I Can See Health

Summer is slowly passing and the weather is getting cooler.

Walking on the path of the hospital, Lu Chen was in a happy mood.

After coming to Beijing, he not only joined the elite group of the Electrophysiology Association, but also won the first place in the national medical skills competition. Next, he will give a speech at the electrophysiology academic exchange meeting.

More importantly, his clinical business capabilities are improving rapidly.

Everything is going in a good direction now.

…

Come to the eighth district of the heart.

The senior doctor on duty, Yin Xinhua, has not arrived yet.

Lu Chen saw Fan Zhiping sitting in the doctor's office.

"Brother Fan, why are you here?"

Jinghua Second Hospital does not arrange night shifts for training doctors.

Fan Zhiping was reading the doctor's orders. When he heard Lu Chen's words, he stood up and turned around and said, "I saw that you were working the night shift, so I wanted to come and take a look together."

Lu Chen smiled and said nothing.

Brother Fan is so positive that he doesn't look like a training doctor at all.

He has an apple in his bag, so tonight's night shift should be fine.

…

The night shift in the general ward of the cardiology department does not need to admit new patients.

Patients who come at night will be admitted to the CCU ward.

However, even if no new patients are admitted, the night shift in the cardiology ward is not easy to work.

Because many patients with heart failure experience changes in their condition during night shifts.

At night, when the human body is in a supine position, the amount of blood returned to the heart increases and the vagus nerve is excited, which can induce heart failure.

Lu Chen opened the doctor's order system. He needed to know about the more seriously ill patients in the ward.

…

5:25 p.m.

With five minutes left before taking over, Yin Xinhua came to the ward.

"You're here." Yin Xinhua looked at Lu Chen, and at the same time, she also noticed Fan Zhiping beside her.

Good guy, the graduate student also has a deputy chief doctor on duty! !

"Lu Chen, let's go see the critically ill patient." Yin Xinhua cleared his throat and said.

"Okay." Lu Chen nodded.

Hearing this, Fan Zhiping stood up and followed closely.

"Bed 2, bed 11, bed 16, bed 18, bed 25, bed 31... these are patients who are seriously ill or critically ill. We must check the patients carefully and not be lazy."

Yin Xinhua took Lu Chen and Fan Zhiping to see all the seriously ill patients in the ward.

This also includes heart transplant and aortic dissection patients that Lu Chen’s group received in the past two days.

During the ward rounds, Lu Chen not only paid attention to the patient's vitality, but also followed Yin Xinhua carefully to ask about the patient's specific condition.

"Lu Chen, this is your first night shift. Let me tell you some things you need to pay attention to during the night shift."

"First of all, all critically ill patients should be checked in the ward to find out whether there are any changes in their condition in a timely manner."

"Secondly, we need to take a look at the new patients coming today to prevent any omissions made by the doctors on the day shift."

"Finally, pay attention to the day shift doctor's handover content, such as which laboratory values ​​to pay attention to..."

Yin Xinhua informed Lu Chen of all the precautions for the night shift.

In addition to some hard requirements, there are also words of experience.

Lu Chen wrote it down one by one. This is what he will do on the night shift in the future.

…

"There are so many patients in big hospitals." Fan Zhiping sighed, "In our county hospital, there are only thirty patients in the entire ward. But you have a little advantage, you don't have to admit patients at night, our county hospital has to admit them every night The patient couldn’t sleep all night.”

"We may not be able to sleep here." Yin Xinhua curled his lips.

Once the patients in the ward get sick, it will not be easy.

Lu Chen looked calm, the night shift god would take care of him!

"Brother Fan, why don't you go back to the dormitory later." Lu Chen looked at Fan Zhiping aside, "If it's too late, it won't be easy to walk at night."

"It doesn't matter. Now that I'm here, I won't leave." Fan Zhiping said with a smile, "It has to start and end. I have nothing to do."

Don't know why.

Fan Zhiping had an intuition that as long as he followed Lu Chen, he would see some weird cases.

"Okay then." Lu Chen said helplessly.

This is the first time I met someone who wanted to work the night shift.

But he felt a little awkward. No matter what he said, Fan Zhiping was still a deputy chief physician.

Fan Zhiping stayed in the department, and Lu Chen couldn't direct him to work!

Fan Zhiping's stay in the department would not be of any benefit to Lu Chen. On the contrary, it would be a hindrance.

…

7 p.m.

The night shift has been almost two hours, and the doctor's office in District 8 is very calm in my heart.

Lu Chen had nothing to do, so he started to look through some treatment guides.

In actual clinical work, the knowledge in internal medicine books can no longer meet the needs.

Many of the practical problems encountered in clinical practice need to be answered in the guide.

Familiarity with various guidelines is a basic skill for a good clinician.

But the good times did not last long!

Night shift nurse Dong Haimeng suddenly walked into the doctor's office.

"Dr. Yin, the patient in bed 41 complains of headache. Please go check it out."

Yin Xinhua glanced at Dong Haimeng and nodded: "Okay, I'll go right away."

Having said that, Yin Xinhua did not get up.

After Dong Haimeng left, she said to Lu Chen: "Lu Chen, go and see bed 41 and see what problems he has. If you can solve them, solve them for him. If you can't solve them, come back and tell me."

"Um."

Lu Chen first looked through the patient's medical records.

This is a patient with high blood pressure, long-term high blood pressure, and no regular medication to control it.

This time, I came to the hospital where I was staying this afternoon because of high blood pressure and swelling and pain in my head.

After understanding the basic condition.

Lu Chen walked out of the doctor's office, took the blood pressure monitor, and went to bed 41.

On the hospital bed, a male patient about sixty years old was sitting on the edge of the bed with a somewhat painful expression.

Lu Chen first looked at his health value - 69.

"Uncle, do you have a headache?" Lu Chen stepped forward.

"Yes." The patient nodded and pointed to his head with his right hand.

Lu Chen continued: "Does it hurt a lot? Are your eyes blurred?"

"It hurts. Apart from the headache, there is no other discomfort for the time being."

Lu Chen immediately measured the patient's blood pressure, which was 180/110mmHg.

"What antihypertensive medicine did you take?"

"Nifedipine extended-release tablets."

On the side, a family member of the patient, a man in his forties, frowned and said: "The pain started at about 6pm, and now it's 8pm. It's been hurting for almost 2 hours, and the headache just got worse, so I asked you to come and take a look. "

An elderly man in his 60s with a history of high blood pressure suddenly developed a headache in the middle of the night. The pain was severe. With his blood pressure so high, the medication was not effective. What was he most worried about?

The biggest concern is cerebral hemorrhage or cerebral infarction, especially subarachnoid hemorrhage. Many patients with subarachnoid hemorrhage complain of unbearable headaches. (Subarachnoid hemorrhage is also a type of cerebral hemorrhage)

You know, cerebral hemorrhage itself can cause high blood pressure, and such high blood pressure may in turn cause cerebral hemorrhage!

Although the patient's health did not drop below 60, Lu Chen still gave the patient a physical examination.

Observe whether the corners of the mouth are skewed, whether the nasolabial folds are symmetrical, etc. The patient may even be asked to stick out his tongue to see if it can be centered.

If the patient has cerebral hemorrhage or cerebral infarction on one side, the tongue will stick out to one side.

In this patient, the tongue is centered, and there is no limb weakness or hemiplegia.

Cerebral hemorrhage and cerebral infarction have been temporarily ruled out.

…

Back to the doctor's office.

Lu Chen reported the patient's condition to Yin Xinhua.

After checking the patient, Yin Xinhua said: "Although there are no localized signs, the patient is so old and has had high blood pressure for so many years. A sudden headache is definitely not such a simple headache."

After thinking about it, Yin Xinhua decided to let the patient do a head CT.

Be careful of sailing too fast, especially now when the doctor-patient relationship is tense.

Yin Xinhua would rather do one more test than miss a diagnosis, which could cost lives!

Even if the physical signs do not look like cerebral hemorrhage, imaging results must be obtained.

Before the CT scan, Yin Xinhua asked Lu Chen to do an electrocardiogram as usual, and the electrocardiogram results showed no major problems.

"Take an antihypertensive pill first. After the blood pressure drops a little, go out on a cart and take a CT scan."

Lu Chen asked the patient to take another nifedipine sustained-release tablet.

The patient's family borrowed a wheelchair.

"Lu Chen, let me accompany the patient for examination." Fan Zhiping volunteered.

But Lu Chen quickly waved his hand and refused, "Brother Fan, it's better for me to go."

It would be unreasonable to ask a deputy chief physician to accompany him for an examination.

Lu Chen measured the patient's blood pressure again.

The patient's blood pressure dropped to 1Hg, and Lu Chen took him out for a head CT.

Because I had time to do the head CT, the results came out quickly.

CT showed some brain atrophy and some lacunar infarction.

Lacunar infarction is a cerebral infarction caused by the occlusion of very small blood vessels in the brain.

Return to the doctor's office in Heart 8.

Yin Xinhua saw the CT results, UU Reading www.uukanshu.net frowned and said: "Old people with high blood pressure usually get a head CT, and they will more or less have lacunar infarction. Just control their blood pressure and blood sugar well. It’s nothing serious and it’s not likely to be the cause of this headache.”

The most important information from brain CT is that no cerebral hemorrhage was found.

Fan Zhiping said from the side: "Then the cause of the patient's headache is related to the increase in blood pressure. Lowering the blood pressure may improve it."

"Yes." Yin Xinhua nodded, "Currently, it seems that the main cause of headaches is a sudden increase in blood pressure."

Lu Chen lowered his head in thought and said nothing.

He felt that this patient was strange, but he couldn't pinpoint what was strange about it.

At this time, the patient's family walked into the doctor's office.

"Doctor, my dad feels a little tight in his chest and seems to be out of breath."

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