I Can See Health

   Chapter 314 People are not in the rivers and lakes, and there are his legends everywhere in the rivers and lakes!

   "Hiccup?" Lu Chen frowned.

   Because he looked at the HP on the old man's head, it was only 57!

   The health value is below 60, this is definitely not as simple as a hiccup!

   "Are there any other discomforts besides hiccups?" Wang Xueyang immediately said, "For example, headache, dizziness, bad habits, vomiting, difficulty breathing, cough, chest pain, or palpitations?"

  The old man thought for a while, then shook his head, "No, just hiccups."

The    voice just fell, and there was another "uh" sound.

The middle-aged man sighed, "Hiccups are not a disease, but they are really fatal! My dad has been hiccups for the past four days, and he basically couldn't sleep at night. Tonight, the symptoms of hiccups worsened, basically for four or five seconds. just one time."

  Wang Xueyang frowned: "Master, did you have any other illnesses before?"

   The middle-aged man on the side replied: "This, my dad used to have three high blood pressure, diabetes, and hyperlipidemia."

   "What about other than that? For example, have you ever hiccups like this before?" Wang Xueyang asked.

  The middle-aged man turned to look at the uncle.

   Uncle shook his head, and then made another "uh".

   "We have searched for many methods on the Internet, such as holding your breath, drinking water, and diverting your attention. We have tried all the local methods, but they are of no use." The middle-aged man shook his head slightly.

   This is where it gets a little tricky.

   Wang Xueyang didn't think of a good way for a while.

  Lu Chen frowned.

   This uncle is definitely not as simple as hiccups, otherwise his health value would not be so low.

   The professional term for hiccups is hiccup.

   This is due to paroxysmal spasm of the diaphragm, accompanied by a sudden closing of the glottis during inspiration, making a short loud special sound

   Hiccup is a reflex activity with afferent branches consisting of the vagus nerve, the phrenic nerve, and the thoracic sympathetic trunk. The hiccup center is located in C3-C5, connecting the central nervous system, respiratory center, phrenic nucleus, medulla oblongata and hypothalamus.

   Efferent branches (vagus, phrenic) have connections to the glottis and accessory respiratory muscles, the intercostal muscles, and the anterior scalene muscles.

   Stimulation anywhere along the afferent branch of the reflex arc can cause hiccups.

   That is, almost any thoracic lesion can stimulate the thoracic branch of the vagus nerve and cause hiccups.

"Doctor, the doctor at the clinic near our community said that the hiccups are benign and don't need special attention. It will get better in time, but we are not doing well now. You can think of a better way for my dad." Zhong The old man said.

  Wang Xueyang explained patiently: "Actually, if the hiccups usually last for a few seconds or a few minutes and disappear slowly, it can be considered benign."

"However, once hiccups are repeated for more than a few days or months, frequently repeated and aggravated, leading to insomnia, weight loss, and fatigue, it may be caused by certain underlying diseases, such as central nervous system diseases, lung diseases, gastrointestinal diseases, Metabolic abnormalities."

   "Is there so much to pay attention to?" The middle-aged man wondered, "But my dad didn't have these diseases before, so he can't suddenly get such a disease, right?"

  Wang Xueyang paused and said to the uncle, "I'll check it out for you first."

   Let the middle-aged man help the uncle to the physical examination table, and Wang Xueyang began to examine the patient.

   for a long time.

  Wang Xueyang ended the examination with a puzzled look, but she still didn't find anything unusual.

   Heart and lung auscultation were also normal.

   "Let's check the plain film of the chest and abdomen first." Wang Xueyang said.

   "Huh? Hiccup and still need to make a movie?" The middle-aged man wondered.

   "I told you just now that any chest disease may cause hiccups. This film is mainly to rule out whether there is a disease called hiatal hernia." Wang Xueyang said.

   "Oh." The middle-aged man seemed to understand.

  Lu Chen immediately issued a checklist to the patient.

   Then, the middle-aged man took the uncle to check.

   As for this hiccups, Lu Chen doesn't have any clues because there is currently no inspection.

   However, the red 57 on the uncle's head is particularly dazzling.

  Lu Chen didn't dare to take it lightly.

  …

  X-ray examination is very fast, and the imaging department will issue the results as soon as it is done.

   About ten minutes later, Lu Chen and Wang Xueyang saw three more ordinary emergency patients.

  The middle-aged man came back with the uncle.

   "There is no problem with the chest and abdominal plain films." Wang Xueyang couldn't judge the patient's condition for a while.

   "Doctor, you should use some medicine first to stop my dad's hiccups." The middle-aged man was a little anxious, "As for what caused the hiccups, I'll check it later."

   Wang Xueyang said solemnly: "That's fine, I'll go to the emergency room first, take some medicine, and observe it overnight."

   "Okay." The middle-aged man agreed.

   He took the uncle to the emergency observation room on the second floor.

  Lu Chen watched the uncle stare at the red HP and leave, feeling a little uneasy.

  Although the uncle went to the emergency observation room, there are many patients in the emergency observation room at night.

  Lu Chen was worried that the doctor on duty might not notice the changes in Uncle's condition in time.

   If the uncle really has some kind of dangerous disease attack and rescue again, it will be too late!

  Lu Chen thought about it, and sent a WeChat message to Cheng Peng, asking him to pay attention to the uncle in the observation room on the second floor.

  …

  Second floor, emergency observation room.

  Cheng Peng received Lu Chen's WeChat.

   "Hey, I really don't worry about it tonight. If I meet Lu Chen next time, I'll have to change classes!" Cheng Peng thought to himself.

   As soon as this thought flashed through his mind, the uncle Lu Chen mentioned came to the emergency room.

   "Let me pay attention to this uncle, and make more rounds..." Cheng Peng carefully gave Uncle Hiccup a lot, "Is there something special about this uncle, isn't he a patient with hiccups?"

   At this time, Wang Xiaodong quickly consulted this uncle.

  Hiccup, a seemingly simple problem, but it is not that simple to cure.

   Then, Wang Xiaodong gave the patient two conventional medicines for hiccups.

   "2 mg of lorazepam and 50 mg of chlorpromazine intramuscularly."

  Lorazepam and Chlorpromazine are both psychotropic drugs that can treat hiccups caused by mental factors.

   After using the medicine.

  Cheng Peng observed for five minutes, the uncle's hiccups eased!

   "This medicine should have been used long ago!" After the uncle calmed down, a relieved smile finally appeared on his face.

   In the past four days, hiccups tortured him badly.

  Cheng Peng immediately sent a WeChat message to Lu Chen, telling him the situation of the uncle.

   "Is it really just a hiccup caused by mental factors?" Lu Chen frowned, "Does mental factors make life so low? It shouldn't!"

  …

  However, just two minutes later, Uncle's hiccups started again.

   And compared to before, the symptoms of hiccups did not ease in the slightest.

   "What's going on?" Cheng Peng was quite surprised.

  Chlorpromazine and lorazepam can only provide temporary relief, not the fundamental solution.

   It is impossible for patients to use these two drugs all the time!

  Wang Xiaodong was also puzzled.

   He was also the first time he encountered such a patient with intractable hiccups.

   At this moment, Cheng Peng received another WeChat message from Lu Chen.

   "Fatty, did the patient do any examinations on your second floor?"

   "There's no need for a blood test for this kind of hiccups." Cheng Peng wondered, "It's just a routine electrocardiogram."

   Admission ECG, which is mandatory for all patients.

   "What about the electrocardiogram results?" Lu Chen asked.

   "I took a look and the electrocardiogram should be normal. Senior Brother Wang also looked at it, and he didn't see any problems." Cheng Peng replied.

   "Normal?" Lu Chen paused, "Send me the electrocardiogram."

  Cheng Peng didn't think much, and sent the electrocardiogram to Lu Chen.

  Lu Chen's ability to read pictures is much better than his, and he also entered the national finals of the electrocardiogram competition.

   He didn't think that Lu Chen was looking down on his ability to read pictures, because the two people's ability to see pictures was too different, and Cheng Peng had no such idea at all.

  …

  The first floor, emergency internal medicine clinic.

   Lu Chen received an electrocardiogram sent by Cheng Peng just after seeing a patient with a fever.

   At present, the patient has not done any examination, only this electrocardiogram.

   Click on the original image to enlarge it.

   At first glance, Lu Chen did not find any problems.

   Hiccups are generally not related to the heart.

  Lu Chen thought about it, and just wanted to turn off the picture.

   He suddenly caught a glimpse of the lower leads of the ECG, which seemed a little strange!

   Inferior leads are II, III, AVF leads.

   At this time, in Lu Chen's eyes, the ST-T segment of the inferior leads seemed to be raised a little bit.

   However, after looking back and taking a closer look, it doesn't seem to be elevated!

This……

  Lu Chen hesitated.

  Clinically, the ECG is not black and white.

   The electrocardiogram in front of you, most doctors will definitely consider it normal.

   Even, Lu Chen thought it was normal in his heart, only a little strange.

   However, I thought of the red health value of 57 on the uncle's head.

  Lu Chen felt that he couldn't just let go of the possibility of "abnormal ECG"!

   He quickly sent Cheng Peng a WeChat message.

   "Fat man, do another electrocardiogram for the patient. If the family agrees, it would be best to check him for myocardial enzymes."

   Cheng Peng, who was in the emergency room, was stunned.

   "Recheck the ECG, and also check the myocardial enzymes? Lu Chen, do you suspect that the uncle has angina pectoris or myocardial infarction?"

   "Yes." Lu Chen simply replied.

  Cheng Peng frowned, and looked at the uncle's electrocardiogram carefully again.

   He still didn't see anything unusual.

  If you suspect myocardial infarction, you must show evidence!

  This patient does not have any symptoms of myocardial infarction...

  No chest pain, no abdominal pain, and no toothache!

  Although Cheng Peng admired Lu Chen very much, at this time he always felt that Lu Chen was constrained by his own specialty and misunderstood the diagnosis of the patient.

  Clinically, many doctors have narrow thinking due to their own professional limitations.

  For example, a cardiologist thinks of coronary heart disease when he has chest pain, but does not consider gastric ulcer, hiatal hernia, etc.

   However, Cheng Peng did not make up his own mind, but told Wang Xiaodong Lu Chen's opinion.

  …

   "Is it suspected that the hiccups are caused by a heart attack?" Wang Xiaodong was stunned for a moment, "This... I've never seen it anyway."

  Wang Xiaodong also checked the uncle's electrocardiogram several times, but found nothing abnormal.

   His thoughts are the same as Cheng Peng, the patient does not have any symptoms of myocardial infarction!

   "Well, I'll communicate with the patient, and I can review another electrocardiogram." Wang Xiaodong paused, "As for myocardial enzymes, it's definitely not possible for the time being."

   If it was another graduate student who proposed this possibility, Wang Xiaodong would probably not accept it.

   But Lu Chen is different, Wang Xiaodong is very aware of Lu Chen's ability, he will never aimlessly.

   Moreover, he also knew about Lu Chen's entry into the finals of the electrocardiogram competition.

  In case, this electrocardiogram really has something they didn't see?

  …

  Wang Xiaodong communicated with patients and their families for most of the day.

   Finally, the patient and his family agreed to review the ECG.

   After all, no one would consider that hiccups and heart disease are linked!

   "Zizzizi..."

  Cheng Peng pushed the electrocardiograph to review an electrocardiogram for the uncle.

  Wang Xiaodong was watching from the side.

   After the electrocardiogram was done, he immediately picked up the drawing.

   "It seems that there is still no problem!" Wang Xiaodong frowned.

   A normal looking ECG, no abnormality was found in either the speed or rhythm of the ECG!

   "Junior brother, you can compare the previous electrocardiogram to me." Wang Xiaodong said to Cheng Peng.

   "Okay." Cheng Peng quickly took out the first electrocardiogram from the office.

   Whether it is angina pectoris or myocardial infarction, there is an important feature, that is, the electrocardiogram must change!

   This is also the reason why Lu Chen asked Cheng Peng to review the electrocardiogram for the uncle.

  Wang Xiaodong took two electrocardiograms and carefully compared them.

  From P wave, QRS wave, T wave…

  Each paragraph, Wang Xiaodong carefully compared.

   "Hey, Junior Brother, look at the ST segment of this lower wall lead, isn't it a bit different!"

  Wang Xiaodong suddenly noticed a little change in the electrocardiogram.

   In the second ECG, the ST segment in the inferior leads is slightly elevated compared to the first ECG.

   After the comparison, and looking back at the first ECG, Wang Xiaodong felt that the ST segment of the lower leads seemed to be elevated in this first ECG!

   Upon discovering this, Wang Xiaodong was not happy at all, instead he broke out in a cold sweat.

  Fortunately, I found it. If I didn’t find it, the patient had a myocardial infarction, and I really dare not imagine…

  Cheng Peng also re-contrasted the ECG, and after Wang Xiaodong's reminder, he also noticed it.

   Actually, the ECG is just like that.

   A lot of details, if you don't remind, you can't see it at all.

   As soon as someone mentions it, you can immediately notice the abnormal place.

   "Senior brother, it seems to be raised a little bit."

   At this time, both Wang Xiaodong and Cheng Peng exclaimed in their hearts.

  From the first electrocardiogram, you can peel off the cocoon and see the abnormality.

  Lu Chen is too amazing!

  …

   However, now is not the time to sigh.

  Wang Xiaodong immediately took the electrocardiogram and went to communicate with the patient's family. At the same time, he also invited the emergency consultation of the Cardiology Department.

   informed the patient and family of the whole story, and the family agreed to check the myocardial enzyme spectrum.

   At this time, Li Qinghua, the chief inpatient of the Cardiology Department, also came.

After checking the two ECGs, he said solemnly: "It is indeed lifted. The second ECG is a little more obvious, but the first ECG is not so obvious. Your emergency department can see this clue and give the patient a re-examination. Zhang ECG, it's really not easy!"

  Wang Xiaodong scratched his head, "I didn't see it, it was a graduate student in your Cardiology Department who saw it."

  Li Qinghua looked at Cheng Peng beside him, his face was quite surprised: "It's you? I remember it's a graduate student in the eighth district in your heart."

  Cheng Peng hurriedly shook his head: "Teacher, it's not me, it's Lu Chen, he is working in the emergency clinic on the first floor today."

  Li Qinghua was stunned for a moment, then smiled, "It's Lu Chen!"

   That's understandable.

   This kid's ability to read pictures was proved by the electrocardiogram competition.

   is not worse than these old guys!

  Li Qinghua smiled and said, "It's rare that I didn't meet him in an emergency consultation, but it's still related to him!"

   "What do you say in those few sentences, people are not in the rivers and lakes, and there are his legends everywhere in the rivers and lakes!"

   "Xiaodong, you can check for myocardial enzymes. If it is really a myocardial infarction, then get CCU."

   "Okay, Mr. Li." Wang Xiaodong nodded.

   Then, Li Qinghua left.

   After Wang Xiaodong gave the doctor's order, the nurse on duty checked the rapid myocardial enzymes of the emergency department for the uncle.

  Two minutes later, the myocardial enzyme results came out.

   Uncle's troponin is more than 20 times the normal value!

   "I'm going, it's really a heart attack!"

   Wang Xiaodong and Cheng Peng looked at each other.

   Although the two were prepared, they were still shocked for a few seconds.

  Myocardial infarction diagnosed!

  …

  First floor, emergency clinic.

   Wang Xueyang looked at the chat records in the emergency WeChat group in surprise.

   The hiccups patient just now had an acute inferior myocardial infarction!

   She hurriedly looked at Lu Chen beside her.

   "Lu Chen, do you know what the hiccups patient was diagnosed with just now?"

  Lu Chen replied lightly: "Myocardial infarction?"

   As soon as he finished speaking, Wang Xueyang's expression became even more astonished.

   This WeChat group is the WeChat group of their undergraduate doctors, but no students have joined!

  Lu Chen, how did he know this diagnosis?

   "Yes... that classmate on the second floor told you" Wang Xueyang suddenly thought of this.

  Lu Chen smiled, neither denying nor admitting.

   Just now, he received a sound from the system.

   "Congratulations, +1 for receiving Cheng Peng's thanks!"

   "Congratulations, +1 for receiving Wang Xiaodong's thanks!"

   "Congratulations, the system upgrade completion rate has increased by 1%!"

   Seeing these reminders, he knew that his guess was correct.

   But when Wang Xueyang saw Lu Chen's smile, he only knew it when he heard what Cheng Peng said.

  Wang Xueyang said slowly: "It's the first time I've seen stubborn hiccups caused by myocardial infarction!"

   "Me too." Lu Chen said, "But the patient has a history of three highs, which is indeed a risk factor for myocardial infarction."

   "But no one will think about it!" Wang Xueyang sighed, "The doctor on duty tonight is not bad, and he can actually consider the disease of acute myocardial infarction..."

  …

   Speaking of which, this stubborn hiccups uncle.

After    was diagnosed with myocardial infarction, Wang Xiaodong immediately transferred it to the intracardiac CCU.

   After undergoing emergency coronary intervention, the patient's hiccup disappeared after the heart blood vessels were opened up...

   The real cases encountered during the second study. However, at that time, no one could see the changes in the first ECG. Afterwards, the patient had a myocardial infarction. When he looked back, he found that there was actually a change in the ECG after admission. Although the patient was fine in the end, everyone sounded the alarm. ps: I haven't read any other medical novels. As stated before, cases are derived from personal experience, or from case reports in the literature.

   (end of this chapter)