This Doctor is Great

"That's how it is..."

"Now I don't know what's going on. I can only ask your cardiology department if you have any ideas."

"Why are diuretics ineffective?"

"Nitroglycerin, the effect is average?"

Zhang Yang explained all the situations.

He looked at Chen Bing and Zhou Mo with questions.

After all, he is in the Department of Respiratory Medicine, and the Department of Cardiology is still separated by a specialist, so perhaps the Department of Cardiology can see what the problem is.

Chen Bing: "What are the diuretics used for?"

Zhang Yang: "Furosemide..."

Chen Bing nodded, the medication was fine.

Furosemide, a loop diuretic commonly used in congestive heart failure and edema. It is a classic drug for acute exacerbation of heart failure.

Chen Bing: "How long has it been used?"

Zhang Yang: "It's been more than 4 hours now..."

Chen Bing raised his eyebrows: "For more than 4 hours, the diuretics are useless at all?"

This is very strange.

At this time, Zhou Mo said, "Is it possible that it is a pulmonary embolism?"

He spoke out his guesses.

He then analyzed: "The patient has been bedridden for several years, and the blood flow of the lower extremities is definitely not very good, and it is easy to form thrombus. Once the thrombus falls off, it may flow into the pulmonary artery, causing pulmonary embolism, which will lead to asthma, hypoxia and other symptoms."

Zhang Yang shook his head: "It is indeed possible, but I have ruled it out, because CT enhancement was done half an hour ago, and no pulmonary embolism was found."

Zhou Mo nodded.

CT enhancement can determine pulmonary embolism, so if there is no CT enhancement, it will definitely not.

Chen Bingdao: "The possibility of heart failure still exists. Diuretics can't rule out heart failure... Have you checked the patient's heart failure markers?"

Zhang Yang: "I have already checked, and the values ​​of markers of heart failure are not too high, not like heart failure..."

Then, using the ipad, he handed the inspection results to Chen Bing and Zhou Mo.

——N-terminal B-type natriuretic peptide precursor, 143 (normal value <125ng/L)

Not too high.

So the possibility of heart failure is not high.

Zhou Mo: "Can I check him up?"

Zhang Yang: "Yes..."

Zhou Mo took the stethoscope and came to the patient's bedside.

I saw that the old patient was still panting and sweating profusely.

The ECG monitor at the bedside showed that the blood pressure was 150/95mmhg and the heart rate was fast.

Blood oxygen is only 96%, which is still under the condition of oxygen.

Zhou Mo took a stethoscope and listened to the old man's lungs.

Sure enough, there are dry rales and wet rales...

(ps: dry rales: the sound of gas turbulence...)

This is a typical manifestation of heart failure.

At this moment, Zhou Mo noticed that the old patient, struggling with asthma, kept saying "Uh uh~~~" to Zhou Mo, and pointed his hand under him with difficulty.

Zhou Mo: "??????"

The old man: (o↓-↓o)

Eyes down, pointing.

Zhou Mo: "………………"

He lifted the bedding of the patient's old man, and then exposed his legs...

A smell came.

I saw that the calf of one of the legs had festered.

It was an attempt to stay in bed, which led to the ulceration and the formation of pressure ulcers.

Zhou Mo: "Here?"

The old man: "Uh uh uh~~~~~~"

Zhou Mo felt that the old man didn't mean this, so he subconsciously lifted the quilt.

This time, it was lifted directly to the abdomen.

"I go!"

Zhou Mo was taken aback, because he saw the old man's abdomen, which was as high as a pregnancy for several months.

Quickly take off the gown.

Showing her bulging belly.

The lower abdomen, at this time, has been stretched without any wrinkles.

This is the bladder!

"Urine retention!!"

Zhou Mo flashed the word all of a sudden!

Zhang Yang also saw this situation, and his face changed suddenly, just like the Sichuan Opera.

With such a big bladder, it must be urinary retention.

How can urine retention happen? Have a urethra?

The only possibility is that the urinary catheter is blocked!

This series of inferences flashed through Zhang Yang's mind.

A mess in the wind!

She scolded the nurse half to death in her heart, and she also scolded herself half to death!

At this time, Zhou Mo tapped lightly on the patient's lower abdomen, the sound was dull, and it seemed that there should be liquid in the lower abdomen.

It's urine, yes!

So much piss, apparently it's all here.

Especially when I used diuretics, I urinated more.

Zhou Mo and Chen Bing looked at each other and said nothing.

Both of them wanted to understand that it was not heart failure or pulmonary embolism at all, but the simplest and most common urine retention!

As for why urine retention?

In the case of a urinary catheter, the biggest possibility is that the urinary catheter is blocked, resulting in the inability to discharge urine.

As for the patient's shortness of breath, profuse sweating, and high blood pressure... it is probably caused by the pain of holding back urine.

Chen Bing and Zhou Mo made eye contact:

"I feel like Zhang Yang has overturned..."

"Let's stop talking..."

"It's embarrassing..."

Zhang Yang sullenly called the nurse over.

When the nurse saw the patient's bladder, her expression changed, and she knew something was wrong.

After tidying up the urine tube, there is no sign of fold or pressure in each section.

Obviously, it was blocked by urine sediment.

The nurse hurried back to push the treatment car over, and then flushed the patient's bladder again.

A rush!

The urethra was cleared.

Then Zhou Mo and others could clearly see that the urine in the urine collection bag was rapidly rising.

Soon, a 1000ml bag was full.

Then I put a lot of it in the urinal.

Now,

The elderly patient let out a long sigh of relief.

I feel comfortable.

1 minute later,

The patient's old man's shortness of breath gradually eased, and his blood pressure also dropped...

Zhang Yang: "......"

He smiled awkwardly at Chen Bing and Zhou Mo, and forced a smile.

This kind of rollover accident, and it was the first time that the car rolled over in front of other departments.

Chen Bing coughed: "Cough... I have something to do in my ward, so I'll go first."

Then he pulled Zhou Mo and left.

Zhang Yang stopped Chen Bing: "Don't tell me about it, I'll invite you to dinner tonight..."

Chen Bing suddenly smiled: "Okay, I've always wanted to kill you but couldn't get it, this time I'll get the chance..."

……

Chen Bing and Zhou Mo left the respiratory department.

A long sigh of relief.

Senior Brother Chen Bing: "This time, Zhang Yang still has the doctor on duty, and the nurses in charge of the two shifts. He may be scolded..."

Zhou Mo sighed: "This kind of thing feels a bit injustice. If you look carefully, you can find the urine storage..."

Senior Brother Chen Bing shook his head: "It's hard to say clinically, I've overturned before..."

"Ah? Senior brother, have you overturned your car before?"

"Too many overturns..."

Then Senior Brother Chen Bing shared with Zhou Mo an incident when he overturned his car before...

"A year ago, I was on duty in the middle of the night, and the emergency department called me for a consultation. The patient complained of chest pain, which was severe and unbearable. He complained of sudden pain under the xiphoid process 6 hours ago, and then gradually spread to the chest area. After the physical examination, the left and right The blood pressure of the limbs was asymmetric, and aortic dissection was considered at that time~www.readwn.com~ emergency aortic CTA--no abnormality in the aorta, free gas under the diaphragm... At this time, a lot of time was delayed... You know, the last What is the cause?"

Zhou Mo shook his head.

Brother Chen Bing said: "We all forgot to check the abdomen carefully. Yes, at that time, the night shift was all young doctors. I was in a hurry. Pain, ... more importantly, we forgot to trace the patient's medical history, the patient's history of abdominal pain for several years ... "

Zhou Mo: "………………"

Senior Brother Chen Bing smiled: "Is it a very low-level mistake?"

Zhou Mo nodded.

It is indeed a very low-level error.

Very low-level!

Even if the doctor present at the time glanced at the patient's abdomen,

Or even if you ask the patient's medical history,

They can all find out what's wrong with the patient's stomach, instead of focusing on myocardial infarction and aortic dissection.

I won't run for an aortic CTA.

Waste of money, waste of time.

Chen Bing finally sighed: "Being a doctor is like walking on thin ice, you have to be careful and professional, and you can't be sloppy. Every new doctor is prone to make such low-level mistakes... In the future, try to be more careful..."

Zhou Mo nodded.

Been taught a lesson!

"Ring Ling Ling ~~~~"

At this time, a call came to Senior Brother Chen Bing's mobile phone.

"Dr. Chen, there is a patient in the emergency department. The cardiology department needs to go to the department for consultation. The director will arrange for you to go. Are you free?"

Emergency Department……

Chen Bing and Zhou Mo said nothing, turned around and went downstairs to the emergency department.

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ps: Sorry for being late...

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