The patient was sent to the hospital in a car accident. Not only were the fractures of the sternum and upper limb bones, but also the twitches of the muscles of the limbs. After the X-rays and CTs of several parts, the twitches gradually spread throughout the body, including the face and torso. Then the heart was stopped, the breath disappeared, and after the return to the session, a large amount of pink foam phlegm was immediately coughed up...

As a first-hand rescue doctor, Qi Jing repeated the patient's condition.

"So you can tell from the symptoms that the patient has taken poisonous rats strong?" A policeman sat in the doctor's lounge and looked at Qi Jing in front of him and asked.

"The symptoms are speculation. You can basically decide when you see the results in the laboratory." Qi Jing took out a liver function test sheet. "The liver function enzymes have increased a lot, which is consistent with the manifestation of poisoning. The toxins initially attack the nerves and cause convulsions, and then cause neurogenic pulmonary edema. The most common poison among these poisons is the strong rats."

"Of course, the correct diagnosis still requires toxicity measurement."

The police officer took down the evidence and suddenly asked, "How do you know that it was his wife who threw the poison?"

"I didn't say it was his wife who committed poisoning," Qi Jing smiled and explained, "On the phone, I only said that there was a patient who was poisoned by a poisonous rat in the hospital. I didn't know what I had eaten, so I called the police first. After all, it is important to find out the source of the poisoning. It is necessary to rule out the possibility of group poisoning and people committing poisoning and murder."

Qi Jing's idea is very clear, and he only talks about the facts he has seen.

Poisonous rats are very common lethal poisons. The amount of poisoning is calculated by Hauke. An adult only needs a few milligrams to quickly develop the disease and die within an hour. Because it is different from other poisons, it is colorless, odorless, and odorless, so it is often used to poison.

As early as the 1980s, the production of poisonous rats was stopped all over the world, and in the early 1990s, the use of poisonous rats was also banned in China.

Just two years ago, in 2002, a large number of agricultural dangerous goods, including poisonous rats, were strictly investigated nationwide, and no one was allowed to register and use them. Both husband and wife are office workers in the city. Unless they have ulterior motives, it is impossible to get poisonous rats.

Therefore, when you see a patient who is poisoned by a poisonous rat, you don’t have to consider whether to commit poisoning or commit suicide. This thing itself should not exist on the market, so you have to find a policeman when you see it.

After Qi Jing finished explaining, he was about to get up: "I've finished talking, I'll leave first if I'm fine."

"Wait, there's another small thing." The police turned the page and began to guide the topic to the center of the case. "You have had a conversation with the patient's wife, right?"

"I have ever asked what I had for lunch during the rescue, but she answered very perfunctorily, and then she refused to answer again." Qi Jing continued after thinking about it.

"Have you found anything particularly abnormal?"

"After contact, she seemed more calm than others. But there were no such family members, and I didn't notice anything unusual about people." Qi Jing said. "It's just that the whole thing, especially this car accident, is very strange."

In some cases, doctors can provide many professional opinions, especially in the handling and identification of trauma and car accidents. Emergency doctors, especially surgical emergency doctors, often deal with police for this reason. So when Qi Jing talks about car accidents, the first reaction of the police was to ask for his opinion.

After all, police judging cases is just like doctors’ diagnosis, and sometimes some details become key points.

The police saw that Qi Jing was still young and had seen him twice when he was in charge of this case, but he had no contact. So when he was discussing, he thought Qi Jing would be nervous, so he explained: "Let's just talk casually, and say whatever you want, maybe it can help us find a breakthrough in the case."

Qi Jing nodded: "Then I will just talk about it casually. The next one is just my guess, don't take it seriously..."

The couple rested at home for lunch today. After the man suddenly felt dizzy and vomited a lot, so he drove to Danyang Hospital with his wife who had no license. By the way, he passed by Huailin intersection, and was probably getting worse and worse. The muscles of the limbs intermittently twitched involuntarily, so he accidentally drove to the cement pier on the side of the road.

A few minutes later, he was sent to the surgical emergency department by 120.

Qi Jing said it just like he saw it on the spot, making the police in front of him not know what to say: "You said just now that you didn't doubt his wife."

"I didn't say no doubt, it was just not stated on the phone." Qi Jing sighed and explained, "The poisonous rat is ill very quickly. It is impossible that the symptoms will appear when you arrive at the hospital. You must have it on the way."

Poisoning cases are not uncommon, and the police are a little familiar with the commonly used poisons: "What if the attack is delayed?"

"The patient is in the ICU, and you can't collect evidence. In fact, there is still evidence." Qi Jing continued to explain, "The patient's shirt has some stains. Although the mouth is very clean, it should have been rinsed after vomiting, but there is still some odor left after vomiting. Obviously, he had vomited before coming to the hospital."

"What does it have to do with the patient's wife being a drug offender?" The police officer couldn't keep up with his thoughts and found it very strange.

"The key to the problem is not about vomiting itself, but about his wife's approach." Qi Jing thought for a while and said, "Before the rescue, she only said that the patient was dizzy and weak, and her head was dizzy, and even kept inducing us to think about encephalitis. She said a lot, but she had never mentioned vomiting, which was very unreasonable."

The police nodded after hearing this, and it turned out that the problem was here.

Vomiting is an important symptom of poisonous rats. Since it has not been there since it was admitted, it means that it had already occurred before admission. Vomiting symptoms usually appear shortly after meals, so it is impossible for the family to not know about it.

"There is indeed a problem, did you just said...?"

Qi Jing knew what he was asking, and quickly replied: "What I said just now, the head nurse and the nurse who just participated in the first aid can testify."

"Okay." The police officer wrote down all the contents and couldn't help laughing twice, "The reasoning just now was very exciting. It would be a pity for you to not be a policeman."

......

The patient who was poisoned by the poisonous rat was still lying on the ICU bed and was in a coma.

On the edge of the bed is the blood perfusion of charcoal kidneys. The blood containing toxic substances enters it through the penis tube and is purified and returned to the patient's body. On the other side are various symptomatic and detoxifying drugs that maintain his vital signs.

The strong toxic mouse is tetramethylene disulfone tetramine, which has very stable chemical properties.

In clinical practice, except for the combination of vitamin b6 and sodium dimercaptopropanesulfonate, it can be slightly confronted, and no other special medicine can be found. The only poison that can compete with it is paraquat, which is also known for its stable nature and no special medicine. The effective method is to purify the charcoal kidney, but the effect varies from person to person.

If the nature is stable, it cannot be further metabolized by the liver. It is very difficult to completely remove the toxins.

Some patients can still find poison residues in their blood even after a week. These toxins will continue to stimulate the patient's body. Even if the amount of poisoning is not large, they will slowly drag down the organs of the body over time, eventually causing multiple organ failure.

There are many patients whose toxins are not completely eliminated after poisoning. Organ transplantation will eventually cause the transplanted organ to continue to fail.

Qi Jing explained to the two curious interns beside him, explaining the power of the poisonous rat: "I hope this patient can survive."

"Senior Qi, I heard you have long seen that it was his wife who poisoned him?" Girls are obviously more gossipy than boys, and the entry point of view of things is a bit different, "Is it a love kill?"

"Maybe it's a fraud in insurance." The boy also posted his own.

"How can I know this?" Qi Jing spread his hands and looked at the case he was still studying before.

The girl sighed, but still stuck to him. She looked at the thick stack of cases in Qi Jing's hand. After thinking for a while, she still asked: "Senior Qi, I heard that you have set up a medical team that specializes in diagnosis?"

Qi Jing felt a little sad when he heard this.

He would not tell people easily about this matter. He usually conducts a large number of screenings, picking out the talents he likes before considering whether to say it. In the past, he screened the nature of the discussion meeting, but now he relies on observing the work of the interns to make a judgment.

Since Hu Dongsheng and Gao Jian came in, the previous students took turns but failed to find other talents.

In fact, his requirements are a bit strange, and grades are not a necessary condition.

Even Hu Dongsheng and Gao Jian, he just mentioned casually about establishing a diagnostic team. The only one who made him reveal all the details was Ji Qing. But since the last message was passed to Li Yuchuan, Ji Qing's mouth has become much tighter. I don't know which one would have been without the door on his mouth this time.

Qi Jing sorted out the inspection report in his hand and asked the girl: "Where did you find out?"

"Teacher Hu said."

"Teacher Hu? Which Teacher Hu?" Qi Jing asked, "Hu Dongsheng?"

"Um."

In May, Qi Jing passed the postgraduate entrance examination and has become a student of Wang Ting with Hu Dongsheng and Gao Jian. Qi Jing naturally took the junior college entrance examination and worked in the hospital. Hu Dongsheng and Gao Jian have also become emergency hospitalized doctors, and have partnered with a superior doctor and started shifts.

In the eyes of new interns, Hu Dongsheng is a master's degree student, and his academic qualifications are at the forefront, so he naturally becomes Teacher Hu. Moreover, Hu Dongsheng's strength is not bad, and this teacher is also convinced.

"Why do you call him Teacher Hu Dongsheng?" Qi Jing was a little surprised, "Why did you become a senior when it was my turn?"

"This..." The girl didn't expect Qi Jing to be confused about such a strange thing. She thought he was angry. She immediately explained with a smile, "I called me the senior when I was dengue last year, so I called me the senior. I'm kind."

"It's because of this?"

"yes."

An intern who has just entered the clinic has only average grades and high abilities, and is not strong enough. In his eyes, there are only two words left, mean. This cannot be changed by just a few words of kind seniors. In fact, no matter what they do, it is impossible.

Your team must be an elite and cannot tolerate half a bastard. This is the requirement set by Qi Jing for himself after rebirth.

When the chat came here, the original topic was already deviated by Qi Jing. Besides, the two of them had questions and answers, and the atmosphere was very harmonious. Seeing that a complete conversation paragraph was over, there was no need to mention this matter anymore. But the girl still refused to give up and asked with a smile: "Senior Qi, what do you think of me? Are there any opportunities to stay by your side to learn further?"

"What are you a girl doing when you are in the emergency room? It's dirty and tired, not good." Qi Jing suggested, "Just find an internal medicine job, especially in the heart, in the spirit, and in the breathing benefits are good, enough to support yourself."

He had already expressed his rejection in a tactful manner, but this did not seem to have any effect.

The girl smiled and said, "Those departments are too unchallenged, but the emergency department is still interesting."

This was the most sarcastic thing that happened when he was in the internship, which was very sarcastic and offended all other departments that were not emergency departments. The last time Qi Jing heard this sentence, he said it from his mouth. For a moment, he began to reflect on whether he had a very good temper recently that made these new interns start to get away.

"Those departments are boring, but if you say there is no challenge, it seems to overestimate yourself."

The girl stopped talking, but judging from her expression, she obviously didn't think she was wrong.

Qi Jing smiled and casually found a case in his mind: "If you can diagnose the following case, I will agree to join."

"Okay, Senior Qi, say it quickly." The girl was very excited, "My diagnosis score is not low."

Qi Jing didn't care about her test scores at all, and immediately introduced a general situational framework: "You are a resident doctor who just entered the respiratory department. A patient came at 2 pm. The main complaint was that he had fever, cough, and sputum for three days. The patient visited Luo Tang's expert clinic in the morning and had a full set of examinations. The diagnosis was very ordinary, which was pneumonia and needed to be hospitalized for treatment."

The girl knew very well that Qi Jing was taking the exam, so maybe this was an opportunity.

Since pneumonia is taken, it means that we need to distinguish the types of pneumonia. There are differences in acute and chronic diseases, and there are also differences in the types of microorganisms that cause pneumonia, and of course some non-infectious inflammations.

What impressed her most was that a patient with encephalitis of the side tumor last year was already treated as a classic case by the diagnosed teacher. I am afraid that interns at Danyang Hospital and all medical students who came in later will passively remember this case.

She thought of this and was full of confidence, but she had to take everything step by step: "After the patient comes, I need to take my blood pressure and heart rate, and follow the consultation and do a physical examination..."

When Qi Jing saw her talking alone, he hurriedly stopped her: "Wait, I haven't finished talking yet."

"Hmm? These are all regular procedures."

At the beginning of the internship, I had already learned about the process of receiving patients from my classmates in other departments. She did a good job, at least more than 80% of the students of the same period. But for Qi Jing, it is not enough to only more than 80% of the same class graduates, and it is not even considered a bonus.

"Don't worry, I'll give you time to talk slowly when I finish speaking." Qi Jing continued, "Just just took out the stethoscope, the patient suddenly looked painful, and he was sweating prone to his body, and his breathing was rapid."

Ha? What the hell?

Why are you sweating coldly and breathing rapidly? I'm afraid you can't keep up with this guy when you jump off the cliff?

The condition changed too quickly, and the girl had no time to react. However, compared to others, since she had the courage to speak up and join Qi Jing's team, she was naturally a little bit good. After calming for a while, she made the judgment that an intern should have: "You have to measure your blood pressure and heart rate first, and ask him where he feels uncomfortable."

"Blood pressure, heart rate and breathing rate can tell you." Qi Jing compiled a few numbers casually and said, "Blood pressure is 185/105, breathing 38 times/minute, p141 times/minute."

The girl nodded and recorded them all: "Where is the patient feeling uncomfortable?"

"Sorry, the patient can't answer you." Qi Jing put the medical history information aside and the knocking officially began, "He can't speak."

.
Chapter completed!