What doctors are most afraid of is not those myocardial infarctions, strokes, or serious injuries in car accidents. It is not that they are easy to deal with, but because these are easy to diagnose, and the treatment methods are relatively fixed, and the probability of errors is very small.

As a doctor, there are always only two things that are most afraid of. One is the incomprehension and unreasonable trouble of the patients and their families, and the other is the "ignorance" of their own faces the unknown.

The ignorance here is not a denial of the doctor's contribution and knowledge reserves, but a kind of awe of death.

After all, no one is omniscient and omnipotent. The exploration of the human body has just begun, and the unknown is everywhere.

A qualified emergency doctor faces the most, in addition to the turnover between patients in and out, there are death and unknowns. As for those unqualified doctors and even interns, it is early for them to respect the unknown. First, it is important to tell whether the one in front of you is known or unknown.

When a large number of symptoms are mixed together, it is particularly important to sort out the lines of thought and how to remove ineffective impurities.

The high fever, confusion, and huge fluctuations in blood pressure and heart rate have made the 17-year-old girl who just sent me a very troublesome patient. Especially the numbers on ECG monitoring, each of which is a bombshell.

"What's the name of the patient?" asked a nurse.

"Li Wei," the patient's mother was also with the car, and she was always with Li Wei. "My daughter is only in high school, so you must save her..."

The mood of the family is closely related to the patient's condition.

Most people do not understand medicine and cannot know the disease status of their relatives at the first time. In the end, they can only judge by the doctor's reaction. Unfortunately, the doctors and nurses in front of her all looked very heavy.

High heart rate and low blood pressure are a common precursor to shock. Combined with high fever, the first thing that comes to mind is septic shock. The medical staff who took over the patient did not have time to comfort her. The most important thing for rescue now is: "Send to the rescue room!"

Just one sentence made the mother understand his daughter’s situation instantly: “My daughter was just anemia after having a checkup a few days ago. Why did it become like this?”

"Anemia?" The doctor who received the doctor felt a little strange.

"Yes, hemoglobin is a little low and people don't have the strength."

"Did you have a fever at that time?"

"It's a little bit." My mother recalled, "It can be said that there is no. When I went to the hospital for examination, it was 37.5 degrees. The doctor said that I had nothing to do and had a blood routine. I had a little anemia and prescribed iron supplement medicine to go home to take it."

"And then it's what it is?"

"Yes, it's only been a few days."

While the nurse was collecting blood for examination, the doctor quickly gave the patient a simple physical examination. From the surface, the little anemia before developed into severe anemia, with pale face, pale lips and nail beds, and blood-colored on both the palms and face.

"Severe anemia, hemolysis..." The doctor opened the patient's eyes, "Good guy, there are also jaundice caused by anemia hemolysis!"

After talking to himself, he ruled out many diseases that needed differential diagnosis, and finally put his eyes back on his family members not far away: "Have she taken any medicine recently?"

"The medicine? It's just a box of blood and iron replenishment."

"What about the others? Antipyretic and analgesics, such as aspirin or sulfa." The doctor asked, "By the way, there are broad beans."

"No, I've been replenishing blood these days and haven't taken any other medicines."

"Not even 38 degrees, and the doctor does not recommend taking antipyretics."

When the doctor heard this, he nodded with satisfaction and cleared his doubts: "Come on, Xiao Jiang, go and ask for a consultation in the hematology department. There is a suspected thalassemia here."

Intern Xiao Jiang was very obedient because he was in front of him.

This time he came to the internal rush to redirect himself, in order to return to the department to advance to the deputy high school. A hematologist who stepped into the deputy high school field halfway through the field of the deputy high school to diagnose a hematology disease is too normal and simple.

So this sentence is the conclusion in his ears, the kind that even "suspected" can be removed.

But when the intern turned around and wanted to leave here and enter the clinic to make a call, she suddenly felt that her sleeve was being pulled to the spot and could not move. When she turned around, she saw that the pre-hospital emergency doctor standing next to her was resting in the emergency corridor.

He also knew Chen Houde, and he had always been a doctor, but this time it was another one.

"You haven't done brain ct yet, and the blood routine results have not been released. You're just determined to have thalassemia? Is it a little arbitrary?"

The doctor in front of the hospital walked to the patient with a smile. Because the closest seat was occupied, he could only stay near his face. He raised his hand and touched the patient's face, but when he touched it, he reflexively shook his hand: "It's so hot, I think it's almost 42 degrees."

“That’s high?”

The doctor of the hospital quickly winked at Xiao Jiang who was beside him. After a while, a thermometer was stuffed into the girl's armpit. The liquid level that was thrown to about 37 degrees quickly rose, and after a while, it broke through the 40 mark and continued to move forward. There was no resistance along the way, and there was no pause at all.

"Take it..."

The doctor of the hospital asked the nurse to take away the thermometer that had passed the 41-degree scale, first instructed to reduce the temperature physically, and at the same time issued a series of treatment orders.

Regardless of the final diagnosis, severe anemia and hemolysis in the patient in front of him are obvious and must be treated immediately. Faced with this situation, pressure boosting, anti-inflammatory and blood transfusion are the unchanging themes.

Of course, in addition to treatment, the doctor who received the doctor couldn't help but want to talk to Qi Jing about diagnosis: "Severe anemia, hemolysis, can indeed cause high fever and mental changes, and can also cause jaundice. Is there any problem?"

These are the symptoms that patients now hold. Combined with the anemia my mother said, it is indeed easy to identify a severe anemia.

The patient's disease is very fast, and there are certainly additional causes that induce the rapid death of red blood cells in the body. Combined with the patient's age and the original physical condition on the medical record, aplasia caused by bleeding from various organs can be eliminated.

Although there are still many types of hemolysis of such severe anemia, there are only two most common cases.

One is G6pd deficiency, dominant genetic disease, which is generally activated by specific foods such as broad beans, drugs, such as antipyretic analgesics. Once activated, it will cause severe hemolytic anemia, but the process is mostly self-limiting and will recover on its own after a period of corresponding treatment.

The other type is thalassemia, which is also a genetic disease, and is divided into three types: mild, moderate and severe.

If Qi Jing was right, the doctor in front of him would probably determine that a mild thalassemia suddenly worsened after infection.

Mild thalassemia has basically no symptoms, and this condition is not rare in clinical practice. If you can quickly select the most likely situation by relying on the only symptoms, you will naturally have the other party's deep foundation.

However, compared with the symptoms shown by the patients now, Qi Jing attaches more importance to the indicators of electrocardiogram monitoring.

Qi Jing heard what they were saying at the door just now, and in order to confirm, he couldn't help asking: "Old Shen, the indicators were pretty good when she first came?"

"Well, the situation was OK when I came, my heart rate was 60 and my blood pressure was slightly higher."

Qi Jing looked at the doctor who was treated again: "In a short period of time, the number on electrocardiogram monitoring has almost undergone a big reversal. The blood pressure has dropped, the heart rate has increased, and the breathing has also dropped. Don't you think it's a bit strange?"

Of course, the doctor who received the doctor found it strange, this is the "unknown" in his eyes.

Instead of escaping, he chose a very typical solution. He first solved what he could solve, and what else could not be solved or explained, and waited for the inspection and improvement before solving it.

"It's a little strange, but as long as the follow-up inspection report comes out, you should find the problem."

"Just expedite the brain ct." Qi Jing didn't have time to play this game of being killed by dogma with him. He knocked on the breathing frequency on the ECG monitoring. "You didn't do anything, your breathing is back and it's still rising. You didn't see the problem?"

Heart rate, blood pressure and breathing, three vital signs have problems at the same time...

"Brainstem? Brainstem damage?"

He is a young backbone in the hematology department. After graduating from a master's degree, he was studying for a doctorate. Now he has graduated. He is well aware of the diseases in his hands. But now he has encountered neurological diseases, and it is still very targeted to have a very slow brain stem, which is inevitable.

If you don’t know, it must be fake. After all, when it comes to the main treatment level, you can tell some tricks about common diseases: "Tidal breathing, heart rate and blood pressure are suppressed, this is a medulla obstruction..."

The medulla oblongata is the center of life. The three major signs are regulated by the medulla oblongata. Once the injury occurs, the patient will leave as soon as he says.

This is no longer a patient like him who can solve the problem of a attending doctor. Not only should he be sent to the brain CT urgently, but he also had to take over immediately: "Director He! This is a medulla obstruction and a tide breathing!"

"Oh, what's wrong today..." He Tianqin muttered in the idiot and replied, "You go to the Shenwai consultation, I'll go to the CT room now."

The female sanitation worker at his hand has not yet been solved, but unexpectedly, another medulla obstruction occurred. He Tianqin was in a state of turmoil this day, and the key was that he had no gains from morning to night. He always felt unhappy.

"Why are you only 17 years old?" He Tianqin entered the CT room and saw the girl's medical record, and felt a little incredible, "Car accident?"

"No, it's just an ambulance called after a sudden high fever at home."

"Home? High fever?" He Tianqin frowned, "Where did you get a high fever? Medicated thrombosis bleeding will not cause high fever."

"this......"

The doctor who received the doctor was speechless for a while and didn't know how to answer.

"Maybe there is something wrong with the pons." A voice came from the corner beside him and said slowly, "It may be multiple brain stem hemorrhage."

"Hey, she's only 17 years old..."

They all know what this age represents for a sudden brain injury, but the reality is so fruitful in front of them: "It's really multiple brain stem hemorrhage. Let's go out and take a look, I hope there is still a rescue."

He Tianqin sighed and sighed at the same time relieved.

Such a troublesome and difficult patient is finally out of his control. If this person also entered the emergency room, it would probably be very difficult to bear tonight. Thinking about the two patients who may have big problems lying there at any time, He Tianqin felt that his blood pressure was full and he would become the same as them at any time.

Unfortunately, he let go, but someone didn't.

"Director He, in addition to brainstem hemorrhage, she also had anemia and hemolysis that had not been treated." Qi Jing was still sitting in the seat just now, looking at the patient's medical record, "I had mild anemia before, and there must be a reason for the sudden aggravation."

"Anemia? Don't worry about anemia at this time."

"It should be a secondary hemolytic anemia."

"It's better to get infected, the autoimmune hemolysis induced by infection."

The doctor who received the doctor was indeed very strong in hematology. He said casually and reminded Qi Jing: "Indeed, it is very likely to be an infection, but what kind of infection is it..."

He Tianqin persuaded: "Infection is just a switch. The door is open. Why do you still care about the door lock? By the way, if you are fine, go with me to help me. Today I'm almost crazy."

Qi Jing smiled: "Director He, I am not a doctor from the first hospital."

"What does this matter? Just save people."

"I'm still at work." Qi Jing carried the collar of his white uniform, "Maybe I'll have to get out of the car later."

He Tianqin originally thought that Qi Jing would rather wait for the ICU to help analyze the situation of the female sanitation worker, but he didn't expect to choose to rest at this time. However, thinking of the explosion in Qinglifang all afternoon, he felt relieved: "You are really tired, go and rest."

The First Hospital is not Danyang Hospital, and He Tianqin is not Wang Ting, so there are not so many people available.

The only one who can use it easily is Xu Jiakang, but unfortunately he is now in Seattle. Although Beth is not bad in strength, his language is not as good as possible, and sometimes he still feels awkward when communicating.

In this case, it is understandable that He Tianqin relies on Qi Jing. After all, not everyone can accept three students at once like Wang Ting.

Qi Jing naturally knew this meaning.

If it were half an hour ago, he would definitely help, but now because of the appearance of the 17-year-old girl, his ideas have changed.

The clinical manifestations of the two groups who did not want to do it were forced into a little girl by the god of death. On one side, hemolytic anemia was very serious, with hemoglobin even less than 40g. On the other side, brain stem bleeding, which was even more severe, and the severity was that it could die at any time.

If hemolytic anemia is caused by infection, what about brain stem bleeding?

This is a 17-year-old girl, not an elderly middle-aged man. She has no trauma, no hemangiomas and strange vascular malformations, no hypertension, no no

"etc!"

Qi Jing sat alone on the green isolation belt at the door of the emergency room, and various symptoms in his mind were flying randomly like pieces of paper that were blown open.

"It's still an infection"
Chapter completed!