Chapter 546: Only those without symptoms are dangerous, a clear-cut diagnosis
When patients with various critical and emergency conditions are sent to the hospital, their conditions are often particularly frightening.
At least when Zhou Can first started his internship in the emergency department, he received five critically ill patients in a dying state in one day.
"I remember your name is Xie Yu, right?" Zhou Can talked to the nurse as he followed her towards the emergency hall.
"I didn't expect you to remember my name. I'm so touched!" The young nurse was a little flattered.
Now the doctors and nurses in the emergency department all know that Zhou Can is a powerful figure in the department. He has strength, status, and a bright future. Not to say that everyone respects him, but at least everyone has reached a consensus and treats Zhou Can as a heavyweight in the department.
"Let me tell you, patients who look seriously ill like this are actually not that scary. What we really need to be vigilant about are those patients who don't look too seriously ill. For example, pulmonary embolism, the onset time is very short, and death can occur within one or two minutes."
Zhou Can gave instructions to the newcomer.
In the hospital, medical staff are a group with a common interest. Especially for members of the same department, if one person gets into trouble, it may affect the entire department. Therefore, even doctors or nurses with eccentric personalities will give appropriate guidance to newcomers as long as they have the opportunity.
The reason why medicine can be passed down from generation to generation is precisely because of everyone's spirit of being a teacher.
"What Dr. Zhou said is not an exaggeration. I still remember when I was a nurse in my first year, I was examining a patient who was under observation in the hospital. The patient was very cheerful and talkative, and he took the initiative to chat with me. His children were also accompanying him at the bedside. I just took his blood pressure and found that it was dropping. The patient was still talking and laughing, and had no obvious symptoms, so how could his blood pressure be so low? I was going to change his arm and take another measurement. As a result, the patient suddenly convulsed, fell on the bed, and his eyes rolled up. The patient died soon after. Later I learned that the patient had a ruptured aortic dissection."
Jiang Wei also shared her own growth experience.
During the process of aortic dissection, pain of varying degrees generally occurs.
However, some patients have a strong tolerance to pain and do not care about less severe pain at all, so they easily ignore it.
There is also a type of aortic dissection that is the most terrifying.
The time from formation to rupture is extremely short, and the mortality rate is basically 100%.
Unless it can be detected in advance and then intervened, such as placing a vascular stent to block the torn part of the blood vessel wall, even the best doctors can't save it.
"I've learned my lesson. I will be more cautious in the future! I never thought that patients without symptoms are the scariest."
The young nurse deeply agreed with what the two seniors said.
The three of them had already arrived in front of the triage desk, and saw a man about thirty-four or thirty-five lying on the emergency bed with a pale face.
You can tell at first glance that it is an emergency patient brought back by ambulance.
The patient held his chest tightly, his face was pale, sweat had broken out on his forehead, and his hair was wet.
His expression also looked extremely painful.
Breathing seems very labored.
Seeing Zhou Can coming, the doctor on duty felt like he had found a savior and quickly made way for Zhou Can to examine the patient.
"Where does it hurt?"
Zhou Can first explored the patient's carotid artery.
If you encounter a patient with suspected chest pain, or a patient who suddenly falls unconscious, probing the carotid artery can provide a lot of diagnostic information.
For example, the working condition of the heart can be roughly inferred by the strength and presence of the carotid artery.
Some patients may also experience neck stiffness, which has certain diagnostic significance for diseases such as meningitis and neuropathy.
"This area hurts so badly! It seems that my left shoulder and back are also in pain."
The patient's voice sounded weak and he looked like he might die at any time.
After hearing this, Zhou Can tried to press the chest area indicated by the patient.
The patient just groaned twice and there was no obvious tenderness reaction.
Some patients are numb to the pain, so they don't know where it hurts, they just know that a large area hurts.
At this time, the doctor needs to rely on his own experience and medical knowledge to identify and finally locate the real pain site.
Everyone knows that pain is actually a kind of protection for the body.
The pain in a certain area indicates that the organ or body tissue in that area is seriously damaged. The more severe the pain, the more serious the damage is.
In addition, if there is only a little pain at first, and it lasts for a long time, and the pain gradually intensifies, or there are intermittent pains, it can basically indicate a chronic disease.
It's only the kind that starts with pain and people quickly become unbearable, and the time it takes for the pain to progress from mild pain to severe pain is very short. You have to be careful about this kind of pain.
They are basically acute diseases and are often very dangerous.
It goes without saying that you should be especially careful about chest pain and tightness, and even acute and severe abdominal pain and headache.
For example, the most common cerebral infarction, cerebral hemorrhage, acute appendicitis, acute intestinal perforation, etc., if not treated in time, it is easy to lose the precious golden rescue time, and eventually die or become disabled.
Zhou Can pressed the patient's chest, and when the tenderness was not obvious, he felt relieved.
It's probably not a heart attack.
The doctor on duty may have heard that the patient had chest pain and vomited, so he was a little panicked.
Since the pain area is not in the chest, it means that the chest pain is radiating pain.
When the pain is severe, it can continue to spread around a certain area, and can even radiate to a distant area.
For example, in the example of treating a headache by treating the feet, it is possible that the foot disease causes the headache.
Zhou Can began to press on the patient's abdomen .
“Ouch…it hurts, it hurts…”
When Zhou Can pressed his fingers to the middle of the upper abdomen, just above the navel, there was not much reaction at first. Then he slightly increased the pressure, and the patient suddenly screamed in a different tone, his body tensed up suddenly, and the veins on his neck became visible.
"It seems that the real pain area is here. It is not superficial in the middle of the upper abdomen, but deep in the abdomen. This is where the stomach and pancreas are located. The stomach is in the more superficial upper abdomen, while the pancreas adjacent to it is in the deeper back. Judging from his symptoms, it is more likely that there is a problem with the pancreas."
While analyzing the patient's condition, Zhou Can turned to look at Dr. Xie on duty.
“Has the patient’s temperature and blood pressure been measured?”
When examining a patient, blood pressure and body temperature are two very important references.
"I've taken my temperature. It's 37.8 degrees. My blood pressure is a little low. The systolic pressure is only around 80."
Dr. Xie has been working in the emergency department for more than a year, and compared to when he first came in, he has made great progress. At least after seeing the patient, he has done a better job in these details.
However, this person is a dull type of doctor. He is rather rigid when diagnosing diseases. He has a lot of medical knowledge, but cannot apply it flexibly.
The patient's temperature is moderately high.
The systolic blood pressure was even lower than 80 mmHg. No wonder Dr. Xie was so panicked.
Chest pain combined with hypotension, the first thing that comes to mind is aortic dissection.
The normal range of systolic blood pressure is between 90 and 140 mmHg. A value below this is clinically considered low blood pressure, while a value above this is considered high blood pressure.
Relatively speaking, there may be many reasons for the occurrence of hypotension in clinical practice.
For example, long-term malnutrition, hypothyroidism, or taking antihypertensive drugs, etc.
Hypotension combined with chest pain is the most frightening. Almost all emergency doctors will immediately suspect aortic dissection and massive bleeding.
Zhou Can has level six hemostasis skills and level six pathological diagnosis skills, and has certain advantages in diagnosing various internal bleeding.
After preliminary diagnosis, he believed that the possibility of massive bleeding in the patient was relatively low.
Many symptoms of aortic dissection are highly consistent with this patient, but it does not mean that it is necessarily aortic dissection.
Clinically, there are numerous diseases with overlapping symptoms.
The measure of a doctor's diagnostic level is whether he can quickly and accurately integrate many symptoms, conduct targeted examinations on patients step by step, and then screen out suspected diseases with a high degree of symptom overlap to diagnose the true cause of the disease.
It sounds simple, but it is extremely difficult to achieve this.
Almost all doctors work towards this goal throughout their lives, constantly learning and accumulating diagnostic experience, but only less than one in ten can truly reach a high level.
With the help of the system, Zhou Can can reach a level in just one or two years that would take others 20 to 30 years, or even longer. This is his biggest advantage at present.
Many doctors may spend twenty to thirty years to improve their hemostasis skills to level six, but they are unable to improve their other medical skills to this level at the same time.
This leads to a certain degree of one-sidedness in their diagnosis.
The scope of knowledge is bound to be narrow.
Zhou Can, however, broke this convention and was able to upgrade multiple medical skills to level 6 or above at the same time. This was equivalent to combining several chief physicians with more than 30 years of diagnosis and treatment experience into one, which was quite terrifying.
It is definitely not as simple as one plus one equals two.
In fact, recently, he has been successful in the emergency department, pediatrics, and cardiothoracic surgery department, and has solved many difficult cases that the chief physicians have not been able to solve after consultation. This is enough to show how amazing it is that he has multiple level 6 medical skills at the same time.
Learning never ends.
He didn't stop there.
On the contrary, he is still working hard to improve his various medical skills and strive to push them to the seventh level.
By that time, it would be difficult to find an expert who can match him in China, let alone the best in the world.
Doctor Xie watched Zhou Can examine the patient and did not dare to urge him. He just stamped his feet in anxiety.
My God, the patient’s condition is already so critical, and the symptoms are highly consistent with aortic dissection, what is Dr. Zhou still considering?
He is really not in a hurry!
No one, whether it was Dr. Xie or the nurse next to him, dared to urge Zhou Can.
In the absence of a chief physician, Zhou Can is the absolute leader.
He is the highest ranking doctor on site.
This is still the case even if the attending physician is present.
"The body temperature is moderately high, the blood pressure is low, and there is severe pain deep in the middle of the upper abdomen..." Zhou Can's brows were tightly furrowed. He needed to quickly clear away the fog and find the real cause of the disease.
At least there needs to be a clear diagnostic direction.
If it is not aortic dissection but is examined as such, it will undoubtedly waste precious rescue time.
When everyone's patience was gradually worn out, the family member finally became the first to explode.
"This patient is almost dying. Can you invite an older doctor to treat him? The young doctor has no experience and is taking his time. There is no result yet. You are not anxious, but we, the patient's relatives, are anxious!"
The family members were very emotional.
"The meat is not in the folds. A young doctor does not necessarily mean he has little experience or low level. Dr. Zhou is an extremely top-notch and high-level doctor in our department. He is concentrating on diagnosing the cause of your family's illness. Please do not disturb him. Otherwise, the patient's treatment will be delayed, which is definitely not the result you want to see."
Jiang Wei once again stepped forward to help Zhou Can out of the predicament.
She is like a shield, blocking the attacks and dissatisfaction from family members.
"Our director is currently rescuing a critically ill patient in the ICU. As soon as the situation there stabilizes, he will rush over. Doctor Zhou looks young, but his skills are no less than our director's. Please be patient."
Dr. Xie also spoke up for Zhou Can and maintained his image and status.
No one will teach you this kind of thing.
It is a skill that evolves automatically with job titles. People who can learn and use it well will be promoted and promoted quickly. People with a dull mind will probably remain at the bottom of the society for their whole life.
After being comforted by the two, the family members felt much calmer.
Zhou Can has been concentrating on thinking about the real cause of the patient's illness and ignored the abuse from the family members.
"Are you thirsty?"
He suddenly asked the patient.
"Yeah, I really want to drink some water!"
The patient answered with difficulty.
At this time, the patient's breathing became much more rapid and heavy, which made people even more worried.
"When did you start feeling sick?"
"It seems that I felt uncomfortable when I woke up the day before yesterday."
"Did you relieve yourself today?"
"not yet."
"Do you feel like peeing now?"
“It seems not!”
After listening to the patient's answer, Zhou Can nodded.
"His pulse was weak, his heart rate was fast, he had a moderate fever, low blood pressure, and severe pain deep in the upper abdomen that lasted for a long time and was getting worse, even radiating to his back and shoulders. He was also thirsty and had little urine, which indicated that there was probably a serious problem with his pancreas. We initially suspected acute pancreatitis, so we immediately drew blood for a routine blood test and a fasting blood sugar test. We then immediately sent him to the ultrasound room for an abdominal B-ultrasound."
After getting the diagnosis, Zhou Can, like the commander-in-chief of the three armies, issued a series of orders to treat the disease.
The patient was promptly given a series of laboratory and ultrasound examinations.
“It’s not aortic dissection!”
Doctor Xie was stunned listening to this.
I really didn’t expect that Zhou Can’s initial diagnosis was acute pancreatitis.
Dr. Xie deeply felt the gap between himself and Zhou Can.
"If there is no problem, arrange for an examination immediately. Do not delay. Take the patient to do these examinations, and contact me or the chief physician on duty as soon as the results are available."
Zhou Can knew very well that the mortality rate of acute pancreatitis was quite high, so he would never dare to be careless.
