Chapter 613 The Importance of Observational Diagnosis, a Breakthrough Discovery
On the day of admission, the patient had another headache, especially severe pain in the bilateral frontal and temporal regions. Eventually, due to the severe pain, he vomited.
If the pain is so severe that the patient vomits, it means the pain level is very high.
The patient's temperature was 38.4 degrees when he was admitted to the hospital, indicating that he had a fever.
After admission, the hospital gave her an intravenous drip of antibiotics, which is also the basic package for most patients after admission. Especially for patients in gastrointestinal surgery, intravenous drip of glucose or sodium chloride, plus the corresponding antibiotics, has become almost a universal formula.
Many people accuse small clinics of being the culprit for the abuse of antibiotics, but in fact, large and small hospitals are not necessarily clean.
It’s just that large hospitals have stricter control over the use of antibiotics.
In order to achieve the maximum therapeutic effect, small clinics often choose to increase the dosage.
After taking antibiotics, the female patient's body temperature returned to normal on the third day of hospitalization.
I have to say that antibiotics are really effective.
This is why doctors and patients love it.
The medical history records the progression of the patient's condition. On the third day of hospitalization, although the body temperature had dropped and the headache had improved to a certain extent, the patient's condition had not improved.
Because she still had a brief period of unconsciousness and convulsions on the third day.
Each time an attack occurs, the symptoms do not last long, only about seven or eight seconds before resolving on their own.
Seeing this, Zhou Can felt that the patient's condition was a bit confusing and difficult to understand.
When symptoms alone cannot pinpoint the cause, doctors can often infer the cause based on test results.
The patient's current body temperature is 36.9 degrees, pulse is 74 beats/minute, respiration is 29 times/minute, and blood pressure is 84/146 mmhg.
The four major physical signs are basically all normal.
In other words, as long as the patient does not get sick, his body is almost the same as that of a normal person.
No wonder she went to the neurology department.
In this case, the first thing to suspect is definitely a neurological disease.
According to her symptoms, there might be something wrong with her central nervous system, such as brain disease or epilepsy.
The patient's nutritional status was good, her skin and mucous membranes were not yellow, her face was not pale, and there were no bleeding spots or spider nevi on her body. Her thyroid gland was not large, her chest was not deformed, her breath sounds were clear, and no dry or wet rales were heard during auscultation.
The heart rate was 74 beats/min, the rhythm was regular, and there was no murmur in the valve areas on auscultation.
The abdomen was soft and flat when pressed, with no tenderness or rebound pain, and no mass was felt. The spine and limbs were normal without deformity.
This series of physical examinations proved that the patient's body was basically normal and no obvious lesions were found throughout the body.
The diagnosis again pointed to the central nervous system.
The brain is a prime suspect.
The first doctor, Director Yin Hua, conducted a preliminary examination of the patient's brain.
Including conversations with the patient, the patient is conscious, has clear thinking, normal speech, and normal memory, calculation ability, comprehension ability, and judgment ability.
The patient's vision and visual field were normal.
Apart from double vision, headaches, and convulsions in the limbs when the disease occurs, there are no other problems.
Director Yin also focused on examining the patient's optic disc at the fundus. The left eye was flexible in all directions, and the right eye's upward gaze and outward gaze were normal, but obviously limited, with diplopia.
During the test, the patient looks at objects with the middle eye and the right eye, and the diplopia is particularly obvious.
Zhou Can couldn't help but think of the child with high paraplegia. After the little boy fell, there was also a clear difference between the left and right sides of his body.
By overcoming this case, perhaps we can gain some inspiration from it.
Although the two people's conditions are completely different, since they are both neurological diseases, they can definitely learn from each other.
Zhou Can decided to go to the ward to see the female patient in person.
No matter the description of the condition in the medical record, the medical history record, or the various examination reports, none of them is as direct as the doctor seeing the patient in person.
Observation has been a basic diagnostic skill for doctors since ancient times.
It is also the first diagnostic technique among the four major diagnostic techniques in traditional Chinese medicine.
Inspection is not the most core diagnostic skill in traditional Chinese medicine, but it is the first diagnostic method after receiving the patient.
Just like a day's plan starts in the morning, a year's plan starts in spring.
It is the starting point for a doctor's diagnosis.
It has a great influence on the subsequent diagnosis of the disease.
The most core diagnostic skill in traditional Chinese medicine is pulse diagnosis.
Western medicine developed thousands of years later than traditional Chinese medicine, and is considered a latecomer. Its diagnostic practices are somewhat copied from traditional Chinese medicine.
Observation is still the first diagnosis item in Western medicine, on par with physical examination.
As for pulse diagnosis, Western medicine does not recognize the theory of tendons and veins. Western medicine believes that pulse diagnosis is metaphysical and illusory. It is also possible that pulse diagnosis is too complicated, so Western medicine has developed a set of diagnostic methods to replace pulse diagnosis.
That is ultrasound examination, biochemical experiments, CT examination, MRI, endoscopic examination, etc.
No matter whether the cat is black or white, a cat that can catch mice is a good cat.
The pulse diagnosis of traditional Chinese medicine is very powerful. A skilled traditional Chinese medicine practitioner only needs to feel the patient's Cun, Guan, and Chi points, which is equivalent to a full-body checkup for the patient in the hospital. Moreover, there may be diseases that cannot be diagnosed by advanced instruments and equipment, but traditional Chinese medicine practitioners can find clues through pulse diagnosis.
However, pulse diagnosis is very difficult to learn. It requires a high level of talent and many years of study to achieve success.
The talent training cycle is too long.
In addition, traditional Chinese medicine is in decline nowadays, and there are not many old Chinese medicine practitioners who really know how to take pulses, so it is even more difficult to pass on the knowledge.
It is easier to promote the various technologies of Western medicine, and any student with a smart mind can study medicine.
This point can be solved by directly screening out medical students who are suitable for studying medicine through the college entrance examination.
Therefore, Western medicine now dominates the world and there are many talented people.
If you don't know how to check and operate the instruments, you can just follow the instructions.
Based on the information in the medical history, Zhou Can found the patient's inpatient ward.
Bed 37 in Shinnei.
A pretty female patient was lying on the bed, and a middle-aged woman in her sixties was accompanying her. She should be the patient's mother.
Even if a woman is married, the family members who will take care of her when she is sick are either her parents, her husband or her children.
In short, there are very few fathers-in-law or mothers-in-law who go to the hospital to take care of their daughters-in-law.
"Excuse me, are you Ms. Zhao Caixiu?"
"Yes, I am."
She saw the doctor coming and quickly sat up.
"It's okay, it's okay. I just came here to understand your condition. Just lie down."
Zhou Can quickly comforted her.
Patients with such neurological diseases should be kept in a relaxed and natural state as much as possible, otherwise they will be nervous and easily fall ill.
"Let me check your eyes."
"OK."
She accepted it with pleasure.
The vast majority of patients are happy to have a doctor examine them and care about their condition.
Zhou Can stared at the patient's eyes and found that the right eye was obviously slow to turn and had difficulty turning upwards.
"Look at my fingers and don't move your head."
After Zhou Can finished speaking to the patient, he stretched out a finger and moved it up, down, left and right in front of the patient's eyes.
The patient's right eye was more sluggish when moving.
Zhou Can first covered the patient's left eye and then extended two fingers.
“How many fingers do you see?”
"It seems to be four!"
Yes, the patient indeed had diplopia in his right eye.
He covered the patient's right eye again and asked again, "How many fingers?"
“Two!”
The patient's left eye had normal vision.
Zhou Can was not finished examining her, as other doctors had already done the same examinations. He just wanted to confirm the results again and see the patient's eye performance.
"Did it hurt when you moved your right eye just now?"
"It seems to hurt a little bit. When I move my right eye, it seems like a nerve is pulled, and my head hurts a little bit."
The patient answered truthfully.
"Okay. Let me touch your face and relax."
Zhou Can touched the patient's left and right face, especially the cheeks and cheekbones, and found no obvious abnormalities.
"Do you chew gum?"
"I eat it occasionally, but very rarely." The patient said a little embarrassedly.
"Here, I'll give you a piece of gum to chew. Just open your eyes normally while chewing, and I'll do a further examination of both of your eyes."
Zhou Can took out a piece of Wrigley gum from his pocket and handed it to the patient.
This unique examination method immediately attracted the attention of other patients and their families in the ward. Everyone watched with curiosity.
After the patient took it, he opened the aluminum foil packaging, put it in his mouth and started chewing.
Although she didn't know what Zhou Can wanted to check, she still felt that the young doctor's examination method was unique and novel.
Zhou Can stared at the patient's eyes and found that her corneal reflex was abnormally slow.
The chewing is quite vigorous.
"Close your eyes."
She closed her eyes obediently. Zhou Can tried to lift her eyelids and felt that she had great strength when she closed her eyes.
He looked at her face carefully again. The corners of her mouth were not crooked, the nasolabial groove was of normal depth, and there was light fuzz on her lips.
Women don't have beards, but they do have some hair, which is normal.
Some women will have elevated levels of male hormones during a certain period of time, and the fuzz on their lips will become thicker and longer, like a beard. Many women often feel panic, but there is no need to worry, this is just a normal physiological phenomenon.
This is especially obvious in older women after menstruation.
Just face it calmly.
If you really feel that it affects your appearance and you are worried about being discriminated against or laughed at by others, you can use a depilatory cream to remove the hair on your lips.
In addition, when men are looking for female companions, if they want to know whether the other person has a strong personality, there is a little trick for reference.
Just secretly observe the girl's lip hair. If it is thick and long, this girl is likely to have a strong personality. After marrying her, be prepared to be dominated by her.
Of course, marrying such a girl is actually very happy.
This type of girl is often very career-oriented, has a clear distinction between love and hate, and may have a bad temper, but she is very good to her husband and children.
If you don't get along with the elderly in your family, just don't live together.
"Okay, please spit out your gum and try to drink some water."
Zhou Can's testing of her continues.
When the patient spit out the gum, she wrapped it with tissue paper and asked her family to throw it into the trash can. Judging from her behavior, she is quite well-mannered.
She picked up the glass and took a sip.
Zhou Can found that she seemed to have some difficulty swallowing. This phenomenon was actually discovered when she was chewing gum just now.
The gag reflex during swallowing is very pronounced.
But there was no choking.
"Stick out your tongue and open your mouth a little wider."
Zhou Can said to her again.
Fortunately, the patient's husband was not here. This kind of examination could easily cause misunderstandings among the female patient's husband.
In fact, the doctor only wants to find out the cause of the patient's illness and has no other bad intentions.
Through observation, he found that the patient's tongue could be naturally centered, without tongue muscle tremor or atrophy.
"Okay, that's fine."
Zhou Can continued to perform other examinations on her.
The patient's limb muscles were normal, muscle tension was normal, and no voluntary movement was found in the body muscles. The test of coordination was normal, there was no abnormality in the deep and shallow sensation of the limbs, and there was no hyperactivity or reduction in the tendon reflexes of the limbs.
Babinski signs appeared positive bilaterally.
This is a new discovery.
The patient lies on his back with his hip and knee extended. The examiner holds the upper part of the ankle with his left hand to fix the calf, and holds a blunt-tipped metal rod in his right hand to quickly and lightly stroke the outside of the sole from back to front to the base of the little toe, and then turns to the big toe side. This is called the bilateral Babinski sign test.
Normal flexion of the toes toward the plantar surface is negative.
This female patient had obvious abnormalities and the initial diagnosis was positive.
It seems that I still have to contact the patient in person.
If he hadn't come to the ward for a thorough examination, it would have been impossible for him to discover so many details.
If we only look at the test results and medical records, as long as the patient is not ill , everything is normal.
Who would have thought that beneath seemingly normal performance, there are so many abnormalities hidden?
"Let me touch your neck. Try to relax and don't be nervous."
Zhou Can tried to touch and press the patient's neck, and the skin was smooth and silky.
Only when palpated, there is obvious neck resistance.
"Relax, don't tense your neck, otherwise the results of my examination will be inaccurate."
Zhou Can spoke gently to comfort the patient.
"OK."
She closed her eyes and tried to relax.
However, the neck resistance phenomenon still exists.
Zhou Can performed Kernig's sign and Brulucki's sign tests on her, and the results were both +.
It's not particularly serious.
"Okay, thank you for your cooperation. We will tell you when there is a new diagnostic breakthrough." Zhou Can has made considerable progress. Although there is no clear direction for diagnosing the cause of the patient's illness, combined with the patient's laboratory tests and various instrument tests, he should be able to diagnose the cause of her illness.
“Are you the patient’s mother?”
He looked at the middle-aged woman who was accompanying him at the bedside and asked.
"Yes! I'm her mother."
"If she has an attack, try to let her lie on her side, preferably on her left side. This will be safer for her."
"Yes, thank you."
The family members nodded to indicate that they remembered.
Family members generally follow the doctor's instructions.
There are also some suspicious family members, or those who think they have some medical knowledge, who will question the doctor's advice.
All I can say is that if you don’t listen to the doctor, you will suffer the consequences.
Sometimes it's easy to suffer big losses.
Zhou Can returned to Director Yin's office and found that Director Yin Hua had already returned.
"I thought you had run away! How about it? Have you read the information of that female patient?"
Director Yin asked.
"When did I sneak away?"
Zhou Can couldn't help but roll his eyes. Director Yin looked serious, with a pedantic personality, but after getting to know him, especially after his strength was recognized by the other party, he became quite open during the conversation.
