Come on, Dr. Wu

Chapter 404 Unwilling
He took a quick glance at where he was. There were beds on both sides. It seemed that one was for doing electrocardiograms, and the other was for patients to lie there and the doctor would listen with a stethoscope.

There was a horizontal table in the middle, and a young man was sitting behind the table.

A young man whom he envied in the past and in the future, dressed in white, with flowing black hair, skin as white as snow, and eyes as bright as crystal.

Well, I don’t know which martial arts novel he saw this plot description from. Normally, he couldn’t even remember these words, but after seeing this young man, he inexplicably remembered them.

It seems that these words are referring to this young man.

At this moment, the young man was looking at him quietly, with a hint of sharpness between his brows.

The damn memory began to knock on his mind again, just as the saying goes: "Long hair, white shirt, the fragrance of osmanthus water, far away in the flying snow passing by the study, except for the three layers of snow on your body, there is no one like you on this street."

Based on past experience, he thought that this must be the doctor he had visited three times. Such a godlike young man must be very powerful. He thought that he might be saved this time.

Maybe it was because the damn memory was hammering at his head, making his head hurt even more, so he began to shout with all his might.

"Doctor! I have a headache!"

"What do you think Chao Yuan should do next?"

Jiang Yuankai suddenly asked, the patient's condition was not actually critical, but it was also urgent.

The condition was not complicated, but that was only the case for experienced doctors like them. For young doctors like Chao Yuan, that might not be the case.

"Looking for evidence and tracking down the murderer, I think Chao Yuan has already gotten some clues. This kid's thinking is right. The patient has been to the hospital three times, and we have the medical records of the first two times. With Chao Yuan's spiritual energy, he should have figured out something by now."

Wu Xiaofu spoke, and Lin Dongping couldn't help but nod. As Chao Yuan's mentor, Lin Dongping undoubtedly knew Chao Yuan best among the few people.

This is really a smart child. According to Lin Dongping's idea, as long as Chao Yuan does not lose his ambition in the future, it is not impossible for him to become a top neurosurgeon with his talent.

This is also the reason why he was willing to accept Chao Yuan as his last disciple.

"My headache is terrible, doctor."

The patient's voice was very low, his spirit was very weak, and his face was in pain. Not to mention Chao Yuan, a professional doctor, even ordinary people could feel that the patient had a severe headache.

"How long has it been hurting?"

Chao Yuan had already gotten into the state by now, and was trying hard to get rid of the stereotypes in his mind. The most frightening thing about seeing a patient was that he already had a preliminary diagnosis in his mind before he even asked about the patient's condition.

Because in that case, it is easy to form preconceived ideas, which will affect subsequent diagnosis and make the doctor ask questions based on this diagnosis, but if it is not this disease, it will easily cover up other symptoms.

"It's been several days."

The patient couldn't remember exactly how many days it had been, but he only knew that the headache had made him miserable.

I have had headaches for a few days, but the doctor initially diagnosed me with "gastroenteritis". It seems that my headaches have suddenly worsened recently. So is there something wrong with my previous complaints? Chao Yuan thought.

"Where exactly does it hurt? Does it hurt all the time or is it intermittent? Is the pain getting worse?"

"My whole head hurts. It hurts here and there. It hurts so bad! It has been hurting all the time recently. It doesn't stop for a moment. I can't sleep at all. Even if I take medicine, I will be woken up by the pain. It is getting worse and worse. It was only the intravenous infusion a few days ago that made it better."

Infusion! Chao Yuan knew what the infusion was for.

"So what caused your headache this time? For example, strenuous exercise, or anger, tension, staying up late, drinking, etc., and has your head been bumped recently?"

"None of them. I think I just got it because of the fever."

When the patient said this, there was some certainty in his tone. After all, he had experience before and had heard some other people's opinions, many of which were related to fever.

There are also cases of people being burned to death by fever.

"How long have you had the fever?"

"I felt like I had a fever intermittently from the beginning, but I didn't measure my temperature myself, so I don't know the exact temperature."

Chao Yuan asked with a question mark after hearing this. Although fever is a common symptom, the patient himself may not be able to accurately know whether he has a fever, especially without measuring his blood pressure.

Patients with possible brain diseases are even more likely to experience hallucinations.

"I noticed that you had gastroenteritis a while ago. What were your symptoms then? Did you have a fever as well?"

"Well, not only did I have a fever, I also vomited and had diarrhea, but I'm not having diarrhea anymore."

"Then are you still vomiting?"

"I vomited so much, but now I can't vomit anymore. But the feeling is still very strong, like wanting to vomit but not being able to. It's worse than vomiting."

"Is what you vomited up the contents of your stomach? Can you see blood? Is it in a jet-like shape? Will the headache be relieved after vomiting?"

"Yes, the kind that spit out like a jet!"

The patient actually skipped the previous question and directly answered that he was vomiting.

That means this symptom is really highly consistent, and this symptom is also what clinicians are more afraid of. I guess every clinician will feel a tightness in their heart when hearing this word.

Because projectile vomiting is likely to involve the brain.

Therefore, Chao Yuan's following questions were almost all about this aspect.

"Besides the fever, do you have any other symptoms? For example, dizziness, difficulty moving your hands and feet, body twitching, slurred speech, etc. By the way, have you ever fainted?"

"No, I haven't felt dizzy, my arms and legs are still fine, I don't have any convulsions, and I can talk fine. I've just been lying in bed for two days, I have no appetite, I can't eat, I feel weak all over, and I feel indescribably uncomfortable...

Doctor, I am not going to die, to be honest, before I came to the hospital, I was so tired.

Chao Yuan was also speechless when he heard this. Is it really okay to talk about such underworld things in the human world?
Moreover, as long as the patient comes to the First Affiliated Hospital, unless he dies on the way, there will be no doubt that the patient will survive until tomorrow.

Chao Yuan quickly ended the follow-up consultation. After all, they had already talked about the underworld, and he was afraid that if he continued, the patient would seem too depressed.

The patient's diagnosis and treatment process was almost the same as the medical records Chao Yuan had seen.

As for the rest of the consultation: poor appetite and poor sleep in the past week;

He had no history of diabetes but no hypertension; no history of mental illness or genetic disease; no history of special medication; and no history of allergies.

After the medical consultation, the next step was physical examination. According to physical examination habits, and because the patient's symptoms were directly related to the head, Chao Yuan started the physical examination from the eyes.

Chao Yuan's finger moved from the center to the left in front of the patient's eyes.

"Come on, look at my hand, look at my fingers, what number is this?"

"1, hiss, ouch"

"what happened?"

Chao Yuan was shocked when he saw this, wondering if there was some acute disease.
"It's okay, it just hurts my neck when I move it."

Chao Yuan's original intention was to check the "eyeball mobility" and "visual field" first, but he didn't expect to get some unexpected results.

The patient experienced obvious pain in the neck whenever he moved.

Could it be...

Chao Yuan decisively skipped the routine physical examination and entered the neurological examination stage. The standard posture for neurological examination is to lie flat without a pillow, with one hand supporting the pillow and the other hand directly on the chest. When he lifted the patient up, he found that the patient's neck had obvious resistance and neck stiffness was positive.

Then support your legs with both hands, keep your knee and hip joints at 90 degrees, and straighten your knees.

"pain!"

Before Chao Yuan could even figure out what to do, the patient started crying out in pain.

Chao Yuan knew what was going on and silently wrote it down: the patient was in obvious pain and Kerning's sign was positive.

Place another pen in front of the patient and ask the patient to point his finger at the tip of the pen, then at the tip of his nose, and repeat this process over and over again.

In fact, people should be familiar with this action, and they can often see it in medical dramas on TV.

In physical examination, this is called the finger-to-nose test.

It is to check for ataxia.

If the finger-to-nose movement is clumsy, inaccurate, uncoordinated, and unstable, it indicates that the patient may have a lesion in the cerebellar hemisphere.

The corresponding thing is the ataxia of the upper limb on the affected side.

If there is little change when the eyes are open and closed, it is cerebellar ataxia.

There is only slight obstruction when the eyes are open, but when the eyes are closed, due to the loss of visual compensation, there is a big difference from when the eyes are open, and even the tip of the nose cannot be found, which indicates that the patient has sensory ataxia.

This examination is usually performed on patients with symptoms of unsteady walking, but this patient obviously needs the full set, so Chao Yuan dare not ignore it.

However, this inspection revealed a problem.

The patient's movements are slow, his pointing is inaccurate, the finger-to-nose test is positive, and he clearly has sensory ataxia.

Another thing is to instruct the patient to slide the heel of one side down along the opposite knee and tibia, with eyes open and closed, and observe the patient's movements.

Examination revealed that the patient's movements were slow, with positive calcaneal, knee and tibia test; bilateral Babinski sign was not induced; and when checking the patient's limb mobility, it was unexpectedly discovered that the patient had clustered blisters on his left arm, but there was no obvious sign of distribution along the nerves.

To summarize the patient's condition, in addition to positive meningeal irritation signs, ataxia is also disordered.

At this moment, in Chao Yuan's mind, the "real culprit" that caused the patient's headache has gradually surfaced.

The patient had positive meningeal irritation signs, based on which the patient's disease could be localized to the meninges.

The patient's calculation ability is reduced, which can be further localized to the cerebral cortex.

In addition, there is muscle weakness in both lower limbs and a positive right Babinski sign, which can be localized to the bilateral corticospinal tracts.

Finally, if the patient's left finger-to-nose test is unstable and inaccurate, the right fronto-ponto-cerebellar bundle or the left cerebellum and its connecting fibers can be located.

Combined with the patient's medical history, he is a middle-aged male with acute onset and a prodromal history of "fever".

The symptoms include persistent headache after diarrhea, which progressively worsens, accompanied by projectile vomiting and "herpes zoster" on the left upper limb.

The use of "antibacterial drugs" was ineffective. Physical examination showed the involvement of meninges and brain parenchyma.

At this time, Chao Yuan was almost certain that the patient had intracranial viral meningoencephalitis.

However, there is still one last key examination missing for the final confirmation, which is also the so-called gold standard in the book - lumbar puncture.

Whether the patient has viral meningitis or not can be known once the puncture results come out.

The secrets of outpatient clinic that Lin Dongping had taught him before appeared in Chao Yuan's mind.

“After a preliminary assessment, the next step is to make a clear diagnosis.

The first step is to do a lumbar puncture to confirm the evidence of infection; the second step is to complete relevant examinations to exclude other diseases. "

The second step was fine, but Chao Yuan also had trouble with the first step.

The patient's condition cannot be delayed any longer and needs to be clarified and treated as soon as possible.

Chao Yuan knows how to treat viral meningitis, but he can do a lumbar puncture, but who will see it?
Not everyone can watch films. Although Chao Yuan had watched a few films with his teacher, he did not have any systematic training, so how could he dare to write a report?

Or should we admit him to the ward and then do the puncture?

Chao Yuan thought to himself that after all, he was working in the emergency department and could actually divert patients based on a preliminary diagnosis.

The neurology department would not refuse to admit the patient, but Chao Yuan suddenly felt unwilling. He had seen the patient up to this point, and if he didn't finish seeing the patient and give him a high score, he would feel like he was losing out.

"What do you think he will choose?"

Wu Xiaofu suddenly spoke, and the others also looked thoughtful.

“There is definitely no problem with the lumbar puncture, but after the puncture, it is actually enough at this stage. We just need to call the neurology department for consultation and send the patient there.

His current performance is already good, and his score will not be low. "

"Haha, if he hands it in, he won't be my student anymore. You guys continue to watch while I go out for a walk."

Lin Dongping said as he walked out.

Lin Dongping had just taken two steps when the phone in his pocket rang.

"Teacher, please consult and help me look at the lumbar puncture film."

Everyone laughed when they saw this scene. Chao Yuan was very smart. Although it was an assessment, it didn't mean that they couldn't help. Just like Chao Yuan said, please have a consultation.

This is a completely routine operation in the emergency room. Of course, they will deduct a few points from Chao Yuan based on the level of his participation in the consultation.

If Chao Yuan just asked Lin Dongping to look at a film, then his score would not be deducted too much, especially compared to the fact that he completed the diagnosis and treatment of this patient.

In the consulting room.

When Chao Yuan heard Lin Dongping's answer that he must be hungry, he couldn't help but clench his fists. He felt a little excited. He knew that this was the case. Wu Xiaofu and the others must be watching outside, and as long as it was within the rules, he could do whatever he wanted.

Chao Yuan did not delay and directly asked the patient's family to take the patient into the operating room.

What is lacking now are the puncture instruments and glass slides. The puncture kit is fine, but the glass slides are not always available. Without these, even if he can perform a lumbar puncture, there will be no results.

However, Chao Yuan thought of this matter when he called Lin Dongping. If there is no emergency room, then just borrow money.

The emergency department does not have routine puncture smears because they do not require them. However, other departments do have them, and the laboratory department can borrow them.

It just so happened that a few days ago he hooked up, no, got to know a female colleague from the laboratory.

Another phone call came in. In the hospital, as long as you know someone in the relevant department, things can be done quickly.

The slides were delivered soon.

After expressing his gratitude and promising to treat him, Chao Yuan started to work directly.

When the patient heard that this could clarify his condition, he nodded without hesitation and authorized his friend to sign the consent form.

(End of this chapter)