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

Soul out of the body?

Everyone was a little interested.

The patient looked panicked, she was alert and alert, and lowered her voice: "Yes, when I was in the ICU, I saw your doctor rescuing me, it was like my soul was floating in the air."

Xu Qiu nodded silently, sniffed his nose, and frowned immediately.

Thinking about hepatic encephalopathy, isn't it here?

The so-called soul out of the body has actually been proposed by patients a long time ago, and some doctors have actually verified it.

Many critically ill patients in hospitals have similar statements after being rescued.

So, doctors at the Stony Brook School of Medicine in the United States conducted an experiment and put a huge, conspicuous number card next to the bed of each critically ill patient.

The patient can't see it when lying down, but if there is really a soul out of the body, he will definitely notice the bright red number.

If there are patients who say that their souls are out of the body, the doctor will ask the number, but no one can answer it.

Subjective feelings cannot be falsified.

However, the objective results undoubtedly severely slapped the face of the saying "soul out of the body". The scientific community gave four main reasons for the explanation. The first is mental illness; the second is damage to the central nervous system; the second is abnormal burst of electrical signals in the brain; and the last is brain neurotransmitter disorder.

The so-called out-of-body experience of this patient is mainly related to damage to the central nervous system.

Xu Qiu prescribed deamination, acidification of the intestine and mannitol dehydration treatment. Like the pastor, the most important treatment method at present is to reduce blood ammonia, that is, taking L-ornithine L-aspartate.

"There may be some minor vomiting, abdominal pain, and diarrhea as side effects." Xu Qiu reminded the family.

After leaving the ward, Xu Qiu's eyes fell on the huge group of doctors.

"What stage of hepatic encephalopathy is this patient?" Xu Qiu asked.

Everyone immediately became nervous, and several of the drowsy ones woke up all of a sudden, and quickly lowered their heads, not daring to look at Xu Qiu.

In the crowd, Mo Wan and Shi Lian both raised their faces, and their good looks were particularly pleasing to the eye among a bunch of doctors with worrying hair volume.

Xu Qiu's eyes directly passed over Mo Wan.

This person can be regarded as the first person in the young generation of hepatobiliary surgery in China. Asking her to answer such a question is simply asking an academician how to solve a quadratic equation...

"Shi Lian." Xu Qiu nodded.

Shi Lian straightened her back and said in a clear and pleasant voice: "It should be the second stage."

"Yeah."

Xu Qiu nodded and motioned her to continue.

Shi Lian raised his voice a few notches and said, "Hepatic encephalopathy is mainly divided into five stages.

Stage 0 is the normal stage.

Stage 1 is also called the prodromal stage, with mild personality changes and behavioral disorders, as well as flapping tremors, but the EEG is generally normal. Many stage 1 patients have very hidden symptoms and are most easily overlooked in clinical practice.

Stage 2 is the pre-coma stage, which is mainly characterized by confusion, drowsiness and behavioral disorders. Hallucinations are one of the manifestations, and there are also fears, mania, etc., which are often mistaken for mental illness. If a diagnosis is to be made, characteristic abnormalities can be elicited through EEG.

Stage 3 is drowsiness and confusion; stage 4 is coma and complete loss of consciousness!"

Xu Qiu nodded: "Almost there, there is another point in stage 2 of hepatic coma, which may be difficult to notice without clinical practice."

Shi Lian looked inquiring: "Teacher, what is it?"

The others also pricked up their ears.

"Liver odor."

Xu Qiu said concisely: "Stage II hepatic encephalopathy is also the beginning of liver odor."

Liver odor is actually the smell of rotten apples and rotten eggs mixed in the patient's breath or urine. Some patients may also smell a sweet and fishy smell.

The formation mechanism is also related to severe liver damage.

After multiple effects such as digestion and bacterial decomposition, the methionine in the patient's body not only releases a large amount of ammonia, but also produces dimethyl sulfide and methyl mercaptan. The retention of the two in the body forms a complex special odor.

Just now, he smelled a faint liver odor on the patient.

In fact, if you think about it carefully, the previous Wei Ding, who had many twists and turns, took diet pills, and replaced meals to get sick, could have been considered to have ruled out severe liver damage.

Because even with Xu Qiu's master-level odor identification ability, he didn't smell any liver odor on him at the beginning.

However, everyone was deceived by the transaminase index of thousands at that time. They did not expect that Wei Ding was not suffering from liver damage in the conventional sense, but congestion of the liver...

"Liver odor?"

After listening to Xu Qiu's explanation, everyone suddenly realized.

The emergency department has smelled the liver odor of patients with liver failure, but has not studied it carefully. It is actually one of the signs of hepatic encephalopathy stage II!

"I have learned a lot!"

"You can't learn this from textbooks, and you may not be exposed to such detailed clinical experience in the emergency department."

Mo Wan nodded.

Except for the specialists in hepatobiliary surgery, the emergency department and other departments may not know it.

Xu Qiu's teaching rounds are ambitious enough.

He not only wants to train doctors who can save lives, but also hopes that everyone in the emergency department of clinical medicine can be rough but also meticulous, and save every patient's life in the best condition within their medical ability.

"With such a director, there is no need to worry about the growth of clinical medicine." Mo Wan sighed.

...

Soon after, Xu Qiu brought people to Yuan Yu's ward.

This patient was too defensive and concealed too much information. She was diagnosed with pancreatitis due to taking hydrochlorothiazide, which then rapidly progressed to acute severe pancreatitis. At the same time, the blood clots dropped and caused pulmonary embolism...

If Xu Qiu had not keenly noticed that her blood pressure fluctuations were too strange, and had followed the clues to find out that Yuan Yu had a history of hypertension, and found the antihypertensive drug hydrochlorothiazide, it might not be the cause of death, but the cause of death.

"You have learned a lesson last time. If you conceal information from the doctor, you are irresponsible for your own life!" Yunmei came over to remind her.

Yuan Yu's condition has improved a lot compared to yesterday.

After rehydration, blood transfusion, and stopping the heavy bleeding of the endometrium, her condition has gradually stabilized.

However, her pale face only highlights the yellowing of her skin.

Jaundice!

Compared with the rescue, Yuan Yu's jaundice seems to be more serious, to the extent that Mo Wan can carefully identify it with the naked eye.

"The patient has a history of hypertension, and long-term excessive drinking of water has increased the heart load and caused chronic heart failure. Could it be the same as Wei Ding, with liver congestion and hypoxia caused by heart failure?" Mo Wan guessed in his heart.

Congested liver can quickly lead to worsening clinical manifestations, but as long as the venous return obstruction is removed, it can recover in a short time.

Since Wei Ding, this characteristic manifestation has become a knowledge point that clinical doctors will never forget in their lifetime...

And now, Yuan Yu has a relevant medical history, and the disease progression is not slow, which can indeed be linked to chronic heart failure.