This Doctor is Great

the next day,

Morning.

Zhou Mo's two hospital beds were empty and there was no need for ward rounds, so he came to the department with the bell ringing at 8:00.

Senior Brother Chen Bing saw Zhou and waved: "Today I am on duty for consultation, and I may go to the emergency department or other departments for consultation... Zhou Mo, you should be free today, are you interested in going with me?"

When Zhou Mo heard this, he was naturally overjoyed.

Being able to experience more patients is very helpful to Zhou Mo's increase in clinical experience.

This is definitely Brother Chen's cultivation!

Zhou Mo quickly thanked: "Thank you, brother! I'm on call!"

Senior Brother Chen Bing nodded: "Okay, if there is, I will call you."

At this time, Director Niu came.

Start the ward rounds in the group, and use PPT to go through the critical and difficult diseases.

At 9:00, the house inspection was successfully completed.

Just as the room check was over, the phone at the nurse's station rang. Not long after the nurse answered the phone, she shouted at Senior Brother Chen Bing:

"Dr. Chen, the Department of Respiratory Medicine is calling. There is a consultation. The director asked you to go..."

"Consultation? Good!"

Zhou Mo was surprised.

"Zhou Mo, let's go!"

Chen Bing greeted Zhou Mo, and the two left the cardiology department and went to the respiratory department.

...

...

respiratory department.

"Hey, Chen Bing, why are you here..."

"The director arranged for me to come..."

"Zhou Mo, this is my classmate, just call him Senior Brother Zhang Yang... Zhang Yang, this is Zhou Mo, a medical student who has been training hard, I will take him now..."

"Hello Senior Brother Zhang!"

To briefly introduce, Zhang Yang brought Chen Bing and Zhou Mo to one of the wards.

43 beds.

Zhou Mo saw an old man in his fifties or sixties lying on the bed.

And beside the bed, is the accompanying wife.

Zhang Yang began to introduce the patient's condition to Chen Bing and Zhou Mo.

English is used.

Sometimes the doctor is in front of the patient, in order not to give the patient too much psychological burden.

"This patient had a stroke three years ago."

Stroke, that is, stroke (pronounced cu), usually at the entrance of the hospital, there will be a sign with words such as "Stroke Center".

It shows that this disease is more common, more urgent and serious.

Stroke includes ischemic stroke (cerebral infarction) and hemorrhagic stroke (parenchymal hemorrhage, ventricular hemorrhage, subarachnoid hemorrhage).

"After the patient had a stroke three years ago, he suffered from a large area of ​​cerebral infarction. Although he was rescued, it also caused paralysis of the left side of the body, loss of language function, and other minor motor nerve problems."

"This time, he mainly had fever, cough, and sputum, and then he was admitted to our respiratory department... After our diagnosis, it was pneumonia!"

Zhou Mo sorted out while listening.

Why do you get pneumonia?

It's easy!

Because patients with sequelae of cerebral infarction will have some neurological problems, they may have swallowing and coughing dysfunction, and they are very prone to aspiration.

After aspiration, food and foreign objects enter the airway, all the way to the lungs, and then cause pneumonia.

Pneumonia is a common disease in stroke patients.

Brother Zhang Yang continued to talk about his condition: "After using the antibiotics, the effect is good. The patient coughed less and did not have a fever..."

This shows that antibiotics have played a role in pneumonia.

"but!!"

"At 5 o'clock this morning, an accident happened!"

Zhang Yang said,

"The patient suddenly didn't know why, and began to breathe rapidly, and then called the doctor and nurse on duty to come over."

"I asked about it. I was sleeping well, but suddenly I became short of breath. There is no special reason... But the nurse measured the blood pressure and found that it was as high as 190/120mmhg!"

190,

This blood pressure is already super high!

Such high blood pressure!

Zhou Mo couldn't help raising his eyebrows.

Zhang Yang continued: "The patient has a history of high blood pressure. It has been seven or eight years. He is an old patient. His stroke back then was also caused by high blood pressure. He didn't take medicine on time...but he never reached such a high level."

"The doctor on duty at that time listened to the patient's heart and lungs with a stethoscope, and found that there were a few moist rales in both lungs."

Wet rale is the sound of foaming and bursting when the gas rushes through the liquid.

Moist rales usually mean pneumonia or pulmonary edema.

"By the way, there is another point. When he was admitted to the hospital, we had an echocardiogram, and his heart function was damaged, so we guessed that it might be a sudden heart failure..."

Zhou Mo nodded.

He can understand Brother Zhang Yang's words, which roughly means: the patient's heart function is poor, and the blood pressure is so high now, it is difficult for the heart (left ventricle) to pump blood out, so the heart will increase the power. It will be exhausted, gradually exhausted, leading to heart failure.

And the performance of this process is: shortness of breath and rapid heart rate, just like the performance of the patient.

In addition, heart failure will cause blood to stagnate in the heart, and pulmonary venous blood cannot enter the heart, and moist rales are prone to occur.

However, since Dr. Zhang Yang has this inference, but now he invites the cardiology department for consultation, it is obvious that the patient's condition is not so simple.

Chen Bing and Zhou Mo didn't speak.

keep listening.

really,

Dr. Zhang Yang continued: "Then, we checked the patient's urine output and found that the difference in the amount of urine in and out is relatively large... The amount of urine in 12 hours is 1000ml, and the amount of urine is only 300ml, with a gap of 700ml..."

Those who are hospitalized know that there will be a form given to the family members. As long as the patient drinks fluids and urinates, they must be recorded, and the nurse will make relevant statistics. This is the fluid intake and output of the patient.

And the patient takes 1000ml in and 300ml out, which means that there is an 'excess' 700ml of fluid in the patient's body.

The more fluid in the body, the greater the heart load will naturally be!

Then according to the above inference, the next step is to infer: there is a problem with the kidney function.

Resulting in decreased urine excretion.

Among the complications of high blood pressure, there is one called hypertensive nephropathy, which is damage to the structure and function of the kidneys caused by high blood pressure.

Everything seems to make sense!

So far, evidence-based medicine seems to be perfect.

And consistent with monism.

However, the condition is not so simple.

Zhang Yang said: "Based on the inference above, consider high blood pressure + heart failure + kidney disease..."

"Then, the doctor on duty contacted me, discussed it, and adopted the plan: diuresis + lowering blood pressure..."

Diuretic: Quickly analyze the water in the body and drain it through urine. With less water, the load on the heart will be reduced, and heart failure will also be relieved.

Antihypertensive: Use nitroglycerin, which can not only lower blood pressure, but also increase coronary blood flow, killing two birds with one stone.

"but!"

"After we gave the patient diuretic and nitroglycerin, the patient did not get better!!"

"The patient's urine did not come out!"

This is why Zhang Yang asked the cardiology department for consultation.

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ps: Monthly ticket, recommendation ticket feeding port...

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