Chapter 57: Blizzard Conquest, Have You Seen It Before (Leader added an update that day)
Lin Yuming stared blankly at the image.
The director of the Ct room was also stunned. He quickly looked through the patient's medical records and looked for the course of the disease.
The diagnosis was correct, it was indeed pulmonary embolism, but what about the embolus? Where is the image of the embolus?
In the images, there are no emboli at all, but the lungs show a strange characteristic.
Lin Yuming felt like he had seen this kind of image somewhere, but he couldn't remember it for a while.
"Director Lin, this is a typical blizzard-like shadow. Judging from the images, it is also considered that the load on the right heart has increased. It should be fat embolism, yes." Luo Hao said with certainty.
"Blizzard Shadow?"
"There is no time to explain, let's go back as soon as possible." Luo Hao urged, "If the nurse sees that the infusion valve is closed and opens it to give the patient thrombolysis, it will be fucked. "
"Yeah, yeah." Lin Yuming had no idea for a moment.
On one side was Luo Hao, on the other was an expert from the Second Hospital of the Medical University. Who should I listen to when they had conflicting opinions?
It must be Luo Hao.
Lin Yuming had great confidence in Luo Hao from some unknown time. Even though he was facing an expert from the Second Hospital of the Medical University, he only hesitated slightly before voting for Luo Hao. .
"Go and convince the experts from the Second Hospital of the Medical University." Lin Yuming assigned Luo Hao a task.
Luo Hao ran to the ward without looking back, "Director Lin, call Corey and tell him that the film is out!"
The hurried sounds echoed in the corridor of the CT room, full of the rhythm of emergency rescue.
Lin Yuming smiled.
This hurried look makes him look like a young man.
Always full of energy, always full of enthusiasm.
He reserved 1 minute for Luo Hao. When the time came, he called Dean Qiu Bo.
"What? Didn't you see the bolt? Director Lin, are you sure?" Dean Li was surprised when he heard the news.
But half of his surprise was false.
Essentially speaking, Dean Li Qiubo, like Lin Yuming, trusted the young Luo Hao more than the expert from the Second Hospital of the Medical University.
After learning the news, Li Qiubo finally breathed a sigh of relief.
"What? There is no embolus? Bring up the image and let me see." Professor Chu said seriously.
"Now, please wait."
The director of orthopedics began to refresh the interface, and soon the 64-row CT image appeared on the screen.
The patient's laboratory test report showed elevated dimers, and blood gas analysis showed that the partial pressure of oxygen was only 55 mmHg and the partial pressure of carbon dioxide was 28 mmHg under oxygen inhalation.
The diagnosis of hypoxemia, hyperventilation, and type 1 respiratory failure are all consistent with the symptoms of pulmonary embolism. Everything seems to be in order, and we are waiting for the results of CTA.
However, when the results of the CTA appeared in front of them, the experts from the Second Hospital of the Medical University were stunned.
In the image, no emboli appear.
Damn it, where is the damn bolt! !
Suddenly, not only Professor Chu, but also the director of the Department of Orthopedics was dumbfounded. Could it be that it was not a pulmonary embolism? !
It’s impossible. The patient has difficulty breathing and is in coma. It’s not a pulmonary embolism or something!
Looking at the image in a daze, Professor Chu even began to search manually frame by frame.
"Teacher Chu, the patient does not have pulmonary embolism."
A cheerful and sunny voice appeared behind him.
Professor Chu did not look back. He was focused on searching for the emboli of pulmonary embolism, forgetting that he was no longer in the Second Hospital of the Medical University after traveling so long, but in the Mining General Hospital of Donglian City.
As if attending a hospital-wide consultation in the Second Hospital of the Medical University, Professor Chu heard his colleagues express different opinions.
“It may also be that the embolized artery is relatively small and the CTA cannot be seen or is difficult to see at a glance.”
Professor Chu explained.
“If this is the case, it can explain the results of the 64-slice CTA and also explain the patient’s symptoms of dyspnea. But there is one thing that cannot be explained – why the patient became unconscious and comatose.”< br>
"That's because..."
Professor Chu racked his brains to think about it, but he couldn't find an explanation for Luo Hao's problem at all in his knowledge reserve.
"The patient's immobilization after surgery is a common high-risk factor for pulmonary embolism, but the patient's examination results are not consistent. Considering that the patient has a long bone fracture, the existence of fat embolism syndrome should also be noted."
"Fat embolism? What evidence do you have?" Professor Chu asked.
“Look at the X-ray plain film of the 64-slice CTA.”
Angiography comes with X-ray plain film, but almost no one looks at it. Who would look at rough flat films when there are more detailed and accurate images?
Professor Chu was about to retort, but he hesitated when he saw the blurry pneumonia image on the CT scan.
“What are you considering?” Professor Chu asked.
"Pulmonary blizzard sign."
"!!!"
Professor Chu quickly exited the frame-by-frame search state and found the x-ray film.
The patient’s pulmonary blizzard sign was extremely obvious, and the blizzard sign is a typical image of fat embolism.
“It’s really a fat embolism.” Professor Chu murmured.
"The patient's skin all over his body, mainly on the inner thighs on both sides, has needle-like bleeding points." Luo Hao continued, "This is also the main reason for judging fat embolism."
"Pulmonary embolism can induce ARDS. It is life-threatening. Fat embolism generally manifests as local embolization areas, bleeding, exudation, interstitial edema, and difficulty in gas exchange, while the symptoms of ARDS are more obvious pulmonary changes."
" The urine drawn from the patient's urine bag showed signs of slight fatty urine."
Luo Hao stated all the key signs he observed.
Professor Chu tried hard to recall the physical examination. He was a little confused. He really didn’t notice the pinprick-like bleeding spots.
Even if I recall it now, I still have no impression.
The office suddenly fell into dead silence.
"Dean Li, can your little doctor not interfere with the expert consultation!" Secretary Chu, wearing glasses, said to Dean Li very unhappily.
He did not lower his voice when speaking, and did not hide his dissatisfaction with Luo Hao at all.
Dean Li smiled apologetically, but said nothing. He just scratched his head.
"Keep your voice down." Professor Chu glanced at the man with glasses unhappily, and then murmured to himself, "It seems to be a fat embolism."
Suddenly his body paused, "Not good. The patient is still being given thrombolytic drugs!”
“I’m going to stop the thrombolytic drugs right now” Luo Hao trotted out of the doctor’s office.
"Who is he?" Professor Chu asked looking at Luo Hao's back.
"Ronald Luo is a doctor who graduated from the eight-year program of Xiehe University with a bachelor's, master's and doctoral degree. He is considered a treasure in our hospital." Director Li judged the situation clearly and explained with a smile, "After he came back, Director Lin and I took care of him. He was placed in the medical office.”
"Medical Office? Why didn't you go to the clinic?"
"In the Medical Office, I preside over the hospital-wide consultation work. Dr. Luo has diagnosed many difficult and complicated diseases over the years and has done practical things for the people of Donglian City."< br>
Dean Li's next words were spoken in perfect detail. He had already known them by heart. He had refined them during meetings. There were absolutely no mistakes, but they were also of little practical significance.
No one cared what he said, it was just background music.
Xiehe graduated from the undergraduate, master’s and doctoral programs in eight years, which is a well-known golden sign.
Not knowing what he thought of, Professor Chu sighed and continued studying the film.
Typical blizzard sign in both lungs. I didn’t see the blood clot just now, so I ignored it.
Professor Chu felt a little ashamed and blushed.
He tried hard to watch the film, not wanting anyone to see his blushing embarrassment.
Suddenly Professor Chu remembered something, he stood up in a hurry and strode out.
"Professor Chu!" Dean Li didn't know what was going on and walked out quickly.
“I’m going to have a physical examination to see the pinprick-like bleeding spots on the patient’s body.”
Acupuncture-like bleeding spots!
Except for Secretary Chu, everyone present was an old doctor. Luo Hao said there were pinprick-like bleeding spots, but no one noticed them during the physical examination.
Dean Li was also curious. He briefly explained to Secretary Chu and followed to see the patient.
Luo Hao came out with a micropump and bumped heads with Professor Chu.
Dodge slightly, Luo Hao made way for Professor Chu.
Professor Chu glanced at Luo Hao and felt something was wrong, but he couldn't tell what was wrong.
Without thinking about it, Professor Chu entered the ward to see the patient.
Sure enough, there were many pinprick-like bleeding spots scattered on the patient's body.
This kind of bleeding spots are very small and fine, and you won't notice them at all if you don't distinguish them carefully.
Although as Luo Hao said, the patient had more bleeding spots on the inner thighs on both sides, they were definitely not eye-catching.
Professor Chu looked at the bleeding spots in a daze.
Dean Li followed him in, looked at it for a long time, and then asked doubtfully, "Professor Chu, is this it?"
He pointed to the bleeding spot on the inner thigh that was not obvious and asked. road.
"Yes." Professor Chu nodded, "The pinprick-like bleeding points caused by fat embolism syndrome."
"That is..."
"It refers to blood vessels with a diameter of 10-40 microns. Internal, a syndrome of a series of pathological changes caused by fat particles blocking the lumen of blood vessels. It often occurs in severe trauma, fractures, especially long-term injuries. Bone fractures. ”
“Severe symptoms occur within approximately 24-48 hours—characterized by impaired consciousness, progressive hypoxemia, dyspnea, and skin ecchymosis. < br>
Clinical manifestations vary greatly and are often complicated by shock, craniocerebral trauma, pulmonary contusion, etc. ”
Professor Chu explained the knowledge points related to fat embolism as if giving a lecture to students.
The eyes of the patient’s family members shined when they heard this. At this moment, Professor Chu was as professional as a god descending from heaven, and everyone had hope for the patient’s recovery.
"So that's it." When Dean Li saw that Professor Chu also agreed with Luo Hao's diagnosis, he gradually had an idea in his mind. When the stone fell to the ground, he took advantage of the situation and praised it.
"Professor Chu, is it important?" Dean Li asked.
“During a fracture, the fat cell core venous sinus ruptures, fat enters the venous circulation as hematoma content, spongy bone particles and larger fat droplets block the smallest pulmonary blood vessel branches, while small fat droplets can pass through Prepulmonary capillaries bypass and enter the pulmonary veins.”
Professor Chu did not answer Dean Li's question, but whispered to himself.
He has a problem, that is, when encountering big problems, he will say whatever he thinks in his heart.
This is not a big problem, it is innocuous, and at most it is a slanderous comment.
“The toxic effect of fat particles can lead to direct damage to lung endothelial cells, nuclei and pneumocytes.
On this basis, capillaries leak, perivascular appearance, platelet adhesion and blood clot formation .
Chemical pneumonia is characterized by pulmonary edema, hemorrhage, atelectasis and fibrin deposition. Since the emboli are hydrolyzed, mechanical infarction of the lungs is no longer the main problem.
The patient then develops an imbalance in the ratio of pulmonary ventilation/blood flow and gas diffusion disorder, eventually leading to hypoxemia and respiratory distress syndrome. "
Professor Chu was long-winded, and then his voice rose.
"Prepare...how much does the patient weigh? "Professor Chu asked.
"180 pounds. "A worker replied.
Professor Chu began to do mental arithmetic.
“30mg/kg, 2700mg…”
He quickly calculated the answer and asked the nurse to prepare the medicine and give methylprednisolone shock treatment. "Dean Li, does your hospital have a hyperbaric oxygen chamber?"
"Yes, there is, but it is in disrepair and can barely be used."
"As long as it works, give methylprednisolone first, and then treat the symptoms. When the patient's condition improves, send him to a hyperbaric oxygen chamber as soon as possible."
With an accurate diagnosis, a series of related treatments are a matter of course.
Methylprednisolone entered the patient's veins with the micropump. In less than 40 minutes, the dyspnea improved significantly and the blood oxygen saturation gradually returned to about 92%.
After another hour, the patient regained consciousness.
Although the coma has only ended and the person can only open his eyes and cannot speak for the time being, this is enough for the doctor.
Various neurological examinations also improved.
Everything proves that the diagnosis and treatment are correct.
As the patient regained consciousness and his blood oxygen saturation increased, everyone present breathed a sigh of relief.
Professor Chu wanted to say a few words to Luo Hao. He thought this young man was indeed very good.
But as soon as he thought about himself entering the house, he was fierce to Luo Hao. He was a little embarrassed and blamed himself.
Soon Secretary Chu reported the matter to the leaders of the mining area. They knew that the patient's condition was stable and his life was not serious, and they were extremely happy to come and see the patient.
The ward became lively.
Luo Hao found a corner to stay and did not go up to join in the fun.
When the leaders of the mining area enthusiastically invited Professor Chu to have dinner, Lin Yuming gave Luo Hao a look.
The two communicated silently, and Lin Yuming knew that Luo Hao did not want to go and wanted to take care of the patient.
That's okay. Although the patient is temporarily out of danger, who knows what else will happen.
After all, it is fat embolism. Even if the severity is less than pulmonary embolism, it is still a serious and critical condition.
It would be safer to keep Luo Hao.
Otherwise, champagne would have been opened at halftime, while the patient on the other side was eating and drinking, and the patient on the other side would have an unexpected respiratory and circulatory arrest, and there would be no room to cry.
After everyone left, the ward finally became quiet.
The anxious group of people just went to eat with smiles, Luo Hao simply moved a stool to the ward, sat beside the patient's bed and looked at the monitor.
The patient's condition was stable, his blood oxygen saturation was slowly rising, and his dyspnea symptoms improved rapidly under the impact of methylprednisolone.
These are changes visible to the naked eye.
Luo Hao reviewed the mission for a while. Although the patient was diagnosed clearly and treated promptly, there was little progress in the mission.
Forget it, don’t think about it for now.
Taking out his mobile phone, Luo Hao sent a message to Chen Yong and called him to the 4th Ward of Orthopedics.
Soon, Chen Yong came over, and Luo Hao heard him laughing and joking with the orthopedic nurse on duty in the corridor.
Although it was a little bit uncomfortable at first, you get used to it.
Luo Hao does not force himself, and has never thought of making Chen Yong look like him.
Three minutes later, Chen Yongcai entered the ward wearing a mask with eyes filled with peach blossoms.
"Luo Hao, do you have a problem with me?" Chen Yong asked.
He spoke very harshly to Luo Hao, with a hint of impatience, and was not as gentle as he spoke to the nurse.
"The patient's diagnosis is fat embolism. Take a look at the pinprick-like bleeding spots." Luo Hao sat on a stool with his back against the wall of the ward.
“…”
Chen Yong was stunned for a moment, but he was neither stupid nor stupid. He immediately knew that Luo Hao wanted him to have more clinical experience.
Although the correct diagnosis of fat embolism is not of great significance to general surgeons, who knows when it will be useful.
Chen Yong carefully observed the needle-prick-like bleeding spots under the skin and asked several questions, which Luo Hao answered one by one.
Then Luo Hao asked Chen Yong to bring over the X-ray machine and take a bedside chest X-ray for the patient.
When the film was developed, the blizzard sign in the patient's lungs had disappeared.
An hour later, when I was filming again, there was another blizzard sign.
However, Luo Hao did not continue to explain why this situation occurred, but asked Chen Yong to go back to reading.
……
……
Everyone was full of food and wine.
Professor Chu has listened to countless compliments, but he knows in his heart that if the young doctor from the mine manager hadn't been there, it wouldn't be certain how the patient would be doing now.
On the way back, Professor Chu insisted on sharing a car with Lin Yuming. After getting in the car, Professor Chu asked, "Director Lin, is Dr. Luo your nephew?"
"Yes." Lin Yuming nodded proudly while driving.
He knew very well that Professor Chu took his car to inquire about Luo Hao.
Luo Hao has made himself look bad recently. He was deported to Qianhe County after Wen Youren reported his real name. Now that the clinical director sees him, he is afraid +3.
Even the experts from the Second Hospital of the Medical University who were invited to put out the fire were interested in Luo Hao.
Little guy, it's really good.
"Ordinarily, the doctor who came back from Xiehe would be in the mine manager...I'm not saying that the mine manager is not good, I mean at least he should be given a deputy director, otherwise why would he come back?"
"Is he my nephew?" Lin Yuming said the word nephew particularly loudly.
“He saw that I had a lot of difficulties, especially when it came to difficult and complicated diseases. If they were not handled well, major medical disputes would arise, so he stayed at the medical office and was responsible for consultations throughout the hospital.”
"Those who are good at fighting have no great achievements. This is an important position, but it is difficult for outsiders to know the importance. But it has no reputation and no development, which is a bit of a delay for young people." Professor Chu said seriously.
"Hey, he is my nephew."
Lin Yuming became more and more proud.
When he mentioned Luo Hao, he slowly felt proud in his heart. He was my nephew. This thought reverberated in his mind.
Professor Chu could hear the pride in Lin Yuming's words, and then he thought about how great it would be if he had such a nephew.
It would be great if he were my nephew.
"Dr. Luo is really good." Professor Chu said with envy. "To be honest, I didn't realize it was fat embolism at the time. His diagnosis was correct."
"Professor Chu is being polite, but in fact we know better. , Luo Hao just looked at the patient twice before you did. If you were given more time, the misdiagnosis wouldn't be possible."
Although he was proud, Lin Yuming did not lose Professor Chu's face.
This is true. Professor Chu has a good impression of Lin Yuming.
He intentionally or unintentionally inquired about Luo Hao, but Director Lin concealed everything and was unclear.
Is this all a secret? Professor Chu was a little helpless.
The leadership of the mining area has gone back, and Dean Li also had a few drinks and went home. He was originally going to send Professor Chu to the hotel to rest, and he would wait until the patient was stable before returning to the provincial capital tomorrow.
But Professor Chu was worried and asked Lin Yuming to drive to the hospital for another look on the way.
Arrived at the hospital, Professor Chu entered the ward and saw Luo Hao sitting in front of the patient's bed, holding a folder in his hand. The A4 paper on the folder recorded dense numbers.
"Dr. Xiao Luo, you have been taking care of the patients." Professor Chu saw Luo Hao's serious look, and his affection for him suddenly exploded.
"Teacher Chu, you are back." Luo Hao immediately stood up and began to "report" the changes in the patient's vital signs and the values of the laboratory tests during this period.
Professor Chu noticed that Luo Hao did not read the numbers on the paper, and was even more surprised.
When Luo Hao finished his report, Professor Chu's cell phone rang.
He took out his phone and saw a video.
Close.
But before Professor Chu put the phone away, the video came on again.
Professor Chu was a little irritated, but had no choice but to pick up the video.
"I'm at the Donglian Mine General Clinic. I'll tell you what I need later." Professor Chu scolded directly in a deep voice.
"Boss, junior sister's mouse died again. She couldn't stop crying. We are worried..."
Lin Yuming was startled.
Junior sister’s mouse?
What is that?
Professor Chu is having a lot of fun.
But it seemed that he had thought wrong. Lin Yuming tried hard to change his thinking to the normal track.
“I’m having a consultation...”
Professor Chu was just about to lose his temper when a heartbroken cry came from the video.
"Teacher Chu, is it the guinea pig used in drug testing that died?" Luo Hao asked.
"Yes."
"You see the patient, can I talk to your students?" Luo Hao asked with a smile.
Professor Chu didn’t think much and threw this “trouble” to Luo Hao.
Luo Hao walked out of the ward with his cell phone.
The ward suddenly became quiet.
Professor Chu breathed a sigh of relief, picked up the A4 paper on which Luo Hao wrote the values, and read again what Luo Hao reported just now.
Young people should have a good memory. When I was young, my phone number book was empty and I could remember all the phone numbers.
As Professor Chu watched, he explained to himself in his mind.
The patient's recovery is indeed good, the medicine is suitable for the symptoms, and the vital signs are no longer on the edge of life and death. It seems that there should be no problem.
A few minutes later, Professor Chu left the ward with satisfaction.
He was very satisfied with the emergency treatment of this patient. Although he did not make the initial diagnosis by himself, he did make various emergency medical instructions.
The patient can recover smoothly, and I have at least 80... no, 70... no, 50% of the credit.
"Director Lin, Dr. Xiao Luo is really good." Professor Chu thought of Luo Hao helping him to deal with his students, and praised with a smile, "High level, serious and responsible."
"He has obsessive-compulsive disorder." Director Lin explained. "Originally, there was no need to sit on the bedside to see the patient, but Luo Hao said that he felt uneasy going elsewhere, so it was better to sit on the bedside."
" Hahaha." Professor Chu smiled knowingly.
"It's okay when there are few patients. Once there are more patients, how can we handle it? You think so."
"Dr. Xiao Luo is still young, wait and see It’ll be fine in a few years.”
As they spoke, the two returned to the doctor’s office.
The door was not closed, and Professor Chu's pupils suddenly shrank sharply, as if looking directly at the sun.
Lin Yuming was also stunned and looked at Luo Hao in the office blankly.
(End of this chapter)