Gou is practicing medicine in the clinic

Listening to this man's voice, it was obviously hoarse.

"Come, let me take your temperature first."

Li Jingsheng measured the patient's ear temperature.

36.6 degrees.

This is a perfectly normal body temperature.

Clinically, the data obtained by measuring ear temperature are basically consistent with the results obtained by measuring oral temperature.Precisely because the temperatures of the two are similar and the measurement results are accurate, major hospitals now basically use ear thermometers to replace the old-fashioned mercury meters.

The results obtained by the forehead thermometer are not as accurate as the ear thermometer.

The oldest methods of measuring body temperature were cumbersome in the past, such as clamping it in the armpit or inserting it into the anus.Some are even put directly into the mouth for measurement.

However, considering factors such as infection, although oral temperature measurement is the most convenient, patients generally resist it.

It is very uncomfortable to let another patient hold a thermometer in his mouth after someone else has held it, even if the thermometer has been sterilized.

The doctor has no choice but to insert a tube into the anus and measure the rectal temperature when measuring the child's temperature.

This method is also somewhat unworkable when measuring the temperature of adults.

Both men and women are resistant and are even more afraid of contracting some terrible viruses.Such as AIDS, syphilis, etc.

If disinfection is not thorough and strict, it is very easy for this kind of thing to happen.

As the times continue to advance, it has become more and more convenient for doctors and nurses to diagnose and treat patients.

In the past, it took at least several minutes to take your temperature, and it had to be taken by a professional medical staff.Ordinary people cannot understand a mercury thermometer at all.

Now you can use an ear thermometer to measure your temperature, which can be done in two or three seconds.

And the values ​​are accurate.

The male patient's body temperature was normal, and diseases such as tonsil inflammation could basically be ruled out.

The patient himself also reported that he had bought medicine at pharmacies and other clinics, but it had no effect after taking it.

For general throat inflammation, obvious effects will be seen within two or three days after taking the medicine.

"Have you had a cold these past few days?"

"no!"

The patient shakes his head.

Li Jingsheng noticed that the patient showed pain when shaking his head.

It means that even if he just shakes his head, it affects his throat and causes pain.

"Open your mouth and I'll show you your throat!"

His clinic has now gained a lot of diagnosis and treatment business, and patients with various throat diseases often seek treatment.Looking at it with a small flashlight is not very clear.

Especially some deep lesions are basically difficult to see.

Also, it is not easy for patients to cooperate.

Raising your tongue can easily block the doctor's view.

Some patients have such strong oral odor that even wearing a mask by Li Jingsheng is of no use.There's no way to prevent it.

If you get a laryngoscope, you can deal with many problems.

I should be able to pay the remaining balance of the clinic purchase next month, and then I can consider upgrading the clinic and purchasing some new advanced equipment.

The patient had no difficulty opening his mouth.

Li Jingsheng used a small flashlight to examine the depths of his throat and found no abnormal redness, swelling or lesions.

That's strange. The patient has neither a cold nor a swollen and inflamed throat. So what is the cause of the pain?
"Siying, check his blood pressure and heart rate!"

Li Jingsheng frowned. The cause of this patient's illness was really strange.

A careful examination of the patient's neck, particularly the pharynx, did not reveal any trauma.

"In recent times, your throat hasn't been hit by any hard object or hit by anyone, right?"

"No, absolutely not."

The patient denies it.

His voice was hoarse and cracked.

"Are there any triggers before the onset of the disease? For example, eating spicy food, drinking a lot of alcohol, or smoking, etc."

"I usually don't smoke or drink, and I haven't gone out for late-night snacks recently. About seven or eight days ago, I felt a little uncomfortable in my throat after getting up. When I coughed, I noticed something was wrong with my voice. Then when I spoke, my voice was a little hoarse. When I was eating , it will hurt a little bit.

I didn't pay attention at the time, thinking I had a cold or a fever.

After two days, my voice became hoarse and I struggled to speak.

Eating also became more painful.Even drinking water and swallowing saliva will hurt.

I quickly went to the drugstore to buy anti-inflammatory medicine and took it, but it had no effect.

Then I went to Kuaikang Clinic. Dr. Zhao prescribed medicine for me, and I was given intravenous injections for two days, but it still had no effect. "

Boss Zhao is simply the god of needlework.

It is estimated that out of ten patients entering his clinic, at least six will need intravenous injections.

For some diseases, taking pills or capsules actually has the same effect.The high profit point is the intravenous injection.

Including the cost of nursing care, the cost of needles, etc., the profit is more than ten times greater than taking pills.Boss Zhao has an annual income of 200 million, how did he get it?

Just by prescribing pills that cost one or two yuan to patients, let alone prescribing Daben, it is considered good to be able to maintain the normal expenses of the clinic.

"Master, the patient's blood pressure and heart rate are normal."

Han Siying showed Li Jingsheng the measurement results on the screen.

High pressure 121mmhg, low pressure 85mmhg, heart rate 71 beats per minute.This is perfectly normal blood pressure.

It's very good.

All physical signs are normal, so what causes the patient's sore throat and hoarseness?

Lung problems?That won’t cause these two symptoms!
Li Jingsheng had no clue for the time being and couldn't find out what the problem was, so he decided to listen to the patient's heart and lung sounds.

There are only a few important large organs in the human body, and the heart and lungs are one of the organs most prone to problems.

Moreover, they have various connections with various organs of the body. Even if there is nothing wrong with them, sometimes you can find out some clues by listening to their voices.

He listened carefully to the patient's lung sounds and found crackles, but they were still normal.

The heart sounds sound normal at first, but after listening carefully, they always feel a little special.

But he couldn't tell.

He had never encountered this situation before.

How should I put it, when listening to his heart sounds, I always feel that there is a lingering sound, or in other words, it seems like there is a weakened echo.

It's hard to describe in words.

In short, when listening, after the normal heart sound has passed, there is a feeling of unfinished sound.

"Let me check your chest, abdomen and neck! Lie down on the bed inside and take off your coat."

After Li Jingsheng asked the patient to lie down, he began to examine the patient's abdomen.

No obvious masses or tender points were found.

The chest cavity was observed with the naked eye, and the appearance was normal, with no abnormalities such as barrel chest and three concave signs.

It’s really strange. What is the problem with this patient?
Li Jingsheng tried to check the patient's armpit and found no swollen lymph nodes.

Check the neck again and gently press the pharynx, and the patient will feel pain when breathing.

But he found that the patient's pain point was not on the throat, but a little below the throat.

"Does it hurt here?"

"Ah yo...yes, yes!"

The patient's voice was hoarse and he could not speak clearly at all.

Li Jingsheng looked at the patient's tender points and already had some thoughts in his mind.

Unfortunately, the conditions at our clinic are limited and we are unable to conduct further examinations.

But by next month, his clinic will definitely be able to purchase some new equipment.

"Your situation may be a nerve or blood vessel problem. The lesion should be at this location. I don't have the equipment here. You can go to the second hospital to take a CT scan. Considering that this location is the aorta, I suggest you check it directly. Aortic CT imaging. If you can trust me, I will write you a note. You can just go to the Second Hospital and directly see Director Zhang of the Department of Cardiothoracic Surgery."

Li Jingsheng said to the patient.

Although the cause of the disease has not yet been identified, it is basically certain that there is a problem with blood vessels or nerves.

There are many ways to cause pain.

Some are caused by necrosis of body tissue, which is the most common cause of pain.

As long as a large number of normal body cells die, the breath they release after death will not only summon a large number of immune cells to support and search for enemies.It will also stimulate the body's prostate to release prostaglandins, and then cause severe pain, reminding the owner of the body that a disease has occurred in this area.

Sometimes it is obvious that the pain is in the head, but the feet need to be treated. This is also related to the body's prostaglandins.

It is relatively dull and cannot accurately identify some hidden lesions.

Or some stimulation can cause it to release wrong pain signals.

"I trust you! Many people say that your medical skills and medical ethics are very good. I didn't know it at first, but it didn't work after two days of treatment at Kuaikang Clinic. A colleague heard about it and told me that I could come to you for treatment. .So many people praise you, I believe you can’t be any worse.”

Patients trust him very much.

Li Jingsheng wrote a note to the patient and asked him to go to the Second Hospital to find Director Zhang.

Of course, Director Zhang is the director of the department and an expert, so he may not necessarily treat this patient personally.

But after the cardiothoracic surgeon sees the note, he will definitely help deal with it.

And report to Director Zhang.

Doctors do not have high or low positions. Even the top first-level chief physicians must treat patients in order to realize their value.

Otherwise, it is just empty honor.

The patient took the note and left.

Less than an hour later, Director Zhang from the cardiothoracic surgery department called him.

"Jingsheng, the patient you introduced has had a CT scan, and a large hemangioma was found below his thoracic aortic arch. In my experience, it is probably just a pseudoaneurysm. But surgery must be performed, otherwise the main Once the artery wall ruptures, it's dangerous."

Director Zhang always handles things neatly and neatly.

After the cause of the disease is found, a treatment plan will be given directly.

"It turned out to be an aortic aneurysm, and it grew under the aortic arch. No wonder! The patient's pharynx was not red or swollen, nor did he have a cold. Now it seems that the aortic aneurysm is growing rapidly and is compressing the recurrent laryngeal nerve. .”

After Li Jingsheng heard about the cause of the disease, he suddenly realized.

Aneurysms are relatively common in clinical practice. They are not only dangerous in themselves but can also cause unexpected complications as they grow.

But this is actually a good thing.

For a patient like this, at such a young age, who would have thought that there was already an aneurysm on the aortic arch?
Aneurysms are difficult to detect if there are no symptoms.

Once broken, the consequences will be catastrophic.

A life can be taken away in an instant.

Pseudoaneurysms are sometimes more dangerous than true aneurysms. (End of chapter)