Doctor, is my husband seriously ill? "A middle-aged woman followed the physician out of the resuscitation room.
Zheng Ren was still in a daze when he heard someone speak.
"Seriously!" The physician said confidently. "Gastrointestinal bleeding. There's a faucet inside that's pumping blood. Do you think it's serious?"
The physician looked up at Zheng Ren and greeted him, "Chief Zheng, is the chief alright?"
"He's fine." Zheng Ren smiled. "What patient?"
"Nausea, vomiting, low blood pressure. We're considering upper gastrointestinal bleeding. We're preparing to admit him to the hospital."
This kind of situation was relatively common. TIPS surgery targeted patients with portal hypertension, gastric fundus, and intestinal mucosa ulceration, rupture, and bleeding were another type.
If it was not hematemesis due to portal hypertension and gastric varicose veins, the bleeding arteries would not be too large. Admission to the hospital would require gastrointestinal decompression and hemostatic drugs. It would take two to three days for the patient to recover.
"What's the blood pressure?" Zheng Ren asked casually.
"75/50mmhG." The physician left Zheng Ren with the patient's family to write the admission form.
Fortunately, although it was shock, the blood pressure was not particularly low.
Zheng Ren glanced over and saw a middle-aged man lying on the bed in the resuscitation room. His face was pale. The value on the ECG monitor …
Why was the blood oxygen saturation so low? There was also something wrong with the ECG waveform.
Zheng Ren felt that something was wrong and entered the room to take a look.
The System panel was frighteningly red. The diagnosis seemed to be bleeding — a large amount of pericardial effusion, aortic epineurium ulcer.
Uh … What kind of illness was this?
Zheng Ren knew that the emergency physician had made a wrong diagnosis. He did not think about why he had made such a mistake.
He immediately opened a drawer on the operating table, which contained a mercury sphygmomanometer and stethoscope.
Zheng Ren picked up the stethoscope and began to listen to the patient.
He could hear a large amount of moist sounds in his lungs. The sound of the heart was low and distant. It was undoubtedly the sound of a cardiac tamponade.
Because it was a man, Zheng Ren did not check for the condition of the 'disguised' patient he had encountered previously.
Cardiac tamponade was divided into acute and chronic types. If it was traumatic, there would be a large hole in the heart and blood would accumulate in the pericardial cavity. It was considered acute.
If heart function and kidney function were not complete, it could lead to fluid circulation disorders and chronic cardiac tamponade.
The presence of pericardial effusion or even cardiac tamponade was understandable. But what the hell was the diagnosis of aortic epicardial ulcer? How did it get here?
The aorta can also have ulcers, which are caused by the rupture of the aortic intimal atherosclerotic plaque and the ulcer penetrating the internal elastic layer.
However, the System gave him an aortic adventitial ulcer.
Inflammation? Or something else?
While he was thinking, the emergency physician finished writing the admission form for the Gastroenterology Department and walked out. He called for the escort to send the patient to the hospital.
She saw Zheng Ren checking his body in front of the bed and asked, "Chief Zheng, what's wrong?"
"Don't be in a hurry to be hospitalized. Do a lung CT scan," Zheng Ren said. "What's the medical history?"
The emergency physician was stunned. It was clear that there was upper gastrointestinal bleeding. Why didn't Chief Zheng admit him to the hospital? Why did he want to perform a lung CT scan?
"Male patient, 42 years old. He came to our hospital for treatment three hours ago due to repeated nausea, vomiting, and dyspnea. "Although the emergency physician had his doubts, he still reported the patient's history out of habit.
The tyranny of a senior doctor was not a joke. He had long been used to it.
"The patient suddenly had dyspnea three hours ago. He felt a slight tightness in his chest, accompanied by nausea and vomiting many times. Each time, there was a small amount of stomach content and a small amount of coffee-colored substance. There was no abdominal pain and it had nothing to do with eating. There was fecal incontinence, and the stool was yellow. "
"Nausea and vomiting? Coffee-Colored? "Zheng Ren asked.
"Yes, the occult blood was positive. It was considered to be caused by upper gastrointestinal bleeding. Because there was no hematemesis, the bleeding shouldn't be very serious, "the emergency physician said.
Zheng Ren was deep in thought.
Something was very wrong.
According to the inference of the medical history, the emergency physician's diagnosis was correct.
Nausea and vomiting. The vomit was sent for examination. There was a positive occult blood, which was inferred to be upper gastrointestinal bleeding. All of this was logical. There was no problem.
But why was there dyspnea?
Seeing Zheng Ren looking at the patient in a daze, the emergency physician whispered, "Chief Zheng, hurry up and send him to the Gastroenterology Department. If the bleeding can't be stopped, we'll need a major resuscitation or something."
The emergency department would send him wherever he needed to after the diagnosis.
They were all in the emergency department for resuscitation, so they were too busy.
There were more than ten or dozens of emergency patients outside. When they encountered a bad-tempered and anxious one, they would directly open their mouths and curse.
It was not uncommon for them to be beaten.
It was not uncommon for them to be slapped in the face for resuscitation.
Zheng Ren shook his head and said, "Go get a lung CT scan. I'll take the patient for a checkup."
The emergency physician did not know why Zheng Ren insisted, but she did not hesitate. The senior doctor had said so, and she had also given her opinion. If he did not listen, then she would follow the senior doctor's medical advice first.
Even if the sky fell, there was a senior doctor to hold it up. What was there to be afraid of?
"What patient, boss?" Su Yun returned to Zheng Ren's side after dealing with the female student.
"It's very strange. Listen." Zheng Ren handed the stethoscope to Su Yun.
"Huh? Strange? "
"According to the medical history, the patient is diagnosed with upper gastrointestinal bleeding. There's no doubt about it. However, there are problems with both lungs and pericardium. I'm going to take the patient for a CT scan first. "
Su Yun took the stethoscope doubtfully and began to listen.
In less than a minute, he raised his head with a solemn expression and said, "There's a problem. Hurry up and check."
After saying that, Su Yun asked again, "Upper gastrointestinal bleeding?"
"Nausea and vomiting. The vomit occult blood test is positive."
"Chief Zheng, the CT list is done. Do you want to take it?" the emergency physician asked.
"Yes."
The patient's family was a little confused. They had just said that they would send him to the gastroenterology department to be hospitalized. The doctor had even described the condition as very serious. If it was a little later, he might die. Why did they have to do a checkup now?
"Doctor, what's going on?" the patient's family asked anxiously.
"Has he suffered any trauma recently?" Zheng Ren did not explain. He asked as he and the accompanying examiner carried the patient onto the stretcher trolley.
"Recently? No, "the patient's family said." He was injured a few years ago. He fractured his collarbone and had surgery. Nothing has happened recently. Everything is quite normal. "
Zheng Ren took a glance. There was an old surgical scar on the patient's left sternum area. It had happened a long time ago.
Strange, there was no trauma. Where did the aortic adventitia ulcer come from?
According to the System's diagnosis, Zheng Ren began to ponder.
However, no matter how he thought, it was a dead end. There was no clue at all.
Zheng Ren and Su Yun pushed the stretcher trolley and jogged all the way. They sent the patient to the CT room with the accompanying examiner.
It was not until the patient was on the bed and the CT scan began that they heaved a sigh of relief.
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