I Can See Health

   Chapter 208 Sudden Headache

  Summer slowly passed and the weather turned cooler.

   Walking on the path of the hospital, Lu Chen was in a happy mood.

   After coming to Jinghua, he not only joined the elite group of the Electrophysiology Association, but also won the first place in the National Medical Skills Competition. Next, he will give a speech at the Electrophysiology Academic Exchange Conference.

   More importantly, his clinical business capabilities are rapidly improving.

   Everything is going in a good direction at the moment.

  …

   came to the eight districts of the heart.

   Yin Xinhua, the superior doctor on duty, has not arrived yet.

  Lu Chen saw Fan Zhiping sitting in the doctor's office.

   "Brother Fan, why are you here?"

   Jinghua Second Hospital does not arrange night shifts for advanced doctors.

  Fan Zhiping was reading the doctor's order, and when he heard Lu Chen's words, he stood up and turned around and said, "I think you are on the night shift, so I thought of taking a look together."

  Lu Chen smiled and said nothing.

   Brother Fan is too active, he doesn't look like a training doctor at all.

   He has an apple in his bag, and the night shift should be fine tonight.

  …

  The night shift in the general ward of the Cardiology Department does not require admission of new patients.

   Patients who come at night will be admitted to the CCU ward.

   However, even if no new patients are admitted, the night shift in the cardiology ward is not very good.

  Because many heart failure patients experience changes in their condition during night shifts.

  At night, the human body is in a supine position, the return of blood to the heart increases, and the vagus nerve is excited, so it will induce a heart failure attack.

  Lu Chen turned on the doctor's order system, he needed to know about the seriously ill patients in the ward.

  …

   5:25pm.

   With five minutes left to take over, Yin Xinhua came to the ward.

   "You're here." Yin Xinhua looked at Lu Chen, and at the same time she noticed Fan Zhiping beside her.

  Good guy, the postgraduates are on duty with a deputy chief doctor for further study! !

   "Lu Chen, let's take a look at the critically ill patient." Yin Xinhua said, clearing his throat.

   "Okay." Lu Chen nodded.

   Fan Zhiping heard the words, stood up and followed closely.

   "2 beds, 11 beds, 16 beds, 18 beds, 25 beds, 31 beds... These are all patients who are seriously ill or critically ill. We must check the patients carefully and not be lazy."

  Yin Xinhua took Lu Chen and Fan Zhiping to see all the critically ill patients in the ward.

   It also includes heart transplants and patients with aortic dissection received in the Lu Chen group in the past two days.

   During the ward round, Lu Chen not only paid attention to the patient's life value, but also followed Yin Xinhua carefully and asked about the patient's specific situation.

   "Lu Chen, this is your first night shift. Let me tell you some things to pay attention to during night shifts."

   "First of all, all critically ill patients should be rounded to find out in time whether their condition has changed."

   "Secondly, take a look at the new patients who came today to prevent the day shift doctors from making mistakes."

   "Finally, pay attention to the content of the day shift doctor's shift, such as which test values ​​to pay attention to..."

   Yin Xinhua told Lu Chen all the precautions for the night shift.

  In addition to some hard requirements, there are also some experience.

  Lu Chen recorded them one by one. This is what he will do in the night shift in the future.

  …

"There are so many patients in big hospitals." Fan Zhiping sighed, "In our county hospital, there are only thirty patients in the entire ward. But you are also a little good, you don't have to admit patients at night, our county hospital does it every night. The patient can't sleep all night."

   "We may not be able to sleep here." Yin Xinhua pouted.

Once a patient in the    ward becomes ill, it will not be easy.

  Lu Chen has a calm expression, the **** of night shift will take care of him!

   "Brother Fan, why don't you go back to the dormitory in no time." Lu Chen looked at Fan Zhiping who was beside him, "If it's too late, it won't be easy to walk at night."

   "It doesn't matter, since I'm here, I definitely won't leave." Fan Zhiping said with a smile, "It has to have a beginning and an end, and I have nothing to do."

   I don't know what happened.

   Fan Zhiping had an intuition, as long as he followed Lu Chen's side, he could see some strange cases.

   "Alright then." Lu Chen said helplessly.

   It was the first time I saw someone who wanted to work night shifts.

   It was just that he felt a little awkward, no matter what Fan Zhiping said, he was also a deputy chief physician.

   Fan Zhiping stayed in the department, and Lu Chen couldn't even direct him to work!

  The fact that Fan Zhiping stayed in the department was not beneficial to Lu Chen at all, on the contrary, it was a bit of a hindrance.

  …

   7pm.

  The night shift has passed 2 hours, and the doctor's office in the eighth district is very calm.

  Lu Chen had nothing to do, so he started to look at some treatment guides.

  In actual clinical work, the knowledge in internal medicine books can no longer meet the needs.

   Many practical problems encountered in clinical practice need to be found in the guidelines.

  Familiar with various guidelines, this is the basic skill of a good clinician.

   But the good times don’t last long!

   Dong Haimeng, a night shift nurse, suddenly walked into the doctor's office.

   "Dr. Yin, the patient in bed 41 complained of a headache, you should go and have a look."

  Yin Xinhua glanced at Dong Haimeng and nodded: "Okay, I'll go right away."

   Having said that, Yin Xinhua did not get up.

   After Dong Haimeng left, she said to Lu Chen, "Lu Chen, go and see the 41st bed and see if he has any problems. If you can solve it, solve it for him. If you can't solve it, come back and tell me."

"Um."

  Lu Chen first read the patient's medical records.

   This is a patient with high blood pressure. He has long-term high blood pressure and is not controlled by regular medication.

   This time, I came to the hospital this afternoon because of high blood pressure and pain in the head.

   After understanding the basic condition.

  Lu Chen walked out of the doctor's office, took a blood pressure monitor, and came to bed 41.

   On the hospital bed, a male patient about 60 years old was sitting on the edge of the bed with a pained expression.

  Lu Chen looked at his health first—69.

   "Master, do you have a headache?" Lu Chen stepped forward.

   "Hmm." The patient nodded and pointed his right hand to his head.

  Lu Chen continued: "Does the pain hurt so bad? Is there any blur in your eyes?"

   "It hurts. Except for the headache, there is no other discomfort."

  Lu Chen immediately measured the patient's blood pressure, 180/110mmHg.

   "What antihypertensive drugs did you take?"

   "Nifedipine Sustained-Release Tablets."

On the side, a family member of the patient, a man in his 40s frowned and said, "The pain started at about 6 o'clock in the afternoon, and it is now 8 o'clock. "

   An elderly man in his 60s with a history of high blood pressure suddenly has a headache and the pain is still severe. In addition, the blood pressure is so high that the effect of taking medicine is not good. What is the most worried about?

   The biggest worry is cerebral hemorrhage or cerebral infarction, especially subarachnoid hemorrhage. Many patients with subarachnoid hemorrhage say that the headache is unbearable. (Subarachnoid hemorrhage is also a type of cerebral hemorrhage)

  Be aware that cerebral hemorrhage itself can cause high blood pressure, and such high blood pressure may in turn lead to cerebral hemorrhage!

  Although the patient's HP did not drop below 60, Lu Chen still performed a physical examination on the patient.

   Observe whether the corners of the mouth are skewed, whether the nasolabial fold is symmetrical, etc., and even ask the patient to stick out the tongue to see if it can be centered.

  If the patient has a cerebral hemorrhage or cerebral infarction on one side, the tongue sticks out to one side.

   In this patient, the tongue is centered, and there is no limb weakness or hemiplegia.

   Cerebral hemorrhage and cerebral infarction are temporarily excluded.

  …

   Back to the doctor's office.

  Lu Chen reported the patient's condition to Yin Xinhua.

  Yin Xinhua said after checking the patient, "Although there are no localization signs, the patient is so old and has high blood pressure for so many years, and suddenly he has a headache. It is definitely not such a simple headache."

After    consideration, Yin Xinhua decided to ask the patient to do a cranial CT.

  Be careful sailing for thousands of years, especially now that the doctor-patient relationship is tense.

  Yin Xinhua would rather do one more examination than miss a diagnosis, but this is life-threatening!

   Even if the signs are not like cerebral hemorrhage, the imaging results must be obtained.

   Before the CT, Yin Xinhua routinely asked Lu Chen to do an electrocardiogram, and the electrocardiogram results were not too problematic.

   "Take an antihypertensive pill first, after the blood pressure drops a little, go out in the cart to take a CT scan."

  Lu Chen asked the patient to take another nifedipine sustained-release tablet.

   The patient's family borrowed a wheelchair.

   "Lu Chen, let me accompany the patient for an examination." Fan Zhiping volunteered.

   But Lu Chen quickly waved his hand to refuse, "Brother Fan, let me go."

   Let a deputy chief physician accompany him to do the examination, no matter what.

  Lu Chen measured the patient's blood pressure again.

   The patient's blood pressure dropped to 160/90mmHg, and Lu Chen took him out for a CT scan.

  Because of time, the first CT was done, and the results came out soon.

  CT showed some brain atrophy and some lacunar cerebral infarction.

   Lacunar cerebral infarction is a cerebral infarction caused by the occlusion of very small blood vessels in the brain.

   Back to the doctor's office in the eight districts of the heart.

Yin Xinhua saw the CT results and frowned: "For elderly people with high blood pressure, if a CT scan is performed, they will have lacunar infarction more or less. It is enough to control blood pressure and blood sugar. May be the cause of this headache."

   The most important information of cranial CT is that no cerebral hemorrhage is found.

  Fan Zhiping said on the side: "Then the cause of the patient's headache is related to the increase in blood pressure. Lowering the blood pressure may improve it."

   "Well." Yin Xinhua nodded, "At present, the main reason for the headache is the sudden increase in blood pressure."

  Lu Chen lowered his head in thought, but did not speak.

   He felt that this patient was strange, but he couldn't tell exactly what was strange.

   At this time, the patient's family walked into the doctor's office.

   "Doctor, my dad feels a little tight in his chest and seems to be out of breath."

   What kind of review is the doctor doing? I went home at 9 o'clock this evening and wrote a chapter. I really can't bear it anymore. I will make it up tomorrow.

   (end of this chapter)