Rebirth of Medicine Practices the World

"I went to the Municipal People's Hospital 2 weeks ago. My body temperature was 38.9 degrees. A routine blood test showed 16,000 white blood cells, mainly neutrophils. I heard obvious crackles in both lungs. The Municipal People's Hospital classified it as 'acute'

Pulmonary infection and hospitalized."

"During hospitalization, the symptoms were good and bad. In the past week, the patient's condition has taken a turn for the worse. The patient's mental state has deteriorated, his blood pressure is low, and his body temperature mostly rises in the afternoon. Sometimes, his body temperature is also relatively high in the morning. There seems to be no change in body temperature.

law."

"Due to the worsening of the condition, the patient was transferred to the ICU for treatment. After nearly a week of treatment in the ICU, the condition continued to worsen, the consciousness was obvious, and the patient also suffered from irritability, delirium, and anorexia."

"Because the condition did not improve, the patient's family decided to leave the hospital and come to our hospital for treatment. After consultation with various departments, he was admitted to our department for hospitalization."

It can be seen that in a short period of time, Ye Xiu has a very thorough and accurate grasp of the condition.

Lin Lin looked at the medical records and listened to Ye Xiu's report. Finally, she looked at Ye Xiu and said with satisfaction, "Okay, very good."

Lin Lin took a look at the patient and found that the patient had a gastric tube inserted.

"The patient can't eat?"

"He could eat, but not much, so they inserted a gastric tube into him."

"Chief nurse, remove the gastric tube immediately." Lin Lin frowned and said decisively to Ke Jing.

Ke Jing immediately stepped forward and gently removed the patient's gastric tube.

The moment the gastric tube was removed, the slightly irritable patient breathed a long sigh of relief. It can be seen that the gastric tube not only brings discomfort, but also brings psychological pressure.

"When do you feel better during the day?"

"In the morning, when I woke up, I felt more comfortable and wanted to eat something, but not much."

"In the afternoon, I feel fever all over my body, as if I've been 'barbecued'. I feel dry and irritable in my mouth. At this time, I can't cough up phlegm, I have no appetite at all, and I resist eating."

"Is there a lot of phlegm now?"

"It feels like there's a lot of phlegm inside, but I can't cough it out."

"Can't you cough it up in the morning?"

"Not even in the morning. The phlegm is very thick and difficult to cough up."

"Feeling thirsty?"

"Thirsty, very thirsty, always want to drink water."

"Do you have the habit of smoking and drinking?"

"Yes, I smoke a lot and drink a lot. Before I got sick this time, I got drunk. I was helped home. I slept until midnight and vomited a lot next to the bed."

"Did you feel like you were choking in your lungs?"

"I think so. I was vomiting and coughing violently at the same time."

"How are your bowel movements now?"

"Small, very little, very little in both urination and defecation."

"How many times a day do you pee?"

"I can't remember clearly, but it was very little anyway. The color of the urine I produced was a bit like tea."

"Have you ever been as sick as this time before?"

"No, I've always been in good health and I rarely catch colds."

"Okay, lie down and I'll check it for you."

"Okay, thank you!" The patient seemed to be in good spirits.

Lin Lin first touched the patient's skin with her hands. She felt that the temperature of the skin was slightly higher and the skin seemed particularly dry. Lin Lin pinched the skin with her hands and gently pulled it up. Then she immediately let go and saw that the skin retracted very slowly.

This kind of situation should not be seen at such an age. Lin Lin frowned again when she saw it.

"What's your blood pressure now?" Lin Lin asked abruptly.

"The blood pressure I measured just now is 95 mm Hg systolic and 55 mm Hg diastolic." Ye Xiu replied immediately.

"Yes." Lin Lin responded and continued to auscultate the patient's lungs.

Lin Lin listened to every auscultation area on the chest, back, under the armpits... involving the lungs. After completing the internal medicine system examination, Lin Lin did the neurological examination.

During the neurological examination, Lin Lin paid special attention to two signs, one was the examination of meningeal irritation, and the other was the fundus examination.

"Chief nurse, open an extra tube for the patient right now. One tube will deliver glucose and the other tube will deliver glucose and saline. Measure blood pressure and pulse every fifteen minutes and record them."

"In addition, pay close attention to changes in urine output. Put a graduated urinal next to the bed and ask the patient's wife to record the amount of urine each time and the total input and output. Before infusion, draw a tube of blood.

, do a complete set of biochemical examinations." Lin Lin's doctor's instructions were clear and correct.

"Okay, I'll make arrangements right away." Ke Jing agreed. Lin Lin led everyone out of the room and back to the doctor's office.

"Let's discuss it. Speak freely without me calling your name." After everyone was seated, Lin Lin immediately asked everyone to take the initiative to speak.

"Let me talk first." Ye Xiu was very proactive.

"This is a middle-aged man who started with cough and sputum accompanied by fever, and the symptoms gradually worsened."

"While the patient was hospitalized in the People's Hospital, a large number of different types of antibiotics were used. Although it had a certain effect, it was not very significant. The main symptom was that the patient's body temperature never returned to normal."

"In the past week, the condition has worsened, and the patient has begun to experience delirium and confusion. What's strange is that these symptoms are most severe in the afternoon and evening and milder in the morning, which are highly consistent with the fluctuations in body temperature."

"In the People's Hospital, the patient's routine blood examination showed an obvious inflammatory change after bacterial infection. The chest X-ray showed obvious inflammation at the base of both lungs. The patient's erythrocyte sedimentation rate was very fast, the blood sodium and potassium were high, and the blood pressure curve was

Lower and lower changes.”

"To sum up, I believe that the patient's diagnosis is bilateral lower lung infection. Dean Lin's physical examination and medical history just now gave me great inspiration."

"I think this patient still has a problem of insufficient blood volume. The change in the patient's blood pressure is not caused by the septic shock diagnosed by the People's Hospital, but caused by a serious lack of intake. If it is septic shock, the patient's

My mental state should be worse."

"For the next treatment, it is best to change the antibiotics. As for what kind of antibiotics to change, I don't have more experience. I would like to hear the opinions of the teachers." Ye Xiu paid great attention to every detail of Lin Lin's ward rounds.

Next, Li Yun'e, Zhuo Yiming, Ling Xiaoyun and Ding Feng's speeches were almost the same as Ye Xiu's speeches. At this moment, Ye Xiu was showing off her talents for the first time, very much like Lin Lin's elegance when she just graduated.

"This patient has the following characteristics." Due to time constraints, Lin Lin began to speak.

"First, acute onset, there are obvious triggers before the illness, there is a history of suspected foreign body inhalation, and cough and fever subsequently occur."

"Second, judging from the records of the People's Hospital, the patient's early treatment results were good. The recurrence of the disease was due to the sudden discontinuation of medication midway. As for the reason, it is unknown."