I Can See Health

  Chapter 200 Doctors Without Medical Ethics

  Lu Chen came to the 18th bed.

  Fan Zhiping and Yao Jie, his little valet, followed behind him.

   A male patient of about forty years old was lying on the hospital bed.

  Lu Chen was stunned when he saw his health.

   His health is only 51.

   Another critically ill patient!

   However, the patient does not look uncomfortable now.

  Lu Chen patiently began to ask about his medical history.

   He couldn't have run up the first time and told the patient that your condition was very serious.

   Seeing a doctor still has to follow the procedure, but Lu Chen has a string in his heart, and pays attention to the changes of the patient's condition at any time.

  …

   After routine medical history inquiries, Lu Chen collected brief information about the patient.

  Patient, male, 46 years old, complained of chest pain for 2 days and was admitted to the hospital.

   Another patient with chest pain!

   Most of the patients in the Cardiology Department are patients with chest pain or chest tightness.

   "Where is the pain? Show me the specific location." Lu Chen said to the patient.

   The patient raised his right hand, paused, and then pointed to his chest: "It hurts here, the whole part hurts."

   This position is at the lower end of the sternum.

   "What kind of pain do you feel? For example, is it like a needle stick, or a stone pressing, or a tearing pain?"

   "This..." The patient couldn't find the words to express for a while, "It's like something is pulling on my chest."

   "When did it hurt the most?" Lu Chen continued.

   "Two days ago when I was working, the pain started. It started again at 4 am this morning. The most painful time should be around 5 am this morning. After taking painkillers in the emergency department, the pain went away."

   "Did you sweat when it hurt?"

   The patient nodded quickly and said, "Sweat!"

  Lu Chen's heart sank.

  In cardiology, there is an empirical talk.

  Patients with chest pain, if the pain is sweating, it is generally not a bad disease!

   In addition, combined with the patient's health, his condition is not optimistic.

  …

   Next, Lu Chen asked about other situations.

   It turned out that the patient had a history of herpes zoster in the first half of the year.

   The chest pain attacked this time, and I went to the local hospital to consider intercostal neuralgia.

   After symptomatic treatment, the symptoms of chest pain were relieved during the medication.

   But at 4 o'clock this morning, the patient suddenly woke up from his sleep with pain. After seeing the local hospital, the pain continued to not relieve, so he came to Jinghua Second Hospital. "

   Next is the physical examination for admission.

   The patient was conscious, with a soft neck, negative cardiopulmonary and abdominal examination, and no edema in both lower extremities. There were no obvious positive signs.

  Because of the broken heart syndrome patient yesterday, Lu Chen also specifically asked the patient's mental state, and there was no problem.

   "Sister, give the patient an ECG review."

  Although the patient brought an electrocardiogram from the local hospital and also had an electrocardiogram in the emergency department, both electrocardiograms were normal, but Lu Chen adhered to the principle of prudence and gave the patient a reexamination of the electrocardiogram.

   “Zizzizi…”

  The ECG machine finished the paper.

  Lu Chen picked up the electrocardiogram, and Fan Zhiping also came over.

   "Sinus rhythm, generally normal ECG."

   There is no difference from the ECG done before.

   At this time, Yao Jie said from the side: "Senior brother, the patient's blood pressure is a little high, and the blood pressure is 172/90mmHg."

   "This is the blood pressure of the right hand, what about the blood pressure of the left hand?" Lu Chen frowned.

   "Oh, I haven't measured yet, I'll take another measurement on my left hand." Yao Jie took out the blood pressure monitor again.

  Patients with high blood pressure must measure the blood pressure of both hands.

   Yao Jie took the stethoscope and fastened the cuff to the patient.

  Press the air bag to inflate.

   Then slowly deflate. When the first beat is heard, it is the systolic blood pressure; when the beat disappears, it is the diastolic blood pressure.

   "What's your blood pressure?"

  Lu Chen saw Yao Jie re-measure several times, but did not report a prepared value.

   Yao Jie took off the stethoscope and frowned: "Brother, I don't know if I heard it wrong or what. The blood pressure of the patient's left hand is only 140/72mmHg."

  Lu Chen was shocked.

   "I'll measure it."

   Put on the stethoscope and tie the cuff.

   Inflate, deflate.

   The first pulsation was indeed at 140.

   "That's right, the systolic blood pressure is 140." Lu Chen put down the stethoscope and glanced at Fan Zhiping beside him.

   Both of them could see the solemnity in each other's eyes.

  The chest pain persists and does not relieve, and there is high blood pressure.

   And the blood pressure on both sides is not equal.

  The diagnosis of aortic dissection is about to come out!

   The aorta is composed of three layers, from the inside to the outside are the intima, the media and the adventitia.

   Long-term high blood pressure, not well controlled. The intima is easily torn. Once the intima is torn and the blood flows between the intima and the adventitia, a local false lumen will be formed in mild cases, while in severe cases the false lumen may involve the entire aorta.

  If the blood pressure is too high or the activity is intense, the adventitia is ruptured, and the blood in the false cavity will be gushed out, and the patient has almost no chance of survival.

   This is one of the most dangerous killers in cardiology - aortic dissection!

  If the patient is not treated in time, the mortality rate is 25% within 24 hours, 50% within 48 hours, and 70% within 1 week.

   At this point, Lu Chen almost confirmed the diagnosis of "aortic dissection".

  Because the patient not only has the same symptoms and signs, his HP is also lower than 60, and he is in a very critical state.

  …

   Back to the doctor's office.

  Lu Chen immediately reported all the patient's conditions to Sun Guoguo.

   "Aortic dissection?! I'll go see the patient first." Sun Guoguo stood up abruptly.

  If it is really aortic dissection, then this is a ticking time bomb!

  Sun Guoguo came to the ward and checked the patient again.

   "There is a high probability of dissection." Sun Guoguo said to Lu Chen, "But still do aortic CTA diagnosis."

   No matter how similar the clinical manifestations are, to diagnose any disease, evidence must be presented.

   For aortic dissection, that is contrast-enhanced CT of the aorta.

   "Okay." Lu Chen nodded.

   The patient is accompanied by a family member, his wife.

  The conversation went smoothly, and the family agreed to go out for inspection.

  Because the patient's condition was relatively critical, Lu Chen personally took him out for an examination.

   Prepare the monitor and first aid kit for going out for inspection. When Lu Chen was about to go out, he was stopped by Nurse Liu.

   "Lu Chen, the patient is in arrears after completing this examination. Afterwards, the medicine is paid on credit first, so you are urging the family to pay."

  Lu Chen nodded in agreement.

  Patients are covered by rural medical insurance in different places, and they need to pay first and reimburse them later when they go back.

  …

   pushed the patient to the CT room.

  When the image results are displayed on the computer, the patient's aortic arch all the way to the thoracic aorta, all of which are tears.

   There is no suspense, this is aortic dissection, Stanford type A, requiring emergency surgery.

   "Congratulations, the completion of the system upgrade has increased!"

   At this time, Lu Chen didn't mean to be happy at all.

   He immediately called Sun Guoguo and informed him of the test results, then carefully moved the patient back to the hospital bed and escorted him back to the ward.

  Lu Chen was afraid that something might happen in the middle of the road.

   However, nothing happened along the way, and he returned to the eight districts of his heart safely.

  Sun Guoguo has requested an emergency consultation of vascular surgery.

   This kind of operation involves surgery, and ordinary medical intervention can no longer be solved.

  …

   The vascular surgeon arrived soon after.

   "Director Zhang, transfer the patient to your department?" Sun Guoguo looked at the cardiac surgeon who came for consultation.

   "If you want to have surgery, you can transfer to our department. If you don't have surgery, it doesn't make sense to transfer to a department. It's just a symptom of lowering blood pressure. Your internal medicine department is more professional than our surgery."

   The opinion of the consulting doctor is clear.

   This type of dissection requires emergency surgery.

  Without surgery, it is like carrying a time bomb on your body that may explode at any time!

   Director Zhang of the Cardiac Surgery Department wrote the consultation opinion and explained the condition to the patient's family before leaving.

  …

   The antihypertensive drugs have been used, and the next step is to communicate with the patient about the operation.

  Lu Chen followed Sun Guoguo to the ward and called the patient's family out of the corridor.

  Sun Guoguo repeated the conversation with his family countless times before.

   "You even have to do surgery, if you don't do it, you will die at any time!"

   The patient's wife, who also looked very poor in the countryside, asked Sun Guoguo with tears in her eyes: "Doctor, we have medical insurance in the countryside, how much does the operation cost?"

Sun Guoguo paused and said slowly: "Rural medical insurance, you have to pay for it yourself and then go back to reimburse. If everything goes well, the overall hospitalization fee will be 20W, but you pay 10W first, enough for the operation fee, we can first Surgery to save your life."

   The patient's wife cried, and after groping for a long time in her pocket, she found several pieces of ten yuan and five yuan: "After two days of tossing, we only have so much in our family."

  Lu Chen took a look and saw that it was not enough to add up to 100 fast, it was too far behind.

  Sun Guoguo was also a little anxious: "Don't you have a card or something? WeChat and Alipay are also fine!"

   The patient's wife fumbled in her pocket for a long time and took out a bus card.

Sun Guoguo was stunned for a while, seeing that she had already cried to tears, gritted her teeth: "In this way, hurry up to raise money, as long as you have 5w, I will report it here for you, find a way to transfer you to a department, and help you. Done!"

   The patient's wife may really be out of money, shaking her head and crying.

  Lu Chen and Sun Guoguo felt tight, this was already their best effort.

   If this is not enough, then there is really nothing that can help.

  …

   It may be that the cries of the family members were too sad, which attracted a middle-aged woman from the family members of the next ward.

  The woman listened to the outline, probably thinking that her relatives were also in critical condition, so she stepped forward, shed a few tears with her, and said fiercely, "The current doctor is really unethical!"

  Lu Chen and Sun Guoguo were a little confused.

   For no reason, he was hammered all of a sudden.

   Just listen to the woman continue to say: "The doctor in the past, the operation was done first, so it doesn't matter if you have money or not."

Before Sun Guoguo could recover, Lu Chen sank his heart and said slowly: "There is no money in the account, I can't get anesthesia, and I can't even get anesthesia. He can lie down on the water for treatment, and he has already used the head nurse. The authority allowed him to treat him on credit."

As if she hadn't heard, the woman comforted the patient's wife, and continued to breathe out a fragrance: "The doctors now are all in the eyes of money! In the past, the old doctors in our village used to advance money to treat others by themselves. Now How can there be such good people, everyone is full of bad water!"

  Lu Chen's heart sank to the bottom.

   He stood directly in front of the woman and took out his mobile phone.

The    woman was startled, thinking that Lu Chen was going to smash her.

   But thinking that this is in the hospital, there are so many people around, and there are cameras, so he doesn't show weakness and glares.

   At this time, Lu Chen held up his mobile phone and opened Alipay's Yu'ebao.

   glanced at the balance, quickly exited, and reopened the loan.

Lu Chen gritted his teeth and said, "Eldest sister, you are right, I really should be a doctor with medical ethics. Look at this, I don't have much money as a poor doctor. There is a loan of 3W here. Lend them all out and put them on the mat. You are so caring, put together the remaining 2w, and let's do a good deed together to save people, right?"

  The patient's family listened, widened their eyes, and looked at the woman with hope.

  The woman's mouth trembled, and she stepped back.

   The patient's family took a step in front of the woman, wiped away tears, and tried to speak.

  The woman was so frightened that she pushed her hard and quickly disappeared in the corridor of the ward...

   (end of this chapter)