Zhan Hao was lying on the bed, his face a little yellow.

After Sun Lien took the doctor back from the Second Hospital, he pushed the bed into the emergency room with the war army, and deliberately placed him near the door to facilitate the imaging examination later.

"Did you bring the previous cases and examination reports?" Although there were some unpleasant stories in the emergency department of the fourth hospital and the second hospital, the two sides still recognized each other's test results and reports. Although the provincial prescription network allows Sun Lien to see what drugs Zhan Hao used in the second hospital, the detailed imaging examination results and some specific treatment details still need to be obtained by asking the patient's family.

"As you said, they were all brought. The soldier took out a thick book of nailed materials from his bag and handed it over, "Xiao Sun, you take a look at everything first, if there is anything not detailed enough, I will go to the second courtyard again." ”

Sun Lien nodded, took the information, and instructed, "I'll go and ask someone to come for a consultation now, and you can go through the registration and other formalities for him." The soldier nodded and walked to the registration window in the rescue hall, while Sun Lien turned around and entered the small conference room.

In the conference room, Xu Yourong, Yuan Ping'an, Pascal, Zhou Ce and Liu Pingchuan were all sitting in their seats, and when they saw Sun Lien walking in, they temporarily stopped chatting.

"I'm sorry everyone. Sun Lien smiled at them embarrassedly, and then put the information in his hand on the digital projector, and the camera magnified the information on it to 150 inches and projected it on the wall of the conference room. "This is the patient we need to deal with today. ”

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Zhan Hao, male, 39 years old. Nine days ago, he was admitted to the emergency department of the Second Central Hospital with severe abdominal pain. After admission, liver function showed that alanine aminotransferase (ALT) level was 1970U/L, which was much higher than the reference value of 0~40U/L. After ultrasound examination, which ruled out acute temporary obstruction caused by common bile duct stones, the emergency department of the Second Central Hospital determined that Zhan Hao's severe abdominal pain was caused by acute liver injury. However, the cause of acute liver injury is unknown. Rapid tests and immunological tests rule out viral hepatitis. And Zhan Hao himself firmly denied that he had the experience of taking drugs before the onset of the disease.

After the emergency doctor at the Second Central Hospital palpated Zhan Hao's abdomen, there was no rebound pain or tenderness, but Zhan Hao's pain attack was very intense, sweating profusely, snot and salivation, his body curled into a forced position, and his expression was extremely painful - but in addition to his rapid heartbeat and rising blood pressure, his body temperature and even respiratory rate were within the normal range.

After the B-ultrasound examination confirmed that it was not a perforation of the digestive organs, in order to further diagnose and treat, the emergency department of the Second Central Hospital used three sticks of Demerol in a row to Zhan Hao in an attempt to relieve the pain. However, the analgesic effect is very limited, which leads to the second diagnostic view of the emergency department of the Second Central Hospital - the onset of drug addiction?

Fortunately, a quick urine test proved Zhan Hao's innocence. All of his tests were negative. This means that he has not been exposed to these drugs for at least two months. A follow-up hair test also confirmed that he had not taken drugs in the past year. This diagnosis is not valid.

Two hours after admission, the emergency physician at the Second Central Hospital added a diagnosis of intestinal obstruction. The pain relief effect of Demerol is poor, the pain is severe and has a tendency to be paroxysmal, and Zhan Hao did vomit after being admitted to the hospital, and the vomiting did not relieve the symptoms of abdominal pain, the doctors of the Second Central Hospital suspected strangulated intestinal obstruction, which is actually very well-founded.

Although there is no obvious area of obstruction on plain abdominal radiograph, it is still possible that the obstruction is due to early onset of obstruction and lack of obvious imaging features. To confirm the diagnosis, the doctors at the Second Central Hospital gave Zhan Hao an injection of atropine. While the effect of atropine is observed, fluids, blood transfusions, and antibiotics are given at the same time to prevent the rapid progression of intestinal obstruction. In this way, in case atropine does not work well to relieve smooth muscle spasms, it is safer to perform emergency laparotomy directly.

Subsequent observations have proved that atropine does have a very good effect. The abdominal pain was quickly relieved, and Zhan Hao's vital signs stabilized. After 24 hours of observation, Zhan Hao was transferred to the Department of Hepatobiliary Medicine to prepare for follow-up examinations. His acute liver injury has not been completely resolved, and intestinal obstruction does not lead to acute liver injury.

On the second day of hospitalization, Zhan Hao developed new symptoms - decreased muscle strength in his lower limbs, and vision in his right eye. These symptoms were quickly diagnosed as central demyelinating lesions, but the cause remains unknown.

On the fifth day after hospitalization, Zhan Hao was able to stand with support, and although alanine aminotransferase had decreased, it was still at the level of 435U/L. He was able to eat and defecate normally, and he did not have any more acute abdominal pain in the past five days.

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"Their treatment is a typical medical protocol, try to see if things get better. After listening to the introduction, Liu Pingchuan spoke first, "As long as the patient's condition improves, the specific disease he has and why he has such symptoms are not in their first consideration." ”

This kind of diagnostic guidance is not uncommon, and it can even be said to be the norm. Doctors don't know how many cases they see each year. Many diseases are similar and will respond well to the same treatment. The lucky ones may not know exactly what they have until they are cured, and those who are unfortunate ...... You may not know what you are dying for.

It must be emphasized that this has nothing to do with the quality of doctors in the second central hospital. In fact, even if it is as strong as Xie, there are still many patients with "unknown causes" every year. The human body is too complex a system, and there are too many interference factors that can affect this system.

"So, we need to find out what disease he has?" Xu Yourong didn't seem to be very interested in this case, she shook her head and said, "It's been nine days since the onset of the disease, and the Second Central Hospital has given him two antibiotics, hormones, and blood transfusions...... If we were the policeman who was going to start with the crime scene, then his body was the first crime scene that had been cleaned several times. What can this find?"

Not only did Xu Yourong lack interest in this case, but Yuan Ping'an also didn't quite understand the reason why Sun Lien was admitted to this patient. "Isn't he already getting better? Now that he's admitted to the hospital, even if we can diagnose what disease he has, it won't really help him, right?"

"The main reason I took this patient was because the course wasn't quite right. Sun Lien thought about it and decided to tell the truth to his teammates. "His acute abdomen, which we can confirm by the time period when the treatment takes effect, is smooth muscle spasm. However, this is not linked to acute liver injury. And the demyelinating lesions that followed are not linked to acute liver injury – if the smooth muscle spasm is caused by a central nervous system demyelinating lesion, I can accept it. But in general, there is a lack of a unified explanation for the patient's disease. ”

"It's not important to explain, it's important to see if the patient's condition is really under control. Liu Pingchuan frowned and concluded, "What I'm most worried about now is autoimmune diseases, after all, the second hospital used hormones in the process of treatment, and if the hormones mask the symptoms, then there is a possibility that the disease will continue to occur after that." ”

"Anyway, I think it's better to go at our pace. Dr. Pascal spoke, and he was not very interested in the theory that Zhan Hao might have an autoimmune disease, after all, the order of his onset did not conform to the common law of the autoimmune system "preceded by the kidney or nervous system". But he still agrees with the rest of Mr. Liu's views. Although the use of hormones in rheumatology and immunology is a very conventional approach, Dr. Pascal has always felt that hormones are not the best approach. While relieving symptoms, hormones can mask a lot of problems that really need the attention of doctors. Many diseases do have this particular "onset-remission-recurrence" fluctuation. The causes of this fluctuation are varied, but these disorders have one thing in common – the second episode can be very severe and the prognosis is extremely poor.

"Imaging tests are already being done. Sun Lien took out his mobile phone and looked at the examination to show that the density of the liver was diffusely reduced, and there seemed to be a small low-density shadow on the head of the pancreas, and the small intestine was dilated to varying degrees and fluid accumulation could be seen. ”

"This is a new development. A tense air suddenly filled the conference room. A day earlier, Zhan Hao's CT scan had shown that everything was normal.

A shout suddenly sounded in the rescue room outside the door, "A bed of blood oxygen saturation has come down!"

A group of doctors bounced out of their seats as if they had been kicked in the ass, and everyone rushed to the emergency room.

Zhan Hao began to have abdominal pain again, the severe pain made his cheeks flush, he was short of breath, and the whole person curled up on the hospital bed like a big shrimp, at first he still had some strength to scream, and after less than thirty seconds, he could only let out a "roar" gasp sound from his throat. Blood pressure quickly rose to 135/90 mmHg, heart rate began to increase to 93 beats per minute, but oxygen saturation was decreasing, from 98% to 95% on admission.

"Give him oxygen, draw blood to do a blood routine, and do a liver exercise five!" In the chaos, Sun Lien came to the side of the bed in a favorable position, stretched out his hand and ripped off the quilt on Zhan Hao's body, and pressed his abdomen hard. There was no tension in the abdominal muscles, and Zhan Hao did not react to significantly aggravate the pain after pressing it. Looking at his face again, sweat gushed out like a spring, and snot and saliva were mixed in it, making it look terrifying. "Zhan Hao, Zhan Hao?!Can you hear me?" Sun Lien patted Zhan Hao's shoulder vigorously and asked in the loudest voice possible.

"Can ......" Zhan Hao took two quick breaths, held back a response with all his might, and then continued to scream. "Help!"

"Zhan Hao, male, 39 years old, nerve center demyelinating lesions, rapid vision loss in the right eye, acute liver injury, smooth muscle spasm, acute hemolysis, hemolytic anemia. The status bar has updated three statuses for face, and there are two words vaguely in front of "hemolytic anemia", and the handwriting is slowly deepening, looking like "moderate".

"One milligram of atropine, intramuscularly!" Sun Lien decided. Atropine was determined to be effective against Zhan Hao in previous treatments, and the pain relief effect was more effective than opioid analgesics. First stop his acute abdomen, and then the doctors can find a way to help him - under the forced position, Zhan Hao can only contract his body with all his strength and bend it into the shape of a shrimp. It was very difficult to draw blood and create new venous access in this state - the indwelling needle in his hand had been accidentally pulled out during the episode of abdominal pain.

Atropine has a rapid onset of action, reaching its peak blood concentration fifteen minutes after intramuscular injection. The severe spasms were slowly relieved by the action of atropine. Next, it was Sun Lien's turn and the others to have a headache.

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"Atropine is so effective, it means that the spasm should be in the gastrointestinal tract or bladder. He hasn't had a catheter yet, so it's unlikely to be bladder spasm. After making sure that Zhan Hao's symptoms had eased, Xu Yourong whispered his opinion. "Second episode of intestinal obstruction in a short period of time?"

"The CT scan taken 10 minutes before the onset of his illness only showed a dilated small intestine and some effusion. Yuan Ping'an raised his eyebrows, "Intra-abdominal hernia?"

"If it's an intestinal obstruction caused by an intra-abdominal hernia, that's ...... Be...... Strangulating intestinal obstruction. Dr. Pascal didn't remember what the Chinese term for the disease was for a long time. "But there is little chance that this condition will be relieved by medication, and if it is really Strangulating Intestinal Obstruction, how did he carry it without surgery after the last episode?"

"The T1/2 metabolic rate of atropine is four hours. Yuan Ping'an suddenly thought of something, "When the second hospital treated him, he only received one injection of atropine and got complete relief, right?"

Sun Lien didn't quite understand what Yuan Ping'an wanted to say, but his memory was not wrong, "I really only used atropine once." ”

In other words, the spasms did not last too long, or in other words, a certain treatment method used by the second hospital during those four hours successfully resolved the spasms. Yuan Ping'an expressed his guess, "He has received blood transfusion, and I suspect that he may have severe anemia!"