Chapter 289: The relationship between the fall and the pulmonary infiltration, another meritorious service
As the number one expert and the chief leader of the expert group, it is impossible for her to accompany the patient for the examination.
But she was worried about sending someone else.
Only by sending Zhou Can to accompany the pregnant woman for the check-up can she feel at ease.
With Zhou Can's outstanding rescue skills, if a pregnant woman is really in danger, she can be rescued immediately.
"Can I come with you?"
The female reporter Mu Ming seemed to smell the scent and followed.
"If you are not a medical staff, it is best not to go, because it may interfere with the normal rescue work. If you want to interview, you can do it afterwards."
Although Section Chief Tang was being polite, he was actually telling the female reporter clearly that it was not possible.
The condition of this pregnant woman looks scary. If she dies, who knows how the media reporters will report it.
As the head of the Propaganda and United Front Work Department, I must guard against potential propaganda risks.
"Oh well!"
Although Mu Ming was unwilling, he had to give up.
…
The examination for pregnant women is expedited and goes through the green channel.
Even in her condition, no one dared to let her queue up for examination like an ordinary patient.
After the X-ray, the pregnant woman kept saying she couldn't breathe and felt very uncomfortable.
Fortunately, the chest X-ray and femoral head X-ray have been completed.
However, it will take a while before the X-ray examination results can be printed out on the self-service printer.
"Let's give her nasal oxygen first! The concentration is 28%, and the oxygen flow rate is 1.6L/min!" Zhou Can saw that the pregnant woman's blood oxygen level had been very low. Even if the adult could hold on, the fetus in her belly would be affected to a certain extent.
First give the pregnant woman nasal oxygen and keep it up for a while. Wait until the X-ray examination results come out, and then ask Director Zhang Bihua to make a diagnosis.
While waiting for the results, he took the patient's chest X-ray and looked at it.
The patient's lungs showed diffuse infiltration shadows, but no obvious lesions were found in other parts of the body.
Usually, when diffuse infiltrates are found in the lungs, the first thing to consider is infection.
Such as bacterial and fungal infections.
This pregnant woman developed breathing difficulties the day after the fall. She may have an infection, but it is relatively minor.
Tumors can also cause diffuse infiltrative shadows in the lungs, such as in patients with advanced lung cancer.
Zhou Can had limited experience, and after looking at the film, he was unable to give an accurate answer.
Because there are too many causes that can cause diffuse infiltrates in both lungs.
Lung infections caused by viruses, fungi, and bacteria, lung tumors, carcinomatous lymphangitis, diffuse lung injury...the specific cause is difficult to diagnose, not to mention Zhou Can, even the experienced Director Zhang Bihua may not be able to diagnose it.
At present, it has only been confirmed that there is a problem with the lungs. Further examination is needed to find out what exactly causes the lung lesions.
After waiting for more than ten minutes, the X-ray examination results were finally printed out.
The right femoral head fracture was obvious.
This is consistent with Director Zhang's prediction. No wonder the patient can no longer stand or walk. How can he stand or walk after his femoral head was fractured?
I really admire this pregnant woman. She managed to stay at home for an entire night after falling.
"Go get the blood test results for this patient and send them directly to Director Zhang Bihua."
Zhou Can said to a nurse who was accompanying him.
"OK!"
The nurse brought by Tuya is also considered a family member.
Zhou Can's orders were well executed.
"Doctor Zhou, what are you going to do next?"
Section Chief Tang asked.
"I'm going to take her directly to the outpatient hall and ask Director Zhang to diagnose the cause of her illness."
Zhou Canke would never dare to diagnose such a high-risk pregnant woman alone.
He doesn't have the ability yet and can't take on the responsibility.
"I'm just a little worried that pushing her over will affect the normal diagnosis and treatment order in the diagnosis hall."
Section Chief Tang was obviously reluctant to push the pregnant woman to the outpatient hall.
Zhou Can understood his concerns.
"If you think it's better to take her directly to the emergency room, I have no objection. But I think if we take her directly to Director Zhang, we can combine the experience of many experts in our Tuya Hospital to complete a quick diagnosis for her. This is the most time-saving method."
Zhou Can was concerned about the safety of the patients, but Section Chief Tang was concerned about preventing negative impacts on the hospital.
He was afraid that something might happen to the patient in the outpatient hall.
They are even more worried that the cause of the disease cannot be found, and many Tuya experts become nothing in front of the media.
The best way is to send the patient to the emergency room.
However, the cause of the disease is still unknown, and sending her directly to the emergency room will undoubtedly make the pregnant woman wait for a long time before getting a diagnosis. Although she looks scary now, her vital signs are still stable.
The experts on site had agreed yesterday that any crisis situation would be handled by the crisis team.
There was no way the experts would stop their current work and run to the emergency room to diagnose the pregnant woman.
"The doctor in the emergency room can actually make the diagnosis." Section Chief Tang was still in a stalemate.
Zhou Can didn't want to refute him in person, so he looked at the patient's husband and father-in-law and winked at them quietly.
Although the pregnant woman's husband is a farmer, he is not stupid, and has some cunning and cleverness that are unique to farmers. During the Anti-Japanese War, the farmers made the Japanese army suffer a lot.
There were many brave farmers who pretended to be good citizens but secretly drugged and stabbed the Japanese troops stationed in the town.
"Can ordinary doctors be the same ? My wife has an appointment with an expert, so she must be treated by an expert!"
As he spoke, the pregnant woman's husband pushed the stretcher towards the outpatient hall.
Section Chief Tang could "negotiate" with Zhou Can, but he had no way to deal with the family members.
I could only watch helplessly as the patient was pushed into the outpatient hall.
At this time, nurse Ji You had already arrived with the patient's blood test report.
"Director Zhang, this pregnant woman's femoral head was broken just as you expected. The chest X-ray shows diffuse infiltration shadows in both lungs."
Zhou Can was afraid of delaying the patient's condition, so he quickly reported to Director Zhang.
"Is there anything wrong with your heart?"
After hearing this, Director Zhang immediately took the inspection report and looked at it.
"My level is still low, and I haven't found any problems so far." After Zhou Can answered, he took the opportunity to look at the blood test report. There was no abnormality in white blood cells, which meant that the possibility of bacterial and viral lung infection was relatively low.
This shows that the patient's lung lesions are likely related to the fall.
He thought to himself, could it be that the pregnant woman already had lung cancer and the fall just showed it out?
This actually happens in clinical practice.
Some patients have great endurance and even if they feel a little uncomfortable, they still endure it silently.
It is not until you catch a cold, fall, or other illness, and are completely devastated and unable to get up, that you think of going to the hospital for treatment.
"Have you ever had trouble breathing or lung problems before?"
Zhou Can asked the patient.
As the deputy head of the crisis management team, he must play his due role.
Help the attending specialist to find the cause of the patient's illness and avoid tragedy as much as possible.
"No... no! I can feel the baby moving constantly. Is it okay?"
The pregnant woman experienced abnormal fetal movement after receiving oxygen.
Normally, you can feel obvious fetal movement three months into the pregnancy, and by five months, the fetal movement is already quite noticeable.
"Yang Chan, measure her fetal heart rate!"
Director Zhang was still frowning, thinking about the cause of the diffuse infiltration shadows in the lungs.
This is the main cause of breathing difficulties in pregnant women.
Only by finding the cause of lung disease can the problem be solved.
Zhou Can stood by and watched.
When Yang Chan lifted up the pregnant woman's clothes, Zhou Can found bruises all over her abdomen. Not just one, but everywhere.
At first, he thought the pregnant woman had been subjected to domestic violence and was beaten like this.
After careful inspection, it was found that these bruises were irregular in size and varied in shape.
And spread all over the upper body.
"Let me check your back to see if there is anything wrong with it!"
After Zhou Can explained, he pulled up her collar to check the patient's back.
The results were the same as on the chest and abdomen, with bruises everywhere.
Seeing this situation, he immediately became highly alert.
At this moment, Yang Chan had already finished measuring the fetal heart rate.
"The fetal heart rate is generally quite normal."
Her words also made everyone feel a little relieved .
I hope the child is fine.
The fetus in the womb is actually not as fragile as we imagine. Sometimes, even if the pregnant woman's abdomen is accidentally hit or other accidents occur, the fetus can be safe and sound.
There was even a pregnant woman who was involved in a car accident and was thrown five or six meters away.
By the time the medical staff arrived, the pregnant woman was already seriously injured and in critical condition. She was taken back to the hospital for emergency treatment, but she could not be saved. The doctor detected that the pregnant woman's fetal heart rate was still there, but it was a little weak, so he quickly performed a cesarean section.
A premature baby was taken out and after examination, everything was normal.
The baby survived after staying in the incubator for nearly a month.
From this we can see that the fetus is actually very safe in the mother's belly.
With the cushioning of the mother's abdominal fat layer and the protection of amniotic fluid, the fetus can feel like wearing two thick cotton coats.
"Squad leader, please check her armpits and chest to see if there are any bruises like this!"
It was inconvenient for Zhou Can to check it directly, so he had to ask Yang Chan to do it for him.
After checking, she confirmed, "There are bruises in both areas. Especially obvious in the armpits."
"OK!"
Zhou Can's discovery has also attracted the attention of Zhang Bihua. She also walked to the patient and examined him carefully.
At this time, the pregnant woman's condition is worsening.
Even though she was using nasal oxygen, her breathing was still as heavy as if she was breathing like a bellows.
It looks very worrying.
To put it bluntly, in this situation, if one person can't breathe, there is a high possibility that two people will die.
"Come on, open your mouth and let me see your oral mucosa."
Zhou Can put on the mask and asked the pregnant woman to open her mouth.
Her reaction was already a little slow, and it was only after Zhou Can said it several times that she slowly opened her mouth.
Because his mouth was not open wide enough, Zhou Can could only shine a small flashlight into his mouth to check what was going on inside.
“There are similar ecchymoses on the oral mucosa.”
Zhou Can reports to Director Zhang.
Suddenly thinking of something, he subconsciously looked at the patient's eyelids.
"There are also ecchymoses on the conjunctiva."
There are no external injuries in these areas, so they definitely were not caused by domestic violence.
Then her bruises are an important diagnostic direction.
"Could it be aspiration pneumonia?" Yang Chan offered her own diagnosis.
"That's possible. But her consciousness seems to be starting to become unclear, which is a very bad sign. It means that the disease is progressing very rapidly. If the cause is not found as soon as possible, she may die in an instant."
Director Zhang's expression was particularly solemn.
Deputy Director Shi, the leader of the crisis management team, has also come over to help with the diagnosis.
He only specializes in diseases in the field of gastroenterology and is somewhat helpless in treating the pregnant woman's illness.
Two more experts joined the consultation after diagnosing the patients in their hands.
Experts from Tuya Hospital carry out expert outpatient activities here, and everyone prospers and suffers together.
If you encounter a patient whose illness a specialist cannot identify, then you can work together to treat him.
Unity is very important at this moment.
"Director Zhang, isn't it too little to just give the patient a chest X-ray?"
Deputy Director Shi saw that the patient was breathing in more than out, and he was as anxious as an ant on a hot pan.
It's not easy to be the leader of this crisis management team.
If things go wrong, a patient might die on the first day in office.
"The lung X-ray showed snowstorm-like changes in the lungs. This must be watched carefully as it can easily lead to death."
Another expert expressed his opinion.
"So many bruises on the body indicate that the subcutaneous punctate hemorrhage is serious."
An expert in obstetrics and gynecology was not to be outdone.
Director Jiang then stepped forward and focused on checking the patient's consciousness and head, and then reviewed all the tests.
"She didn't have any obvious head injuries, but she did have some neurological symptoms such as chest tightness and palpitations. The diagnosis should focus on the heart and lungs. The possibility of brain problems is extremely low."
Director Jiang is a neurologist and has a certain authority in neurological diagnosis.
Many experts gathered together, discussing with each other.
Several reporters came over like flies that smelled a bad smell, taking all kinds of photos.
Section Chief Tang's face turned black. He had already said that patients should not be brought to the outpatient hall. If something happened now, how would he end it?
Just as the experts were anxiously making a joint diagnosis, Zhou Can picked up the patient's blood test report again to check it.
The white blood cell count was normal, but the blood test results showed that several indicators were abnormal.
Now there are subcutaneous punctate hemorrhages, and blood count is also an important reference.
"Her blood test results showed thrombocytopenia, which may be related to subcutaneous punctate hemorrhages and bruises on the upper body. I checked her legs and there were no bruises. This means that it is likely mainly concentrated in the upper body."
Zhou Can, the deputy team leader, is also working hard to contribute his strength.
"In addition, the patient's serum lipase is significantly elevated. I think we should check the blood free fat. It would be best if we could also do a urine test to check urine fat."
At this point, Zhou Can had clearly made a major diagnostic breakthrough.
He has the diagnostic bonus of the special medical skill of emergency rescue, and the effect of this special medical skill is particularly obvious when rescuing some critically ill patients.
It can make his brain extremely clear and his thinking more flexible than ever before.
"What does Dr. Zhou suspect is the cause of the patient's illness?"
After listening to Zhou Can's diagnosis and treatment opinions, Director Zhang's eyes brightened slightly.
"Based on the patient's symptoms and the current examination data, I personally prefer fat embolism syndrome. When I was doing my orthopedic training, I had the honor of hearing my senior physician say that traumatic fractures should be especially vigilant against this disease. The patient had a femoral head fracture due to a fall, and the onset time was approximately within 48 hours."
"Generally speaking, the likelihood of fat embolism syndrome occurring within 72 hours of a traumatic fracture is highest."
Every time Zhou Can enters a department, he can learn from one or more chief physicians and perform consultations and surgeries with them.
He was also appreciated by the chief physicians, who taught him everything they knew.
This gave him practical knowledge that ordinary doctors could hardly match.
To put it bluntly, these are valuable clinical experiences summarized by our predecessors.
"Immediately give the patient a blood free fat test! And then draw urine for emergency testing."
The pregnant woman is now unable to urinate on her own.
Consciousness almost fell into a coma.
If we take off her pants and insert a urinary catheter here, the family members will not agree. It is impossible for the doctor to do such a thing without regard for the patient's privacy.
"Send her to the emergency room first. Insert a urinary catheter to collect a urine sample and send it for testing immediately. Instruct the laboratory to test urine fat first."
In fact, current examinations are all analyzed by highly intelligent automated instruments, and the results of urine and blood tests can be obtained very quickly.
It’s just that there are often many patients queuing up for examination, so it feels like the time is very long.
"Director Zhang, isn't it a bit hasty to just confirm that the patient has fat embolism syndrome?"
Du Leng didn't know what was wrong with him.
He also came over enthusiastically to help with the diagnosis.
It's a pity that I couldn't do anything.
He had two arguments with family members yesterday, and was obviously affected when he was seeing patients today. Although the new patients today did not know that he was a fool, he was afraid of being embarrassed again during the consultation process, so he immediately pushed any cases that were slightly difficult to diagnose to other doctors.
The consequence of this is that fewer and fewer patients come to him for treatment.
Everyone was not stupid. They stood there in line, watching Du Leng diagnose and treat the patients in front of them. He couldn't cure this one, and he couldn't find out what was wrong with that one. They immediately understood that this overseas returnee doctor was just that good.
Apart from the gimmick, their ability to diagnose diseases is far worse than that of other real experts.
As a result, some patients who originally had an appointment with Du Leng quietly changed their appointments to other specialists.
Anyway, registration is free.
They are not willing to entrust their lives to a doctor who is a returnee with a doctorate degree but only has the appearance of a doctor. For patients and their families, titles such as doctorate and professor are certainly attractive, but what they really need is someone who can cure their illness.
This is the most important.
