it is very likely that a serious chest infection has occurred. After using so many antibiotics, the infection still could not be controlled, and the body temperature did not go down, which indicated that an abscess cavity had probably formed in the chest cavity and there was pus accumulation.
This has seriously threatened the patient's life.
Therefore, I recommend checking the laryngoscope overnight and then arranging further treatment plans as soon as possible. "
Li Jingsheng explained his diagnosis.
He believes that further treatment options and drug treatment are unlikely to be effective.Surgery is required.
In terms of safety assessment, it is definitely more advantageous to perform surgery as early as possible.
It was really delayed until the patient's condition was so bad that the anesthetist did not dare to accept the order. At that time, it was difficult to even perform an operation.
Nowadays, better hospitals attach great importance to CMI scores.
More powerful doctors all want to have their CMI scores higher, which can increase their reputation, which is very beneficial for promotion in many positions, merit evaluation, and entry into some organizations.
If the patient is admitted and cannot undergo surgery at all, then he will definitely not be admitted.
Basically, patients are advised to go to other hospitals and ask again.
Or advise the patient to return to the local hospital for treatment.
"Tell me about your diagnostic ideas. For such a difficult case, you can solve it in just three strokes, five divisions, and two divisions. That's ok! I really want to recruit you to help."
Lian Tao took off his glasses and rubbed his tired eyes.
"I've been so busy lately that the dark circles under my eyes haven't gone away."
Li Jingsheng told him his diagnostic ideas one by one.
"Old man, promise me, after work, whenever you are free, you can come to my place often. Really, I really need the help of experts like you. I have been diagnosing this case for more than two hours and there has been no big breakthrough. , I thought I would stay up late to check information and papers later to see if there were any similar cases. I didn’t expect you to solve it. It seems that I don’t have to stay up late tonight to hurt my liver.
I'll arrange a laryngoscope right away. "
After listening to his analysis, Lian Tao was already beaming with joy.
Another difficult case has been solved.
This feeling is very good.
"I'll do whatever it takes to help my brothers share their worries. I'll definitely come over to learn from you when I have time."
Li Jingsheng readily agreed.
In fact, he is also very busy.
This is also inevitable. As long as you are a better doctor, you will definitely become busier and busier.
The greater the ability, the heavier the burden will be.
"Then I'll go back today. I have to go to work tomorrow."
Li Jingsheng was about to stand up and say goodbye.
"Don't worry, there is still a case that has not been diagnosed here! Help me again, please, please."
Lian Tao put his hands together and made a series of please gestures to him.
"You are more powerful than the ancient landowner Zhou Papi. I finally came to your place to play once, and you squeezed me as hard as you could."
Having said that, Li Jingsheng still took the patient's information.
When encountering such difficult cases, it is indeed easier to achieve a breakthrough by gathering the wisdom and experience of several experts.
(End of this chapter)
In addition, there were no cases of caseous pneumonia or hematogenous dissemination in the chest X-ray.
These lesions must be very typical in a patient with tuberculosis that has progressed to such an advanced stage.Therefore, the possibility of tuberculosis is almost slim.
Since it is not tuberculosis, how does pneumothorax form?
Based on the symptoms and disease progression described by the patient, it can be determined that the patient first developed pneumomediastinum and then developed pneumothorax. So where did this gas come from?
Inferred from this direction, it is no longer possible to support the idea that bullae rupture or emphysema will lead to pneumothorax.
Under normal circumstances, the air in pneumothorax must come from the lungs, trachea, bronchi or esophagus.
Recall that the patient mentioned that it started with pain when swallowing food, and then gradually progressed to chest pain and difficulty breathing.
Li Jingsheng believes that the air that causes pneumothorax probably does not come from the lungs.
Then its only source is the esophagus.
Because there are only so many channels through which the human body can inhale gas.
Whether it is inhaled through the mouth or nose, it enters the body through the trachea or esophagus.
The normal path for air intake is through the trachea and then through the bronchi into the lungs.
But when you eat, open your mouth to swallow, or talk, you may ingest gas through your esophagus and into your stomach.
In this case, as long as the digestive tract is not broken, the gas has two places to go.
One is farting through the intestines, which is called gas or flatulence in medical terms.
Normal people actually excrete a lot of farts in a day, more than 1.5 liters.
And spanking is not a bad thing, it is actually good for the intestines.
There is also gas that passes through the upper gastrointestinal tract and then out of the esophagus.
A common way to do this is through hiccups.
This patient's pneumothorax should not come from the trachea, bronchi, or lungs.
The symptoms of air leakage in the trachea or bronchus will be different. When listening to lung sounds, experienced doctors may even hear a whistle or a sound similar to a tire leak.
It would be even more serious if the bulla ruptured.
The patient should not be able to delay going to the hospital for so many days.
In addition to the rupture of lung bullae to form pneumothorax, there is also a relatively rare situation that may also lead to the occurrence of pneumothorax.
The lung abscess penetrates backward into the chest cavity.
This situation can actually be ruled out.Because the patient first developed dysphagia, then chest pain, and finally dyspnea.Especially difficulty breathing.
Li Jingsheng believed that the patient's difficulty in inhaling was caused by the compression of the left lung by more than 30 degrees.
If the lungs cannot open, it also means that the alveoli cannot open, and fresh air cannot be sucked in.
In fact, after our lungs relax, we breathe fresh air into our bodies.Then it shrinks again to expel the waste gas from the body.
This is the basic working principle of the lungs.
If the patient's left lung has a severe abscess from the beginning, he should first have symptoms of difficulty breathing and painful breathing.
You may even cough up pus or blood.
Therefore, just by inferring from the symptoms, we can rule out the possibility of lung abscess penetrating the chest cavity.
After ruling out all the possibilities, the only possibility left was esophageal perforation and leakage.
He concluded that the patient's esophageal rupture should be small.
Otherwise, let alone more than a month, or less than a week, the person would send him away directly.
The food eaten leaks out of the broken esophagus and then enters the chest. The consequences are terrible to think about.
A large amount of food chewed through the mouth, mixed with saliva and soup, is rich in bacteria in the mouth.They get into the almost undefended chest cavity and it's an absolute disaster.
The patient did not have a high fever at the beginning, but the fever started after painful swallowing.
This is also consistent with Li Jingsheng's inference.
The esophagus may be broken, but the hole is very small.
"Have a good rest! From now on, don't eat anything, including drinking water. Because your condition is very serious, we will try to arrange a check-up on you in the evening."
Li Jingsheng's diagnosis already has a relatively clear result.
What we have to do now is to convince Director Lian Tao to perform a fiberoptic laryngoscopy on the patient.
Li Jingsheng was about to go back to Lian Tao's office, but he didn't expect that Lian Tao came out of the ward and happened to see him.
"Jingsheng, did you come to the patient in person to inquire about the situation? I like your down-to-earth style. How is it? Have you found anything?"
"I just asked about the patient's general condition and there are some diagnoses. It may be necessary to arrange for him to have a laryngoscopy overnight to check the esophagus. I think his condition is quite serious. I am afraid that the condition is still progressing rapidly. The sooner we can find out problem, the less damage he will suffer.”
That is to say, the relatively euphemistic word injury was used in front of the patients and their families.
Li Jingsheng actually knows very well that if the cause of the patient's disease cannot be identified in time, the probability of death is extremely high.
The current situation is already very bad.
"I knew that asking you to come over would help me share my worries. The patient with the esophageal tumor had just been scheduled for a puncture. There were only two people on duty at the anesthesia department, and I finally called one. I watched these difficult patients being promoted one by one. , I'm quite happy. Come on, let's go to the office and talk."
Lian Tao went to the office with him.
This scene was seen by the nurses and doctors on duty in the gastroenterology department, and they all looked at Li Jingsheng in surprise.
Some people have seen Lian Tao walking alongside him, like old friends.
But because Li Jingsheng came here very rarely, most people didn't know him. "Director Lian, who is this handsome guy?"
"It's my good friend, Dr. Li from the Second Hospital."
"I feel so young! Dr. Li, if you are still single, there are several girls in our gastroenterology nursing station who are still single! Sweet, salty, cute, there are all kinds of styles you want."
The short-haired nurse must be 27 or [-] years old. She has a diamond ring on her left ring finger and a necklace around her neck. She must be a married young woman.
When she said this to Li Jingsheng, her main intention was to show her kindness.
After several years of training in the workplace, highly educated girls have improved their emotional intelligence, and after getting married, they are no longer so shy about the topic of love, but become more open and generous.
At this time, all of them are elites in the workplace.
The only way to control a man is within a few inches.
"Okay, thank you, I already have a girlfriend."
Li Jingsheng responded with a smile.
Perhaps in this girl's view, if he can sit on an equal footing with Director Lian Tao and talk like old friends, he must have considerable strength.
It is an excellent potential stock.
That’s why I was willing to take the initiative to help Zhang Luo.
"Oh, why are all the outstanding men these days being taken over by women! Dr. Li is welcome to visit us often!"
"Haha, that's a must. You have so many beauties, all of them are a beautiful sight. I will definitely come and see you often when I have time."
Li Jingsheng didn't have any airs, and he never pretended to be aloof.
After chatting with the nurses and becoming familiar with each other, he and Lian Tao returned to the office together.
"Tell me, why did the patient just need a laryngoscope?"
"Based on the current examination results and the patient's symptoms, I initially diagnosed that there may be a small rupture in the patient's esophagus, and then a pneumothorax will form. Now that it has progressed to so many complications, it is very likely that a serious chest infection has occurred. After using so many antibiotics, the infection still could not be controlled, and the body temperature did not go down, which indicated that an abscess cavity had probably formed in the chest cavity and there was pus accumulation.
This has seriously threatened the patient's life.
Therefore, I recommend checking the laryngoscope overnight and then arranging further treatment plans as soon as possible. "
Li Jingsheng explained his diagnosis.
He believes that further treatment options and drug treatment are unlikely to be effective.Surgery is required.
In terms of safety assessment, it is definitely more advantageous to perform surgery as early as possible.
It was really delayed until the patient's condition was so bad that the anesthetist did not dare to accept the order. At that time, it was difficult to even perform an operation.
Nowadays, better hospitals attach great importance to CMI scores.
More powerful doctors all want to have their CMI scores higher, which can increase their reputation, which is very beneficial for promotion in many positions, merit evaluation, and entry into some organizations.
If the patient is admitted and cannot undergo surgery at all, then he will definitely not be admitted.
Basically, patients are advised to go to other hospitals and ask again.
Or advise the patient to return to the local hospital for treatment.
"Tell me about your diagnostic ideas. For such a difficult case, you can solve it in just three strokes, five divisions, and two divisions. That's ok! I really want to recruit you to help."
Lian Tao took off his glasses and rubbed his tired eyes.
"I've been so busy lately that the dark circles under my eyes haven't gone away."
Li Jingsheng told him his diagnostic ideas one by one.
"Old man, promise me, after work, whenever you are free, you can come to my place often. Really, I really need the help of experts like you. I have been diagnosing this case for more than two hours and there has been no big breakthrough. , I thought I would stay up late to check information and papers later to see if there were any similar cases. I didn’t expect you to solve it. It seems that I don’t have to stay up late tonight to hurt my liver.
I'll arrange a laryngoscope right away. "
After listening to his analysis, Lian Tao was already beaming with joy.
Another difficult case has been solved.
This feeling is very good.
"I'll do whatever it takes to help my brothers share their worries. I'll definitely come over to learn from you when I have time."
Li Jingsheng readily agreed.
In fact, he is also very busy.
This is also inevitable. As long as you are a better doctor, you will definitely become busier and busier.
The greater the ability, the heavier the burden will be.
"Then I'll go back today. I have to go to work tomorrow."
Li Jingsheng was about to stand up and say goodbye.
"Don't worry, there is still a case that has not been diagnosed here! Help me again, please, please."
Lian Tao put his hands together and made a series of please gestures to him.
"You are more powerful than the ancient landowner Zhou Papi. I finally came to your place to play once, and you squeezed me as hard as you could."
Having said that, Li Jingsheng still took the patient's information.
When encountering such difficult cases, it is indeed easier to achieve a breakthrough by gathering the wisdom and experience of several experts.
(End of this chapter)
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