At the desk of the emergency department of the surgery, Yan Yunkai was grabbing the microphone and reporting his medical history to someone: "Is it Teacher Wang from the urology department? I am Yan Yunkai who is in an external emergency. I have an acute abdominal disease here."

The sound on the other side of the microphone was very soft: "What do you say?"

Yan Yunkai looked at the patient who was tossing and turning on the bed and enduring abdominal pain, recalled the physical examination he had just done, and said with certainty:

"I just did two abdominal percussions on the patient, with mobility voiced, plate-shaped abdomen, and the tenderness and rebound pain were obvious. The patient had drunk a lot of beer before, but after two hours, he still had no intention of peeing. I guess it was because of the bladder that had broken."

"How about vital signs?"

"All are very good, no signs of heavy bleeding."

The microphone pondered for a while, then said, "Okay, I'll come down and take a look."

After hanging up the phone, Yan Yunkai was waiting by the patient for a while, and he was relieved until the urology department took the person away. Yan Yunkai leaned against the back of the chair, looked up at the ceiling, and stretched his waist: This time bomb was sent away.

Of course, in addition to being grateful, his mind was more scared.

If Qi Jing did not help him with abdominal percussion and heard of mobility voice, he had to go around a big circle. He first looked for his general doctor, then differentiated diagnosis, and then discovered problems on the bladder, and finally contacted the urology department.

The process is correct, but it will take at least half an hour to remove it.

Although the urine is filled with organic matter and electrolytes, it is still quite dangerous to have a bladder rupture after all.

"I'll let this kid save me. I'll have to be more cautious next time. Be cautious and absolutely no accident..."

At the same time, the 16-year-old boy's cerebrospinal fluid report is still under test, but the hematuria electrolyte and liver function have already come out early.

The test papers are covered with various arrows that are up and down. Compared with the teenager's calm body and physical examination results, these report papers can only be described as amazing.

The body is as silent as a cicada, but the numbers in the test report are moving like rabbits, which is rare in clinical practice.

Creatine kinase increases, lactate dehydrogenase increases, blood sugar increases, blood potassium increases, blood calcium decreases, blood magnesium decreases, and carbon dioxide decreases.

After turning over the blood electrolytes and creatine kinase, and looking at liver function, both important enzymes are fine, and bilirubin only increases slightly, but the most important blood ammonia is significantly increased, which has exceeded 500!

Turn on the thrombin report again, the three lines are red, all of which are rising!

Wang Ting sat on the main seat in the emergency room and talked about these reports. Qi Jing, Ji Qing and another doctor were actively analyzing the condition.

"The liver function prompts are too big. There is a problem with thrombin and blood ammonia." Ji Qing said, "I think there is a possibility of hepatic encephalopathy."

"Now the patient is in a coma, the two important enzymes in the liver are fine, and we cannot make a judgment immediately."

Wang Ting took a sip of tea and looked at the report and asked, "Give some supportive treatment first, and wait for the cerebrospinal fluid report."

Qi Jing said too much at this time and asked Li Yuchuan: "Why are you watching when testing cerebrospinal fluid? What is the pressure?"

Li Yuchuan flipped through the case record book and said, "190, not very high."

Qi Jing shook his head helplessly. This patient was too complicated.

The person is in a coma, but the physical examination is completely normal. On the contrary, the blood report values ​​are outrageous, but there is not much correlation between them, and some are even inconsistent.

However, the more complicated the patient's condition is, the less clue it is, the more it can arouse his interest.

His style of conduct is different from other doctors. As long as his thinking is not in a dead end, he will not wait for the inspection report.

Now that there are so many clues on hand, it would be a pity not to analyze them. Qi Jing selected four obvious abnormal data from a large number of abnormal reports: "Creatine kinase, blood sugar, blood potassium, and blood ammonia. These four increases can indicate that there is a large amount of muscle necrosis and dissolution."

"But the electrocardiogram is good, and I didn't say that the child has a myocardial infarction." Another doctor explained.

"Why do you always think of myocardial infarction? You are only 16 years old!"

"Are you talking about rhabdomyolysis?" Wang Ting thought about it and immediately contacted a possibility. "There will definitely be a problem with rhabdomyolysis urine, and urine tests are mostly normal."

"No, don't care about the muscle itself. The muscles are also cells. What if the cells are destroyed?" Qi Jing explained, "There are mitochondria in the cells, and maybe the mitochondria will also be destroyed."

Ji Qing recalled some of the metabolic processes mentioned in biochemistry, which all need to be completed through mitochondria.

He sorted out his thoughts in his mind and said tentatively: "Because the mitochondria are destroyed, the ammonia after protein metabolism cannot be converted into urea, so the blood ammonia increases?"

"right!"

"Where is the fat?"

"Fat is better explained." Ji Qing said instead of Qi Jing, "Because fat cannot be oxidized and metabolized, it accumulates in the liver in large quantities, and liver function will be abnormal in the long run."

"Does it have to be called to the gastroenterology department to take a look?"

Qi Jing sighed: "Actually, I don't know which department to call to see."

"What does this mean?"

Wang Ting took a sip of tea and his face looked bad: "Do you say he has reye syndrome?"

After all, the chief director is different from two newbies, with a broad vision and broad knowledge. After Qi Jing mentioned a few characteristics of the disease, Wang Ting had already found the answer in his mind.

Reye syndrome is very rare, mostly occur in children and belongs to the pediatric category. However, this patient is over 14 years old, with multiple organs involved, and the symptoms are not typical, so it is difficult to define which department to belong to.

The causes of the disease are diverse, and various viral infections, salicylic acid stimulators, and even various mild toxins may destroy children's tissue cells.

The subsequent process is the same as Qi Jing and the others analyzed. Mitochondria are destroyed and the metabolic paths of various substances are blocked.

In the end, all substances cannot be absorbed or metabolized, and accumulate in the body, which will cause serious damage to the liver and brain.

Wang Ting pondered for a long time, looked back and forth three or four times, and finally shook his head: "There are still many doubts. Reye syndrome has a large number of tissue cells destroyed. If so many cell fragments are produced, the scavenger white blood cells in the blood will definitely increase, but the child's white blood cells are normal."

"And you have to know that sugar metabolism is different from the other two. If there is a problem with sugar metabolism, blood sugar will not rise but fall."

"Of course I know this." Qi Jing argued, "but if the cells are destroyed in large quantities, the sugar inside can also be slightly increased."

Although Wang Ting had already followed his thoughts, he still took another fork when he was making a judgment: "The patient didn't eat for most of the day, and his blood sugar should have dropped. Your explanation is too far-fetched."

"But there are various conflicts everywhere in these reports, and it is not a solution to wait."

"The two enzymes in the liver have not increased either."

"The patient is young and has been using his liver for 16 years and is still 80% new. He can always get over it for a few more days."

Wang Ting naturally knew what Qi Jing meant, but he couldn't make this decision: "I'd better wait first, wait for the cerebrospinal fluid report, and then do mri."

"Director! The patient is already in a coma! From the report, it is a mental symptoms caused by elevated blood ammonia, and there will be no problem with cerebrospinal fluid."

"Boy, this is not your father's dean's office. I'll have the final say in the emergency!"

Wang Ting slapped his palm at the table and shook the lid of his beloved teapot, which scared the two interns involuntarily dodged backwards.

The entire clinic was silent. After a while, he sighed before saying, "Forget it, go and call digestion, and let the endocrine and Shennei come to consult together."

Ji Qing picked up the phone and suddenly thought of something. She smiled at him awkwardly: "Teacher Wang..."

"What's wrong? He was talking hesitant."

"Today, I called a hospital-wide consultation again outside my chest, and several senior directors were called away again."

After hearing this, Wang Ting's anger surged, his forehead bulged, and his hands shaking while holding the report sheet: "Okay, Xiong Yong, I didn't call me twice during the consultation, I clearly looked down on our emergency department!"

"This will be open for an afternoon, and I don't know when it will end."
Chapter completed!