Zhan Hao was lying on the bed, his face a little yellow.
After Sun Lien scolded the doctor from the Second Hospital, he and Zhan Jun pushed the bed into the emergency room, and deliberately placed him near the door to facilitate subsequent imaging examinations.
"Have you brought all the previous cases and inspection reports?" Although there are some unpleasant stories between the emergency department of the Fourth Hospital and the Second Hospital, both parties still recognize each other's test results and reports. Although the provincial prescription network allows Sun Lien to see
What medicines did the Second Hospital use for Zhan Hao? However, detailed imaging department examination results and some specific treatment details still need to be obtained by asking the patient's family members.
"As you said, I brought them all." Zhan Jun took out a thick book of stapled information from his bag and handed it over, "Xiao Sun, please take a look at it first. If there is anything that is not detailed enough,
, I’ll go to the Second Hospital again.”
Sun Lien nodded, and after taking the information, he said, "I'm going to invite someone for consultation now. You go and go through the registration procedures for him." Zhan Jun nodded and walked towards the registration window of the rescue hall, while Sun Lien
Turned around and entered the small conference room.
In the conference room, Xu Yourong, Yuan Pingan, Pascal, Zhou Ce and Liu Pingchuan were all sitting in their seats. When they saw Sun Lien walking in, they temporarily stopped chatting.
"Sorry to trouble you." Sun Lien smiled sheepishly at them, then placed the information in his hand on the digital projector. The camera enlarged the information to 150 inches and projected it on the wall of the conference room.
"This is the patient we need to deal with today."
Zhan Hao, male, 39 years old. Nine days ago, he was sent to the emergency department of the Second Central Hospital due to severe abdominal pain. After admission, the liver function test showed that the alanine aminotransferase (alt) level was 1970u/l, which was much higher than the reference value of 0~40u/l.
level. After B-ultrasound examination, after ruling out acute temporary obstruction caused by common bile duct stones, the Emergency Department of the Second Central Hospital determined that Zhan Hao's severe abdominal pain was caused by acute liver injury. However, the cause of acute liver injury was not yet known.
It is clear that rapid tests and immune tests ruled out the possibility of viral hepatitis. Zhan Hao himself also firmly denied that he had taken drugs before getting sick.
After the emergency doctor of the Second Central Hospital palpated Zhan Hao's abdomen, there was no rebound pain or tenderness. However, Zhan Hao's pain attack was very severe. He was sweating profusely, with mucus and saliva coming from his nose. His body was curled into a forced position, and his expression was extremely painful.
But apart from an accelerated heartbeat and an increase in blood pressure, his body temperature and even respiratory rate were within normal limits.
After B-ultrasound examination confirmed that it was not a perforation of the digestive organ, in order to further diagnose and treat him, the Emergency Department of the Second Central Hospital gave Zhan Hao three doses of Pethidine in an attempt to relieve pain. However, the pain relief effect was very limited, which led to the emergency department of the Second Central Hospital.
Branch's second diagnostic view of drug addiction?
Fortunately, a quick urine test proved Zhan Hao's innocence. All of his test results were negative, which meant that he had not been exposed to these drugs for at least two months. A subsequent hair test also confirmed that he had not taken drugs in the past year.
This diagnosis is not valid.
Two hours after admission, the emergency doctor at the Second Central Hospital added a diagnosis of intestinal obstruction. Pethidine has poor analgesic effect, severe pain and a tendency to have paroxysmal episodes. In addition, Zhan Hao did have vomiting after admission, and he vomited.
The symptoms of abdominal pain were not relieved, so the doctors at the Second Central Hospital suspected strangulating intestinal obstruction, which was actually very well-founded.
Although no obvious obstruction area was found on the abdominal plain radiograph, this may still be caused by early onset of obstruction and unclear imaging features. In order to confirm this diagnosis, doctors from the Second Central Hospital gave Zhan Hao an injection.
One injection of atropine. While observing the effect of atropine, in order to prevent the rapid progression of intestinal obstruction, fluid rehydration, blood transfusion and antibiotic treatment are given at the same time. In this way, if atropine is not effective in relieving smooth muscle spasm, it is safer to perform emergency laparotomy directly.
Follow-up observations proved that atropine indeed had a very good effect. The abdominal pain was quickly relieved, and Zhan Hao's vital signs also stabilized. After 24 hours of observation, Zhan Hao was transferred to the Department of Hepatobiliary Medicine to prepare for follow-up examinations.
His acute liver injury has not been completely resolved, and intestinal obstruction does not cause acute liver injury.
On the second day of hospitalization, Zhan Hao developed new symptoms of decreased muscle strength in his lower limbs and vision loss in his right eye. These symptoms were quickly diagnosed as central nervous system demyelination, but the cause was still unknown.
On the fifth day after hospitalization, Zhan Hao was able to stand with support. Although his alanine aminotransferase had declined, it was still at a level of 435u/l. He could eat and defecate normally, and he had no acute abdominal pain in the past five days.
.
"Their treatment idea is a typical internal medicine plan. They try and the situation seems to improve." Liu Pingchuan spoke first after listening to the introduction. "As long as the patient's condition improves, it will be fine. What disease does he have and why does he behave like this?
Symptoms are not among their first considerations."
This kind of diagnostic guidance is actually not uncommon, and can even be said to be the norm. Doctors don’t know how many cases they see every year for cases that cannot be fully diagnosed. Many diseases behave very similarly, and will respond better to the same treatment.
The effect. Lucky patients may not know what disease they have until they recover, while those who are unfortunate...may not know what they died of.
It must be emphasized that this has nothing to do with the level of doctors at the Second Central Hospital. In fact, even if the synergy is stronger, there are still many patients with "unknown causes" every year. The human body is really a too complex system, and this system can be affected
There are too many interfering factors.
"So, we need to find out what disease he has?" Xu Yourong didn't seem very interested in this case. She shook her head and said, "Nine days have passed since the onset of the disease. The Second Central Hospital gave him two kinds of antibiotics.
, hormones, blood transfusions... If we are the police who plan to start from the crime scene, then his body is the first crime scene that has been cleaned several times. What can be found from this? "
Not only did Xu Yourong lack interest in this case, Yuan Ping'an also didn't understand Sun Lien's reason for admitting this patient. "Isn't he already getting better? If we admit him to the hospital now, even if we can diagnose what disease he has, it will not be good for him.
It doesn’t really help in any practical sense, right?”
"The main reason why I accepted this patient is because the course of the disease is not right." Sun Lien thought for a while and decided to tell the truth to his team members. "His acute abdomen, we can determine the time it takes for the treatment to take effect.
The segment is confirmed to be smooth muscle spasm. However, this is not related to acute liver injury. And the subsequent demyelinating lesions are not related to acute liver injury. If smooth muscle spasm is caused by demyelinating lesions of the central nervous system, I can
Accepted. But overall, this patient's illness lacks a unified explanation."
"The explanation is not important. What is important is whether the patient's condition is really under control." Liu Pingchuan frowned and concluded, "What I am most worried about now is the autoimmune disease. After all, the Second Hospital used
If hormones mask the symptoms, the disease may continue to occur later.”
"In short, I think we should follow our own pace." Dr. Pascal said. He was not very interested in the theory that Zhan Hao might suffer from an autoimmune system disease. After all, his onset sequence did not conform to the common autoimmune system.
The rule of "it starts in the kidneys or nervous system first". But he still agreed with the rest of Yanagi Hirakawa's point of view. Although the use of hormones for treatment in rheumatology and immunology departments is a very common method, Dr. Pascal always feels that hormones are not the best
means. While relieving symptoms, hormones will also cover up many problems that really need doctors to pay attention to. Many diseases do have this special fluctuation of "onset, remission and relapse". There are various reasons for this fluctuation.
, but these diseases have a common feature: the second attack will be very serious, and the prognosis is extremely poor.
"Imaging examinations are already being done." Sun Lien took out his mobile phone and checked WeChat. "Abdominal CT examination showed a diffuse decrease in density of the liver, small low-density shadows in the head of the pancreas, and varying degrees of dilation in the small intestine with fluid accumulation."
"This is new progress." A tense atmosphere suddenly filled the conference room. One day ago, Zhan Hao's CT examination results showed that everything was normal.
A shout suddenly rang out from the rescue room outside the door, "The blood oxygen saturation of the first bed has dropped!" The first bed was talking about Zhan Hao.
A group of doctors jumped up from their seats as if they had been kicked in the butt, and everyone rushed to the emergency room.
Zhan Hao started to have abdominal pain again. The severe pain made his cheeks flush and his breathing became rapid. He curled up on the hospital bed like a giant shrimp. At first, he still had some strength to scream. In less than thirty seconds, he could only scream.
A "roaring" wheezing sound came from the throat. The blood pressure quickly rose to the level of 135/90mmhg, and the heart rate began to increase to 93 beats/min, but the blood oxygen saturation was declining, from 98% at the time of admission to 95.
%.
"Give him oxygen, draw blood, do a blood routine, and do a liver function test!" In the chaos, Sun Lien took a vantage point and came to the bedside. He stretched out his hand to pull off the quilt on Zhan Hao and pressed it hard.
There was no tension in his abdomen or abdominal muscles, and Zhan Hao did not notice any increase in pain after being pressed. Looking at his face, sweat was pouring out like spring water, and his nose and saliva were also mixed in, making him look scary.
"Zhan Hao, Zhan Hao?! Can you hear me?" Sun Lien slapped Zhan Hao on the shoulder hard and asked as loudly as possible.
"Yes..." Zhan Hao took two quick breaths, tried his best to hold back a response, and then continued to scream. "Help!"
"Zhan Hao, male, 39 years old, suffered from demyelinating disease of the central nervous system, rapid vision loss in the right eye, acute liver damage, smooth muscle spasm, acute hemolysis, and hemolytic anemia." The status bar was updated with three statuses, and in "
There are two words in front of "hemolytic anemia", and the writing is slowly getting darker, and it looks like "moderate".
"One milligram of atropine, intramuscular injection!" Sun Lien made a decision. Atropine was confirmed to be effective for Zhan Hao in previous treatments, and its analgesic effect was more effective than opioid analgesics. First, the symptoms of his acute abdomen were stopped, and then the doctor
Only then could they find a way to help him. In the forced position, Zhan Hao could only contract his body with all his strength and bend into the shape of a shrimp. In this state, it is very difficult to draw blood and establish a new venous channel. The indwelling needle in his hand is
During the attack of abdominal pain, it had been accidentally pulled out.
Atropine takes effect very quickly, reaching the peak blood concentration fifteen minutes after intramuscular injection. The severe spasms were slowly relieved by the action of atropine. Next, it was Sun Lien and others' turn to have a headache.
"Atropine is so effective, which means the spasm should be in the gastrointestinal tract or the bladder. He hasn't inserted a catheter yet, so it's unlikely to be bladder spasm." After confirming that Zhan Hao's symptoms had eased, Xu Yourong lowered his voice.
Voiced his opinion. "Second intestinal obstruction in a short period of time?"
"The CT scan taken ten minutes before his onset only showed dilation of the small intestine and some fluid accumulation." Yuan Pingan raised his eyebrows, "Intra-abdominal hernia?"
"If it is intestinal obstruction caused by intra-abdominal hernia, it is...tinging intestinal obstruction (strangulating intestinal obstruction)." Dr. Pascal couldn't remember what the Chinese term for this disease was for a long time. He could only use English.
Instead, "But this condition is almost impossible to be alleviated by drug treatment. If it is really strangulating intestinal obstruction, how did he get over it without surgery after the last attack?"
"The t1/2 metabolism rate of atropine is four hours." Yuan Pingan suddenly thought of something, "When the second hospital treated him, he only received one injection of atropine and he got complete relief, right?"
Sun Lien didn't quite understand what Yuan Pingan wanted to say, but his memory was correct, "I did only use atropine once."
"In other words, this kind of spasm will not last too long, or in other words, a certain treatment method used by the Second Hospital during those four hours successfully resolved the spasm." Yuan Pingan expressed his guess.
, "He has received blood transfusion treatment, and I suspect he may have severe anemia!"