Oncology Physician Life

Chapter 4 Chapter 03 Special Pediatric Patients

Jiang Li lowered his head. In the emerald white emergency center hall, there was a little boy sitting in a wheelchair with a plaster cast on his left arm, and he was pulling the corner of her white coat with his right hand.The boy was cute and cute, with small prickly hair, Jiang Li bent down and patted his head lovingly.

The little boy gritted his teeth and called his sister, then coughed dryly.Jiang Li found that his face was pale, trembling all over, panting heavily, and suddenly it became difficult to breathe.

The little boy tugged at the corner of her clothes, gritted his teeth and said, "Sister, I feel so uncomfortable. I feel like I can't breathe. Help me tell the brother doctor over there. I'm really uncomfortable."

Jiang Li looked up, not far from the hall, Li Ming, a doctor on duty in the emergency department, was anxiously calling Director Sun of the Department of Surgery. The poisoned female college student had been transferred to the ICU, and he needed to give a first diagnosis, but he It is still impossible to determine what the other party was poisoned by.

Sun Renyi gave a few instructions on the phone, and he hung up the phone in a hurry as he was on his way back.

Jiang Li pushed the little boy's wheelchair and walked over, "Hello, Dr. Li, I'm Jiang Li, a doctor of tumor surgery, this child..."

Li Ming looked up at the little boy sitting in the wheelchair, and forced a smile on his tired and stiff face: "Little Jiang Hao, please wait here for a while, the aunt of your orphanage is going to pick up the medicine, and it will be here soon." I will come back, don't be naughty next time, if you break your hand again, Auntie will spank her ass."

Jiang Li looked at the little boy covered with dense sweat on his forehead, but he still had some doubts in his heart, and the nurse beside him hurriedly explained.The child is an adopted child of the nearby Tongxin Welfare Institute. Because of spinal muscular atrophy, he was abandoned by his parents at the gate of the orphanage at birth. He was found and adopted by the director of the Tongxin Welfare Institute. Now because of the aggravation of his illness, his hands and feet have symptoms of muscle weakness. Can only travel in a wheelchair.

At about eight o'clock this evening, the child sneaked out with his companions while the auntie in the welfare home was not paying attention. As a result, the wheelchair fell down the stairs and broke his left forearm.

Jiang Li held the little boy's left hand in his hand, and carefully observed the part where the plaster was fixed. The dose of anesthetic was very small. After the plaster was put on, the left arm would naturally hurt once the effect of the medicine wore off.

I don't know if it was because of the fright that the little boy's lips were a little pale, and his whole body was still shaking.

In the consulting room, Li Ming touched the little boy's head: "Man, bear with it, be stronger."

After a while, the aunt of the welfare home who went to get the medicine came back and heard Li Ming say a few doctor's orders.

Jiang Li squatted down and asked with a smile: "Little fat man, what's your name?"

"My name is Jiang Hao, Ri Tianhao."

The little boy kept frowning: "But sister, I still can't breathe."

Lu Jiajia on the side touched his little head: "Little hypocrite, be careful when you get back, and don't run around alone again."

The aunt of the orphanage who was in charge of Jiang Hao held the child's hand, said words of thanks, turned around and walked out of the emergency room.

The little fat man was being pushed in a wheelchair, and kept yelling, "Mother Jiang, I'm so uncomfortable, I'm about to suffocate to death."

Listening to the little boy's words, Li Ming smiled: "The children nowadays are just a little too delicate."

But Jiang Li frowned when he saw the little boy's appearance.

She looked at the little boy's trembling body and the painful expression on his face, it didn't seem like an exaggeration, it was really uncomfortable.

Just as she was about to catch up and ask for clarification, the boy in the wheelchair suddenly fainted on the ground within two steps, causing quite a commotion around him.

The aunt at the orphanage saw the child fainted suddenly, and hurriedly hugged the child and shouted "Help".

Jiang Li was the first to rush up to check the child's heartbeat and pulse. He was shocked and shouted at Li Ming who was rushing over: "It's ventricular fibrillation! Send it to the emergency room!"

Hearing the word ventricular fibrillation, Li Ming was completely shocked. It was just a broken bone, how could there be ventricular fibrillation?
Jiang Li looked at the nurse who hadn't brought the cart for a long time, gritted his teeth, picked up the little boy, and ran to the spare emergency room.

"Prepare for defibrillation, start cardiac monitoring, start breathing, and open intravenous access."

At Jiang Li's order, the nurses in the emergency department immediately pushed the defibrillator in the consulting room to the bedside, and at the same time put the little boy on a ventilator and put on an oxygen mask.

Li Ming was about to take over the defibrillator, but Jiang Li snatched it away, and she gave an order to the nurse: "250 joules, ready to charge."

Li Ming held back his anger and acted as an assistant, helping to apply the conductive paste, fix the electrodes, and nodded to the nurse: "Start discharging."

After finishing the words, Jiang Li lowered the defibrillator against the boy's chest.

The strong electric current instantly made the boy's body tremble violently like a wave.

The steady straight line of the heart monitor began to fluctuate up and down, and then returned to a straight line.

"Again!"

With another electric shock, the ventricular fibrillation rhythm on the heart monitor finally changed to sinus rhythm.

At the same time, the nurse pulled out a strip of electrocardiogram.

Looking at the little boy who was lying on the cart and already on the ventilator, his expression was still panting heavily with pain.

"Professor Jiang, what's going on?"

Lu Jiajia looked at the frowning Jiang Li full of doubts.

"The patient had sudden dyspnea and ventricular fibrillation. There was no obvious cause. The preliminary examination ruled out lung function problems. It is recommended to take a CT scan for thoracic fluoroscopy."

Jiang Li snatched the ECG from Li Ming's hand, looked at the crooked curve, and frowned.

The electrocardiogram is one of the most complex examination images. It contains 12 leads, and the bands generated by each lead represent a change.

From the most common QRS wave, it is the normal wave band from the descending to the rising of the heart, and the abnormal TU two wave bands are ring waves, which only appear when the heart is shocked or abnormal, such as acute myocardial infarction and hyperkalemia.

Li Ming, who was marginalized in the consulting room, couldn't bear it anymore: "This doctor Jiang with out-of-tumor surgery, this is a surgical emergency department, please don't overstep your boundaries and do it for me!"

Jiang Li ignored Li Ming.

Li Ming snatched the electrocardiogram, "There is no abnormality in the electrocardiogram, and the ventricular fibrillation and dyspnea caused by heart problems can basically be ruled out. My preliminary diagnosis is that he can't breathe, and it may simply be an asthma attack."

"No!" Jiang Li immediately vetoed him, "Although the patient is only six years old, he has no history of asthma attacks."

Everyone just looked at the little boy lying motionless on the cart with his eyes closed, his face pale, and his whole body still shaking.

"Li Jiajia, go and push the mobile X-ray machine over there!" Jiang Li immediately took over the entire emergency room. She pointed to the equipment in the consulting room and said to the intern Lu Jiajia beside her.

Lu Jiajia knew that this was not the time to correct the professor's surname, so she hurriedly pushed the mobile X-ray machine behind the consulting room to the patient to perform X-ray imaging scans of the abdominal cavity and chest cavity.

Jiang Li looked around, looking for a stethoscope, and his eyes fell on Li Ming. Without waiting for the other party's permission, he picked up the stethoscope around Li Ming's neck, and checked the little boy's pulse and breathing.

Li Ming was a little distraught: "Dr. Jiang, who has swollen tumors, I told you that this is a surgical emergency department. You can't see my patients across departments. This is not in line with the hospital's regulations. Also, please show some respect to me." , I am the attending physician in the emergency department!"

"Li Jiajia, go ask the aunt in the orphanage outside, is there anything unusual about the child these days?"

Lu Jiajia nodded in response, and hurried out of the consulting room to inquire.

Seeing that Jiang Li ignored his words, Li Ming stared angrily, but there was nothing he could do. He decided to go to the hospital office early tomorrow morning to complain about this new female doctor.

In the consultation room, the nurse looked at the connected heart monitor and measured data: "Blood pressure 80/60, pulse 70, respiration rate... 3... 30..."

"30? What's the situation? Isn't the ventilator turned on!" The nervous Li Ming immediately looked at the equipment.

Jiang Li lay on the boy's chest and listened carefully to his heartbeat. The heartbeat was weak, but the electrocardiogram did not show any abnormalities in the heart. The patient's breathing was short and weak, which was classified as dyspnea.

After a while, Lu Jiajia went back and forth: "Auntie Jiang from the orphanage said that Jiang Hao had a dry cough a few weeks ago, and sometimes he was listless. Auntie thought the child had just a common cold, so she gave him a few cold medicines."

The nurse suddenly pointed to the monitor and shouted: "Doctor, the patient can't breathe on his own."

Jiang Li's expression became more serious: "The patient may have a foreign body blockage in the chest cavity, causing difficulty breathing, and is ready to be intubated!"

"Is there a foreign object in the chest cavity?" Li Ming scoffed at this diagnosis, "The patient did not swallow the foreign object, how could there be a foreign object in the chest cavity!"

Jiang Li looked at the time on the wall, it was four o'clock in the morning.

"Prepare the No. 3 bent-piece laryngoscope!"

Lu Jiajia turned around and searched on the instrument table, and handed the curved No. 3 laryngoscope to Jiang Li.

Jiang Li skillfully inserted the laryngoscope into the patient's mouth until it reached the larynx, then raised the handle of the laryngoscope and pressed the patient's tongue at the same time, only to see that the vocal cords were exposed in the patient's larynx.

She pulled a 25 cm long transparent plastic tube as thick as an index finger—the endotracheal tube.

Hold the catheter with one hand, insert it into the patient's vocal cords, and connect to the ventilator.With the forced delivery of oxygen, the blood oxygen saturation meter, the red display light began to flicker and hover, gradually rising.

The nurse operated the mobile X-ray machine and performed a CT scan on the boy's chest, but the image displayed on the electronic screen made the nurse exclaim in surprise.

The black-and-white film clearly showed a large lump the size of a cantaloupe, densely surrounding the blood vessels around the boy's heart, pushing the heart aside, and compressing the airway between his lungs.

The boy's right lung was completely crushed by the mass, so compressed that no air could get in.

Fluid from the mass filled his right chest, and the boy could only breathe through his left lung, which was also compressing the trachea.

Looking at the CT image, Li Ming frowned and froze: "This...what is this situation, how could this kind of thing appear...is this a tumor?"

Jiang Li finally breathed a sigh of relief, took out a pen and drew a circle on the lump, and said, "It's this foreign object that blocked his chest cavity."

"Let's prepare for surgery," Jiang Li dropped the stethoscope, "Now we must first pump out the fluid secreted by the lump in his right chest, otherwise the child will not be able to breathe, and it is unknown whether he can survive tonight."

Just as Li Ming was about to agree, a word from Sun Renyi, director of the surgical emergency department, suddenly came from outside the clinic.

"No surgery!"

(End of this chapter)