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

The patient only had five systemic diseases in the medical record, which was already very confusing.

But after Xu Qiu came to check the patient himself, he found that his condition was much more serious than what the community hospital reported.

In addition to immune hepatitis, liver failure, anemia, thrombocytopenia and leukopenia, the patient also had hyperbilirubinemia, hypoproteinemia, hemorrhoidal bleeding, mild spleen enlargement, and Xie Yunshi's tumor markers were also elevated.

"Check the blood routine again, and do a cardiac ultrasound..." Xu Qiu immediately gave a further diagnosis.

This patient with a wide range of diseases only has one obvious symptom of recurrent edema of the lower limbs. It is too difficult to identify the cause of the disease.

More importantly, find the answer from various changes.

After returning to the office, Xu Qiu combed through the patient's medical records from beginning to end and found several noteworthy points.

First, the patient had a cesarean section due to ectopic pregnancy ten years ago.

Second, although she was only 36 years old, she had a 22-year history of smoking, was addicted to alcohol, and had multiple tattoos on her body.

During the physical examination, it was found that in addition to the swelling of Xie Yunshi's legs, a large number of dense petechiae were visible on the skin of her calves and dorsum of the feet.

Ectopic pregnancy, drinking and smoking, petechiae on the skin...

Every symptom seemed to have nothing to do with each other.

...

In addition to the symptoms, the patient's auxiliary examinations also showed more abnormalities.

Alkaline phosphatase 169, increased;

Alanine aminotransferase 1, decreased;

Creatine kinase isoenzyme 45, increased;

In addition, bilirubin, lipase, brain natriuretic peptide precursor, etc. all showed abnormal increases. Although the various body functions did not reach the critical value range, the situation was not good.

If it was delayed any further, it was possible to continue to progress at any time.

This is also the reason why Xu Qiu chose to do cardiac color Doppler ultrasound-the patient has so many diseases that it is difficult not to affect the heart. In addition, there are anemia, lower limb edema, etc. Even if the patient does not have problems such as dyspnea, a systematic heart examination should be done.

While waiting for the results, Xu Qiu issued a new medical order.

"Glutathione, compound amino acids, torsemide injection..."

"There is also Tianma injection, potassium chloride injection..."

These are all symptomatic treatment drugs.

Considering that the patient may have heart problems, Xu Qiu also specially adjusted the infusion volume and controlled it to a level lower than that of normal people.

Then, Xu Qiu rushed to the outpatient clinic.

Nothing happened in the morning.

At noon, Xu Qiu had just taken the second bite of lunch when the emergency department called again in a hurry.

Shi Lian glanced at the teacher's lunch box and smiled bitterly: "You came at the right time..."

The chosen doctor is destined not to have a complete meal.

Xu Qiu has long been used to it.

Patients will not specifically choose the time when the doctor is free to deteriorate. Sudden situations are the norm for doctors.

After taking two more bites of rice, Xu Qiu grabbed the white coat on the wall and rushed to the emergency room in a hurry.

On the way, he also understood the basic situation.

The nursing team had just arranged an infusion for Xie Yunshi, and within an hour, she suddenly lost consciousness, and her heart rate and blood oxygen saturation dropped sharply.

The rescue team immediately performed tracheal intubation and used adrenal hydrochloride to rescue.

"There is no problem with the rescue process, continue to execute." Xu Qiu nodded.

Arriving in the rescue room, Xu Qiu saw Xie Yunshi.

At this time, she was already connected to the ventilator, and her blood oxygen saturation increased to about 95%, returning to normal levels.

But she has not regained consciousness yet.

"She should be out of danger." Xu Qiu felt a little relieved.

Next, the rescue should be carried out according to the routine process, and there should be no problem.

But what is confusing is... why did she suddenly fall into a coma?

Xu Qiu frowned and asked, "Are the results of the cardiac ultrasound out?"

Shi Lian quickly called the cardiology department, and brought the paper report in a short while.

Xu Qiu glanced at it.

The cardiac ultrasound showed:

1. The patient's aortic valve forward blood flow velocity increased.

2. Mild insufficiency of mitral and tricuspid valves.

"Just mild insufficiency?"

In this case, the coma cannot be attributed to the heart... Xu Qiu had a headache.

Then we can only infer from the existing diagnosis.

Half an hour later, the patient woke up.

Xu Qiu immediately transferred Xie Yunshi to the ICU.

This kind of patient is in danger and may die at any time. Only in the ICU can we deal with various critical illnesses.

"Did you bring the blood routine?" Xu Qiu asked.

At that time, he arranged two examinations for Xie Yunshi, one was cardiac color Doppler ultrasound, and the other was another blood routine.

Shi Lian nodded quickly: "I brought it, the situation seems to be more serious."

Then he handed the report to Xu Qiu.

As Shi Lian said, the patient's abnormal indicators were more than before, and the abnormal values ​​were larger.

In addition, the most noteworthy are C-reactive protein and related infection indicators.

Rapid high-sensitivity CRP increased, monocyte percentage increased, neutrophil decreased...

The patient's white blood cells also decreased. Clinically, viral, atypical pathogens and certain protozoan infections can all lead to leukopenia.

Bacterial infections such as salmonella, tuberculosis and brucellosis can also lead to leukopenia.

And judging from the patient's white blood cell count, the condition is continuing to worsen, and it is likely to develop into a critical stage soon.

Other indicators indicating inflammation also showed abnormalities.

"Is there inflammation in the body?"

Xu Qiu thought of the bruises on Xie Yunshi's legs.

He suddenly realized that something was wrong...

"Do you have photos of the bruises?" Xu Qiu asked.

"Yes, yes..." Shi Lian took out his mobile phone, and the lock screen was a handsome photo of Xu Qiu in surgical gown.

Shi Lian's hand trembled, and he hurriedly unlocked the phone and opened the album as if nothing had happened.

The first few pictures were photos of Xie Yunshi's calves, which were covered with spotted bruises, which looked dense and extremely creepy.

"Hey, good news for people with trypophobia!" Shi Lian pretended to be nonchalant and changed the subject.

Xu Qiu stared at the picture for a long time, and then enlarged a few details, and finally understood where the problem was.

Neat, too neat.

These bruises seem messy, but there is a sense of regularity.

"Teacher, are the infection indicators due to these bruises? Allergies?" Shi Lian put forward his own opinion.

Allergies can explain many things, such as skin bruises, and perhaps sudden coma is also due to infusion allergy...

In clinical practice, the first thing to rule out for this type of loss of consciousness is the possibility of an allergic reaction to the infusion.

"No, take a closer look." Xu Qiu said.

Shi Lian quickly focused and looked carefully, and suddenly froze for a moment: "These bruises...are very consistent in shape?"

"Yes."

As he said this, Xu Qiu drew a few more circles.

This time Shi Lian saw it more clearly, her mouth almost opened into an O shape, and she said in surprise: "The distribution of the bruises in the circle is exactly the same..."