I Can See Health

   Chapter 264 Vein

  Lu Chen glanced at the patient's elbow, calmed down, and pondered: "This may not be a rash!"

   "Not a rash?" The nurse on duty frowned.

  Lu Chen leaned over and continued: "Look carefully, this may be a pinhole! Some of the pinholes are a little infected, so they appear like a rash."

   When these words came out, everyone was stunned.

  Li Qinghua was also surprised.

   He leaned forward and took a closer look.

   is really a pinhole, densely packed, just near the patient's left arm and cubital vein.

   "The patient's right hand also has a lot of rashes like this, it's really a pinhole!" The nurse on duty opened the patient's right sleeve again.

   She was changing the patient's gown when she found these details.

   "If it's really a pinhole, then it's incredible." Lu Chen frowned and said slowly.

  Li Qinghua also nodded in agreement: "Well, then the thrombolysis can't be done."

   At this moment, Yin Xinhua walked into the ward, heard the conversation between the two, and asked, "Why can't thrombolysis be done again?"

  Li Qinghua paused, looked around, the patient's family was not there, so he said slowly.

   "He is most likely a drug addict."

  Lu Chen also agrees with Li Qinghua's point of view.

   With so many pinholes in the body, there is only one possibility, and that is drug addiction!

   When the nurse on duty heard this, she immediately loosened the quilt on her hand and hurriedly washed her hands and changed her gloves.

  Lu Chencai exposed the patient's pinhole to Yin Xinhua.

  Yin Xinhua looked surprised.

Seeing this, Li Qinghua immediately said: "You don't have to be too afraid, just take personal protective measures. If he is really a drug addict, then there may be STDs or AIDS, etc., but this possibility is not high. Be careful. Just fine."

   After finishing speaking, Li Qinghua looked at Yin Xinhua and Lu Chen on the side, "So I think the patient may not be an ordinary pulmonary embolism!"

   "Well, at least it's probably not pulmonary thromboembolism." Lu Chen nodded slightly.

Li Qinghua continued: "If the patient is really a drug addict, then the fever may be related to the infection caused by this. There was a similar case in our CCU the year before last. Infectious endocarditis occurred in drug addicts, causing long-term Fever. Infective endocarditis will have cardiac vegetations, and if there are vegetations in the right heart, once it falls off, it may also cause pulmonary embolism.”

  If the patient is really infective endocarditis, then the sloughed emboli are bacterial clumps and tissue.

  This is not a blood clot, so there is no need for thrombolysis!

  Thrombolytic drugs are aimed at thrombus and do not help bacterial clumps and tissue clumps. At this time, thrombolysis does more harm than good.

  Although this possibility is very small, it makes sense and can also explain the symptoms that the patient is currently experiencing.

Yin Xinhua frowned and said, "But Lu Chen and I have both auscultated the patient's heart and did not hear any obvious heart murmur. If the patient really has such obvious cardiac growths, they should be able to hear a murmur. "

  Li Qinghua shook his head and said solemnly, "That's not necessarily true!"

   "First of all, the vegetations are not necessarily very large, and the patient was breathing so rapidly at the time that the auscultation was easily disturbed."

   "Let's call the color Doppler ultrasound teachers over and let them see the heart. After all, we don't have their majors, they might be able to see heart growths and pulmonary emboli."

  Yin Xinhua nodded: "Now we have to wait for the teacher from the cardiac ultrasound room to come."

  Lu Chen took a portable ultrasound machine and looked at the patient's heart several times, but he still couldn't see any cardiac growths or pulmonary emboli.

  No way, his Cardiac Ultrasound Skill Card is only rudimentary.

   After learning about the patient's condition, Yin Xinhua immediately called his family and sister over.

   "The pinhole on his elbow, you know? Does he have any bad habits..."

   The patient's sister was so stunned that she almost yelled at her.

   "How could my brother be on drugs!"

  Yin Xinhua comforted the patient's family: "We are just suspicious, whether there is any drug abuse that can be detected, and also ask if you understand."

   The patient's sister did not speak, and kept tugging at the cuffs of her clothes with both hands.

   After being silent for a long time, she continued: "Actually, our sister and brother haven't seen each other for more than half a year. It was absolutely impossible for him to take drugs before, and now I can't guarantee it."

  Can't guarantee now?

   As soon as these words came out, Lu Chen, Yin Xinhua and Li Qinghua looked at each other.

   They found that the patient's sister looked a little panicked.

Li Qinghua said: "Is it a drug addiction? Find a laboratory or a testing institution outside the hospital to do a toxicology test, and use the patient's head to send the test. Generally, drug users can be found within half a year. And your brother has both arms out. It's all pinholes, and we have reason to doubt that."

   When the patient's sister heard this, she almost collapsed on the ground, with a hint of crying in her voice.

   "My eldest brother is a drug addict, but my brother doesn't... Doctor, I beg you to cure my brother..."

   Seeing this scene, Li Qinghua whispered to Yin Xinhua: "The patient should be a drug addict."

   Yin Xinhua nodded calmly.

  …

   At this time, the doctor in the ultrasound room that everyone has been waiting for is finally here!

  The ultrasound doctor held the probe and carefully looked at the patient's heart several times.

   "It's really a pulmonary embolism!"

  Lu Chen and others immediately stepped forward.

  The ultrasound doctor pointed to a place on the screen.

   "Look, there is an embolus in the pulmonary artery. Although it is not obvious, it exists, and there is a growth on his right heart valve. You really guessed it!"

   When Lu Chen heard this, he was completely relieved, and his back was slightly cold.

   Really dangerous!

   If the thrombolysis is performed directly, the consequences will be disastrous!

   "In this case, the embolus should be a bacterial mass, not a thrombus." Yin Xinhua repeated.

  Li Qinghua nodded, and at the same time ordered: "Keep blood for culture, monitor body temperature, and use the strongest vancomycin, which is not thrombolytic."

   If the patient is really an intravenous drug user, then the infective endocarditis that occurred this time is likely to be related to intravenous drug use.

  The most likely bacteria to be infected is Staphylococcus aureus, because this bacteria is most abundant in the skin and may be infected at any time due to needle eyes.

   This Staphylococcus aureus may or may not be resistant.

   But the patient ran out of time and had to cover it with the strongest vancomycin.

  Vancomycin is a special class of antibiotics.

   An application must be submitted for this special class of antibiotics.

   However, this is an emergency emergency.

  Li Qinghua skipped the application and used vancomycin directly.

   Soon, the nurse brought vancomycin from the pharmacy and gave it to the patient.

  …

   Li Qinghua and the doctor in the ultrasound room left.

   Lu Chen and Yin Xinhua looked at each other with lingering fears.

   It's almost twelve o'clock in the evening.

  Yin Xinhua has invited consultations from multiple disciplines, including ICU, respiratory department, ultrasound department and CCU.

   After a comprehensive consultation of so many disciplines, the correct conclusion was finally reached.

   This patient has pits everywhere.

   A little carelessness will cause trouble!

   On the other hand, ICU and respiratory doctors heard that pulmonary embolism was caused by infective endocarditis in intravenous drug addicts.

   They couldn't believe it at first, but they came to the eight areas of the heart, and they were convinced when they saw the patient's arms were densely packed with pinholes.

   "Damn it, it's rare to see drug addicts these days. Drug dealers should really kill the whole family!"

  The ICU doctor muttered, and then left the eight areas in his heart.

   (end of this chapter)