This Doctor is Great

"What's going on today? Why do you have one consultation after another?"

On the way to the emergency room, Senior Brother Chen Bing couldn't help complaining.

Zhou Mo was overjoyed because he could learn more cases. Those that can be used for consultation may be all kinds of strange diseases that cannot be dealt with in the emergency department, but it is much faster than Zhou Mo reading books by himself.

Usually it is the attending physician level, but now it is rare for Senior Brother Chen Bing to visit the doctor.

An opportunity not to be missed.

soon,

Came to the emergency department.

As soon as I entered the door, I felt a 'heat wave' coming.

Noisy voices, all kinds of strange patients gather here, and you can hear the cry of children and the pleas of the patient's family to the doctor.

The two walked quickly to the nurse's station.

"I'm Chen Bing from the Cardiology Department, here for the consultation..."

The nurse raised her head, and at a glance, she was attracted by the handsome and handsome Zhou Mo.

"Hey, Doctor Zhou Mo!"

This nurse was actually Chen Min, the dimpled nurse who exchanged WeChat with Zhou Mo last time.

Zhou Mo: "Hello..."

Chen Bing: "..."

I was just ignored like that?

Chi Chi~~~

Three knives in the heart.

Nurse Chen Min smiled at Zhou Mo with two dimples: "Consultation, right? In the emergency room, an old man kowtowed and was unconscious..."

"Thanks!"

Chen Bing and Zhou Mo hurried to the rescue room.

"Chen Bing, it's you, come on, here's a patient..." Cao Yun, a young doctor in the emergency room, quickly greeted Chen Bing after seeing Chen Bing.

Besides this young doctor, there are two middle-aged emergency doctors.

At this moment,

The door of the emergency room opened, and Zhang Yang from the respiratory department also came.

"Hey, Chen Bing, Zhou Mo, you are also..."

"Are you here too?"

Now, the cardiology department and the respiratory department are here.

Brother Chen Bing said to the emergency doctor Cao Yun: "Tell me what's the situation?"

Emergency doctor Cao Yundao: "This patient, 73 years old, has a history of hypertension. He fell once at 16:00 yesterday afternoon, with a real bone contusion. He came to our emergency department for examination, and a CT scan was performed. No trace of cerebral hemorrhage was found, and he was hospitalized in the emergency department. After a night of observation, there was no problem, and I was discharged from the hospital the next morning..."

"Then 1 hour ago, I fell down again, and I was rescued. My blood pressure was normal and my heart rate was too fast, but my lips were cyanotic, and my pulse oxygen was only 91%. Although my eyes were big and round, they were not so sensitive to light reflection. There was a problem with the department, and then a CT was performed on the patient, no cerebral hemorrhage was found, but a certain space-occupying..."

Note: Cyanosis of the lips: It is caused by the decrease in the oxygen content of the blood-red veneer in the blood of the body, and it is the color change of the human mucous membrane in the absence of oxygen.

Note: Cranial CT: The density of brain tissue itself is relatively low, and the contrast with blood is obvious, so if there is bleeding, there will be a darker color (increased density shadow).

"When the mass is found, we suspect that the patient's brain has cerebral edema, which causes the edema volume to squeeze the normal brain tissue, resulting in cerebral edema..."

Cerebral edema is a symptom.

It's like having a fever.

Indicates that something is causing cerebral edema.

"Cranial CT has confirmed that there is no cerebral hemorrhage, indicating that there is a cerebral infarction, or when I fell yesterday, I injured the brain tissue..."

Zhou Mo nodded.

The mind has already begun to analyze.

If there is no cerebral hemorrhage, it must be a brain injury: either a cerebral infarction or a fall.

Wrestling at 16:00 yesterday afternoon, less than 18 hours from now.

Brain tissue damage, in the early stage (within 24 hours), is difficult to see on CT. There is no obvious change on CT, and there may be only a little edema. Only after 24 hours, or 48 hours, the brain tissue is severely necrotic, and then the obvious low-density shadow can be seen.

It's 18 hours now, so I can't see the results after doing CT.

Emergency doctor Cao Yun: "10 minutes ago, the patient's blood pressure suddenly dropped rapidly, reaching 70/40mmhg at one point... But now I've resisted it with vasopressors..."

Zhou Mo looked at the ECG monitor.

Blood pressure: 96/65mmhg…

Blood oxygen: 97 (in oxygen)

Emergency doctor Cao Yun: "The patient's condition is probably like this. At present, we haven't found why there is a problem with the heart pumping blood, so please come to the cardiology department to see what the problem is. In addition, the respiratory department can help you to see if the breathing is correct. There is a problem, because the patient's blood oxygen has been hanging..."

He looked at Chen Bing, Zhang Yang, and Zhou Mo.

Zhou Mo already had some thoughts at this time, and he didn't hide it and asked:

"Have you ever asked the patient, when you fell yesterday, did you fall down due to dizziness, or did your feet fall unsteadily?"

There are still differences between the two.

If you feel dizzy and fall, it means there is a problem with your brain.

Cao Yun, an emergency doctor, saw Zhou Mo, an unfamiliar and handsome boy, and was deeply impressed.

Cao Yundao: "We asked about this... The patient's fall yesterday was dizziness first, and then the fall..."

"Dizziness and fall..." Zhou Mo continued to ask: "Is it possible that it is pulmonary embolism? The patient is 73 years old and is likely to have venous thrombosis. If the thrombus travels to the lungs, it is pulmonary embolism, resulting in low blood oxygen and further cause dizziness..."

Cao Yun nodded: "This, we have considered..."

The logic in it:

The first fall (yesterday afternoon): the thrombus blocked the pulmonary artery branch -> then the blood + oxygen could not be combined -> the amount of oxygen in the blood delivered to the whole body was not enough, causing the whole body hypoxia (lip Cyanosis, low oxygen saturation) -> lead to cerebral hypoxia -> dizziness, falls...

The second fall (1 hour ago): cerebral hypoxia + cerebral edema + mass -> dizziness, fall...

It's all possible...

Emergency doctor Cao Yun: "We also considered pulmonary embolism later...because the patient has severe varicose veins."

Then a pair of the patient's pants.

The patient's lower limbs were displayed in front of Zhou Mo and the others:

Varicose veins!

There are obvious varicose veins on the left and right lower limbs!

And the number is not small!

What are varicose veins?

If you can observe the legs of the elderly in parks, subways and other places in summer, you can find that most of the elderly's legs, veins and blood vessels are exposed to the surface of the skin, like blue earthworms, twisting and twisting, and some even curled into a ball, protruding …

These are varicose veins.

The reason for its formation is that the heart needs to return blood, and it relies on the power of the heart to draw the blood back from the legs, but when the legs stand, it is too high, and the blood has to overcome the huge gravity to be transported upwards. What should we do at this time? Don't be afraid, there is something called a venous valve in the veins. Every venous blood vessel has a venous valve, and the access is not allowed to go out (just like the mitral valve, tricuspid valve, and aortic valve inside.) With the venous valve, the vein The blood is transported upward, and then each segment is blocked by the venous valve and does not flow back.

However, long-term loads (such as long-standing occupations, the elderly) can cause a series of valves to be destroyed one after another.

And then there are varicose veins!

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