Since 1981 Health School Chapter 521

  Yi Zewen was very happy sitting in the front seat of the emergency van.

  Before leaving the car, he was still a little nervous. The patients who have to be picked up by the first aid are so serious. Maybe the heartbeat and breathing have stopped, and he has to press all the way back to the hospital.

   In the end, nothing happened, just a fall, at most a concussion or something, these are minor problems.

  So Section Chief Yi, who was in a good mood, was still in the mood to joke with the driver, but his joy turned into sadness.

  The car was still driving halfway, Bai Xue fainted again and lost consciousness.

  At the beginning, the nurse with the car found that Bai Xue was not in the right state. She felt that she was in a daze, and thought she was motion sick, so she didn't care.

   As a result, who knew that Bai Xue started to twitch again without saying a word, and Manager Xie was so frightened that she yelled, and the little nurse had no response to calling Bai Xue at this time.

  Yi Zewen saw that the spirit of this posture was gone, and after parking the car, he rolled and crawled into the compartment. He felt his body temperature was still there, his breathing was still there, and his heartbeat was normal, so he was greatly relieved.

   As long as he didn't die, and there was the miraculous Dean Chen in the hospital, he wouldn't worry about anything.

   "Old Yu, hurry up, the patient's condition is not right and needs to be rescued immediately."

  When the driver, Old Yu, heard this, he stepped on the accelerator to the end, and the ambulance rushed into the People's Hospital at a high speed, and rushed all the way to the door of the emergency room.

  Chen Qi and the others had heard the loud sirens of the ambulance a long time ago, and they were already waiting at the door pushing the emergency bed.

   Seeing that the patient had fainted and convulsed, the little doctors and nurses who participated in the rescue for the first time became nervous.

  Chen Qi became serious when he saw the patient arrived, and asked:

   "What's the patient's condition?"

  "The patient is a 22-year-old female. One hour ago, due to an unknown cause, she suddenly fainted and lost consciousness, mixed with convulsions. According to colleagues, the patient had a history of head trauma a week ago, but there was no coma and vomiting at that time."

  Chen Qi deliberately wanted to treat this first patient as a textbook-like demonstration, so the instructions he gave were all in accordance with the diagnosis and treatment norms.

"Chen Li, measure your blood pressure immediately; Xiao Chang, take an electrocardiogram immediately; Wang Lin, immediately open two venous channels and put on normal saline first. Yi Zewen, you prepare a diazepam mixed with 10ML normal saline for IV push."

   While Chen Qi was considering whether to take some other anti-epileptic drugs, the patient's convulsions suddenly stopped, and suddenly he changed from rough to calm.

  Everyone was stunned. The patient stopped smoking before taking any medication?

  Chen Qi immediately took out a small flashlight, and took a look at the patient's pupils on both sides. Fortunately, at this time, the pupils were opposite to the light, and they were equal in size and round.

   "Dean Chen, blood pressure is only 98/52mmHg, heart rate is 110 beats/min."

  The blood pressure is low, and the reason is unknown.

  Chen Qi was just meditating, and Yi Zewen next to him couldn't help asking: "Chen Tou, does this look like epilepsy?"

   "It's hard to say now, I can only say that it is doubtful. You see that the patient's seizures were not accompanied by vomiting, and the frequency of the twitches was not correct. There was no tonic seizures. Of course, it may be a small seizure or something like that.

  Considering that the patient has a history of traumatic brain injury, he had two disturbances of consciousness and convulsions today. We absolutely cannot rule out brain problems. Brain CT is a must. By the way, are the family members of the patient here? "

   Manager Xie quickly raised his hand: "I am the manager, the leader of Comrade Bai Xue's unit. My surname is Xie. Her family has not arrived yet."

  The most fearful thing for emergency patients is that there is no accompanying person, or no family member who can make the decision and sign, so that the next step of treatment will be difficult.

   "The manager is fine too. Let me tell you, this patient is in critical condition and is unconscious and comatose now. We don't rule out cerebral hemorrhage or other possibilities. In the most serious case, he may even suffer cardiac and respiratory arrest in a short period of time.

   Let's explain it this way. The brainstem of the brain controls the life center of the human body and is the most important thing in all organs. If there is damage there, the consequences will be disastrous, and the person may simply disappear today. "

  Doctors, especially emergency doctors, like to speak of the seriousness of the condition, or to say the worst in advance.

  In this way, many medical disputes after the event can be avoided. At the same time, the family members have a clear idea and can actively cooperate with the follow-up treatment.

  In the 1980s, there were no mobile phones and the Internet. It was very troublesome to find someone in a big city. Sometimes you needed human flesh to find someone. It was not certain when the family members would arrive.

  So sometimes it is not an exaggeration to say that it is an ordinary goodbye.

   Manager Xie can be considered a responsible person, so he gritted his teeth and nodded:

   "Okay, listen to your doctor. I'll take care of anything. In addition, Comrade Bai Xue is a regular employee of our department store and enjoys public medical care. You don't have to worry about medical expenses. Try to rescue him, and you must rescue him back."

  As soon as these words came out, Chen Qi was relieved, the money was in place, and the leader agreed, and the rescue could be carried out according to his ideas.

   "Okay, Manager Xie, don't worry, we will do our best."

  Everyone in the rescue room acted quickly, and all entered a fighting state.

  In order to facilitate the rescue, Chen Qi asked the nurse to open another venous channel for the patient, which means to give an extra injection. In case a large amount of blood transfusion is needed, it will be much more convenient to have an extra needle for infusion.

   At the same time, blood was drawn for routine tests.

  Chen Qi approached the patient's head again and called out her name loudly: "Bai Xue, Bai Xue, can you hear me?"

  The patient still didn't respond. In this scene, Manager Xie was very worried, thinking that the female employee was dying.

"Oh, what can I do? I was fine before I went to work this morning, but now I'm about to die suddenly. How can I explain to my family? Oh, what a pity, what can I do? Come, we will not see each other for the last time."

   Manager Xie was heartbroken there, while Chen Qi was busy continuing to check:

  The flashlight was illuminated again, the pupils were still equal in size and round, and the light reflex still existed.

  Chen Qi felt a little relieved, because a severe traumatic brain injury may lead to anisotropic pupils or even slow or disappearing light reflexes, which means that one foot has stepped on the gate of hell.

  Even if he does not die, the prognosis will be very unsatisfactory.

  At this time, Zhu Zhongyi from the emergency department rushed in from the back door, "President Chen, the CT room is ready."

   "Okay, send it to the CT room for brain CT examination immediately."

  For the sake of safety, Chen Qi originally planned to let Yi Zewen and Zhang Xing go with the patient, but after thinking about it for a while, it was not safe, so he went to the battle himself.

  A total of 5 doctors, a nurse, followed by Manager Xie as the unit representative.

   And prepared various rescue medicines:

Epinephrine (rescue cardiac arrest), norepinephrine (increase blood pressure), diazepam (anti-epilepsy), nicothamide (excited breathing), atropine (increase heart rate), etc. bring them all.

  Chen Qi has his own considerations, because he doesn't know the situation in the brain, the patient's heartbeat and breathing may collapse at any time, and a delay of one second may cause an irreversible situation.

  Especially now that the family members have not arrived at the scene, there can be no mistakes. With more people, cardiopulmonary resuscitation is more convenient, and the rescue will not be in the dilemma of insufficient manpower.

  So the people who came to the People's Hospital to see a doctor today saw a female patient pushed out from the back door of the emergency department, surrounded by a large group of doctors, and there was a clearer in front shouting for everyone to get out of the way.

  Many people are talking about it:

   "Yo, what's the matter with this man?"

   "Could it be someone dying? I'm in a hurry to see a doctor."

   "That's not necessarily the case. I think the woman is still moving. She must be related to some leader's family. She doesn't have to wait in line."

   "Yeah, it's so unfair. We've been waiting for three days for CT, and they can do it as soon as they come, huh."

  Chen Qi didn't care what others thought. After rushing into the CT room, he manipulated the machine and began to carefully examine it. Bai Xue didn't know that the young doctor in front of him wanted 50,000 US dollars.

   Earn a lot of money.

   Fortunately, things were not as bad as Chen Qi thought.

  As soon as Bai Xue arrived at the CT room, she woke up leisurely, and the first thing she said when she woke up was: "Where am I?"

  Chen Qi suddenly had a strange feeling in his heart, wondering if the patient had some mental problems?

   After all, patients with mental illness also twitch.

  Otherwise, how do you explain dizziness for a while, not dizziness for a while; vaping for a while, and suddenly stop smoking for a while? This comes as soon as it is said, and leaves as soon as it is said, without warning?

   But the most important thing as a doctor is to be patient. You can doubt in your heart, but don't show it, otherwise you will be beaten easily.

"Bai Xue, right? You are in the People's Hospital now. You fainted again just now. Now we need to do a CT scan of your head. Don't worry, Manager Xie from your department store next to you has been with you all the time, and your unit has notified you The family will come as soon as possible.”

  Stabilizing the patient's emotions and allowing the patient to cooperate with the treatment are the basic skills of a doctor.

   Upon hearing this, Bai Xue knew that she was in a bad situation, so she nodded slightly: "Okay, I see, thank you doctor."

  Head CT is done.

  Chen Qi couldn't wait for the film to come out, and stared at the display screen (picture tube TV), frame by frame, and found no obvious craniocerebral hemorrhage lesions.

  Chen Qi breathed a sigh of relief, and said to his subordinates and Manager Xie:

   "Fortunately, it was not a cerebral hemorrhage, and no obvious skull fracture was seen. It is estimated that the impact did not cause obvious damage at that time, and the most serious situation did not occur."

   If the brain is really bleeding, or if the blood stasis must be removed, it will involve a craniotomy. This kind of brain surgery, let alone the Yuezhong People's Hospital, even the provincial hospital dare not do it lightly.

   Then there is only paralysis or death.

   Then a new problem comes.

  The patient fainted twice successively, with impaired consciousness and convulsions. If it was not cerebral hemorrhage, what would be the reason?

  The doctors all breathed a sigh of relief, but Manager Xie still frowned, and asked cautiously:

   "Doctor, could Bai Xue have epileptic seizures? In the unit, many old employees said so. You also know that if a girl like her gets this disease, her life will be ruined."

   Manager Xie's question made sense. After eliminating the problem of his brain, Chen Qi himself thought about it in the same way.

  A patient faints for no reason and then convulses, any doctor would consider epilepsy.

  The so-called epilepsy refers to the abnormal discharge of neurons in the brain.

   To put it simply, the brain was short-circuited at that time, sending out many abnormal electrical signals, causing abnormalities in the patient's sensation, movement, consciousness, spirit, behavior, etc.

   Mild seizures, the patient may still be conscious.

  Severe epileptic seizures, such as grand mal epileptic seizures, the patient will have disturbance of consciousness, accompanied by severe convulsions, typically foaming at the mouth, eyeballs turned up, contraction of the masticatory muscles to open the mouth and then violently close, and may bite the tip of the tongue.

  Excluding brain problems, to be honest, Bai Xue is more suitable for this symptom. Although it is not so exaggerated, who can guarantee that it is not a petit or moderate seizure?

   And there are statistics that show that 50%-60% of epilepsy patients are teenagers. Bai Xue is only 22 years old this year. In later generations, she is only a college student.

   If it is just epileptic seizures, Chen Qi is not worried, because this disease usually does not kill people immediately. (family members don't think so)

   Chen Qi is worried that there are other reasons behind the patient's disturbance of consciousness and convulsions.

  For example, heart disease.

  Don't think that coma and convulsions can only occur in brain diseases, and heart diseases can also have similar manifestations.

  For example, if the patient has a tachyarrhythmia attack, or a severe bradyarrhythmia, the heart will not pump blood enough, the brain will be hypoxic and hypoxic, the brain will be dysfunctional, and transient coma and convulsions will also occur.

   This is the so-called Aspen syndrome.

  When Chen Qi expressed his doubts, Zhang Xing thought for a while and said:

   "But the electrocardiogram we did just now, I remember that there was no obvious abnormality in the electrocardiogram."

"No, no, there was no abnormality at the time, but it doesn't mean it has been normal all the time. If it is really Asperger's syndrome, it may be a sudden onset and a sudden termination. This has to be monitored with ECG. If the patient falls into coma and convulsions again, And the ECG monitoring can capture abnormal ECG activity, so it is a real hammer."

  As soon as Chen Qi said this, the surrounding doctors immediately became nervous again.

  If the patient has epilepsy, at most, he will have more convulsions, and it will not be life-threatening.

  But if it is Aspen syndrome, it is a heart problem, then it is really possible to die suddenly, and the heartbeat will stop at any time.

"Aspen syndrome" is also called cardiogenic cerebral ischemic syndrome, which refers to a sudden onset of severe, fatal slow or rapid arrhythmia, which causes a sharp decrease in cardiac output in a short period of time, resulting in severe cerebral insufficiency. bleeding, loss of consciousness and fainting.

  This syndrome has nothing to do with changes in body position. It often occurs very suddenly due to syncope caused by sudden severe tachycardia or bradycardia.

   Now the doctors are starting to worry. If the patient dies at home or in the workplace, although it is a pity, it has nothing to do with the hospital, and the doctor does not have to bear any responsibility.

   But if he died in the emergency department, the emergency department must be involved, and none of the doctors who received the treatment could escape.

   Now everyone in the CT room is worried, wondering what is the cause of the disease?

Chapter end