I Can See Health

  Chapter 261 Sudden chest tightness

   "Am I not having a common cold?" the patient wondered.

  Lu Chen shook his head.

   "Pneumonia is very different from a cold. Most colds are also viral infections, but the infection site is generally limited to the nose and pharynx, which may cause discomfort such as runny nose, sneezing, and sore throat."

   "Once the infection enters the trachea, it is bronchitis. If it continues to penetrate further and violates the alveolar lung parenchyma, it is pneumonia."

   "In this respect, pneumonia is definitely much heavier than a cold."

   "What's more, if it's just a common cold, you will definitely not be hospitalized, and you will be admitted to our cardiology department."

   The patient nodded, indicating that he understood.

  Lu Chen asked a few more questions, all of which were routine medical histories, and the patients truthfully explained them.

   Such as no marriage, no children, no history of unclean sex, etc., and no infectious diseases such as hepatitis B and tuberculosis.

   Although there should be records in the medical records, Lu Chen asked again.

   Back to the doctor's office.

   Yin Xinhua immediately looked at Lu Chen and Fan Zhiping.

   "What is the patient's condition?"

  Lu Chen paused and said, "It is initially considered to be a delayed pneumonia. In addition, the patient's electrocardiogram has ST-T changes, which does not rule out the possibility of myocarditis."

   Such young patients are generally unlikely to have myocardial infarction, but myocarditis cannot be ruled out.

  Myocarditis is also easy to miss. It is like a cold, but it is much more serious than a cold. Blood must be drawn to test for myocardial enzymes and troponin to confirm the diagnosis.

   For patients with pneumonia and suspected myocarditis, the emergency department usually receives a cardiology department instead of a respiratory department.

   Cardiology department will definitely treat pneumonia, but respiratory department will not necessarily cure myocarditis.

   Therefore, this patient was admitted to the Cardiology Department in the emergency department.

Yin Xinhua nodded slightly, "I just looked at the medical records, and the diagnosis was a pulmonary infection, which does not rule out the possibility of myocarditis. The patient's myocardial enzymes are normal, and it is considered to be a pulmonary disease. We attach great importance to the diagnosis and treatment of pneumonia and cannot be trusted. Big, it might really be fatal."

   Pneumonia will not be cured without antibiotics.

  You must know that in the era of no antibiotics, pneumonia will kill people.

   We don’t feel scared to hear pneumonia now, that’s because we are used to the times when we have antibiotics.

   "The patient's examination has not been done yet." Lu Chen checked the patient's doctor's order.

   When the patient was admitted to the hospital, his body temperature was only low fever, which was not as high as it is now, so the receiving doctor did not perfect the chest CT examination.

   "Let's do a chest CT in the emergency department, and then do an abdominal CT as well." Yin Xinhua said, "Then check the blood culture and review the inflammatory indicators."

   Some patients who appear to be pneumonia may also have cholecystitis, appendicitis, and pancreatitis.

   In this case, it’s hard to explain, it’s hard to understand.

  Check is the most reliable.

  Your hands and your eyes are not necessarily reliable, don't rely too much on your own eyes, unless you really have sharp eyes.

  Lu Chen returned to the ward again and explained to the patient the necessity of these examinations.

   The patient was very cooperative and went out for an examination.

   The results of chest and abdomen CT came out, suggesting a little inflammation in both lungs.

   Among the indicators for the blood reexamination later, except for the high white blood cell count, the others were basically normal. The myocardial enzymes were re-examined again, and the myocardial enzymes were basically normal.

"Look, the problem should still be in the lungs, the possibility of myocarditis is very small." Yin Xinhua pointed to the lesions on the chest CT, "The patient may have had pneumonia more than ten days ago, but he has not paid attention to it. When treating a cold, Without antibiotics, that's not going to work."

  Lu Chen nodded, "I'm going to explain the condition to the patient."

  …

  Lu Chen came to the ward.

   "Then can I be discharged after a few days of anti-inflammatory injections?" the patient wondered.

Lu Chen paused and said, "It depends on the specific condition. A patient with pneumonia has chest tightness, and you must be alert to the possibility of developing severe pneumonia, so don't worry, take good care of yourself. In addition, we still have to be vigilant about the heart. If you are sick, it is good to run less."

"it is good."

   The patient was obedient. He had no family to accompany him, so he borrowed a power bank from the patient in the bed next to him, and then infused it with peace of mind.

   After dealing with the patient, Lu Chen and Fan Zhiping returned to the doctor's office.

  …

   Today's night shift seems to be extraordinarily quiet.

  Except for the 37-bed patient who has a fever, other patients in the ward are in stable condition.

Ten p.m.

   The lights in many of the wards went out.

  Yin Xinhua breathed a sigh of relief.

   She turned to look at Lu Chen and Fan Zhiping beside her.

  The two are discussing the knowledge of electrophysiology in full swing.

   "It seems that these two are not popular tonight?"

   As soon as this thought flashed through his mind, Yin Xinhua heard the cry of the nurse on duty from the nurse station.

   "Doctor Yin! 37 beds are sick! No way!"

   The nurse shouted several times in a row.

   "I really can't think about this!" Yin Xinhua's slightly relaxed heartstrings immediately tightened.

   picked up the stethoscope beside her hand, and immediately ran out of the office.

  Lu Chen and Fan Zhiping saw this and followed closely.

  …

   ran out of the doctor's office.

   As Lu Chen ran, a big question mark appeared in his heart.

   "The 37-bed patient is dying? But didn't he just have 68 HP?"

   "Even with severe pneumonia, how could he suddenly get sick?"

   With this question in mind, Lu Chen hurried into the ward.

   in the ward.

   The patient was panting heavily and sweating profusely.

   My eyes are almost blurred!

   "The patient suddenly became short of breath, and his entire face turned blue."

  The nurse on duty quickly reported the situation.

   Yin Xinhua is a battle-hardened attending doctor after all.

  Although the situation in front of her happened quickly, she responded very quickly. She immediately asked several nurses to help the patient breathe oxygen, and at the same time ordered Lu Chen to prepare tracheal intubation, ventilator and other equipment.

The    rescue kit was also pushed over.

  Yin Xinhua put the stethoscope close to the patient's chest.

   But at this time, the patient's breathing sounds were too chaotic, and with the sound of gasping for breath, no special changes could be heard at all.

   But one thing, Yin Xinhua is clear, the breath sounds of the patient's two lungs are basically symmetrical.

   This means that the patient should have no pneumothorax or atelectasis, which is critical.

  If the patient has tension pneumothorax, the patient will definitely be finished if he can't breathe.

   Watching the patient's lips turn purple.

   "What was the patient doing just now, and why is his condition getting worse so fast?" Yin Xinhua said to the two nurses on duty again.

   The two nurses on duty shook their heads, "There's nothing special, I've been here all the time, nothing else."

   came so suddenly that everyone couldn't understand the situation.

   Beside him, Lu Chen was ready for endotracheal intubation.

   had no choice, at this time the patient was severely hypoxic.

  Although the cause is not very clear, pulmonary embolism, pneumothorax, atelectasis, pericardial effusion, etc. still need to be considered.

   Auscultation is not like pneumothorax or atelectasis.

  The pericardial effusion cannot be heard, and the breath sounds are too loud, which especially affects the auscultation of the heart. We can only rely on echocardiography, but it is obviously not possible to do echocardiography now, and we must save your life first!

   (end of this chapter)