This Doctor is Great

Zhou Mo could see that the patient in front of him was suffering from chest pain.

Because he was covering his heart and wrinkling his face, as if he was holding back.

Patient, Cheng Wenle, 33 years old

Time is urgent, Zhou Mo's speech speed has accelerated a lot.

"I'm your bed doctor. Where are you feeling now?"

"Chest pain." Patient Cheng Wenle whispered in pain.

"What kind of pain method? Crushing pain, dull pain, sharp pain from acupuncture, tearing pain?"

"I can't tell, it's just pain..."

"Does it last forever, or does it come in bursts?"

"For a while..."

"When did the chest pain start?"

"Two hours ago, when I was working in the company, I suddenly had a little chest pain, and then I panicked, so I asked my colleague to bring me to the emergency room..."

At this time, the patient Cheng Wenle's chest pain seemed to have eased a little, and his speech became a little smoother.

At this time, Zhou Mo saw that the patient's friend was carrying a bag, revealing a corner of the medical record book.

"Is this the inspection report?"

"Yes yes..." Patient Cheng Wenle's friend was a little reserved.

"give me…"

Zhou Mo took the inspection report and read it.

While watching, while stroking.

This disease, first rule out the danger.

The first is acute myocardial infarction and aortic dissection, both of which are very urgent.

Acute myocardial infarction is myocardial necrosis caused by acute and persistent ischemia and hypoxia of coronary artery.

Once the course of the disease progresses acutely, a large number of myocardial cells are necrotic, and the heart is severely damaged and expanded, resulting in cardiogenic shock, malignant arrhythmia (such as ventricular fibrillation), and death at any time.

Its diagnosis is simple.

The myocardium is necrotic in a large area, so the electrocardiogram, which measures the electrical activity of the heart, will naturally be very sensitively reflected.

In addition, large areas of myocardial necrosis, myocardial fibers will degrade and release troponin in a large amount, so troponin with poor blood pumping will soar rapidly.

Troponin is a marker of myocardial injury and necrosis (gold standard), which has important clinical significance for the diagnosis and risk stratification of acute myocardial infarction, with a diagnostic sensitivity of 100% and a specificity of 91%.

Summary method: ECG + troponin

Zhou Mo quickly pulled out the patient's long ECG chart and glanced at it.

Fortunately, the electrocardiogram is normal.

I looked at the patient's blood troponin again, and it was normal!

"Whoo~~~~"

Zhou Mo finally breathed a sigh of relief.

The patient has had chest pains for two hours. If there was a real myocardial infarction, the troponin should have responded long ago.

Excluded: acute myocardial infarction!

Big crisis, rule out one!

(Off-topic: This derivation, reverse inference is not possible, elevated troponin does not mean myocardial damage, it may also be renal insufficiency.)

However, to be on the safe side, Zhou Mo still asked the nurse Xiao Liumei to draw blood and continue to do the troponin test to dynamically monitor whether it will improve.

In addition, Mei Zhao, a night-shift nurse who just took over, was busy taking an electrocardiogram and applying electrodes to the patient.

Next, what Zhou Mo needs to rule out is—

The second danger: aortic dissection!

Aortic dissection is also very dangerous. Once ruptured, the aorta will bleed, spray water like a faucet, and life will be at stake.

"Liu Meimei, after you draw blood, help me measure his blood pressure on his left and right arms..."

"OK."

The little beauty Liu was busy while crying in the storm.

This time it is estimated that it will not be off until 6 o'clock!

…

Zhou Mo began to stroke:

Aortic dissection, how should this disease be ruled out and judged?

The first is pain.

Almost all patients with acute dissection have severe chest pain.

It is characterized by an immediate peak in a short period of time, often with symptoms of exhaustion due to severe pain.

Its tear (pain) process: Begins in the ascending aorta, passes through the aortic arch, and extends toward the descending aorta, producing pain extending from the anterior chest to the posterior back, between the shoulder blades.

(Boss, give me a picture?)

For clarity, Zhou Mo made a special gesture:

"Your pain progressed for two hours, did it go from here (in the chest) and all the way to here (behind between the shoulder blades)..."

The patient Cheng Wenle looked at Zhou Mo's gestures seriously, and then thought about it.

Shaking his head.

"No... it's always been a heartache, no pain in the back and shoulders (scapula)..."

Zhou Mo breathed a sigh of relief.

Fortunately not.

At this time, the nurse Xiao Liumei has completed the blood pressure measurement of the patient's arms.

"Dr. Zhou, the blood pressure is out. The blood pressure in the left upper extremity is 150/93mmHg, and the blood pressure in the right upper extremity is 152/95mmHg..."

Zhou Mo was stunned for a moment.

It's symmetrical!

"Do you usually have high blood pressure?"

"Have…"

Patients with aortic dissection may have asymmetric blood pressure between the left and right arms, which is very different.

If it exceeds 30-50mmHg, it is highly suspected that there is a possibility of aortic dissection.

Why is there a blood pressure difference?

(Boss, continue to give pictures?)

Of course, aortic dissection can be inferred with a large blood pressure difference, but aortic dissection does not necessarily have a large blood pressure difference.

Zhou Mo pondered for a while.

"Otherwise, let's do a CT..."

Although the blood pressure in the arms is symmetrical, and although the pain is not tearing from the chest to the back, several possibilities of aortic dissection (such as abdominal aortic dissection) cannot be ruled out.

After all, the condition is very dangerous, and a CT scan is only a few hundred yuan. You can try it, after all, it is a human life.

As for why not use color Doppler ultrasound?

Color Doppler ultrasound can also see aortic dissection, but its accuracy is not high, and there is the possibility of false negative and false positive.

So to be on the safe side, get a CT!

Zhou Mo informed the patient of his own considerations.

"Do it! Must do it!"

Patient Cheng Wenle nodded decisively.

The income of programmers is quite high, and naturally they will not save money at such a critical juncture.

Zhou Mo nodded: "Okay, before I go, I have to do other inspections for you..."

Currently,

In addition to the previous acute myocardial infarction and aortic dissection, what other dangerous and fatal causes could the symptoms of patient Cheng Wenle be?

The third danger: pulmonary embolism!

(I wrote this earlier, probably because of thrombosis of the lower extremities, backflow to the pulmonary artery and capillaries, and then blocked)

In addition to the occupation of standing for a long time, programmers have been sedentary for a long time, which can also be regarded as a occupation with frequent thrombosis.

but,

When Zhou Mo checked the patient Cheng Wenle's calf, there was no sign of varicose veins.

However, Zhou Mo still asked the nurse to help push the bedside color Doppler ultrasound.

Then a cardiac ultrasound was performed on the patient Cheng Wenle. If there is a pulmonary embolism, it is difficult for the right ventricle to pump blood into the pulmonary artery, which can lead to a rapid increase in right ventricular pressure, which can be seen on echocardiography.

At last,

"Heart ultrasound is fine..."

"That means pulmonary embolism is ruled out..."

In addition to acute myocardial infarction, aortic dissection, and pulmonary embolism, what else is more dangerous?

The fourth danger: pneumothorax.

A pneumothorax is when the lungs are ruptured, and gas accumulates in the chest cavity, squeezing the lungs and limiting the expansion of the lungs.

(The big guy continues to take the picture?)

However, Zhou Mo looked at the patient's state. Although his breathing was a little rushed, the pulse oxygen and blood oxygen on the ECG monitor was still 98 (the normal range of pulse oxygen was 94-100).

When you have a pneumothorax, you will have difficulty breathing, and your blood oxygen should decrease.

Zhou Mo took the stethoscope and listened to the patient Cheng Wenle's heart and lungs.

Pneumothorax is naturally restricted breathing, so the sound heard by the stethoscope will be very weak.

So it is easy to identify.

Upon hearing it,

Pneumothorax was directly ruled out.

So far,

Excluded: acute myocardial infarction, pulmonary embolism, pneumothorax, UU reading www.uukanshu.com

Finally, aortic dissection awaits further examination…

"Go, do CT!"

At this time, the various departments of the hospital have been off work, but CT is on duty 24 hours a day.

There is no need to make an appointment in advance. After all, the condition is urgent, and it is enough to go directly to the imaging department.

Zhou Mo made a phone call and said hello there.

Gollum~~~~

The patient lay in the car and was pushed out of the ward.

"Doctor, why don't I go over there..."

The patient Cheng Wenle was lying in the car, blushing like a monkey's butt, feeling very embarrassed for this kind of 'treatment'.

Zhou Mo is serious: "Sit down, don't get up."

.