I Can See Health

Remember [new] in one second! Come to the bedside of the patient on bed No. 12.

Xiao Shikang whispered to Lu Chen: "The purpose of our consultation is to roughly judge the patient's condition. If it is a disease in our department, he can be admitted to the hospital..."

"Okay, Teacher Xiao, I understand." Lu Chen nodded slightly.

In his hand, he held the medical records of 12 patients in the bed.

This is an old man in his sixties.

Three years ago, I suffered a massive cerebral infarction due to a stroke.

After two months of treatment, his life was saved, but he still suffered from paralysis of his left limb and aphasia.

Because I can't speak, my quality of life is not as good as before.

The patient's family member, his wife, explained at the side: "The doctor said back then that it would be very difficult for him to survive such a large-scale cerebral infarction. If he couldn't speak or get out of bed, there was nothing better. There is no other way but to recover slowly.”

Three years ago, the patient underwent rehabilitation exercises in many large hospitals. His physical movements seemed to be slightly better, but he still could not speak.

"Alas, the old man asked for it!" the patient's wife sighed, "I used to let him take antihypertensive drugs, but he was stubborn! He refused to take the medicine. In the end, he was not tormenting me. He was fine, just lying in bed. No need to do anything.”

"But then again, I'm thankful to have survived three years ago, thanks to your hospital."

"Doctor, you rescued him three years ago, you can't leave him behind this time!" The patient's wife pulled Lu Chen's cuffs and almost burst into tears.

This time, the old man was hospitalized again.

Mainly fever, but also cough and expectoration.

His ability to cough up phlegm is pretty good, and he can cough up phlegm into his mouth, while his wife is wiping it away with a tissue.

Lu Chen looked over his head and saw that his health was 65 (-).

Lu Chen was a little surprised. This disease had nothing to do with their cardiology department, right?

Patients with sequelae of cerebral infarction may have swallowing and cough dysfunction, and are very prone to aspiration and pneumonia, which was the case for the old man.

In the past three years, pneumonia has occurred repeatedly, and even doctors are not surprised.

"Fan Jian, why do you ask us to consult a patient with such a cerebral infarction?" Xiao Shikang was also surprised and quickly called Fan Jian over.

Fan Jian stepped forward, picked up the patient's medical record, shook his head slightly and said, "If the patient only has pneumonia, we will send him to the respiratory department of the hospital below. We have given antibiotics to the patient in the emergency department in the past two days, and the effect is good. The cough and phlegm are also reduced. But last night, an accident happened..."

Last night, the patient's family fed the old man some fruit and then lay down to rest.

Not long after, the old man's breathing suddenly became rapid.

The patient's wife added: "I was very nervous last night. After all, he has never breathed like this after being hospitalized for so long. I think maybe his condition has worsened!"

Xiao Shikang frowned and said, "Is it aspiration? His swallowing function is not good. If you feed him like this, aspiration will easily lead to wheezing."

"No, it went very smoothly when eating." The patient's wife recalled, "I used to feed him like this before, and it was fine."

At this time, Fan Jian said: "The patient did not cough obviously last night, which ruled out aspiration. Later, our nurse measured the blood pressure and found that the blood pressure was very high, 200/120mmhg. If it was not aspiration, I thought it might be Acute heart failure due to hypertension.”

The higher the peripheral vascular pressure, the greater the work the heart needs to do to pump blood, and it may even be difficult to pump blood out!

At this time, the heart will become less and less powerful, which can easily induce acute heart failure, leading to difficulty breathing, shortness of breath, etc.

"Has the patient's heart ultrasound been done?" Xiao Shikang asked.

"I did it." Fan Jian nodded, "The heart ultrasound showed that the heart function was low, so I considered sudden heart failure. And last night I listened to the patient's lungs and could hear a small amount of crackles. It’s more serious than before.”

"What's the income and output in the past two days?" Xiao Shikang asked.

"It was okay a few days ago, with about 2,000 ml of urine, but today it's very little, only 300 ml of urine."

Xiao Shikang nodded slightly, "Looking at the patient's condition now, he has no obvious difficulty breathing."

"Yes, but the patient still has symptoms of wheezing and shortness of breath intermittently from last night to now. The heart failure may not be easy to control, so I asked you to come for consultation."

After listening to Fan Jian's words, Xiao Shikang looked back at Lu Chen, "What do you think, do you think this patient should be admitted?"

Lu Chen nodded slightly: "Perennially high blood pressure, and echocardiography shows damage to cardiac function. The possibility of acute heart failure cannot be ruled out at present. In addition, he only had 300ml of urine during the day. Maybe his kidneys are also damaged. I think it can be treated Come to our cardiology department.”

Hearing Lu Chen's words, the patient's wife was stunned for a moment.

The old man had suffered a stroke and was paralyzed in bed. This time he said he had heart failure, kidney failure, etc. Can he still survive?

But after hearing what Lu Chen said later, "Admit to the ward," his wife felt a little excited. Being able to be admitted to the ward means that there is still hope!

"Yes, that's a good analysis." Xiao Shikang nodded and turned back to Fan Jian, "Old Fan, you should use some diuretics to lower the blood pressure first. After I've seen other patients, we'll write a consultation order together, and then I'll treat this patient Transferred to cardiology.”

"Okay, thank you." Fan Jian breathed a sigh of relief, patted Xiao Shikang's shoulder gently, and then smiled at Lu Chen.

If a seriously ill patient can be transferred, his emergency department ward can also be safer.

…

"Let's go and see bed 22."

Time was limited, so Xiao Shikang immediately took Lu Chen to see the 22-bed patient.

In bed 22, a 35-year-old male patient was admitted to the hospital due to "chest tightness and dyspnea for more than 3 months."

His health is 56 (--).

The patient had no past history of any specific disease.

I spent a month or two in a lower-level hospital and did a lot of tests, but no cause was found.

The symptoms got worse and worse, and finally I had no choice but to go to the Department of Cardiology, Kyoto University First Affiliated Hospital.

Lu Chen came to the bedside and after a brief consultation, he began to examine the patient.

"A grade 2/6 systolic murmur can be heard at the apex of the heart, crackles can be heard in both lower lungs, and edema occurs in both lower limbs."

After the physical examination, Lu Chen opened the patient's medical record.

Among them, laboratory tests: BNP2312ng/l, echocardiography: lvef30%, left ventricular end-diastolic diameter 70mm, electrocardiogram report: complete left bundle branch block.

A piece of information quickly flashed through Lu Chen's mind, UU read a book www.uukanshu． net is thirty-five years old, with cardiac insufficiency and left ventricular dilation.

The cause of this patient's illness is not yet clear, but it is obvious that it is indeed a cardiology disease.

"Do you think this patient should be admitted to the hospital?" Xiao Shikang asked.

Lu Chen nodded without hesitation: "The patient should have heart failure, but the cause of the heart failure is not known yet. Further examination is needed to clarify the cause. The patient is so young. If the root cause can be found, that would be the best!"

"Okay." Xiao Shikang smiled, "The judgment is accurate!"

At this time, Lu Chen couldn't help but sigh in his heart, the quality of patients in this emergency department is not generally high!

If they were in Jinghua Second Hospital, this kind of patient might have been pushed to the inpatient ward.

But at this moment, there was a sudden noise from the ward not far away, and the doctors and nurses in the emergency department all ran in one direction.

Lu Chen frowned, put down the medical record folder in his hand, and took a closer look.

He was startled. This seemed to be the direction of the 12-bed patient? !