Doctor Started a Plug-in

You can search for “when the doctor opened the plug-in wonderful pen novel novel network (imiaobige.com)” in 100 degrees to find the latest chapter!

Since then, Tan Zhonglin successfully joined Chen Cang’s team and became Chen Cang’s second assistant, referred to as 2 rooms!

The addition of Room 2 has given Chen Cang’s support team a little more competition.

An Yanjun in the main room finally came out of the comfortable environment and started competing with Tan Zhonglin.

However, this kind of competition is obviously beneficial. Both sides have their own skills to compete for pets and love, and they learn a lot more.

But after all, An Yanjun, who is a main house, has a great advantage. After all, there are three small nurses who hold pumps.

After all, only by leaving Chen Cang can they compete fairly.

10000 As soon as Tan Zhonglin snatched it away, it was boring to scramble.

At this time, Chen Cang suddenly found that the blessing of Qi Ren was not good, 2 people were annoying… Chen Cang suddenly fell in love with Qin Yue.

Don’t speak or speak.

Occasionally shouting that you are good.

Blink his eyes wide.

Surgery also has a good mood.

The most important is still pleasing to the eye.

Chen Cang looked really upset about these 2 old fogeys of the river for love…

……

……

October 1st finally arrived, Chen Cang first class,

Although the emergency department is as busy as fighting, but…at least not so annoying.

He finally understood why the ancient official was that many die an untimely death, so tired!

In the daytime, you have to get 10000 machines per day, and in the evening you have to get 10000 days…

Hey……

The National Day Hospital Hospital has much fewer patients, and the amount of OPD is less than one of the 20% normally.

However, the emergency department will not be easy. The first line of surgery besides Chen Cang and Wang Yong, 2 people are busy all morning.

Doctor Yao in the internal medicine department is as busy as a dog, because Yan Ming Doctor Yan is on duty with him today.

Doctor Yan is a well-known arm-flinging shopkeeper in the emergency department. It is more than Li Baoshan’s.

All in all, the emergency department is the nursing department.

The Hospital is also reluctant to worry about this kind of people. It is a two-year retirement after thinking about it. After all, there will be no major problems if he is present.

Although Yan Ming doesn’t care much, he is very likely to be worldly-wise and play safe, which is a skill in today’s context.

Now, when any Doctor is on the job, the first lesson taught by the Teacher is how to protect himself.

Yao Zhiwen and Chen Cang are a group of them. They are Post-Graduate of Department of Cardiology of Dongyang Medical University, and are the same as Wang Qian and Qin Yue. They are qualified.

Yao Zhiwen has a more introverted personality and does not like to talk. When he meets people, he always smiles and smiles at you. He looks like your shy big girl and is more honest. He met Yan Ming as a bad luck.

I was too busy all morning to rest.

At about 1 o’clock, Yao Zhiwen hurriedly found Chen Cang, some worriedly said: “Doctor Chen, help me see a patient!”

Chen Cang nodded followed Yao Zhiwen to the rescue room.

Yao Zhiwen walked and said, “Patient is a middle-aged man, 41 years old. He sent 120 with chest pain. He came to a coma after a short time. The situation is very serious.”

Chen Cang heard Yao Zhiwen’s words and sharply captured a few clues.

“Chest pain!”

“coma!”

Is it myocardial infarction?

This is Chen Cang’s first feeling.

Yao Zhiwen continued: “Patient began to appear confused and unconscious shortly after arriving in the emergency department. 120 sent it, and when he told the doctor that the patient was still awake on the road, he only said that his chest was tight and his chest hurt. As with acupuncture, nitroglycerin was not relieved, and ECG was normal.”

Chen Cang froze for a moment, and quickly asked: “Did you get an ECG in the emergency department?”

Yao Zhiwen nodded: “It’s made up, and troponin is also urgently checked.”

“I didn’t see the acute Myocardial Infarction performance pattern, and blood was drawn to see that troponin was elevated.”

Chen Cang frowned as soon as he heard it. When he arrived in the room, Yao Zhiwen quickly took the ECG and handed it to Chen Cang: “Look.”

Chen Cang took the ECG and found that the ECG not at all typical Myocardial Infarction performance, ST is basically normal…

This is strange!

Yao Zhiwen: “I’m still worried about heart problems. I just called the Department of Cardiology for an emergency consultation. I haven’t come down yet. Doctor Yan… I’m going to please!”

Chen Cang unable to bear sneers…

2 Everyone knows that even though the ECG does not have a typical waveform, the Patient still cannot rule out the possibility of acute Myocardial Infarction.

When encountering a typical Myocardial Infarction, the ECG will indeed have those characteristic waveforms of ST and other waveforms, which is easy to understand, because normal myocardial cells will have electrical activity, and necrotic myocardial cells will not have electrical activity. The mechanism of ECG is The waveform is displayed by capturing such anomalies.

However, when Myocardial Infarction is early, the heart muscle may not be completely necrotic, and the electrocardiographic reaction still exists, which means that the electrocardiogram may not have the typical performance.

In addition, troponin is mainly in cardiomyocytes, and its increase often indicates that the cardiomyocytes are damaged.

Chen Cang asked: “What’s the history?”

Yao Zhiwen said: “The oral history of the family members is basically reliable. There is a history of hypertension, hyperlipidemia and fatty liver disease. So… it is impossible to rule out the possibility of acute Myocardial Infarction.”

Chen Cang snorted: “Do you suspect cardiogenic shock?”

Yao Zhiwen nodded!

While speaking 2 people have arrived in the rescue room, Patient is now on ECG monitoring.

When Chen Cang first glanced at the Patient, not at all he saw something special on his face, and he was already in a coma. He was lying on the bed without any movement.

On ECG monitoring: the heart rate is 120 minutes, which is a bit fast. The blood pressure is 8050mmHg, which is low… The blood pressure of normal people should be 90-14060-90mmHg,

The blood pressure of 8050 is low anyway. The blood pressure is low, indicating that the patient has shock.

All clues are unclear.

Bode ill rather than well !

Patient usually has a history of hypertension, and at this time only has a blood pressure of 8050. In this case, the blood pressure simply cannot meet the blood supply of the brain. To put it simply, the heart is like a water pump. The blood must be pumped all over the body, and the water pump provides The pressure is not enough, there is no way to hit the water on the head.

The brain is very sensitive to ischemia and hypoxia. Once the blood and oxygen supply is reduced, it will be comatose!

In order to quickly eliminate Myocardial Infarction, Chen Cang once again made an ECG for the Patient.

Chen Cang hesitated: “I’ll ask the family what happened.”

Patient’s family is his wife, accented in the field.

Chen Cang asked: “When did chest pain occur?”

His wife was obviously terrified, and his speech was somewhat logical: “He is usually very good, just like drinking, but… I… I can’t remember how long he was uncomfortable, it should be yesterday, I I didn’t care, but today I couldn’t walk because I was serious. I hurriedly called 120 and coma soon after I came to the emergency department.”

Talking and talking, she cried while talking, terrified.

Chen Cang sighed, also understand that after all, a good person, suddenly comatose like this, and whoever changes, will be nervous.

Chen Cang understands her, but now is not the time for comfort.

Because Myocardial Infarction is terrible,

If the diagnosis is confirmed, you must race against time, and then send it in time for interventional treatment.

What is Myocardial Infarction?

That is, the blood vessels of the heart are blocked by the formed emboli, and the blood flow is blocked. The heart is actually a muscle tissue, and his movement depends on the blood supply of the coronary arteries.

If the heart ischemia is too long, the cardiomyocytes will gradually necrosis. When there are enough necrotic cardiomyocytes, the heart will be weak. At this time, heart failure will occur, then shock, and finally die.

This process may only have several points of minutes at the fastest!

So once confirmed to be Myocardial Infarction, the most effective treatment is to open blood vessels immediately, immediately, decisively, and as soon as possible, whether it is medical thrombolysis or interventional stents, the purpose is to open up blocked blood vessels and restore blood flow to the heart .

So, everything is imminent!

Chen Cang habitually put his hand on the Patient, looked at the pupil, and checked the reflection.

This is a habitual operation as a surgical doctor.

When Chen Cang touched Patient’s belly with the other hand, Chen Cang was stunned!

Thinking of this, Chen Cang quickly said to Yao Zhiwen: “Did you do the physical examination?”

Yao Zhiwen shook his head: “It’s too late!”

Chen Cang shook his head and quickly lifted the Patient clothes.

Handy press!

Tummy is a little tight…

This is not normal. Normal people’s abdomen should be relaxed when lying down. No matter how hard your abdominal muscles are, your tummy should be soft.

Moreover, this Patient is already comatose, why is his stomach stiff? And tight!

This man is overweight and obviously not an abs…

Yao Zhiwen also suddenly discovered this situation and quickly touched it, suddenly stunned!

“Muscle tension?”

Abdominal tension often indicates inflammation in the abdominal cavity. Inflammation stimulates the peritoneum, causing abdominal muscles to tighten, so it feels a little tight when touched.

Could Patient’s Myocardial Infarction cause abdominal tension?

At this point the ECG result came out, the nurse handed it over, and Chen Cang took it over. After reading it carefully, he still didn’t see the typical Myocardial Infarction graph.

Chen Cang unable to bear asked his family: “How long has it been since the attack?”

His wife was confused: “Hours for hours? 3 4…”

Chen Cang looked at Yao Zhiwen: “It doesn’t look like a myocardial infarction! It’s been 3 or 4 hours. If it’s really acute Myocardial Infarction, there should be obvious ECG changes.”

Chen Cang unable to bear asked: “Is a chest radiograph, CT?”

Is there another cause of chest pain?

Yao Zhiwen took the film and Chen Cang took a look, it was basically normal!

What’s so strange about him?

what happened!

Chen Cang’s brain flew rapidly, thinking about various probabilities.

Thinking back to thinking, but Chen Cang’s hand didn’t stop. He was always checking Patient’s abdomen, trying to find out more information.

Just when he routinely gave the patient a percussion examination of the liver area, when he tapped the liver, he found that the patient suddenly brows tightly knit, showing a painful expression.

This time shocked Chen Cang!

You have a comatose patient with a painful expression. What does that mean?

Only one possibility!

That is, Chen Cang did hurt him!

Well, this is not nonsense, it is true!

Even when a person is comatose, he feels severe pain.

And normal people will not have any reaction to percussion in the liver area, unless he has diseases of the hepatobiliary system!

But also those acute inflammatory diseases, such as liver abscess, or cholecystitis, biliary colic.

The wife saw that the man had a painful expression and thought he was awake. He quickly patted and beat in his ear and called his name loudly, but he didn’t respond at all.

In order to further verify the idea, Chen Cang’s left palm was placed on the lower part of the right chest of the patient, and the thumb of the left hand was used to press the gallbladder area. If the patient has gallbladder inflammation, such a deep pressure will inevitably cause severe pain in the patient. Because the gallbladder is under Chen Cang’s thumb.

really!

When the left thumb is pressed down deeply, Patient’s brows are even more wrinkled and twisted into a ball!

Chen Cang took a long breath.

Patient is correct, but Patient is not cardiogenic shock, but may be septic shock.

Cardiogenic shock refers to shock caused by heart disease. If it is Myocardial Infarction, then intervention or thrombolytic therapy should be done immediately.

However, if the gallbladder infection is severe and the septic shock occurs, the treatment is completely different.

Inflammation of the gallbladder and bile ducts may also cause chest pain. Although it is less, it is possible that, in turn, Myocardial Infarction may also cause abdominal pain instead of chest pain.

The human body is very complicated, and it is not simply a pain or a disease!

At this time, the Patient is probably a disease of the gallbladder system!

Chen Cang: “Give me the test report.”

If two people are mistaken and the treatment opportunity is missed, the Patient may breathe one’s last.

After taking the Patient’s test report, after reading it carefully, the blood routine showed that the white blood cells were too high, not too high.

However, Myocardial Infarction itself will cause high white blood cells and infection, so it can not be identified by blood routine alone.

Chen Cang looked at Yao Zhiwen: “Replenish fluids first! Lots of fluids!”

Yao Zhiwen also understood what happened at this time: “You mean… worry about septic shock?”

Chen Cang nodded!

In fact, whether it is cardiogenic shock or septic shock, fluid supplementation is correct at this time.

As long as the blood volume of the Patient is raised and the blood pressure is raised, the blood and oxygen supply of each organ can be guaranteed, otherwise, those organs that are hypoxic and ischemic will be starved to death by one!

“Notify the B-Urgent Emergency Consultation!” Chen Cang decisively ordered the doctor.

The nurse quickly picked up the phone and began to contact.

For the sake of 10000 without fail, Chen Cang did a detailed examination of the Patient again. There were not many abnormalities in the cardiopulmonary auscultation. Reading the chest radiograph again did not indicate the performance of heart failure and pulmonary edema. I re-drawn an electrocardiogram and still did not see it. Typical Myocardial Infarction performance, Patient is really not Myocardial Infarction! ! !

Chen Cang is basically sure!

To diagnose Myocardial Infarction early, the most objective method is to do ECG non-stop.

The electrocardiogram is cheap, convenient, and no radiation. It can also provide great value. It is really a rare good check.

The B-mode room was in the vicinity, and after a while they pushed the machine over.

Not long!

The inspection results came out.

The result surprised Chen Cang and Yao Zhiwen!

B ultrasound showed that the gallbladder was obviously enlarged, the gallbladder and the bile duct wall were thickened, there were still many stones in the gallbladder, and the bile duct was still significantly expanded!

All this shows that the patient’s gallbladder and bile duct are inflamed, and it is likely to be acute obstructive suppurative cholangitis.

Once the stones block the common bile duct, the bile cannot be smoothly discharged from the digestive tract, and it will inevitably accumulate more and eventually lead to increased pressure in the bile duct, and the bile will flow back into the blood. With the bacteria entering the blood, there will be obvious sepsis. In severe cases, there may be shock.

Chen Cang took out the phone and called Zhang Youfu directly. Zhang Zhixin was on duty and ran down with a jump!

Discuss with B-Teacher White Teacher.

Comprehensively evaluated the situation of Patient, clearly considered acute obstructive suppurative cholangitis, septic shock, it is recommended to immediately go to General Surgery, timely operation of biliary decompression and drainage surgery, as long as the bile duct is opened, let the bile flow spout Out, the condition will be significantly improved.

As for the gallstone problem, I will discuss it slowly afterwards.

After the Patient sent away, Yao Zhiwen was sweating with fear.

Chen Cang pats his back and found that behind him was all sweat.

The dim tears in Yao Zhiwen’s eyes: “Chen Cang…you said…if I don’t invite you to come…is he gone?”

One sentence dumbfounded Chen Cang.

Chen Cang sighed, I don’t know what to say.

Diagnosis of diseases is too complicated, who can guarantee that they can be accurately diagnosed?

Chen Cang has a plug-in, but it can’t be seen through at a glance. If it’s not lightly touched, Chen Cang himself can’t guarantee…

Chen Cang looked at Yao Zhiwen, this can’t blame him…

Diseases can be countless changes. The symptoms and auxiliary examinations of different diseases often overlap. If they are not carefully identified, it is very easy to make mistakes.

so.

Practitioners, when trembling with fear, follow the thin ice!

And this time, Doctor Yan is back… with the Doctor of Department of Cardiology.

Chen Cang sighed, looking at Yao Zhiwen: “You are excellent, at least you didn’t run…”

Yao Zhiwen cried with a smile, really cried with tears, and the tears went down.

“I really want to be a good Doctor!”

Chen Cang laughed: “You are already…”

What can I say besides comforting him?

Yan Ming hurriedly ran over: “Little Yao, man? Where’s Patient?”

Watching Yao Zhiwen cry, Yan Ming shuddered: “Is the person gone?”

Chen Cang sighed, hook the head, and returned to emergency surgery.

ps: Thank you Xiaoya for the 10000 reward, thank you!

To be a clinical doctor really needs to be on thin ice. Before any Junior Doctor grows into a truly senior doctor, he needs to exercise continuously. I was in the clinic as well. It is really not true to encounter this kind of thing. knowing what to do.