I Can See Health

"Hiccup?" Lu Chen frowned.

Because when he looked at the life value on the old man's head, he saw it was only 57!

With a health value below 60, this is definitely not as simple as hiccups!

"Besides hiccups, are there any other discomforts?" Wang Xueyang asked immediately, "For example, headache, dizziness, bad habits, vomiting, difficulty breathing, coughing, chest pain, or palpitations?"

The old man thought for a moment, then shook his head, "No, it's just hiccups."

As soon as he finished speaking, there was another "uh" sound.

The middle-aged man sighed, "Hiccups are not a disease, but they are really fatal when they occur! My dad has been hiccups for the past four days, and he basically can't sleep much at night. The symptoms of hiccups got worse tonight, and they last for four to five seconds. just one time."

Wang Xueyang frowned: "Uncle, did you have any other illnesses before?"

The middle-aged man on the side replied: "Well, my dad used to have three high blood pressure, diabetes, and hyperlipidemia."

"Other than that? For example, have you ever hiccupped like this before?" Wang Xueyang asked.

The middle-aged man turned to look at the uncle.

The uncle shook his head, and then said "uh" again.

"We searched a lot of methods on the Internet, such as holding your breath, drinking water, and diverting your attention. We tried all the traditional methods, but nothing worked." The middle-aged man shook his head slightly.

This is a bit tricky.

Wang Xueyang didn't think of any good solution for a while.

Lu Chen also frowned. This old man must not be as simple as hiccups, otherwise his health would not be so low.

The technical term for hiccups is hiccups.

This is due to paroxysmal spasms of the diaphragm, accompanied by sudden closing of the glottis during inhalation, resulting in a short, loud and special sound.

Hiccup is a reflex activity, and its afferent branches are composed of the vagus nerve, phrenic nerve, and thoracic sympathetic trunk. The hiccup center is located at C3~C5, connecting the central nervous system, respiratory center, phrenic nucleus, medulla oblongata reticular formation and hypothalamus.

The efferent branches (vagus nerve, phrenic nerve) have connections with the glottis and accessory respiratory muscles, intercostal muscles, and anterior scalene muscles.

Irritation anywhere along the afferent branch of the reflex arc can cause hiccups.

In other words, almost any chest lesion can stimulate the thoracic branch of the vagus nerve and cause hiccups.

"Doctor, the doctor at the clinic near our community said that the hiccups are benign and do not require special attention. They will get better gradually. But we are not all well now. Please think of a solution for my dad quickly." The young man said.

Wang Xueyang explained patiently: "In fact, if hiccups generally last for a few seconds or minutes and disappear slowly, it can be considered benign."

“However, once the hiccups are repeated and worsened frequently for several days or months, leading to insomnia, weight loss, and fatigue, it may be caused by certain underlying diseases, such as central nervous system disease, lung disease, gastrointestinal disease, Metabolic abnormalities."

"Why are there so many details?" The middle-aged man asked doubtfully, "But my dad didn't have these diseases before. He can't suddenly get such a disease, right?"

Wang Xueyang paused and said to the uncle: "Let me check you first."

Asking the middle-aged man to help the uncle to the physical examination table, Wang Xueyang began to examine the patient.

A long while.

Wang Xueyang ended the physical examination with a puzzled look, but still found nothing unusual.

Auscultation of the heart and lungs were also normal.

"Let's get a plain X-ray of the chest and abdomen first." Wang Xueyang said.

"Ah? You still need to take a film for hiccups?" the middle-aged man asked doubtfully.

"I just told you that any chest disease may cause hiccups. The main purpose of taking this film is to rule out a disease called hiatal hernia." Wang Xueyang said.

"Oh." The middle-aged man seemed to understand.

Lu Chen immediately gave the patient a check list.

Afterwards, the middle-aged man took the uncle for a check-up.

Regarding this hiccupping old man, Lu Chen didn't have any clue as there was currently no examination.

However, the red 57 on the uncle's head is particularly dazzling.

Lu Chen didn't dare to take it lightly.

…

The X-ray examination is very fast, and the imaging department will issue the results as soon as it is completed.

About ten minutes later, Lu Chen and Wang Xueyang visited three more ordinary emergency patients.

The middle-aged man came back with his uncle.

"There is nothing wrong with the chest and abdominal plain films." Wang Xueyang could not judge the patient's condition for a while.

"Doctor, please give me some medicine first to stop my dad's hiccups." The middle-aged man was a little anxious. "As for the cause of the hiccups, we will investigate later."

Wang Xueyang said in a deep voice: "Okay, let's take him to the emergency observation room first, take some medicine, and observe him overnight."

"Okay." The middle-aged man agreed.

He took the uncle to the emergency observation room on the second floor.

Lu Chen watched the old man leave staring at the red health points, feeling a little uneasy.

Although the uncle went to the emergency observation room, there were many patients in the emergency observation room at night.

Lu Chen was worried that the doctor on duty might not notice the changes in his uncle's condition in time.

If the uncle really has a dangerous disease and needs to be rescued again, it will be too late!

Lu Chen thought for a while and sent a WeChat message to Cheng Peng, asking him to pay attention to the man in the observation room on the second floor.

…

Second floor, emergency observation room.

Cheng Peng received Lu Chen's WeChat message.

"Hey, I'm really worried this night. If I meet Lu Chen next time, I'll have to change classes!" Cheng Peng thought to himself.

With this thought flashing through his mind, the uncle Lu Chen was talking about came to the emergency observation room.

"Let me pay attention to this uncle and make more ward rounds..." Cheng Peng took a closer look at the hiccup uncle. "Is there something special about this uncle? Isn't he a patient with hiccups?"

At this time, Wang Xiaodong quickly treated the old man for emergency treatment.

Hiccups may seem like a simple problem, but actually curing them is not that simple.

Subsequently, Wang Xiaodong gave the patient two conventional medicines for treating hiccups.

"Administer 2 mg of lorazepam and 50 mg of chlorpromazine intramuscularly."

Lorazepam and chlorpromazine are both psychotropic drugs that can treat hiccups caused by psychological factors.

After using the medicine.

Cheng Peng observed for five minutes, and the uncle's hiccups subsided!

"I should have used this medicine a long time ago!" After the uncle calmed down, a relieved smile finally appeared on his face.

In the past four days, hiccups had tortured him terribly.

Cheng Peng immediately sent a WeChat message to Lu Chen and told him about the uncle's situation.

"Is it really just a hiccup caused by mental factors?" Lu Chen frowned, "Do mental factors make the health value so low? It shouldn't be!"

…

However, just two minutes later, the uncle's hiccups started again.

And compared with before, the symptoms of hiccups have not been relieved at all.

"What's going on?" Cheng Peng was quite surprised.

Chlorpromazine and lorazepam can only provide temporary relief but cannot fundamentally solve the problem.

It is also impossible for patients to use both drugs all the time.

Wang Xiaodong also looked puzzled. It was also the first time for him to encounter a patient with such stubborn hiccups.

At this moment, Cheng Peng received another WeChat message from Lu Chen.

"Fat man, did the patient undergo any examination on your second floor?"

"There is no need for a blood test for patients with hiccups like this." Cheng Peng said doubtfully, "Just do an electrocardiogram as a routine."

An electrocardiogram on admission is required for all patients.

"Where are the electrocardiogram results?" Lu Chen asked.

"I took a look and the electrocardiogram should be normal. Senior Brother Wang also took a look and didn't see any problems," Cheng Peng replied.

"Normal?" Lu Chen paused, "Send me the electrocardiogram for review."

Cheng Peng sent the electrocardiogram to Lu Chen without thinking too much.

Lu Chen's ability to read pictures was much better than him, and he even entered the national finals of the electrocardiogram competition.

He didn't feel that Lu Chen was looking down on his ability to read pictures, because there was a huge difference in their ability to read pictures. Cheng Peng had no such idea at all.

…

First floor, emergency medicine clinic.

As soon as Lu Chen saw a patient with fever, he received an electrocardiogram from Cheng Peng.

Currently, the patient has not undergone any examination, only this electrocardiogram.

Click on the original image to enlarge it.

At first glance, Lu Chen did not find any problems.

Hiccups generally have nothing to do with the heart.

Lu Chen thought for a while and was about to turn off the picture.

He suddenly looked at the inferior leads of the electrocardiogram, which seemed a little strange.

The inferior leads are leads II, III, and AVF.

At this time, in Lu Chen's eyes, the ST-T segment of the inferior leads seemed to be elevated a little.

However, when I came back to my senses and took a closer look, it seemed that it was not elevated!

this……

Lu Chen hesitated.

Clinically, ECGs are not black and white.

Most people will definitely think this electrocardiogram is normal when they see it.

Lu Chen even felt that it was normal in his heart, but there was something a little bit strange about it.

However, I thought of the red health value 57 on the uncle's head.

Lu Chen felt that he couldn't just let go of the possibility of "abnormal electrocardiogram"!

He quickly sent a WeChat message to Cheng Peng.

"Fat man, do another electrocardiogram for the patient. If the family agrees, it would be best to check his cardiac enzymes."

Cheng Peng, who was in the emergency observation room, was stunned.

"Recheck the electrocardiogram and check myocardial enzymes? Lu Chen, do you suspect that I have angina pectoris or myocardial infarction?"

"Yes." Lu Chen simply replied.

Cheng Peng frowned and looked at the uncle's electrocardiogram carefully again.

He still didn't see anything unusual.

If you suspect myocardial infarction, you have to provide evidence!

This patient does not have any symptoms of myocardial infarction...

No chest pain, no abdominal pain, and no toothache!

Although Cheng Peng admired Lu Chen very much, at this time he always felt that Lu Chen was limited by his own profession and had misdiagnosed patients.

Clinically, many doctors have narrow-minded thinking due to their professional limitations.

For example, doctors in the cardiology department think of coronary heart disease when they have chest pain, but do not consider gastric ulcers, hiatal hernias, etc.

However, Cheng Peng did not make his own decision, but told Wang Xiaodong Lu Chen's opinions.

"Do you think the hiccups are caused by a heart disease?" Wang Xiaodong was slightly startled, "This... I've never seen it before."

Wang Xiaodong also read the uncle's electrocardiogram several times and found no abnormalities.

He had the same idea as Cheng Peng. The patient did not have any symptoms of myocardial infarction!

"Let me talk to the patient and we can check the ECG again." Wang Xiaodong paused, "As for myocardial enzymes, we can't do it for the time being, and we can't explain it to the patient and his family."

If it were any other graduate student, Wang Xiaodong would probably not accept this possibility.

But Lu Chen is different. Wang Xiaodong knows Lu Chen's ability very well, and he will never do it without a purpose.

In addition, he also knows that Lu Chen entered the finals of the ECG competition.

What if there is something they didn't see in this ECG?

...

Wang Xiaodong communicated with the patient and his family for most of the day.

Finally, the patient and his family agreed to check the ECG again.

After all, no one would consider that hiccups and heart disease are related!

"Zizizizi..."

Cheng Peng pushed the ECG machine to check an ECG for the old man.

Wang Xiaodong stared at the side.

After the ECG was done, he immediately picked up the drawing.

"It seems that there is still no problem!" Wang Xiaodong frowned.

A normal-looking ECG, no abnormalities were found in the speed or rhythm of the ECG!

"Junior brother, compare the previous ECG for me." Wang Xiaodong said to Cheng Peng.

"Okay." Cheng Peng quickly took out the first ECG from the office.

Whether it is angina pectoris or myocardial infarction, there is an important feature, that is, the ECG must change!

This is why Lu Chen asked Cheng Peng to check the ECG for the old man.

Wang Xiaodong took the two ECGs and compared them carefully.

From P wave, QRS wave, T wave...

Wang Xiaodong carefully compared each segment.

"Hey, junior brother, look at the ST segment of this inferior wall lead, isn't it a little different!"

Wang Xiaodong suddenly found a change in the ECG.

In the second ECG, the ST segment of the inferior wall lead is slightly higher than the first ECG.

After the comparison, Wang Xiaodong looked back at the first ECG. He felt that the ST segment of the inferior wall lead seemed to have been elevated!

Wang Xiaodong was not happy at all when he found this. Instead, he broke out in a cold sweat.

Fortunately, it was discovered. If it had not been discovered, the patient had a myocardial infarction, which was really unimaginable...

Cheng Peng also compared the ECG again. After Wang Xiaodong's reminder, he also noticed it.

In fact, the ECG is like this.

There are many details that you can't see at all if you don't remind them.

Once someone points it out, you can immediately notice the abnormalities.

"Brother, it seems to be a little elevated."

At this time, Wang Xiaodong and Cheng Peng all had a feeling of admiration for Lu Chen.

From the first ECG, you can unravel the abnormalities.

Lu Chen is too amazing!

...

However, now is not the time to sigh.

Wang Xiaodong immediately took the ECG to communicate with the patient's family, and also asked for an emergency consultation from the cardiology department.

The patient and his family were informed of the whole story, and the family agreed to check the myocardial enzyme spectrum.

At this time, Li Qinghua, the chief resident of the Department of Cardiology, also came.

After checking the two electrocardiograms, he said in a deep voice: "It is indeed lifted. The second electrocardiogram is more obvious, and the first electrocardiogram is not so obvious. It is not easy for your emergency department to see this clue and recheck the patient's electrocardiogram!"

Wang Xiaodong scratched his head, "It's not me who saw it, but a graduate student in your cardiology department."

Li Qinghua looked at Cheng Peng on the side, his face was quite surprised: "It's you? I remember you are a graduate student in the eighth area of ​​​​cardiology."

Cheng Peng hurriedly shook his head: "Teacher, it's not me, it's Lu Chen. He is working in the emergency clinic on the first floor today."

Li Qinghua was stunned, and then smiled, "It's Lu Chen!"

That's understandable.

This kid's ability to read pictures has been proven by the electrocardiogram competition.

It's not worse than those of them in the old days!

Li Qinghua smiled and said, "It's rare that I didn't meet him during an emergency consultation, but it's still related to him!"

"What do those words say? If a person is not in the world, there will be legends about him everywhere in the world!"

"Xiaodong, just check the myocardial enzyme. If it is really a myocardial infarction, then send him to the CCU."

"Okay, Teacher Li." Wang Xiaodong nodded.

Then, Li Qinghua left.

After Wang Xiaodong gave the doctor's advice, the nurse on duty checked the rapid myocardial enzyme of the emergency department for the old man.

Two minutes later, the myocardial enzyme results came out.

The old man's troponin exceeded 20 times the normal value!

"Oh my god, it's really a myocardial infarction!"

Wang Xiaodong and Cheng Peng looked at each other.

Although they were mentally prepared, they were still shocked for a few seconds.

Myocardial infarction was confirmed!

...

First floor, emergency clinic.

Wang Xueyang looked at the chat records in the emergency WeChat group in surprise.

The patient who hiccuped just now turned out to be an acute inferior myocardial infarction!

She quickly looked at Lu Chen beside her.

"Lu Chen, do you know what the hiccup patient was diagnosed with?"

Lu Chen replied calmly: "Myocardial infarction?"

As soon as he finished speaking, Wang Xueyang's face became even more shocked.

This WeChat group is the WeChat group of doctors in their department, but no students have joined!

Lu Chen, how did he know this diagnosis?

"Yes... your classmate on the second floor told you." Wang Xueyang suddenly thought of this.

Lu Chen smiled, neither denying nor admitting.

Just now, he received a notification tone from the system.

"Congratulations, I received Cheng Peng's gratitude value +1!"

"Congratulations, I received Wang Xiaodong's gratitude value +1!"

"Congratulations, the system upgrade completion rate has increased by 1%!"

After seeing these reminders, UU Kanshu www.uukanｗｈhu.net he knew that his guess was correct!

But when Wang Xueyang saw Lu Chen's smile, he thought he only knew it after hearing what Cheng Peng said.

Wang Xueyang said slowly: "This is the first time I have seen stubborn hiccups caused by myocardial infarction!"

"Me too," Lu Chen said, "But the patient has a history of three high blood pressures, which is indeed a risk factor for myocardial infarction."

"But no one would think about that!" Wang Xueyang sighed, "The doctor on duty upstairs tonight is good, and he can actually consider the disease of acute myocardial infarction..."

…

Let’s talk about this stubborn hiccup.

After being diagnosed with myocardial infarction, Wang Xiaodong immediately transferred him to the intracardiac CCU.

After emergency coronary intervention and opening up the heart vessels, the patient's hiccups disappeared...