Doctor: It's reasonable to perform surgery on yourself.

Emergency Department.

As soon as Xu Qiu arrived, he met Director Jiang of the ICU who had been waiting here for a long time.

"Doctor Xu!"

Director Jiang was overjoyed when he saw Xu Qiu and trotted over quickly.

"What's wrong?"

"There is a patient in the ICU with a blood sugar of 57 and his blood pressure is also very low. Please take a look!"

Xu Qiu's expression became solemn.

Blood sugar of 57?

A normal person's fasting blood sugar is around 3.9~6.1. A critical value can be reported as high as 20 or more. What does it mean to be over 50!

There’s not a drop of blood in the blood, it’s all sugar!

"what's the situation?"

While Xu Qiu asked, he took the abdominal CT scan from Director Jiang.

Just one glance made his expression become serious.

Sign of death!

"Director Zhang of the Imaging Department called specifically to ask, and it was confirmed that it was the Sign of Death..."

Seeing Xu Qiu's expression, Director Jiang understood that the other party had noticed it, and continued: "This is a female patient. The main symptoms are dizziness and abdominal pain. The blood count was checked and it was over 20,000. She was admitted to the hospital and immediately issued a critical illness notice. , the condition progresses extremely quickly!”

Xu Qiu nodded and looked at the film.

In the plain CT scan of the abdomen, there were low-density shadows like dead branches running along the hepatic portal vein, and the entire liver looked like a hornet's nest.

This is a sign caused by abnormal accumulation of gas in the portal vein and intrahepatic portal vein branches due to various reasons. It is also known as the death sign in the imaging department.

It is not a separate disease.

It is often accompanied by digestive tract diseases, such as intestinal obstruction, mesenteric vascular disease, inflammatory bowel disease, etc...

However, the clinical mortality rate of hepatic portal pneumatosis is very high. The mortality rate of intestinal necrosis combined with pneumatosis exceeds 75%, and even the combined mortality rate is more than 50%.

When a case is encountered clinically, death is basically declared, so it is called the death sign.

"At first I thought it was a case of gallstones..." Director Jiang sighed twice.

Sure enough, the diagnostic ability of these clinicians is far behind that of professional radiologists.

"It's simple."

Xu Qiu pointed two fingers and said: "Pneumatosis in the hepatic portal vein is a gas-like low-density area like a dead branch. The gas is mostly distributed at the edge of the liver and near the left lobe of the liver.

It is also possible that gas is distributed in the periphery due to centrifugal blood flow in the intrahepatic portal vein.

However, the location of biliary pneumothorax is relatively fixed, most of which are located in the porta hepatis area, and appear as scattered and discontinuous gas shadows.

In addition, bile flows centripetally, so intestinal gas accumulates in the center of the liver. "

Director Jiang was in awe.

This is too detailed...

He really understands this disease, not just memorized the symptoms!

At that time, Director Jiang made a special call to a doctor in the imaging department, who also explained the difference between pneumobiliary tract and pneumoportal vein.

But when Director Jiang continued to delve deeper into why pneumatosis in the hepatic portal vein was mostly in the periphery, while pneumobiliary tract was in the center of the liver, the doctors in the imaging department were stunned for a long time.

However, Xu Qiu said it casually!

It is precisely because the former is a blood vessel, flowing centrifugally; the latter is a bile duct, converging centripetally!

However, clinically, there are very few doctors who can tell the truth, and most of them only know it.

"Doctor Xu, Doctor Xu!"

At this time, Ma Qin finally arrived belatedly.

Xu Qiu looked back and said, "Mr. Ma, what else can you do?"

"Is it convenient? You guys finish talking first." Ma Qin said.

Director Jiang is from the ICU. He came to Xu Qiu, probably because of some emergency.

"Then I won't waste any time... Doctor Xu, the family members have a strong desire to have surgery and want to give it a try. Can they accept this surgery?"

Director Jiang's purpose is exactly this.

In Linhai No. 1 Hospital, when it comes to difficult and high-risk surgeries, the first person who comes to mind is Xu Qiu.

"The surgery needs to continue to be evaluated..."

Xu Qiu did not give a clear answer.

Facing the sign of death, the vast majority of patients can only wait in vain for their lives to run out.

The mortality rate among the few who can undergo surgery is extremely high. Only if the necrotic intestine can be found, successfully removed, and the infection controlled, can the life be saved from the hands of the King of Hell.

Every step is like walking on the tip of a knife.

Without a grasp of the patient's general condition, he was not sure whether he was qualified for surgery.

"What's the patient's condition now?" Xu Qiu asked simply.

"He was in a slight coma before. He woke up after we rescued him, but his oxygen saturation was only about 80% when he entered the room. Now he is inhaling oxygen, and his vital signs are very poor."

Oxygen saturation is only about 80?

Xu Qiu frowned and then asked: "Are there any symptoms of the central system?"

"Center? There is no projectile vomiting or anything like that, and there is no sign of anxiety. The patient's mental state is very depressed... But if you look carefully, it seems to be a little twitching, does that count?"

"Calculate!"

Xu Qiu's guess has been verified to 70-80%.

The oxygen saturation is 80, which is much lower than the 95~100 of normal people.

And convulsions are a manifestation of cerebral hypoxia.

What can cause the two to appear at the same time is probably not simply difficulty breathing, but... pulmonary embolism!

"Please ask Director Wang Ping to go over and evaluate. There is a possibility of embolism."

"This..." Director Jiang was stunned.

How can we tell if the patient hasn't seen it yet?

However, pulmonary embolism is a serious illness, and the mortality rate is even more exaggerated than the "hepatic portal vein pneumatosis" known as the sign of death. He did not dare to delay at all and rushed to the ICU. On the way, he made an appointment with Wang Ping to rush to the emergency room. .

Pulmonary embolism…

This disease indeed once frightened Linhai No. 1 Hospital.

However, after Xu Qiu treated many patients with pulmonary embolism, he and Wang Ping jointly established an extremely advanced and powerful chest pain center in the emergency department with Wang Ping and the Baiyun Provincial Medical Association, and opened a green chest pain center in the emergency department. aisle.

Coupled with the previous funding awards from the Famous Sword Competition, and the state departments' intervention to negotiate with foreign companies to purchase instruments and equipment at low prices, now Linhai No. 1 Hospital has equipped various departments with weapons, and its diagnostic and treatment capabilities have skyrocketed.

Nowadays, the treatment rate of pulmonary embolism has also been greatly improved. Wang Ping has encountered four cases in the past few months, and all four were saved.

Let him handle this matter, it won't be a big problem.

"What about the Death Sign? Few people know that it can also cause pulmonary embolism."

Ma Qin stepped forward and was not surprised when he spoke.

This is Xu Qiu!

"Yes." Xu Qiu nodded.

Hepatic portal venous pneumatosis is already a rare fatal disease, and the more fatal pulmonary embolism it causes is even rarer.

The pathogenesis is actually quite clever, and it must be matched with a cause to cause it!

That is, necrosis of the intestines, etc.!

Only when pneumatosis occurs, the intestinal and portal vein systems become necrotic, and then progress to collapse, causing the gas to enter the heart along the portal vein, and a large amount of gas enters the blood, and is broken up into foam by the strong impact force, it is possible to cause pulmonary embolism. .

Clinically, there are not many patients who can come up with so many classic manifestations.

However, this in turn illustrates another problem...