Creatine kinase is an important kinase in the human body. It is mainly used for the detection of cardiovascular and cerebrovascular diseases such as myocardial infarction. Generally speaking, if elevated creatine kinase is found in the blood routine, doctors will first
What comes to mind is that the patient may have a myocardial infarction.
"Go for electrocardiogram, do routine blood tests, and send for X-rays after hemostasis..." Sun Lien was arranging follow-up examinations. Gao Yan, who had been lying quietly on the bed, suddenly jerked, and his whole back left the bed, with his head and feet.
As a support point, the back is curved and arched!
The nurses who were busy next to Gao Yan were startled. This action did not seem to be something normal people could do. After the human body's arch-like posture lasted for a few seconds, Gao Yan suddenly seemed to be pulled out of his body.
His bones softened, and then he began to experience severe generalized muscle spasms, stiffness, and tremors. He was foaming at the mouth, twitching all over his body, and his face became cyanotic. These are typical signs of a generalized epileptic seizure.
Sun Lien didn't need to remind him. The nurses pounced on Gao Yan again the moment he had a seizure. They quickly untied Gao Yan's clothes and turned his head sideways to prevent vomit from blocking his respiratory tract.
Gao Yan's epileptic seizure lasted for about a minute. The medical staff all stood back and waited quietly for Gao Yan's epileptic seizure to end. Contrary to common concepts, although epileptic seizures look scary, they actually do not require much intervention.
.Especially for doctors, when a patient has an epileptic seizure, they only need to monitor the respiratory condition. No doctor will try to pry open the patient's mouth and stuff cotton or the like inside. If the tongue is bitten during the epileptic seizure, follow-up intervention will be required.
It is meaningless. On the contrary, it is easy to injure the lower jaw during the process of opening the mouth, or even directly pry off two teeth. As for the practice of pinching a person's philtrum, even Chinese medicine doctors would not recommend it.
Epileptic seizures are another powerful reminder of the patient's symptoms. Abnormal discharge activity in the cerebral cortex is the main cause of epileptic symptoms. Epilepsy is combined with elevated creatine kinase and high cerebrospinal fluid pressure. Then the direction of suspicion should be
It's meningitis or cerebral hemorrhage.
"First go for a CT scan to see if there is any cerebral hemorrhage." The blood routine results will not come out for at least 10 minutes. Before that, Gao Yan's life must be guaranteed first. Cerebral hemorrhage will be fatal in a short time. "
Xiao Guo, go find Liang Baoan outside and ask him to take his family members to register first."
The precious type O negative blood was hung up, and Gao Yan's vital signs were relatively stable. But no one knew whether this stability could be maintained for a long time, or whether it would collapse at an unexpected moment.
Time, time, the most important thing is time. Sun Lien has made a decision. He can wait for registration, but CT must be done immediately. If the cause of the symptoms is cerebral hemorrhage, if the bleeding continues to expand and causes cerebral herniation, this person will be saved.
He didn't come back. He used a pen-shaped flashlight to check Gao Yan's pupils on both sides. They were equal in size and responded well to light.
"Brother Sun..." Xiao Guo, the nurse who ran out the door, ran back again, "Brother Liang said that his family members are missing!"
Sun Lien's eyes widened, "Didn't he follow him?"
Liang Baoan was indeed following the woman. It was just that the four-legged husky ran much faster than the two-legged man. After a few turns, the husky disappeared together with the woman.
"I used to run really fast!" Liang Baoan, who was in his forties, wiped the sweat from his head unconvinced and panted as loudly as a cow. "In the past, no one among the young people from all over the country could outrun me.
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"Anyway, I can't find any family members now." Nurse Xiao Guo said helplessly, "I'll look to see if he has an ID card on him. If not, why don't we just apply for the arrears first?"
The Fourth Central Hospital is a regional emergency center. Every year, special funds are allocated from the provincial government to support the treatment of patients with arrears. Although this fee is basically not enough every year, fortunately, there are still donations from some charitable organizations.
, at least you won’t lose money every year.
Gao Yan's ID card was in his pocket. Xiao Guo went out to register Gao Yan, and Lao Wutou, who was stationed at the Fourth Central Hospital, finally arrived at the emergency room. He wanted to take away Xiao Guo's identity card after using it.
He also used Gao Yan's fingerprint to unlock his mobile phone and began to search for his relatives' phone numbers in the call directory. Sun Lien and others pushed Gao Yan to the CT room.
The results of the emergency CT scan were straightforward and showed no abnormalities and no bleeding focus.
Intracranial inflammation will basically cause an increase in cerebrospinal fluid pressure. An increase in cerebrospinal fluid pressure means an increase in ventricular pressure, which puts the brain in a state of compression.
The brain is a very delicate organ. As long as there is something slightly wrong, it can show a variety of strange symptoms. Hallucinations and epilepsy can be caused by increased pressure in the cerebral ventricles, or they can be symptoms caused by encephalitis affecting specific areas.
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As soon as the patient was returned to the emergency room, nurse Xiao Guo brought a piece of good news. "The system found records of the patient's treatment two days ago. The patient had a high fever of 40.2 degrees Celsius two days ago. He went to a community hospital for examination and received antibiotics.
Intravenous drip.”
Thanks to the networked digital medical record system implemented by Ningyuan City. All community hospitals and large hospitals in the city have realized medical record sharing. Xiao Guo just took Gao Yan’s ID card to register, and got the medical records he just received treatment a few days ago.
record of.
"Main complaint: high fever, chills, headache. Diagnosed as upper respiratory tract infection, intravenous infusion of cefuroxime, oral cefaclor, and oral ibuprofen were given." Xu Yourong quickly browsed through the treatment methods of the lower-level hospital, "Antibiotics are ineffective.
Viral encephalitis?”
Cefuroxime is a second-generation cephalosporin and an antibiotic commonly used clinically to fight unknown bacterial infections. It has a very good effect on most bacterial encephalitis. But it is obvious that it does not help the symptoms of high severity.
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If it is not bacterial meningitis, then the suspect will naturally become viral meningitis.
"Invite Shenai to come for consultation." Sun Lien thought for a while and made a decision. "I will do a physical examination first. Doctor Xu, please hurry up and do a lumbar puncture and measure the cerebrospinal fluid pressure."
Both emergency department doctors and surgical doctors have the same hobby of tapping patients with a small rubber-headed hammer. This somewhat funny action is actually an important examination. By tapping or scraping
Rub different parts and observe whether the patient's reflex behavior is normal. If the reflex movement is too small or too large, and the reflection area changes, it indicates different symptoms. When the patient is suspected of having viral meningitis, it is best to conduct a reflex movement examination.
A valuable means of inspection.
Sun Lien used the wooden end of a cotton swab to scratch the outside of the instep of Gao Yan's right foot. The thumb of Gao Yan's right foot shrank slightly. Then, with the help of Xiao Guo, Sun Lien moved Gao Yan's thigh closer to the edge of the bed.
Position, let his calf hang down naturally. Gently tap the position of his quadriceps with a percussion hammer.
Gao Yan's calf kicked out violently after the knock.
Xu Yourong narrowed his eyes and said, "Tap it on your knee and take a look."
Sun Lien did as he was told. He tapped lightly with the percussion hammer, and Gao Yan's calf kicked out violently again.
At the same time, he showed a positive Chaddock sign and hyperactive lower limb tendon reflexes.
This means that Gao Yan's central nervous system has been damaged.