Luo Tang walked into the emergency room and glanced at several doctors in the room with a cough: "Cough cough, who is going to the ventilator? Are you in a hurry and someone is in trouble?"

When the director of the Nei Department arrived, a few anxious little guys naturally called Director Luo respectfully. After he sat in Wang Ting's seat, Hu Dongsheng smiled and greeted him, explaining: "We are only discussing one case."

"Case?"

When Luo Tang heard the word "case", the first thing that came to mind was Qi Jing. After looking at Qi Jing with a smile on his face and the others who were at a loss, he understood: "You are not talking about that 16 bed, are you? Do they understand?"

The 16 bed in his mouth is the second patient of Guanghao Fund. The fund first allocated 10,000 yuan and handed over the full responsibility to the respiratory department of Danyang Hospital for treatment. Such patients with difficulty in diagnosis need to undergo repeated examinations, and the medical insurance will definitely be overpaid, so Ji Guanghao also relaxed the restrictions and allowed to change to many self-paid projects.

However, he needs to check it out. With Ji Guanghao's connections, he will naturally go to other experts to supervise the cost.

In fact, no matter whether there is anyone supervising it or not, Luo Tang and Qi Jing will not issue examination sheets randomly. What's more, there is such a great charity who is willing to spend money to treat complex patients. Luo Tang and Qi Jing have problems but are too late to solve them. It is impossible to find trouble and touch his reverse scales if they are fine.

Of course, the so-called diagnosis department in Qi Jing’s hands is just a small team for case screening.

The cases supported by this type of fund can only be participated in, and the main control of the main direction must be handed over to the directors of each department.

The patient was screened out by Ji Qing three months ago. After a few people's second and third screenings, he became the ultimate lucky one. One and a half months ago, Ji Guanghao's team began to contact the patient to investigate his identity and family income, and the results met his requirements.

Half a month ago, Qi Jing received all the patient's previous medical records. The patient arrived in Danyang the day before yesterday for some reasons. He took a night off and was admitted to the hospital after completing the procedures yesterday. Today, the patient's examinations began to proceed steadily, and the diagnosis of bacterial pneumonia spanning 16 years has officially begun.

Luo Tanglai held a case discussion meeting in Corey in the afternoon, and now he wants to talk to Qi Jing about the patient's condition.

"What are you making up?"

"Just chatting casually." Qi Jing turned his attention back to the medical records of the patient on Bed 16. Anyway, the case he mentioned was almost done, so he could be distracted and took a few more glances.

"Talking?" Luo Tang disagreed, "I'm going to go on the ventilator and it's still a little chat?"

"It's just a case." Hu Dongsheng said with a smile, "Just talk about your ideas."

Luo Tang was very expecting Hu Dongsheng, so he patted his shoulder and said, "Xiao Hu, you have to remember that it is not the last resort, don't put the patient on the ventilator easily. Many people's lungs are not good at first, and they can't be taken off after they are put."

"I understand the truth, but the case given by Brother Qi..." Hu Dongsheng didn't know how to answer for a while, and seemed very embarrassed.

Luo Tang raised his hand and looked at the time, and suddenly became interested: "What case, let's hear it."

A few people said the case again, saying that patients with confirmed pneumonia suddenly had difficulty breathing and could not speak before undergoing admission to the hospital for education and physical examination.

"Since I have called the director of the University of Respiratory Medicine, the patient's condition has to be taken one step forward." Qi Jing thought about it and shook his head, and decided not to change it. "Forget it, the oxygen saturation is 65%, and it will be gone even further."

Hu Dongsheng looked at the situation in front of him: "Director Luo, look at this patient, you have to go to the ventilator."

With a mask inhaling oxygen, the oxygen saturation dropped to 65%, and the combination of albuterol and aminophylline did not work. Under auscultation, the patient's lungs became more and more dry rales. Anyone who came would rush to put the patient on the ventilator first.

However, Luo Tang’s chief director was not blown by the strong wind, and his approach must be different: “Even if furescence is ineffective, heart failure is ruled out. This patient still needs to rule out myocardial infarction and pulmonary embolism. Didn’t you do an electrocardiogram?”

"In the respiratory department, you know, Director Luo."

Hu Dongsheng has also been in the respiratory department. There is only electrocardiogram monitoring in the ward, and there is no regular electrocardiogram. If you want to do it, you have to go to the cardiology department upstairs to borrow it. The elevator is still on the way back and forth, so it will definitely not be fast. Moreover, the patient's illness is so urgent that even if he wants to do an electrocardiogram, he has to be sent to the ICU and put it on the ventilator before talking about it.

Luo Tang knew the situation of the internal medicine department and said slowly: "The ventilator is not in a hurry. Let the nurse give the patient a first aid and atomize to minimize airway spasm. At the same time, he quietly pushed 40 mg of A-strengthening Dragon to enhance anti-inflammatory and completed the electrocardiogram examination at the same time."

Qi Jing nodded: "Triple atomization of budesonide, terbutalin, ipratropium bromide?"

"right."

“Although it has a little effect, the difficulty of breathing has not really been relieved.”

Luo Tang frowned, and his high concentration made him cough again: "Cough cough cough, electrocardiogram, cough cough, what is the result of the electrocardiogram?"

"There is no myocardial infarction and pulmonary embolism." Qi Jing said, "Since Director Luo has used an electrocardiogram, the patient must take a step forward."

Go forward...

The two interns looked at Qi Jing and looked at Luo Tang, who was sitting aside with a bad face. They couldn't imagine what the patient would look like when he moved forward.

Hu Dongsheng and Luo Tang are different, and adhere to the tradition of decisive treatment in the internal emergency. When encountering such patients, no matter what they do, they are better than waiting for nothing. The oxygen saturation reaches this level, and there is no sign of turning back. If you hesitate about the ventilator, the patient will develop severe pulmonary encephalopathy at any time.

Sudden confusion, hallucinations, delirium, and even fainting, coma may occur, and further down there is permanent hypoxic brain injury.

It is because of the existence of pulmonary encephalopathy that Qi Jing has been stuck in the oxygen saturation value. As long as he takes one step forward, even if he saves the person, he may become a vegetable.

"Go on the ventilator." Hu Dongsheng said this, "First maintain oxygen saturation, and then wait until the oxygen saturation stabilizes."

Qi Jing was waiting for this sentence, but before he could announce Hu Dongsheng was eliminated, Luo Tang objected: "No, there must be a problem with getting on the ventilator."

"Director Luo, it's unreasonable to get on the ventilator when it reaches this point." Hu Dongsheng opposed.

"No, it was all wrong before!" Luo Tang suddenly reacted, jumped out of the vicious circle arranged by Qi Jing, and said, "It was the wrong diagnosis. This patient is not pneumonia, it must be other diseases!"

Qi Jing smiled: "Teacher Luo, this diagnosis cannot be wrong."

"Just kidding, I must be wrong!" Luo Tang emphasized.

"Teacher Luo, in the setting, this patient is the pneumonia you diagnosed and the hospitalization order you issued." Qi Jing continued to smile and said, "This patient was diagnosed by you personally, so you will not deny yourself."

Um?

What kind of shit setting is this?

However, no matter how much I complained, Luo Tang was a little confused, and then he lost his ideological burden: "What's the problem with this? Who hasn't diagnosed it yet? I, the director of the University of Respiratory Medicine, have times when I was wrong. Anyway, it's just wrong. It's impossible to be pneumonia!"

Qi Jing nodded, sincerely admiring him for his "destroying himself for justice": "It's a pity that the diagnosis you made in the outpatient clinic is correct, it is indeed pneumonia."

ha?

Luo Tang slapped the table and stood up in anger. Even his original cough was suppressed by the large amount of adrenaline secreted: "I can't object to my diagnosis?"

"This is the game setting, you can't change it." Qi Jing said seriously.

Mad!

Luo Tang cursed in his heart, his brows getting even tighter.

He knew very well that Qi Jing was digging a hole, and was too lazy to hide it.

The first pit for ordinary inpatients to experience sudden dyspnea after entering the ward is the first pit. Generally, such pits are that undergraduate interns will be confused. A resident who has received first aid treatment can deal with it.

But before dealing with it, the second pit followed, and the patient was unable to speak.

This pit looks big, but in fact it is not a pitfall for doctors with clinical experience. It is generally targeted at people with good academic performance but lack clinical experience.

The inability to speak is just an expression of difficulty breathing.

Because breathing and speaking and making voices cannot be performed at the same time, when breathing is severe to a certain extent, the mouth and nose can only be used entirely for breathing and have no spare energy to speak.

When I avoided the first two, then the third pit was followed.

All the commonly used respiratory support treatments were ineffective, and even made the condition worse. At this time, ordinary doctors probably had never seen such a bizarre thing and could not continue to deal with it.

Because next to it is the last pit.

When all the drugs are ineffective and the mask is ineffective, when everyone takes it as a result of the oxygen saturation that has fallen even more exaggerated than the stock market, everyone will take it for granted. Luo Tang looked at Qi Jing and intuition made him see that the breathing opportunity is a pit, a big pit.

You must not step on this pit, and the consequences will be unpredictable if you step on it.

But the patient's condition is constantly forcing the doctor to step on it. If he doesn't step on it, the condition may continue to worsen.

If the patient was in front of him now and the oxygen saturation dropped from 95% to 65% within half an hour, Luo Tang would have been on the patient's ventilator long ago.

So in theory, he has a high chance of stepping on this pit.

Fortunately, the patient was not in front of him, and Luo Tang still had the time to consider the cause of the disease.

The patient has many sudden symptoms, but in the final analysis, they are all caused by one thing, that is, difficulty breathing. So what causes such simple difficulty breathing?

"The atomization of albutamol, aminophylline, adrenal and m receptor antagonists has been started, but it still failed to hold back the patient's oxygen saturation, which shows that there is a big problem with the lung itself."

After a brief thought, Luo Tang tried to jump out of the scene circle surrounded by Qi Jing, select the patient's symptom reaction from the moment, leaving only a simple oxygen saturation number. Without these subjective factors, he became more objective: "Infection, shock, and cardiogenic problems will not have such a violent reaction."

This sentence not only explains the patient's entire condition, but also points out Hu Dongsheng: "Director Luo's meaning, is the patient suffering from lung injury?"

Luo Tang nodded and looked at Qi Jing: "How is the patient's breathing sound?"

"The breathing sound is weak, and there are a lot of scattered dry rhymes." Qi Jing said.

"You kid is still using this kind of ambiguity of descriptive words, just say that the breathing sound is weak... People have two lungs, so you have to talk about both left and right." Luo Tang seemed to have known the answer and pinched the key point, "You kid has dug this chain of pits pretty well, and even I almost fell into it."

After all, Luo Tang saw this question strange, but this question was not prepared for him.

In order to cater to Director Luo Tang's strength, Qi Jing dug a lot of holes temporarily and cut off an important information to make the condition very suddenly: "Director Luo, what should I do next?"

"What else do you do?" Luo Tang cursed with a smile, "Take out the videos taken in the patient's clinic and take a look."

Qi Jing smiled and raised his thumbs up: "I am worthy of being the chief director."

"Stop this, it's impossible for the outpatient chest X-ray to have only one pneumonia," Luo Tang said. "You actually erased the important point on the chest X-ray. Isn't this forcing me to misdiagnose."

Qi Jing was helpless. If Hu Dongsheng had not done so well. But for Luo Tang, as soon as this information was released, he would immediately think of the patient's current problem: "The patient is indeed pneumonia, and there is bulla in the upper right lung."

Hearing the three words "bulbous" Hu Dongsheng seemed to have thought of something. Combined with the patient's series of development processes, he had to sigh: "Spontaneous tension pneumothorax? Pneumothorax with underlying diseases is no wonder it progresses so quickly..."

After hearing this, the intern on the side suddenly realized: "Ah, is it pneumothorax? Before pneumothorax, it deliberately put a bacterial pneumonia diagnosed by a chief director as a guise. It also erased the bullae that is most likely to be associated with pneumothorax. It's so bad!"

Tension pneumothorax is a common disease in respiratory medicine. Because lung damage causes gas to leak into the chest cavity, compressing the original lungs, completely limiting respiratory function.

The most common one is tension pneumothorax caused by trauma, followed by spontaneous pneumothorax in patients.

Among these spontaneous pneumothorax patients, some are caused by their own physical causes, while others are caused by underlying diseases.

The most common diseases are lung bulla caused by pneumonia and emphysema caused by chronic lung diseases. Among these two underlying diseases, the patient's alveoli are blown into extremely inflated balloons, which will cause pneumothorax after rupture.

Because its symptoms are obvious and the consequences are serious, it has always been the focus of textbooks and can be almost done with a must-take exam every year. Every medical student must master the pneumothorax classification, diagnosis points and treatment methods. Song Yao is not studying well, so she naturally knows how to treat tension pneumothorax, which is nothing more than breast puncture and closed chest drainage.

This patient has severe breathing difficulties, and maybe he needs a mask and artificial ball to help him breathe after the closed drainage.

If you follow the normal development process, take two rounds of first aid medication and have an electrocardiogram, the patient may already have some symptoms of pulmonary encephalopathy. At this time, you need to let the patient have a ventilator on the last ventilator to completely solve the problem of self-respiration on the premise of performing closed drainage.

However, the lungs of pneumothorax patients are just sponges pressed by air. The sponge itself is good. When the air in the chest is removed, the pressure will be gone, and the lungs will return to their original state to ensure breathing.

"Senior Qi, your case is too difficult and too biased."

"Hey, pneumothorax is a must-have for respiratory medicine."

Song Yao glanced at Luo Tang beside her and said, "But even Director Luo couldn't think of how I could diagnose it."

"Director Luo must have fewer clues than you."

Qi Jing emphasized: "As long as you can overcome the first two pits and do half of what Hu Dongsheng said, I might consider your requirements. As long as Hu Dongsheng can think more about it, I will tell him that he has combined lung bullae. After all, the hospitalization sheet is only the size of a palm, and the reason for hospitalization is enough to write a major disease. It is impossible to write all the conditions on it. It is completely your problem if you don't go to the patient's chest x-ray."

To prevent automatic collection from failing to load, click to load manually, and the reading mode does not support it. Please install the latest version of the browser!
Chapter completed!