I Can See Health

   Chapter 564 High-quality critically ill patients! (The leader of Xuantengluo plus 5)

   came to the bedside of the patient in bed 12.

  Xiao Shikang whispered to Lu Chen: "The purpose of our consultation is to roughly judge the patient's condition. If it is our department's disease, it can be admitted to the hospital."

   "Okay, Teacher Xiao, I see." Lu Chen nodded slightly.

   He holds the medical records of the 12-bed patient in his hand.

   This is an old man in his sixties.

  Three years ago, because of a stroke, a large area of ​​​​cerebral infarction.

   After two months of treatment, his life was saved, but he was left with left limb paralysis and aphasia.

  Because I can't speak, the quality of life is not as good as before.

The patient's family is his wife, and explained on the side: "The doctor also said back then that it was very difficult for him to survive such a large-scale cerebral infarction. The only way is to recover slowly.”

  Three years ago, the patient underwent rehabilitation exercises in many large hospitals. His physical activity seemed to be slightly better, but he still could not speak.

"Oh, the old man asked for it all by himself!" The patient's wife sighed, "He was stubborn when he was given antihypertensive medicine before! He has been refusing to take the medicine, and he didn't bother me in the end. No need to do it."

   "But then again, I was able to survive three years ago, thank God, thanks to your hospital."

   "Doctor, you rescued him three years ago, but you can't leave him behind this time!" The patient's wife pulled Lu Chen's cuff, and tears almost fell.

  This time, the old man was hospitalized again.

   Mainly fever, but also cough and expectoration.

   His own ability to expectorate is not bad, he can cough up to his mouth, and his wife is wiping it off with a tissue.

  Lu Chen looked over his head, his health was 65(-).

   Lu Chen is a little strange, this disease has nothing to do with their cardiology department, right?

   Patients with sequelae of cerebral infarction may have swallowing and coughing dysfunctions, which are very easy to cause pneumonia due to aspiration. This is the case with the old man.

  In the past three years, pneumonia has recurred repeatedly, and even doctors are not surprised.

   "Fan Jian, why do you ask us to consult a patient with this kind of cerebral infarction?" Xiao Shikang was also surprised, and quickly called Fan Jian over.

Fan Jian stepped forward, picked up the patient's medical record, and shook his head slightly: "If the patient only has pneumonia, we will send him to the respiratory department of the hospital below. We have given the patient antibiotics in the emergency department for the past two days, and the effect is good. The cough and phlegm are also less. But last night, an accident happened..."

  Last night, after the patient's family fed the old man a little fruit, he lay down and rested.

   Not long after, the old man suddenly became short of breath.

   The patient's wife added: "I was very nervous last night. After all, he has been in the hospital for so long, and he has never breathed like this. I think it may be that his condition is getting worse!"

  Xiao Shikang frowned and said, "Did he **** it up? He doesn't have a good swallowing function. If you feed him like this, if you **** it up, it will easily cause wheezing."

   "No, it went well when eating." The patient's wife recalled, "I used to feed like this before, and it was fine."

At this time, Fan Jian said: "The patient had no obvious cough last night, and aspiration was ruled out. Later, our nurses measured the blood pressure and found that the blood pressure was very high at 200/120mmHg. If it wasn't for aspiration, I thought it might be Acute heart failure due to hypertension."

  The pressure in the peripheral blood vessels is high, the more work the heart needs to do to pump blood, and it is even difficult to pump the blood out!

   At this time, the heart will become weaker and weaker, and it is easy to induce acute heart failure, resulting in dyspnea and shortness of breath.

   "Has the patient's heart ultrasound been done?" Xiao Shikang asked.

"Done." Fan Jian nodded, "It was because the echocardiography showed that the cardiac function was low, so I considered sudden heart failure, and I listened to the patient's lungs last night, and I could hear a small amount of wet rales. It's worse than before."

   "What about the amount of in and out these two days?" Xiao Shikang asked.

   "It was okay a few days ago, about 2,000ml, but today it's very little, only 300ml of urine."

  Xiao Shikang nodded slightly, "Looking at the patient's condition now, he has no obvious difficulty breathing."

   "Well, but from last night to now, the patient still has intermittent symptoms of wheezing and shortness of breath, and the heart failure may not be well controlled, so I will ask you to consult with your heart."

  Xiao Shikang looked back at Lu Chen after listening to Fan Jian's words, "How, do you think this patient should be admitted?"

Lu Chen nodded slightly: "Hypertension is high all the year round, and echocardiography shows damage to cardiac function. At present, the possibility of acute heart failure cannot be ruled out. In addition, he only had 300ml of urine during the day, and his kidneys may be damaged. I think it can be accepted. to our cardiologist."

   Hearing Lu Chen's words, the patient's wife was stunned.

  The old man has had a stroke and was paralyzed on the bed. This time he said that he has heart failure, kidney failure, etc., can he still survive?

   But after hearing what Lu Chen said later, "In the ward", my wife was a little excited. If she could live in, it means that there is still salvation!

"Well, the analysis is good." Xiao Shikang nodded and turned to Fan Jian and said, "Lao Fan, you should use some diuretics first to lower the blood pressure. After I read the other patients, I will write the consultation form together, and then take this patient. Go to Cardiology."

   "Okay, thank you." Fan Jian breathed a sigh of relief, patted Xiao Shikang on the shoulder lightly, and then smiled at Lu Chen.

   Can transfer a critically ill patient, and his emergency department ward can be safer.

  …

   "Let's go and see the 22 beds."

  The time was limited, Xiao Shikang immediately took Lu Chen to see the 22-bed patient.

  Bed 22 is a 35-year-old male patient who was admitted to the hospital mainly because of "chest tightness and dyspnea for more than 3 months".

   His health is 56 (--).

   The patient has no history of any special disease.

  I checked in a lower-level hospital for a month or two, and did a lot of examinations, but no cause was found.

   And the symptoms got worse and worse, and finally I had no choice, so I came to the Cardiology Department of the First Affiliated Hospital of Kyoto University.

  Lu Chen came to the bed, and after a brief consultation, he began to examine the patient.

   "A grade 2/6 systolic murmur could be heard in the apex of the heart, wet rales could be heard in both lower lungs, and edema of both lower extremities."

After the physical examination was over, Lu Chen opened the patient's medical record.

   Laboratory examination: BNP2312ng/L, echocardiography: LVEF30%, left ventricular end-diastolic diameter 70mm, ECG report: complete left bundle branch block.

   Lu Chen's mind quickly flashed a piece of information, thirty-five years old, cardiac insufficiency, left ventricular dilatation.

   The cause of this patient is not yet clear, but it is obvious that it is indeed a disease of the Department of Cardiology.

   "Do you think this patient should be admitted to hospital?" Xiao Shikang asked.

  Lu Chen nodded without hesitation: "The patient should have heart failure, but I don't know the cause of heart failure for the time being. Further examination is needed to clarify the cause. The patient is so young, if the root cause can be found, it is the best!"

   "Okay." Xiao Shikang smiled, "The judgment is very accurate!"

   At this time, Lu Chen couldn't help but sigh, the quality of the patients in this emergency department is not very high!

   If it was in the Jinghua Second Hospital, this kind of patient might have been pushed to the inpatient ward long ago.

   But at this moment, there was a sudden noise from the ward not far away, and the doctors and nurses in the emergency department all ran in one direction.

  Lu Chen frowned, put down the medical record folder in his hand, and took a closer look.

   He was startled, this seems to be the direction of the 12-bed patient? !

   (end of this chapter)