I Can See Health

   Chapter 706 S1Q3T3

   When others hear such a description of the patients, at most they will feel that they are pitiful, and so many people have died.

   But that's not what a clinician thinks when he hears this.

   It happened that Wu Si also came out and heard the description of his family.

  Lu Chen turned his head and asked Wu Si, "Have you done a chest CT?"

   Of course Wu Si knew what Lu Chen meant. Lu Chen suspected that the patient might have lung cancer.

  The patient's brother has cancer, which is a very prominent family history. The normal doctor's thinking should consider whether the patient may have lung cancer.

   If the lung cancer is severe, blocking the bronchial tubes, or severely affecting the lung tissue, it may lead to hypoxia.

   "I asked the patient's family just now. The patient had a physical examination half a month ago, and there was a CT scan." Wu Sidao, "I didn't see the scan, but there was only one report. The report didn't say that there was any lung cancer."

   Wu Si's meaning is obvious, the patient is not lung cancer.

   I didn’t see lung cancer half a month ago, so it can’t be lung cancer now.

   Lung cancer does not grow in ten days or half a month, and it has such a big impact.

   "Most of them are probably pneumonia. Only pneumonia can develop so fast." Wu Si said solemnly.

  Lu Chen nodded slightly, temporarily agreeing with the old horse's judgment.

  The patient's HP is 48(——).

   There is no special case at present.

   "Enter the ICU first." The ICU doctor said, "I'll go back and prepare first."

   "Okay." Wu Si nodded.

  …

   However, just when the patient was about to be transferred to the ICU, his condition suddenly changed.

   This is beyond everyone's expectations!

   The patient was just pushed out of the emergency department gate, and the symptoms of chest tightness got worse!

   The nurse rushed out and said, "The patient's heart rate is very fast, 130 beats per minute, and the breathing is even more rapid."

   Wu Si immediately said loudly: "Push back to the emergency room first!"

   At this time, the patient was sweating profusely and panting, and his panic could be seen in his eyes.

   He said intermittently to the nurse next to him, "Hurry up, turn up the oxygen for me, it's uncomfortable."

   Blood oxygen saturation dropped to 88%.

   "Okay, don't talk too much, just have a good rest!" the nurse said quickly.

   aside, Lu Chen didn't have time to leave.

   "This is not a good thing." Lu Chen frowned, "The patient can't wait to go to the ICU. If he wants to be here, he will be intubated and put on a ventilator."

  Lu Chen immediately listened to the patient's lungs with a stethoscope,

   Breath sounds in both lungs, symmetrical, not pneumothorax!

   The patient's hypoxia suddenly worsens, and we must be alert to the possibility of spontaneous pneumothorax. If one side of the pneumothorax, that is, the lung ruptures, the breath sounds on this side of the chest cavity will be very low, very low, or even inaudible.

   If you hear symmetrical breath sounds on both sides, it is basically not a pneumothorax. This auscultation is very important.

   At this time, Wu Si also had a heart and asked Lu Chen, "Mr. Lu, there shouldn't be a heart problem. The patient's severe hypoxia may induce myocardial infarction. If it is a myocardial infarction"

  Lu Chen frowned deeply.

   He didn't deny Wu Si's idea, "Then review an EKG."

   Wu Si heard the words, and immediately asked the next doctor to help the patient to take an electrocardiogram. At the same time, he increased the oxygen inhalation concentration, and asked the nurse to prepare for endotracheal intubation.

   Another nurse pushed the ventilator too.

  …

   When the patient came to the emergency department, an electrocardiogram had been done, and no obvious abnormality was seen.

  I have also checked troponin, cardiac enzymes, etc., and they are all normal.

   The previous evidence does not support acute myocardial infarction.

   But it’s hard to say whether there will be a sudden heart attack now.

   ECG results came out soon.

  Lu Chen immediately took the electrocardiogram and saw no obvious signs of myocardial infarction.

   No lead elevation or depression was seen.

   Wu Si also put his head close, "It seems that the patient is not a myocardial infarction..."

   "Could it be that his condition suddenly deteriorated?" Lu Chen murmured.

   Just now, the patient's HP dropped at a faster rate!

   A patient with severe pneumonia suddenly has severe shortness of breath, and common diseases such as myocardial infarction and pneumothorax have been excluded, so it can only be explained by the deterioration of the condition.

   For example, the patient may turn over or have arrhythmia, which will cause the heart rate to be so fast and the hypoxia to be more serious.

   "Then let's intubate. I'll talk to my family. I'll intubate here first, and then go to the ICU for insurance." Wu Si looked at Lu Chen, who was beside him, and wanted to ask his opinion.

   "Wait!" Lu Chen waved and stopped Wu Si.

   He frowned slightly, and took the electrocardiogram back to look at it again.

   He always felt something was wrong, a patient with sudden breathing difficulties.

   Have you overlooked something?

   Until Lu Chen looked at the electrocardiogram he had just done, he suddenly stopped!

"what's the situation?"

   Wu Si saw that Lu Chen's expression had changed, and it was estimated that he had something new.

   When Lu Chen heard the words, he immediately handed the electrocardiogram to Wu Si.

   "Look at the S wave in lead I, as well as the Q wave and T wave in lead III. The electrical axis is deviated to the right. Does it look familiar?"

   Wu Si was dumbfounded, and just stared at the myocardial infarction information on the patient's electrocardiogram.

   He was relieved that he didn't see the heart infarction figure anyway.

   But now Lu Chen obviously has something else to discover, that's why he sees it so carefully.

  …

   Wu Si took the electrocardiogram, followed Lu Chen's prompt, and carefully identified the electrocardiogram again.

   "Ah, S1Q3T3? Could the patient have a pulmonary embolism?!"

  S1Q3T3, as well as right axis deviation, the most typical ECG pattern in patients with pulmonary embolism!

   The thought of pulmonary embolism made Wu Si tremble.

   Six months ago, a pulmonary embolism patient died right under his nose.

   "Yes, this is pulmonary embolism!" Lu Chen said solemnly.

   Actually, pulmonary embolism is well understood.

  If there is a thrombosis in the human venous system, and the thrombus falls off, it will enter the pulmonary artery with the venous blood flow.

  If the thrombus gets stuck in the pulmonary artery, the blood cannot pass through, the blood cannot reach the lungs, and there is no way to obtain oxygen.

  If there is no oxygen supply, people are likely to be suffocated to death!

  Severe pulmonary embolism will kill you instantly!

   "I'm going, then this moment can't be delayed!"

   Wu Si was taken aback.

  Although pulmonary embolism is highly suspected at present, ECG diagnosis of pulmonary embolism is still reluctant, and ECG can only provide a general idea.

   To really diagnose pulmonary embolism, we still have to perfect CT pulmonary angiography.

   Therefore, Wu Si has already rushed out to find the family members to sign, and suggested that the family members agree to do CT pulmonary angiography.

  …

   Outside the emergency room.

   Wu Si stared closely at the patient's eldest daughter, "The patient is now in a more serious condition, and it is suspected that there may be a sudden pulmonary embolism. This examination must be done."

   "Do you want to do it now?" The eldest daughter was stunned.

   "Yes! If you don't do it, you will die. If you do it, you may not be able to save it, but at least there is a direction for treatment, and if the rescue is timely, there is still a chance."

   At the critical moment, Wu Si's words were understood.

   The patient's daughter was terrified. They had just glanced at the patient's condition outside and had a general idea of ​​what was going on.

   "Do, do whatever helps!"

   Start work tomorrow, night shift tomorrow.

   (end of this chapter)