Chapter 273: Ignorant mother, Director Dai is a little panicked
Zhou Can was idle and was secretly wondering what the cause of this obese female patient's illness might be.
There are many causes of sudden apnea during sleep, such as genetic factors.
If someone in the family has this disease, then the probability of the offspring being inherited is very high. This kind of patient can usually be seen through inspection. For example, the tongue is huge, which is often called macroglossia, and the person speaks with a bit of stuttering.
This is the most typical inheritance.
Almost all patients with macroglossia are at risk for sleep apnea. Their tongue is enlarged and can easily retract into the throat and block it.
There is also micrognathia, enlarged uvula, enlarged nasal concha, etc., which all pose the risk of sleep apnea.
These people belong to the high-risk group for this disease.
An experienced doctor can tell by naked eye observation.
In addition to genetic factors, people who like to drink and smoke are also prone to this disease.
Drinking too much alcohol can easily aggravate sleep apnea symptoms.
Some people lie on the ground drunk and no one takes care of them. When they are found the next day, they are already dead. This tragedy is not just one case, but many cases have happened.
The images of the obese female patient and her parents flashed through Zhou Can's mind one by one, and there were no obvious appearance defects.
The family members speak clearly and there is no macroglossia or anything like that.
During the consultation just now, neither of the female patient's parents mentioned that other family members had this disease.
Then the possibility of family inheritance can basically be ruled out.
She has been smoking and drinking for a long time, and she doesn't look like that kind of woman.
Obesity causing airway narrowing can basically be ruled out, because she has already undergone surgery in this regard, and her family members clearly stated that the patient's symptoms still exist after the surgery.
This means that it is most likely not caused by airway narrowing.
Or her case is very special, and in addition to the cause of airway narrowing, there are other lesions.
What could be the cause? Endocrine disorders?
This possibility does exist, and the probability is quite high.
Metabolic diseases can also cause sudden breathing stops during sleep.
Zhou Can's diagnostic thinking was basically stuck at this point. If he wanted to make a further diagnosis, he had to wait until she had completed the bronchoscopy and enhanced CT scan before he could continue.
At this time, a woman who was receiving treatment at the next table caught Zhou Can's attention.
The woman was holding a toddler who was only one or two years old and was telling the doctor about the child's symptoms.
" Doctor , please help me. My son seems to have caught a cold these past two days. He makes a strange sound when breathing, as if something is blocking his nose. Also, his forehead feels a little hot."
The woman looked to be about 23 or 24 years old, dressed in a rather old-fashioned way, and her skin was rather dark and rough. If she dressed like this, her family's economic conditions were probably not very good.
And the cultural level is generally low.
The living conditions of this kind of people are not good, and they do not pay much attention to their health, have low cultural level, and have no idea about medical knowledge. Some of them are even extremely stubborn and conservative.
When they are sick, instead of seeking treatment from regular doctors, they prefer to pray to gods or believe in some folk remedies.
If she was sick, it wouldn't be a big deal.
Anyway, no matter how she struggles, she is the one who suffers.
What she feared most was that the child would get sick, and she would still do this. The child would be the one who suffered.
Zhou Can could tell at a glance that the child's face was already somewhat cyanotic, indicating that the child was already seriously ill. She brought the child to see a doctor at this time, and she was really generous as a mother.
The person sitting next to Zhou Can was Director Dai Shan of Tuya Pediatrics.
Her age is estimated to be around forty-one or forty-two.
Her short hair and ordinary looks make her look capable and ordinary.
In Tuya Hospital, being able to become a chief physician at around 40 years old is already considered a very young chief physician.
Although the deputy senior professional titles are reviewed by the municipal competent authorities, and the senior professional titles are reviewed by the provincial competent authorities, it seems that it has little to do with the hospital, but in fact there are many subtleties in it!
The chief physicians of BR county-level tertiary hospitals and provincial-level tertiary hospitals seem to be evaluated by the province.
There may be a huge gap in levels.
Take Tuya as an example. When recruiting doctors, they are very strict from the stage of regular training. The recruitment requirements are extremely harsh. Every winner has fought through layers of competition and emerged from thousands of doctors.
Their foundation is much stronger than that of the trainees in the county's tertiary hospitals.
In terms of later stage training, county-level hospitals cannot compare.
Whether it is the level of teaching teachers, or the hospital's scientific research, teaching, software and hardware, diagnostic flow, experience in treating difficult and complicated diseases, etc., provincial hospitals are far superior to county hospitals in almost every aspect.
It is conceivable how big the gap in level is between doctors of the same level in county hospitals and provincial hospitals.
But this kind of thing is not absolute.
Some county-level hospitals also have very strong chief physicians.
Conversely, provincial tertiary hospitals also have chief physicians of average level.
In short, Dai Shan was able to be promoted to chief physician of pediatrics at such a young age, so her abilities must be very good.
Zhou Can had some impression of the young female doctor sitting next to her .
Chen Jiaojiao, a trainee in the same class as him.
This girl performed extremely well in the regular training recruitment exam and her surgical skills are also quite strong.
After nearly two years of regular training, this group of interns have gradually begun to participate in formal diagnosis and treatment work.
Following the chief physician to see patients is the prelude to starting independent medical practice.
Director Dai stared at the child carefully, without much expression on his face.
"How old is the child?"
"One year and seven months."
"Have you been weaned?"
"The child has been weaned a long time ago, and now eats with adults."
Children from poor families rarely eat milk. They are usually weaned at around one year old and then eat with adults. Many children from wealthy families in the city eat milk as their staple food before the age of three.
There is another phenomenon that is particularly interesting.
Female white-collar workers in cities rarely breastfeed their children after giving birth. On the one hand, they have to work and cannot stay at home to take care of their children. On the other hand, they pay great attention to their body shape and are worried that breastfeeding will cause sagging and shriveling of the breasts, affecting the beauty of the body.
Therefore, they are more willing to spend thousands of yuan a month to buy milk to feed their children.
Until recent years, due to the frequent problems with milk on the market and scientific research showing that children raised on breast milk are healthier and smarter, more and more female white-collar workers in cities have chosen to breastfeed their children.
In addition, the extension of maternity leave has also created favorable conditions for female white-collar workers to breastfeed their children.
The child no longer drinks breast milk, which means that after becoming sick, he must rely on his own immunity to fight off the virus.
Zhou Can could faintly hear a whistling sound when the child breathed.
It sounded like a strange sound made by playing a pipe, or like a puppy barking.
"Oh no, the child's throat must be inflamed, and it is likely an acute inflammation."
From the child's cyanotic face and lips, it can be inferred that the child is likely to have a high fever. There are also problems with breathing, and blood oxygen exchange may be seriously insufficient.
"Doctor Chen, please take the child's temperature and do a physical examination."
Director Dai said to Chen Jiaojiao.
"OK!"
Chen Jiaojiao, who is petite and sweet-looking, appears particularly quiet.
Who would have thought that this seemingly delicate young girl is not only a graduate student at the Imperial Capital Medical University, but also possesses strong surgical skills?
She stood up and walked to the sick child, smiled at him, and said in a very gentle voice, "Be good, little boy. Auntie will check you, but don't cry!"
I saw her skillfully clip the thermometer under the sick child's armpit.
Then we started measuring the patient's key basic vital signs such as heart rate, pulse, blood pressure, and respiration.
It can be seen that the child is quite strong.
The arms, neck and other parts are plump.
The face also looks chubby.
"Oh, his temperature is as high as 41.3 degrees! How scary!"
After a while, Chen Jiaojiao took out the thermometer and looked at it. She was immediately frightened and exclaimed.
A body temperature over 39 degrees Celsius is considered high fever.
The sick child's body temperature was as high as 41.3 degrees, which was really scary.
This also shows that the child's immune system is frantically burning the energy stored in the body to resist the invasion of viruses.
"I think his glottis is swollen, and it's swollen badly."
Zhou Can couldn't help but say beside him.
It doesn't matter anyway, so why not let Director Jie from the Pediatric Department diagnose this sick child?
When the sick child cried, his voice was hoarse, and there was a slight barking sound with every inhalation.
"It seems that Dr. Zhou is also good at pediatric diseases!"
Chen Jiaojiao looked at Zhou Can.
She should have been paying attention to Zhou Can for a long time, but because she was shy and introverted, she had no chance to talk to Zhou Can.
Even though the two of them were sitting between two adjacent examination tables, they did not have any conversation during this time.
"Alas, I am only a mediocre expert, so I dare not say I am an expert. This child's condition is indeed worrying. If he cannot receive effective treatment as soon as possible, his condition will take a turn for the worse, and the prognosis will be very poor. You can see that he has already started to show the four concave signs."
Zhou Can is really not good at pediatric diseases.
The child had such a high fever that he began to show concave signs when breathing, which meant that the child's condition was rapidly deteriorating.
It was also the child's mother's ignorance that failed to send the child to the hospital quickly when his condition worsened.
You have to wait until the condition becomes so serious before coming to see a doctor.
To put it bluntly, the child was almost dying before they came to see a doctor. Not to mention the suffering the child would suffer, it is hard to say whether his life can be saved.
The four-depression sign refers to inspiratory dyspnea. Because gas cannot easily enter the lungs through the glottis during inhalation, the auxiliary respiratory muscles of the chest and abdomen compensate by strengthening their movements to expand the chest to assist breathing. However, the lung lobes cannot expand accordingly, so the negative pressure in the chest cavity increases, causing the chest wall and its surrounding soft tissues, such as the suprasternal fossa, supraclavicular fossa, inferior fossa, under the xiphoid process of the sternum or the upper abdomen, and the intercostal space to collapse inward during inhalation.
Once this symptom appears in a young child, do not hesitate and seek medical attention immediately.
When the patient's face turns cyanotic, like this child, it is already an early sign of respiratory failure and the body begins to lack oxygen.
"It's really serious." Chen Jiaojiao nodded and agreed with Zhou Can's point of view. "Director Dai, what do you think we should do next?"
When the child's mother heard two young doctors say that her child's condition was serious, she suddenly became a little panicked.
He looked at Director Dai anxiously with anxious eyes.
In the face of terrible diseases, the only people ordinary people can rely on are doctors.
"With such a severe fever and the four concave signs, we need to do a laryngoscopy immediately. If purulent secretions are found, medication must be used immediately. Otherwise, once the throat is blocked, he will definitely not be able to breathe."
Director Dai gave further diagnostic advice.
"Mother, you should have taken the child to the hospital for treatment earlier! You have let the child's illness become like this. First, give the child a laryngoscopy, and then decide on the next treatment plan. Do you think this is okay?"
Director Jie's words were critical of the child's mother.
"I... I didn't expect it to be so serious. The child had caught a cold before, and he recovered in two days! The child's father is not at home, and I have three children in total, so I can't spare the time. Even today, I asked my neighbors to help look after the other two children, and I brought him to the hospital for treatment."
The child's mother's voice was trembling.
"Doctor, please treat my son as soon as possible! I finally had this son after giving birth to three children. I can't let anything happen to him!"
It seems that this mother is not only ignorant, but also has a patriarchal mentality.
Although the feudal idea of favoring boys over girls has been eliminated in many places, in reality, there are too many families who want boys. Many people still believe that girls will get married sooner or later and help other families raise children.
"First, take the application form to pay the fee, and then quickly check the child. There are two main items to be checked: blood routine and laryngoscopy. Come to me as soon as you get the results."
Director Dai instructed the child’s mother.
The sick child's illness is not difficult to diagnose because it is all obvious and the symptoms and disease are clear at a glance.
What is really difficult is the treatment.
Given the patient's current critical condition, there is a risk that his respiratory tract may be blocked by sticky purulent secretions at any time.
…
About an hour later, a nurse came running over.
"Director Dai, the child who had a high fever and difficulty breathing is in danger during the examination. Please go over and take a look."
The nurse did not say it explicitly, probably because she was worried about causing a bad impact in front of so many patients and their families.
"Girl, please take us there."
After hearing this, Director Dai's face changed slightly, and he stood up and left.
Chen Jiaojiao followed closely behind.
It would definitely not be a good thing if a patient died during the examination on the first day that the experts from Tuya Hospital opened their expert clinic at Xinxiang Hospital.
"Doctor Zhou, what kind of danger did that child encounter?" Deputy Director Shi beside him looked curious.
"It's hard to say. The most likely scenario is that the bronchus is blocked. Did you notice that the child's face was cyanotic, which means that the body was already lacking oxygen? I suspect that the patient's bronchus was already mostly blocked by sticky purulent secretions at that time. Coupled with the swelling of the throat, the bronchial outlet was further squeezed, making it even more difficult for the patient to breathe."
Zhou Can replied worriedly.
The most likely thing that the child had was a breathing problem.
In this situation, if it happened at home, most people would have died.
In the hospital, as long as the doctors are of a higher level and have more experience in rescue, generally nothing serious will happen.
At least in Zhou Can's opinion, the child will not die if he is treated by him.
Director Dai took Chen Jiaojiao to the laryngoscopy and bronchoscopy examination room, only to see the sick child lying on the bed. His face had turned purple and his expression was extremely painful.
He wanted to cry, but it was difficult for him to make a sound.
Director Dai has extensive clinical experience in pediatrics. When he saw this situation, his heart skipped a beat and his face became extremely solemn.
"Is the patient's airway blocked?"
"Because the child was still young, he began to breathe shortly and with great effort soon after we pried open his mouth and sprayed the anesthetic. We immediately performed a nebulizer inhalation on him, but the effect was not obvious."
The laryngoscopist appeared quite calm.
The emergency rescue measures taken were also appropriate.
Xinxiang Women's and Children's Hospital is not bad, and its comprehensive strength is also quite strong, especially in gynecology, obstetrics, and pediatrics, which are its areas of expertise.
"Did you give him a laryngoscopy?"
Director Dai used a flashlight to shine on the child's mouth, which was still held open by the pry board. The baby teeth had not yet grown in, and the patient's teeth were clenched tightly at this moment, and his tongue was a little stiff under the effect of the anesthetic.
Breathing is almost undetectable, with little inhalation and exhalation.
"After probing the throat, I found that the patient's throat was obviously red and swollen, with inflammation, and purulent phlegm deep inside. I dare not go deeper, his condition is very scary. Do you think we should do an emergency tracheotomy?"
The child is so young that doing a tracheotomy would not only cause great harm to the child, but also be extremely risky.
Director Dai frowned, pondered for a few seconds, and asked, "Are you confident in performing tracheotomy in your hospital?" This statement actually contained some discrimination, which would make the doctors and nurses of Xinxiang Women's and Children's Hospital unhappy.
But human life is at stake, so it is normal for Director Dai to be worried.
"Our hospital should be fully capable of performing tracheotomy in terms of technology and hardware conditions. The only concern is whether the rescue after tracheotomy can be carried out smoothly? Director Meng Chun of our hospital happened to be studying abroad, and we don't have anyone with rich rescue experience in this area. You are a pediatric expert at Tuya Hospital. Can you perform the rescue after tracheotomy?"
The laryngoscopist explained the real purpose of inviting Director Dai over.
