Chapter 469 Airway Obstruction, All Diagnoses Correct
After checking the room, he was still somewhat worried about Director Tang Fei's current condition.
After getting into trouble, you should always ask about the other person's situation.
Basically, he has a superior-subordinate relationship with Director Tang Fei, and they have a certain friendship, but the relationship is far from that of a sister and brother with Director Xue Yan.
Just a good excuse to make a phone call.
He was about to enter the emergency operating room to start his day's work. He could ask about the patient he diagnosed yesterday.
I called and the call was connected quickly.
Explain that the situation is okay.
"Director Tang, I'm sorry to bother you so early!"
Zhou Can spoke first.
"What's the big deal? I'm already at work at the hospital." She seemed to be in a good mood.
Zhou Can plucked up his courage and asked tentatively, "I'm sorry for causing conflict in your family yesterday! If you need my help to clarify any misunderstandings, please feel free to ask."
"Haha, I didn't expect that I was careless yesterday and ended up having an accident. I should be the one to apologize. Fortunately, after I explained everything to my husband, he stopped being upset and even got up early this morning to make breakfast for me!"
She also found it funny when she mentioned what happened yesterday.
Zhou Can even reminded her not to close the door to avoid misunderstanding. As a result, she was so busy with work that she forgot her wedding anniversary. Her husband came to the hospital with a gift and found that she and Zhou Can had been in the office with the door closed for a long time.
"I'm glad he's fine. Has the patient been examined?"
Zhou Can was slightly relieved when he heard that everything was fine.
"Many departments had already closed yesterday, so we couldn't arrange it. But I have talked to the family members, and they agree to do those tests. They should be completed this morning."
It was almost eight o'clock in the evening when Zhou Can came out of her office.
Most of the laboratory staff in the hospital have already left work. Unless there are special circumstances, capsule endoscopy departments generally require advance reservations.
"Doctor Zhou, Doctor Zhou, there's a patient over there who needs emergency treatment, his face is purple!"
A nurse was looking for a senior doctor to come over and direct the rescue, but it was not time for the shift change yet. The most senior doctor on duty was the attending physician.
She saw Zhou Can making a phone call at the window at the end of the corridor and quickly asked him for help.
"Okay, I'll be there right away!"
After Zhou Can finished speaking, he explained to Director Tang Fei on the other end of the phone, "Director Tang, let's do this for now. I have a patient here who needs emergency treatment."
"you busy!"
The two ended the call.
Yesterday’s misunderstanding did not cause much trouble to her marriage, so Zhou Can felt relieved.
Following the nurse to the emergency room hall, I soon saw an older patient lying on a movable flat bed. Two family members gathered around nervously. Doctor Xie was still on night shift today, and the shift had not yet been handed over.
He was manning the triage table.
At this moment, the patient fell into a coma, and Dr. Xie was working hard to perform cardiopulmonary resuscitation on the patient.
However, the patient's face was cyanotic with a hint of grayish white, which was a sign of problems with blood oxygen exchange and the imminent end of life.
Doctor Xie was very professional during the rescue. He pressed the chest with just the right amount of force, doing thirty times and giving the patient artificial respiration.
When performing artificial respiration, Dr. Xie chose mouth-to-nose respiration.
This situation usually occurs when the patient's mouth is difficult to open, there is severe trauma, the patient is in water, or the doctor's mouth is smaller than the patient's.
In movies and TV series, it is common to see the heroine drowning and the hero kissing her mouth to give her artificial respiration. That is really what the plot requires and it is not professional at all.
The correct approach should be mouth-to-nose artificial respiration.
Also, when female doctors or nurses encounter a patient who suddenly faints and needs cardiopulmonary resuscitation, women's mouths are usually smaller than men's. If they are mentally strong enough, they may choose mouth-to-nose artificial respiration.
Because if a female doctor or nurse performs artificial respiration on a patient, their mouth is too small to completely seal the patient's mouth. When blowing, the gas will escape from the unblocked part and cannot enter the patient's lungs.
This situation is ineffective artificial respiration.
When blowing air into the patient's mouth, not pinching the patient's nose is an unprofessional rescue that is usually performed by ordinary people. It is a common sense mistake.
" The patient appears to have some issues with his airway."
Zhou Can has rich experience in rescue and can see that when artificial respiration is performed, the patient's chest can be seen rising and falling obviously.
This means that the air blown in has reached the lungs.
Helps patients complete lung relaxation.
As we all know, the lungs breathe through the expansion and contraction of the alveoli. To put it more intuitively, when the left and right lungs expand like balloons, they are inhaling. When they contract and become smaller, they are exhaling.
When performing mouse dissection, the changes in the lungs can be seen very clearly.
As for the cadaver teacher, don’t even think about it.
The bodies used for medical research are all human beings whose lives have ended. Only the Japanese devils are so cruel and inhumane as to use living people for medical research.
Zhou Can walked forward and tried to raise the patient's head at a wider angle, placing his hand on the patient's chin and lifting it up.
This is the most commonly used method of tilting the head and lifting the cheeks.
The patient's teeth are clenched and his mouth is tightly closed.
He pinched the patient's mouth open with a little force, leaving a gap two or three centimeters wide, and then observed the situation inside the mouth.
"It turns out that the root of his tongue fell back and blocked his airway!"
At first I thought it was food getting stuck in the trachea while I was eating, causing suffocation.
This situation often occurs when the patient has mental disorders, the pharyngeal muscles relax, causing the root of the tongue to fall back, thereby blocking the airway.
The human tongue and epiglottis are connected to the lower jaw. At this time, you only need to push the lower jaw upward like Zhou Can did, which can force the tongue and epiglottis to lift up and move away from the posterior pharyngeal wall, and the patient's airway can be restored to normal.
With Zhou Can's help, the patient's airway was restored, the cyanosis on his face gradually disappeared, and he gradually returned to normal.
"How did he fall into a coma?"
The patient is now in a state of complete unconsciousness.
This is also the main reason for the tongue root to fall back and block the airway.
"My father has always had high blood pressure and loves to drink. The doctor told him not to drink, and we were very careful not to let him drink. This morning he went out very early, bought a bottle of wine, and drank some. Not long after, he started to speak slurredly and couldn't stand steadily. We rushed him here. He was conscious and able to speak on the way, but he fell into a coma afterwards."
The family members are a middle-aged couple in their forties.
The one who should answer is the son.
The daughter-in-law stood by without saying a word, just looking at the unconscious patient anxiously.
"Teacher Lu, have you measured his blood pressure?"
People with high blood pressure should try not to drink alcohol, because no one knows what the consequences will be after taking a sip of alcohol.
Especially for the elderly, the consequences are often serious.
"Systolic 180, diastolic 120."
Nurse Lu is an experienced nurse in the emergency department and often has strong professional predictive ability when rescuing patients.
She can handle just what kind of patients need support from senior doctors.
"Hurry up and check his cardiovascular system! I think his condition is very bad."
Zhou Can inferred from some of the patient's symptoms that it was most likely a cerebral hemorrhage.
Hypertension must be well controlled. Once a cerebral hemorrhage occurs, the probability of stroke is extremely high. Moreover, the danger is particularly great, and the prognosis is often very poor. Suffering from hemiplegia is considered good.
…
He went into the operating room for surgery and didn't care about what was happening outside.
When he came out to eat at noon, he heard that the patient had indeed suffered a ruptured cerebral blood vessel and intracranial hemorrhage. He had now been transferred to the neurosurgery department for treatment.
The neurosurgery department of Tuya Hospital actually includes brain surgery.
Some hospitals have specialized neurosurgery departments.
Many ordinary patients think that neurosurgery belongs to brain surgery, which is completely wrong. The scope of neurosurgery is much wider than that of brain surgery.
Human nerves are distributed throughout the body.
The nerves in the head and spinal column are the most studied in neurosurgery.
The head can be considered a nerve center, and the spinal nerves are the main roads to the body.
Some children suffer spinal injuries during dance practice, or from falls from heights or accidental falls, and then become directly paralyzed, with the most common being lower limb paralysis.
This is because the nerves in the spine are compressed and damaged.
When practicing dance, children have limited endurance. If they feel very painful when stretching their legs or bending their waist, you must not force them. You need to proceed step by step and gradually increase the difficulty of the movements.
Some dance teachers always think they are very professional and everything is fine after teaching so many children, so they are equally rude to every child.
They believe that strict teachers produce excellent students.
Little do people know that this situation would be fine if nothing serious happened. However, if it happens to a child with a fragile body, or if excessive pressure on the lumbar spine occurs during dance training, it can easily cause hemiplegia in the child.
Some children may be fine at the time, or just feel pain.
The teacher also thought she was pretentious.
Then after a period of time, usually a dozen hours to two or three days, the child suddenly becomes paralyzed.
It's too late to say anything now.
So, don’t be foolish and confuse neurosurgery with brain surgery.
The nerve center is in the head, but the diseases that can be treated outside the brain are not limited to neurological diseases, but may also include cerebrovascular diseases, brain hernia, etc.
Zhou Can was eating while checking WeChat on his phone.
There's nothing I can do. He's just too busy.
The only time I could reply to Su Qianqian’s messages or check other people’s private messages was during lunch or after get off work.
"Doctor Zhou, the child's test results are out. I'll send them to you."
Director Tang Fei was really not affected at all. She sent a private message to Zhou Can and continued to chat with him as usual.
Director Xueyan hasn't contacted Zhou Can in the past two days, which inevitably makes him a little worried.
Zhou Can checked the patient's test results and found that both anti-gluten antibodies LGC and LGA were positive. It seemed that Zhou Can's diagnosis was correct and the patient was indeed suffering from celiac disease.
Anti-endomysial LGA antibodies showed weak positivity.
This is consistent with the patient's condition.
Although the child has celiac disease, it is atypical.
Capsule endoscopy showed that the small intestinal mucosa of groups 2, 3, and 4 was swollen and gyratory, and the mucosal surface showed punctate and flaky erosions.
At this point, the diagnosis can be confirmed without a doubt.
No wonder the child’s fecal occult blood test was intermittently positive.
The small intestine is one of the three major nutrient absorption organs in the human body. It is also the most important nutrient absorption organ and has advantages that other organs do not have. It can be said to be uniquely endowed.
The small intestine is not only the longest organ, but it also has many wrinkles, and its inner wall is covered with countless villi and fine villi.
This brings its total absorption area to a staggering 200 square meters or more.
Think about it, what is the concept?
Most of us live in houses that are over 100 square meters, which is about the same size as two small three-bedroom, one-living-room houses.
Continuing to check, the child's 5th and 6th small intestines were swollen and granular, and bleeding spots were found on the mucosal surface.
Ulcers were found in the small intestine of Group 6.
The area was not large, only about 2.5mm*2.5mm. It was covered with white fur, and Zhou Can's mucous membrane was obviously congested.
At this point, there is no need to check further, and celiac disease has been confirmed without a doubt.
"It's good that we've found the cause of the disease. We can just treat it as celiac disease. I hope the child can recover soon."
After reading the test results, Zhou Can breathed a sigh of relief.
Every time he successfully finds out the cause of a patient's illness, or sees a patient recover and be discharged from the hospital after treatment, he feels particularly happy and has a sense of accomplishment.
The purpose of studying to be a doctor is to help patients relieve their pain.
For example, this child had been examined and treated by so many experts, but his condition kept recurring. When the family members brought the child to Tuya Hospital for treatment, they were probably quite desperate.
This is also a true portrayal of many patients and their families.
If a disease is not cured after being treated in two or three hospitals, they will no longer have any confidence and think that the disease is very difficult to cure.
As soon as Zhou Can replied to the message, Director Tang Fei called him directly.
Connected.
"Has Doctor Zhou performed the operation yet?"
"Yeah, I just got out of surgery and am eating in the cafeteria."
"Do you have any suggestions for the treatment of this child?"
There is absolutely no problem treating celiac disease in pediatrics.
The main difficulty in diagnosing this disease is that it is easy to mistake it for duodenal ulcer or enteritis for treatment, especially for this atypical case.
During the capsule endoscopy, ulcers were indeed found in group 6 of the small intestine.
But if you really treat it as an ulcer, it will definitely not be effective.
Director Tang Fei is now humbly asking Zhou Can for advice on treatment, all out of respect for Zhou Can.
"There's nothing else to worry about. The only thing is to start a gluten-free diet. Considering that the patient has almost no diarrhea, hormone treatment is not necessary. Finally, we need to greet the family members and prepare them mentally for long-term diagnosis, treatment and review."
Zhou Can really didn't have any special suggestions.
I have to thank several chief physicians in the Department of Gastroenterology for some of the methods, techniques, and experiences in treating celiac disease. When Zhou Can was doing regular training in this department, these chief physicians gave him a lot of guidance and never kept any secrets.
Director Tang Fei accepted all of his medical advice.
He had just finished chatting with Director Tang Fei when Director Le from the cardiothoracic surgery department also sent him a private message.
After examination, the patient who had undergone total gastrectomy for cardia cancer had a positive result. Zhou Can's inference was consistent with the patient's severe pain caused by the reflux of bile and pancreatic juice, which invaded the esophageal mucosa.
The cause of the disease is clear, but the surgery has already been done, so it is quite difficult to solve it.
"To cure her condition, I'm afraid she'll need a second surgery. And it can only alleviate the symptoms, it's hard to cure it completely."
Zhou Can replied to Director Le’s message.
This operation was purely due to the fact that Director Le's surgical plan was not well thought out. If the possibility of bile and pancreatic juice reflux after the entire stomach was removed could be considered, some room should be left and another more difficult surgical method should be used.
