Medical ethics is a very illusory thing. Generally speaking, once a doctor's actions are understood as "arrogant, arrogant, indifferent, and greedy", they will be directly labeled as "without medical ethics", and then criticized by the general public.

And doctors basically don't comment on peers with "no medical ethics". After all, morality should be used to restrain oneself in the depths of one's heart. Take it out and throw it in other people's faces all day long, no matter how good the original intention is, it will change the taste.

Chen Tianyang said that Sun Lien had no medical ethics, which was a misunderstanding. And Zhou Jun said that Chen Tianyang has no medical ethics, this ...... Presumably deliberate revenge.

Chen Tianyang, who was scolded, said angrily, "In order to guide Sun Lien to write that broken paper, I haven't slept well for three days." When you get on the plane, you have to sleep! What doctor is idle and starts to observe the passengers around him as soon as he gets on the plane?"

"Me. Zhou Jun pointed to himself, then lowered his head to touch the phone. "You don't even have the habit of observing physical signs, you're a surgeon, right?"

An emergency physician is not considered an internal medicine or a surgeon. Strictly speaking, they may be closer to a mix of general practitioners, intensive care medicine, anaesthesiology and orthopaedics.

Because of the variety of jobs, emergency physicians can follow the trend of black surgeons or internists. This is probably one of the few benefits that emergency physicians can get from their busy work every day.

Chen Tianyang, who was hacked, was speechless, and his rebuttal was stuck in his throat, and he couldn't go up or down. After a long while, Chen Tianyang let out a long breath and sighed, "There is a full-time flight attendant in the business class, and she may have observed the condition of the previous patient. Why don't you give us a call and ask? ”

Zhou Jun took the phone away from his face and said angrily at Chen Tianyang, "Be quiet, I'm asking about the flight attendant." ”

·

·

·

The flight attendant's answer didn't help much, and there was nothing unusual about the passengers she saw. No shivering, no coughing, no headaches, no forcing yourself to sit up straight - nothing, everything was fine. In fact, the most abnormal performance in the entire business class was Chen Tianyang. He had obvious sleep apnea syndrome, which he could hear clearly in the cabin, and after a deafening snoring sound, he had to hold his breath for a long time before he finally exhaled. The time of holding her breath was so long that the little girl in the flight attendant was worried that Chen Tianyang might suffocate herself to death.

"Nothing useful news. "The ambulance has pulled up to the highway and is running at top speed again. Zhou Jun sat on the side, not paying attention to the shaking of the car body at all. He readjusted the inhaled oxygen level on the ventilator from pure oxygen in the previous emergency to 90% oxygen concentration, and then he made another phone call to go out. "I'm Zhou Jun from the emergency department, and in about eight minutes we will send a critically ill patient to the hospital, leave a CT scan, and then ask Zhao Hua, the director of the nuclear medicine department, to watch the film. ”

Patients do not have high blood pressure, infection, or forced sitting with left heart failure prior to pulmonary edema. In other words, the patient had a sudden onset of acute pulmonary edema without any indication about two hours ago. Although the progression of acute pulmonary edema may be rapid, there will always be some signs beforehand.

Acute pulmonary edema caused by other symptoms? Zhou Jun frowned, and he asked Chen Tianyang, "Is there a loss of pressure in the plane?"

"Loss of pressure? What loss of pressure?" Chen Tianyang was confused by the question.

Zhou Jun sighed and asked differently, "Did the respirator mask on the plane fall? ”

"It's falling. Chen Tianyang nodded.

Zhou Jun's brows furrowed even deeper, and the rapid loss of pressure in the air may cause severe pulmonary edema in some patients. This sequence of reasoning is consistent with the patient's condition and Chen Tianyang's testimony. But Zhou Jun still felt that something might not be right.

He looked at Chen Tianyang, who was jumping around, and then asked, "When did the breathing mask on the plane fall off? Was it before the plane jolted and vibrated or after the vibration? Did the flight attendant tell you to wear a mask when the mask fell off......?" he sighed, "Forget it, you sit honestly, I'll call and ask again." ”

Zhou Jun looked at Chen Tianyang and thought of a very critical question. If the patient's acute pulmonary edema was caused by the loss of pressure at high altitude, then why did Chen Tianyang seem to have nothing to do at all? The patient was a middle-aged man in his thirties and almost forty years old, and his physical fitness seemed to be definitely stronger than Chen Tianyang's white fat man. If he was suffering from acute pulmonary edema caused by high-altitude decompression, then Chen Tianyang should at least be a little unwell.

However, considering that Chen Tianyang didn't even know what the loss of pressure was, it was obvious that his testimony was not necessarily reliable. Zhou Jun has seen in the news that sometimes, the oxygen mask on the plane may fall due to the violent vibration of the fuselage. The quickest way to tell if a patient's acute pulmonary edema is caused by a loss of pressure is to ask a flight attendant.

"The oxygen mask fell after the plane shook violently, and there were no instructions from the cabin, right?" Zhou Jun got the answer he needed, but the answer did not uncover the source of the patient's acute pulmonary edema. It just makes the already clueless diagnosis a little more difficult.

Pulmonary edema is not caused by loss of pressure.

"It's at the hospital. While Zhou Jun was pondering, the ambulance had already rushed into the main road in Ningyuan City's quiet district with its siren. About 400 meters away, the logo of the Fourth Central Hospital of Ningyuan City shone brightly.

"The injured man, anonymous, about 35 years old, highly suspected of cervical vertebra fracture, acute pulmonary edema of unknown cause, unconsciousness, coma score of 9. Zhou Jun quickly conveyed his examination results and preliminary diagnosis to the doctor who came to pick up the car. "Send the CT room immediately, has Director Zhao arrived?"

"125ml of 20% mannitol, hang it immediately!" The doctor who came to pick up the car was Cao Yanhua, and he asked the nurse to go back to the emergency room to get the medicine, and said to Zhou Jun, "The imaging department called just now, and Director Zhao has arrived." ”

Another benefit of the ambulance transfer in your own hospital is that you don't have to rush to move the patient from the emergency transfer bed to the hospital's gurney. The ambulance convoy of the Fourth Central Hospital left two ambulances as a backup force for the corresponding 120 emergency center dispatch, so there was no need to worry about the press problem.

By the time a group of people rushed to the door of the imaging department with the emergency transport bed, mannitol had already been hung next to the bed. A strong male nurse grabbed the sheets on the emergency transport bed with her hands, and then gently moved the patient to the CT machine.

"Scan the cervical spine, the thoracic cavity, and add a lumbar spine. Zhou Jun quickly said the request, and when the CT machine started to run, he suddenly added, "After the chest cavity is finished, don't be in a hurry to check the lumbar spine, add a brain CT to see." ”

The speed of CT results is fast, and Zhou Jun can also see that the patient currently has C5 and C6 cervical dislocations, and his lungs are scattered with uneven cloudy shadows. These two points prove Zhou Jun's diagnosis of "cervical spine damage" and "acute pulmonary edema" in patients. However, the cause of acute pulmonary edema remains uncertain – chest CT confirms that the patient has mild left ventricular hypertrophy but no signs of pulmonary infection, which excludes cardiogenic pulmonary edema and infectious pulmonary edema.

Zhou Jun's brows furrowed even deeper, he already had a general guess in the direction, but this guess still needs to be confirmed by the results of CT examination.

"Go and ask Vice President Liu to come over. The brain CT scan was about to start, Zhou Jun turned to Cao Yanhua and said, "Please come over immediately, this patient may be a little troublesome." ”