"Doctor Liu, what's the situation?" Xu Guosheng, the chief of the cardiology department, came to the emergency department.

"Dr. Xu, this patient has a history of epilepsy for two years and was diagnosed with idiopathic epilepsy in other hospitals. Liu Banxia hurriedly said.

"Three seizures today, the second in the ambulance for 27 seconds. The third seizure was in the emergency department, two units of lorazepam were injected two minutes after the seizure, and recovered after 3 minutes and 17 seconds. ”

"When the monitor was first connected, there was a moment when my blood pressure and heart rate were zero, and then I recovered. I suspect ventricular fibrillation occurred at that time, but it happened so quickly that it could not be relied upon. ”

Xu Guosheng frowned, "You mean epilepsy caused by cardiogenic causes?"

Liu Banxia nodded, "If it wasn't the instrument's reason when it was connected, it would be very possible." However, there is no clear indication at the moment, so I can only ask you to come over. ”

"Hey...... , a little sad. Xu Guosheng sighed.

"Heart diseases are sometimes very special, and what can be done at the moment is an ultrasound of the heart to see the dynamics of the heart and the amount of blood output. Then in the backpack bar, check the Holter ECG. ”

"If I had one more seizure today, I would have been able to capture the data. Otherwise...... Oh my God, you kid wouldn't have such a risky idea, would you?"

Seeing Liu Banxia looking at him intently, Xu Guosheng was a little uneasy.

Liang Xiaolin and the others were very curious, not to mention them, even Wang Chao listened with his ears pricked up. The designation is a big event, otherwise Xu Guosheng would not be in such a state of affairs.

"Dr. Liu, it's not that I can't help you with this diagnosis, but the patient's age is too young and a guardian must be present. And you also need to ask for the consent of your guardian, otherwise our brothers will be in trouble. Xu Guosheng said helplessly.

"Teacher Liu, Teacher Xu, what are you talking about, can you solve our doubts?"

"Your lovely teacher Liu plans to do heart disease induction, if it is really as he judged, it will definitely be able to be detected after the induction is successful, and then you can do a targeted and precise examination. Shi Lei spoke.

"However, this operation is still somewhat dangerous, and the child has no history of heart disease. Not only is it very sinful in the process of inducing operations, but healthy people can also have heart attacks. ”

As soon as Shi Lei explained this, everyone understood. Artificially induced heart disease is actually a routine operation, but it is for people who are suspected to have a history of heart disease, at least those who have experienced symptoms such as chest pain and rapid heartbeat.

Now that the child is diagnosed with characteristic epilepsy in other hospitals, his own teacher Liu wants to induce heart disease in the child, which is really a bold idea.

Liu Banxia touched his nose, "I also have a basis, we injected two units of lorazepam first, but the epilepsy stopped after a minute." ”

"It's because we can't be sure whether it's a brief reset to zero on the monitor, and this isn't fake, right? ”

"Of course, you can pack it first, and then I'll talk to his parents when they come. The current epilepsy must have taken a big toll on his life. ”

"Hmm...... , dressed as a little girl, maybe she wants to get more attention, maybe she has been ostracized intentionally or unintentionally when she was in school. After all, he is like this, and no one can take him to play. ”

"Doctor Liu, if you really can't do it, you can think about it after his guardian arrives. But I advise you to be cautious, there is a bit of chaos in the courtyard now, and it is not worth it to carry a complaint on your back. Xu Guosheng persuaded.

"Yes, Mr. Liu, let's observe more if we really can't do it. I've had three seizures today, and I really got on the machine and did a test, maybe the heart attack didn't happen, and the epilepsy happened again. Wang Chao also said.

Liu Banxia nodded, "I will indeed think about it." ”

It's a difficult choice, but he says so, and he'll give it when the child's parents come over. It's not because of that task, it's at most about giving some experience and proficiency in diagnostic skills, for the sake of this patient.

Being surrounded by strange eyes and being excluded is very uncomfortable. And he really didn't believe that there was something wrong with the instrument, or that Liang Xiaolin's electrodes didn't stick at first.

But in this matter, how sure you say Liu Banxia is, he doesn't have too much, just doubts. It is a judgment of the possibility that is given in combination with what is seen today.

In the absence of clear indications, all diagnoses are guesswork, i.e., mongery.

I did a cardiac ultrasound first, and everything was normal. The patient is then given a backpack in the hope that something will be found on the Holter ECG. even designated Wang Chao at the patient's bedside, and looked at this patient today.

"You are really bold enough, although I think you have some possibilities, but I dare not recommend it to the parents of the child. Shi Lei said.

"Why do you think I will definitely tell the child's parents?" asked Liu Banxia curiously.

"I don't know what kind of character you have?

Liu Banxia nodded, "I see that they have the intention of throwing the pot and directly asked me to seal it back, it has nothing to do with personal grievances, the main thing is that this matter can't be done like this." ”

"Whatever they thought, I think they did. It's a simple thing, so why complicate it. ”

"Then you don't take it easy, if you don't do it, you'll be burdened with a complaint. Shi Lei said.

"Boss, you said that with my temperament, I can let the patient go in such a daze, can I get the energy?" Liu Banxia said helplessly.

"If there was no zeroing of the monitor, and there was no lorazepam injection, I wouldn't have thought much about it. What if I guess correctly? The next time I get sick, there will probably be no time to be rescued. ”

Shi Lei glanced at it and nodded.

What Liu Banxia said is also true, but in combination with today's doctor-patient relationship, even if you are good for the patient, if the test results are still unclear, it will attract the dissatisfaction of the patient.

After waiting for nearly half an hour, the patient's parents arrived.

After they finished seeing the patients, Liu Banxia also pulled them aside and explained his suspicions.

"Doctor, are you sure?" asked the patient's father, after a moment's hesitation.

"We went to many hospitals for tests, but all of them came to the same conclusion, which was characteristic epilepsy. As the child gets older, there is a possibility that it will disappear. ”

"That's what I thought about at first, but today my child had three seizures in a short period of time. I guess this is still a little different from the previous situation, right?" asked Liu Banxia.

The child's mother nodded, "In the past, it was only an occasional seizure, we just need to protect him and not let him bump into it, and he will be able to recover soon." ”

"The last time we took the medicine today, it took a full 3 minutes and 17 seconds to get back to normal. Liu Banxia continued.

"I had reason to suspect that the child's epilepsy might be caused by a cardiac cause, and we did an ultrasound of the heart, and we didn't see anything wrong with the amount and shape of the blood output. ”

"So judging from these conditions, I think it may be an epilepsy reaction caused by the abnormal center rate of Ass syndrome. The onset time is around 7-40 years old, and there is a certain hereditary nature. ”

"The pathogenesis of this disease is that the heart rhythm is irrhythmic due to a certain part of the heart muscle, resulting in supraventricular tachycardia, that is, the heart beats rapidly, there is not enough blood supply to the brain, resulting in a lack of oxygen to the brain, resulting in epilepsy. ”

"Heredity, inherited from whom, both of us are fine. The patient's father asked in surprise.

"Even if it is inherited, there is only a certain chance of developing it. And at the moment this is just a guess on my part, I just think that the child has seizures today too often, and this is the only one left after ruling out the rest of the causes. Liu Banxia said.

"And if we hadn't connected the monitor today, if we hadn't seen zero on the display, I wouldn't have thought about that. ”

"Doctor, how do you check it?" asked the patient's father.

"Originally, I was going to do some experiments to make judgments and induce the onset of the disease. I just thought about it, we can do a more direct and cardiac electrophysiology test. Liu Banxia said calmly.

"But it's an invasive intervention, which is where we test the response status by electrifying the child's heart muscle. If there is a lesion at a certain point or a bundle of myocardial fibers, it will be directly fed back. ”

"This kind of inspection is more accurate and we can do a thorough inspection. Cardiac ultrasound can also see images, but it can be seen macroscopically, and it cannot be seen in the absence of organic lesions. ”

"Invasive tests are also dangerous, so you can consider it. In order for the child not to be excluded in the future life, but also for the sake of the child's life safety, I will explain the surgical steps and risks to you. ”

This is indeed the result of Liu Banxia's careful consideration, and the original plan was to test a little bit, but in that case, the patience of the patient's parents may be consumed, and a lot of useless work has been done.

It's just that his proposal is more direct and bold, which makes Shi Lei on the side sweat for him.

The principle followed in a normal hospital is from small to major examinations, such as ultrasound first, followed by X-ray, CT and other diagnostic sequences.

This time, Liu Banxia's recommendation can be called the ultimate examination, or invasive interventional examination. As long as the patient's family has a temper, they will definitely give a round of complaints after not checking for the problem.