"What's the matter?" Zheng Ren asked.
"There was a female student who fell down the stairs." Su Yun's expression was a little strange, but he spoke quickly. "She came to the hospital for an examination and found that the right lower lung had pneumonia and a large amount of pleural effusion on the right side."
"Is it on Fang Lin's side?" Zheng Ren asked.
Su Yun glanced at Zheng Ren as he drove and asked, "Did I tell you that she fell down the stairs?"
"…"
"Brain injury, left temporal fracture with pneumatosis, traumatic shock, occipital … This is not important," Su Yun said. "Fang Lin went for a consultation and felt that something was wrong. He called me to consult."
"What did you think?"
"A large amount of pleural effusion. What would you think about a 19-year-old girl?" Su Yun asked.
"Tuberculous pleurisy. That's the first impression," Zheng Ren said. "But if you consider that the fall also caused a fracture of the left temporal bone and traumatic shock, we can't rule out the possibility that she fell because of shock."
"Shock with a large amount of pleural effusion. That's what I thought too," Su Yun said.
"Let's take a look first." Zheng Ren pondered the patient's situation, and his hand unconsciously returned to the state when he was looking at the radiographic films.
"Boss, if you maintain this state on the road, you look very handsome. Silly handsome, silly handsome," Su Yun said.
"Shock, pleural effusion … What if it's nothing? Is it just a simple pleural effusion? "Zheng Ren ignored what he said and whispered to himself.
"If that's the case, it'll be simple.
"By the way, Fang Lin saw the patient. What did he think?"
"The patient's left temporal bone fracture is accompanied by pneumatosis, but the patient's right calf has a large area of bruising. He thinks it's a vascular embolism," Su Yun said.
"Well, Fang Lin is not bad," Zheng Ren said. "It shouldn't be common for the thoracic department to think of thrombosis at a glance. The patient might have a pulmonary embolism … Maybe … No, it should be a pulmonary embolism! "
"Boss, pulmonary embolism is very common!" Su Yun said disdainfully, "It's just that this patient's situation is more special, so Fang Lin called me for an echocardiogram while calling me to consult."
"I think Fang Lin's diagnosis is well-founded." Zheng Ren outlined the patient's situation in his mind and said, "The strangest thing is that young students will have a large amount of pleural effusion, which is very rare. Falls, coma, and falls are common. "
"Yes, coupled with the bruises on his legs, I think Fang Lin's logical process is the same."
"Yes." Zheng Ren said, "It's okay. After the examination, we'll probably have a definite diagnosis before we return to the hospital. He might have even used thrombolytic drugs … "
As he spoke, Zheng Ren was stunned for a moment.
Intracerebral hemorrhage and thrombolysis were two completely different treatments.
If we use low molecular weight heparin and warfarin for thrombolysis, will there be a lot of bleeding in the left temporal fracture? Brain herniation?
However, if it was not treated, the thrombosis alone was enough to be fatal!
"When will the bus arrive?" he asked.
"Three minutes."
"Tell Little Feng to go to the hospital quickly," Zheng Ren said anxiously.
Su Yun was startled.
"Fang Lin, are you with the patient?"
"Call and urge them! Do the echocardiogram immediately! " Zheng Ren's voice was very loud. "If you find any problems, immediately call the whole hospital for a consultation. The vascular department and the circulatory medicine department will come together."
"I think it might be a pulmonary embolism with syncope. The situation is very urgent. We can't use a lot of anticoagulants. Emergency thrombectomy is needed, "Zheng Ren said.
After explaining everything that needed to be said, Zheng Ren hung up.
Su Yun also ended the call. He saw Zheng Ren's anxious expression and asked, "Boss, are you making a fuss out of nothing?"
"Fang Lin's intuition is right!" Zheng Ren said firmly. "It's difficult for a fracture of the left temporal bone to cause a large bruise on the right calf. It's caused by a venous embolism in the lower extremities."
"So young …"
"Contraceptives can cause venous thrombosis in the lower extremities," Zheng Ren said. "Hurry up and go back. Keep in touch with Fang Lin."
As he spoke, a car stopped by the roadside with its flashing lights on. At the same time, Su Yun's phone rang.
Su Yun glanced at the license plate and walked over.
When he got into the car, Zheng Ren heard a mission notification.
[Emergency Mission: Misdiagnosis.
Mission Details: Most of the time, people focus on the 'main' symptoms, especially bleeding. However, the internal disease is more serious and can even be fatal. Please rescue a patient with pulmonary embolism in time.
Mission Time: 3 hours.
Mission Reward: 10,000 experience points, 1,000 skill points.]
Uh … Zheng Ren had not seen a mission with such a low reward in a long time.
However, the biggest significance of this mission was to confirm his earlier speculation. Zheng Ren, Su Yun, and Fang Lin's speculation were all correct.
It was a pulmonary embolism! Not a temporal bone fracture and pneumatosis.
The so-called traumatic shock was also a wrong diagnosis. It was the pulmonary embolism that caused the shock. Trauma was a problem for the future.
Various emboli in the systemic circulation blocked the pulmonary artery and its branches, causing the clinicopathological syndrome of pulmonary circulation disorders.
The most common emboli was thrombosis. Pulmonary embolism caused by thrombosis was also known as pulmonary thromboembolism.
The patient suddenly experienced unexplained collapse, pale complexion, cold sweat, difficulty breathing, chest pain, coughing, and other symptoms of cerebral hypoxia, such as extreme anxiety, fatigue, nausea, convulsions, and coma.
Transient hypoxia in the brain led to coma, which was why things like falling down occurred.
A large amount of fluid in the right thoracic cavity indicated that the right pulmonary artery was blocked, an acute pulmonary embolism.
The patient's current blood oxygen saturation …
Zheng Ren thought about it and entered the System's storage space to purchase surgery training time.
The System's operating theater rose from the ground and Zheng Ren went straight in.
The simulation mannequin lay obediently on the operating table. The diagnosis was — pulmonary embolism, deep vein thrombosis in both lower limbs, and so on.
Compared to pulmonary embolism, the other diagnoses were really not worth mentioning.
Zheng Ren glanced at the simulation mannequin's ECG monitor. The blood oxygen saturation was 85%, a very dangerous value.
There was no other way. Zheng Ren took a deep breath and began the embolectomy.
Generally speaking, after deep vein thrombosis fell off, it would flow with the blood to the right atrium, then to the right ventricle, and then to the pulmonary artery. This would block the pulmonary artery branches or the larger pulmonary artery.
This was a formality.
There was also the continuous shedding of small emboli in the lower limbs, leading to continuous embolism in the small pulmonary arteries, and finally leading to a large embolism.
Another reason was the shedding of the emboli formed in the right heart system and flowing to the pulmonary artery, leading to a pulmonary embolism. For example, congenital heart disease caused the right atrium to expand and form a thrombosis.
The patient in front of him was caused by deep vein thrombosis in the lower limbs.
Zheng Ren was still quite confident in removing the embolus.
However … After removing the embolic catheter through the inferior vena cava to the right atrium and right ventricle, he was stunned.
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