This Doctor is Great

the next day,

Morning.

Zhou Mo's two hospital beds were empty, and there was no room for rounds, so he came to the department following the 8:00 bell.

Senior Brother Chen Bing saw Zhou and waved, "I'm on duty today, and I may go to the emergency room or other departments for consultation... Zhou Mo, you should be free today, are you interested in coming with me?"

When Zhou Mo heard this, he was naturally overjoyed.

Being able to experience more patients is very helpful to Zhou Mo's clinical experience.

This is definitely the cultivation of Senior Brother Chen!

Zhou Mo quickly thanked: "Thank you, Senior Brother! I'll be there whenever I'm called!"

Senior Brother Chen Bing nodded: "Okay, if there is any, I will call you."

At this time, Director Niu came.

Start the ward rounds within the group, and use PPT to go through the critical and difficult cases.

At 9:00, the room inspection was successfully completed.

Just after the room was checked, the phone at the nurse's station rang. Not long after the nurse picked up the phone, she shouted to Senior Brother Chen Bing from a distance:

"Dr. Chen, the Department of Respiratory Medicine called, there is a consultation, the director asked you to go..."

"Consultation? Good!"

Zhou Mo was surprised.

"Zhou Mo, go!"

Chen Bing greeted Zhou Mo, and the two left the Cardiology Department and went to the Respiratory Department.

……

……

Respiratory Medicine.

"Hey, Chen Bing, why are you here..."

"The director arranged for me to come..."

"Zhou Mo, this is my classmate, just call him Senior Brother Zhang Yang... Zhang Yang, this is Zhou Mo, a medical student who is tired of training, I will take him now..."

"Hello, Senior Brother Zhang!"

To briefly introduce, Zhang Yang brought Chen Bing and Zhou Mo to one of the wards.

43 beds.

Zhou Mo saw an old man in his fifties or sixties lying on the bed.

There is also the bedside, the wife who accompanies him.

Zhang Yang began to introduce the patient's condition to Chen Bing and Zhou Mo.

English is used.

Sometimes the doctor is in front of the patient in order not to put too much psychological burden on the patient.

"This patient had a stroke three years ago."

Stroke, also known as cerebral apoplexy (read cu), usually has a sign at the door of the hospital with words such as "Stroke Center" written on it.

It shows that this disease is relatively common, and it is also more urgent and serious.

Stroke includes ischemic stroke (cerebral infarction) and hemorrhagic stroke (parenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage).

"The patient suffered a large-scale cerebral infarction after a stroke three years ago. Although he was rescued, it also caused paralysis of the left body, loss of language function, and other minor motor problems."

"This time, he mainly had fever, cough, and sputum, and then he was admitted to our respiratory department... After our diagnosis, it was pneumonia!"

Zhou Mo listened and combed.

Why do you get pneumonia?

Very simple!

Because patients with sequelae of cerebral infarction may have some neurological problems, they may have difficulty in swallowing and coughing, and are very prone to aspiration.

After aspiration, food and foreign objects enter the airways, all the way to the lungs, and then cause pneumonia.

Pneumonia is a common disease in this type of stroke patients.

Brother Zhang Yang continued to talk about his condition: "After taking antibiotics, the effect is good, the patient has less phlegm and cough, and there is no fever..."

This shows that antibiotics play a role in pneumonia.

"but!!"

"At 5 o'clock this morning, an accident happened!"

Zhang Yang said,

"The patient suddenly didn't know why, and began to breathe quickly, and then called the doctor and nurse on duty to come over."

"I asked, and I was sleeping well, but suddenly shortness of breath. There is no special reason... But the nurse took the blood pressure and found that it was as high as 190/120mmhg!"

190,

This blood pressure is already super high!

What a high blood pressure!

Zhou Mo couldn't help but raise his brows.

Zhang Yang continued: "The patient has a history of high blood pressure. It has been seven or eight years. The old patient, the stroke was also caused by high blood pressure, and he did not take medicine on time... But he has never reached such a high level."

"The doctor on duty at that time listened to the patient's heart and lungs with a stethoscope, and found that there were a few wet rales in both lungs."

Wet rales are the sound of bubbles and bubbles bursting when the gas rushes through the liquid.

If there is wet rales, it usually means pneumonia or pulmonary edema.

"By the way, there is one more point. When he was admitted to the hospital, we had a heart ultrasound and his heart function was damaged, so we guessed that it might also be a sudden heart failure..."

Zhou Mo nodded.

He could understand what Brother Zhang Yang said, which probably meant: the patient's heart function is poor, and with such a high blood pressure, it is difficult for the heart (left ventricle) to pump blood out, so the heart will increase its power. You will be exhausted, gradually exhausted, and lead to heart failure.

And the performance of this process is: the breathing will be rapid and the heart rate will increase, just like the patient's performance.

In addition, heart failure will cause blood to stagnate in the heart, and pulmonary venous blood cannot enter the heart, which is prone to wet rales.

However, since Dr. Zhang Yang made this inference, he has now invited the Cardiology Department for consultation. Obviously, the patient's condition is not so simple.

Chen Bing and Zhou Mo did not speak.

Keep listening.

Sure enough,

Dr. Zhang Yang continued: "Then, we checked the patient's urine output and found that the difference between the intake and output is quite large... The 12-hour intake is ~www.readwn.com~ The output is only 300ml, and the difference in the middle is 700ml..."

Everyone who is hospitalized knows that a table will be given to the family members. As long as the patient drinks liquids and urinates, they must record them, and the nurses will make relevant statistics. This is the patient's fluid intake and output.

The patient's input volume is 1000ml and the output volume is 300ml, which means that the patient has an 'excess' liquid volume of 700ml.

The more fluid in the body, the greater the load on the heart!

Then according to the above inference, the next step is to infer that there is a problem with the kidney function.

lead to decreased urine output.

One of the complications of hypertension is hypertensive nephropathy, which is the damage to the structure and function of the kidneys caused by high blood pressure.

Everything seems to make sense!

At this point, evidence-based medicine seems to be perfect.

And in line with monism.

However, the condition is not so simple.

Zhang Yang said: "According to the above inference, consider high blood pressure + heart failure + kidney disease..."

"Then, the doctor on duty contacted me and discussed it. The plan was: diuretic + blood pressure..."

Diuresis: Quickly separate out the water in the body and excrete it through urine, the water is less, the load on the heart is reduced, and heart failure will also be relieved.

Antihypertensive: Using nitroglycerin, nitroglycerin can not only reduce blood pressure, but also increase coronary blood flow, killing two birds with one stone.

"but!"

"After we gave the patient diuresis and nitroglycerin, the patient was not well!!"

"The patient's urine did not come out!"

This is why Zhang Yang invited the Cardiology Department for consultation.

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ps: Monthly pass, recommended votes to feed the mouth...

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