This Doctor is Great

"What's going on today? Why are there consultations one after another?"

On the way to the emergency room, Brother Chen Bing couldn't help complaining.

Zhou Mo was happy because he could learn more cases. Those who can use consultation may be all kinds of weird diseases that the emergency department can't handle, but it is much faster than Zhou Mo's own books.

Usually, he is an attending physician, but it is rare for senior brother Chen Bing to make visits now.

Don't miss this opportunity.

soon,

Came to the emergency department.

As soon as you enter the door, you can feel a 'heat wave' coming over your face.

Noisy voices, all kinds of strange patients gather here, and you can also hear the cries of children, and the pleadings of the patients' families to the doctor.

The two walked quickly to the nurse's station.

"I'm Chen Bing from the Department of Cardiology, here for consultation..."

The nurse looked up, and the handsome and handsome Zhou Mo immediately attracted her attention.

"Hey, Doctor Zhou Mo!"

This nurse is obviously the dimple nurse Chen Min who exchanged WeChat with Zhou Mo last time.

Zhou Mo: "Hello..."

Chen Bing: "........."

How can I be ignored like this?

chi chi~~~~

Three stabs in the heart.

Nurse Chen Min smiled at Zhou Mo showing two dimples: "Consultation, right? In the emergency room, an old man kowtowed and fell into a coma..."

"Thanks!"

Chen Bing and Zhou Mo hurried to the emergency room.

"Chen Bing, it's you, hurry up, here's a patient..." Cao Yun, a young doctor in the emergency room, quickly greeted Chen Bing after seeing him.

In addition to this young doctor, there are two middle-aged emergency doctors.

At this moment,

The door of the emergency room opened, and Zhang Yang from the respiratory department also came.

"Hey, Chen Bing, Zhou Mo, you are also here..."

"You're here too?"

Now, the Department of Cardiology and Respiratory Medicine are here.

Brother Chen Bing said to Cao Yun, the emergency doctor, "Tell me what's going on?"

Cao Yundao, an emergency doctor: "This patient, 73 years old, with a history of hypertension, fell once at 16:00 yesterday afternoon and suffered a real bone contusion. He came to our emergency department for examination and had a CT scan. No trace of cerebral hemorrhage was found, and he was hospitalized in the emergency department. After observing for one night, there was no problem, and he was discharged from the hospital the next morning..."

"Then one hour ago, I fell down again and was rescued. The blood pressure was normal, the heart rate was too fast, but the lips were cyanotic, and the oxygen in the finger pulse was only 91%. Although the eyes were big and round, they were not so sensitive to light reflection. There was a problem with the whole department, and then CT was performed on the patient, no cerebral hemorrhage was found, but a certain space occupation was found..."

Note: Cyanosis of the lips: it is caused by the decrease of the oxygen content of the red veneer in the blood of the body, and it is the color change of the human mucous membrane when it is hypoxic.

Note: Brain cranial CT: The density of the brain tissue itself is relatively low, which is obviously contrasted with the blood, so if there is bleeding, it will have a darker color (shadow of increased density).

"We found that the space occupied, and we suspected that the patient's brain had cerebral edema, which caused the edema volume to squeeze the normal brain tissue, resulting in cerebral edema..."

Cerebral edema is a symptom.

Just like a fever.

That means something is causing the cerebral edema.

"The brain CT has confirmed that there is no cerebral hemorrhage, indicating that there is a cerebral infarction, or that the brain tissue was injured when I fell down yesterday..."

Zhou Mo nodded.

The mind has already begun to analyze.

If there is no cerebral hemorrhage, it must be a brain injury: either a cerebral infarction or a fall.

Wrestled at 16 o'clock yesterday afternoon, less than 18 hours from now.

In the early stage (within 24 hours) of brain tissue damage, it is hard to see on CT. There is no obvious change on CT, and there may be only a little edema. Only after 24 hours or 48 hours, the ischemia and necrosis of the brain tissue is severe, and then the obvious low-density shadow can be seen.

It's 18 hours now, so I can't see the result after doing ct.

Emergency doctor Cao Yun: "Ten minutes ago, the patient's blood pressure suddenly dropped rapidly, reaching 70/40mmhg at one point...but now it is resisted by booster drugs..."

Zhou Mo glanced at the ECG monitor.

Blood pressure: 96/65mmhg...

Blood oxygen: 97 (inhaling oxygen)

Emergency doctor Cao Yun: "The patient's condition is probably like this. At present, we haven't found out why there is a problem with the heart pumping blood, so I invite your cardiology department to come over to see what the problem is. In addition, the respiratory department can help to see if the breathing is abnormal. There is a problem, because the patient's blood oxygen has been hanging..."

He looked at Chen Bing, Zhang Yang, and Zhou Mo.

Zhou Mo already had some thoughts at this time, and he didn't hide it, and asked:

"Have you ever asked the patient, when he fell yesterday, did he fall because of dizziness or because his feet were unsteady?"

There is still a difference between the two.

If you feel dizzy and fall down, it means that there is something wrong with your brain.

Cao Yun, the emergency doctor, saw the strange handsome guy next week Mo, and was very impressed.

Cao Yundao: "We have asked about this... Yesterday the patient fell because he was dizzy first and then fell..."

"Dizzy and fell..." Zhou Mo continued to ask: "Is it possible that it is a pulmonary embolism? The patient is 73 years old, and it is very likely that he will have a venous thrombosis. If the thrombus travels to the lungs, it is a pulmonary embolism, resulting in low blood oxygen. Further causing dizziness..."

Cao Yun nodded: "We have considered this..."

The logic in it:

The first fall (yesterday afternoon): thrombus blocked the branch of the pulmonary artery --\u003e and then caused the blood + oxygen to fail to combine --\u003e the amount of oxygen in the blood delivered to the whole body was not enough, resulting in hypoxia throughout the body (cyanosis of the lips, oxygen saturation low) --\u003e lead to brain hypoxia --\u003e dizziness, fall...

The second fall (1 hour ago): Cerebral hypoxia + cerebral edema + space occupation --\u003e dizziness, fall...

It's all possible...

Emergency doctor Cao Yun: "Behind us, we also considered pulmonary embolism...because the patient has severe varicose veins."

Then a handful of the patient's pants.

The patient's lower limbs were displayed in front of Zhou Mo and the others:

Varicose veins!

There are obvious varicose veins on the left and right lower limbs!

And the quantity is not small!

What are varicose veins?

If in summer, you can observe the legs of the elderly in parks, subways and other places, you can find that most of the elderly's legs, veins and blood vessels expose the surface of the skin, like blue earthworms, curved and twisted, and some even tangle up and bulge ...

These are varicose veins.

The reason for its formation: the heart needs to return blood, relying on the strength of the heart to pump the blood back from the legs, but when the legs stand, it is too high, and the blood has to overcome the huge gravity to transport upwards. What should we do at this time? Don’t be afraid, there is something called a venous valve in a vein. Every segment of venous blood vessel has a venous valve. The blood is transported upwards, and then each section is blocked by the venous valve, so there is no backflow.

However, long-term loads (e.g. prolonged standing occupation, old age) can lead to successive damages of the valves in succession.

Then there are varicose veins!

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