I Can See Health

   Chapter 192 The truth of the coma

   "Brother, are there any problems with these inspection results?" Lu Wenjun asked nervously.

   "I haven't found it for the time being." Lu Wenguo shook his head, "I have to look at the results of the blood test. When the results of the blood test come out, let Xiaohui send it again."

   "Okay." Lu Wenjun nodded.

   At this time, Lu Chen took the mobile phone from Lu Wenguo and turned to this picture of the electrocardiogram.

   "Dad, you look at this electrocardiogram, I think it's a little strange." Lu Chen pointed to the electrocardiogram and handed the phone to Lu Wenguo.

   "The electrocardiogram?" Lu Wenguo was taken aback, he hadn't looked at the electrocardiogram carefully.

   As a general surgery surgeon, he glanced at the "machine report" of the electrocardiogram at most.

   is the result of automatic analysis by the electrocardiograph.

"Xiaochen, isn't this right bundle branch block? I remember that in normal people, right bundle branch block should also appear, right?" Lu Wenguo took another look at the electrocardiogram, and then replied tentatively. .

  Although he is an old doctor for many years, he does not dare to care about the electrocardiogram.

  Lu Wenguo deeply remembered that Lu Chen once saw the electrocardiogram of "idiopathic ventricular tachycardia" at a glance.

   This is a figure that even the deputy chief physician of the Cardiology Department misjudged.

   Lu Wenjun was stunned for a while.

  Why does he feel that his big brother cares about Xiaochen's opinion?

  Although Xiaochen is very powerful and won the championship in the skill competition, he is only a student after all.

   However, his eldest brother, Lu Wenguo, has been in clinical practice for so many years!

  Is this my own delusion?

   "Dad, this is indeed a right bundle branch block." Lu Chen stroked his chin, "However, in addition to the right bundle branch, there are other abnormalities."

  Lu Wenguo took the mobile phone and carefully identified it again.

   After a while.

   He finally noticed something abnormal and quickly said, "The electrical axis is deviated to the right, right bundle branch block, right ventricular high voltage, clockwise transposition. And s1q3t3, does it look like a pulmonary embolism?"

   Pulmonary embolism, some patients do have signs of coma.

   At first glance, it sounds quite similar.

  Lu Chen was startled when he heard what his father said, but he didn't see it.

   He picked up the electrocardiogram, then shook his head: "It doesn't look like it in lead III."

  Lu Wenguo scratched his head, took a closer look, this III really doesn't look like it, he is a bit far-fetched.

   "Dad, look at the test sheet later." Lu Chen said, "By combining the test sheet, we can make a more accurate judgment."

  …

  Huzhong Province, H County near Jiangcheng.

   County People's Hospital, Emergency Department.

  Liang Hui nervously looked at the emergency doctor in front of her.

   "Doctor Fu, can you take pictures of my dad's blood draw results?"

  Fu Shuo frowned, "I didn't explain it to you just now."

   "Well, there is a relative in my family who is also a doctor. I will take a photo and show it to him." Liang Hui explained quickly.

   "Well, that's fine."

  Fu Shuo is most afraid of such relatives who have a doctor. They not only ask for reports of various laboratory tests, but also sometimes dictate the treatment plan.

   "Where is your relative's doctor?" Fu Shuo asked casually.

   "It's a surgeon at a county hospital." Liang Hui thought about it.

   "Oh." Fu Shuo nodded.

   He really didn't believe that a doctor in a county hospital could remotely see the cause of a patient's coma.

   Common causes of coma, such as cerebrovascular accident, hypoglycemia, diabetic ketoacid, cardiogenic, etc., have been ruled out.

  Liang Hui quickly took all the test sheets and passed them to Lu Wenjun.

  …

   A community in Jiangcheng.

   "Brother, I received a test order."

  Lu Wenguo took over the phone.

   In this photo, there are not only laboratory test sheets, but also detailed medical records.

   A 64-year-old male patient was admitted to the hospital mainly due to a 2-hour coma. The family members complained that the patient is a "strict vegetarian" and does not eat eggs and dairy products, but has recently developed symptoms of fatigue and anorexia without any inducement. The patient had no history of specific diseases.

   Physical examination on admission: coma, GCS score: 8–9 points. BP132/67mmHg, HR115bpm, R24/min, BMI16kg/m. Cardiopulmonary and abdominal examination showed no abnormality.

   Admission laboratory report: urea 6.84mmol/L, creatinine 263mmol/L, calcium 4.17mmol/L, phosphorus 0.14mmol/L, alkaline phosphatase 189U/L, albumin 38g/L, globulin 37g/L. 24-hour urinary calcium was 286mmol/24h.

   Blood routine, coagulation function, free thyroid function, prostate-specific antigen (PSA), carcinoembryonic antigen (CEA), and CA19-9 were all normal.

  …

  Lu Wenguo immediately said, "The patient's vital signs are temporarily stable, and the renal function is abnormal, but this level of abnormality should not lead to a coma, right?"

  If there is severe renal failure and uremic encephalopathy, there is a possibility of coma.

   However, the patient's creatinine is not particularly high, and this diagnosis is not supported for the time being.

   At this time, Lu Chen added: "He still has hypercalcemia."

  Lu Wenguo looked at the test value again and nodded: "Well, the normal value of blood calcium is 2.25-2.75mmol/L, this indicator is indeed higher."

  Lu Chen shook his head.

   "Dad, this is not just higher. The electrocardiogram of this person just now shows that the right bundle branch is accompanied by a 120ms shortening of the QT interval. Combined with the results of the test, it is completely consistent with the performance of hypercalcemia."

   "I read all the medical records, and at present, cerebrovascular accident, hyperosmolar glucose coma, and hypoglycemia coma have been ruled out. I think the most likely one is the coma caused by hypercalcemia."

   "Coma caused by hypercalcemia?" Lu Wenguo frowned.

  Lu Chen nodded: "When the blood calcium reaches about 3-4, the patient should have symptoms of mental weakness and fatigue, which can also explain why there was anorexia a few days ago."

   "When the blood calcium is above 4, there may be delirium and confusion, and if it is close to 5, it may be persistent coma."

   After listening to Lu Chen's explanation, Lu Wenguo was still skeptical.

   He has yet to see a case of coma caused by high calcium levels.

   And Lu Wenjun on the side was even more surprised.

   When Xiaochen talks about it, he is really righteous.

  Although he didn't quite understand it, he didn't seem to have thought of it when he saw the expression on his elder brother's face.

   The level of medical graduate students is so much higher than that of county hospital doctors?

   At this time, Lu Wenguo thought about it and said, "Xiaochen, just tell me what is the reason for the high blood calcium, so I can tell your aunt and let her remind the doctor over there."

Lu Chen blinked and continued: "The differential diagnosis of hypercalcemia, including distant metastasis of malignant tumors, multiple myeloma, primary hyperparathyroidism, sarcoidosis and vitamin D poisoning, I That's all I can think of right now."

  Lu Wenguo coughed lightly, "Xiaochen, can you put it in a simpler way?"

   The knowledge reserve of surgeons is really not too much.

  These diseases, he knew all about them, but when he looked closely, he didn't seem to know.

  Lu Chen paused, is he still unclear?

   "Dad, please ask the doctor at the county hospital over there to do a chest CT. Most likely there is a problem with the parathyroid glands."

   "Okay." Lu Wenguo nodded, so he would understand.

   (end of this chapter)