(Thanks to book friends 20170517172854664 for their encouragement, and thanks to book friends 20170224103839411, 11111 Xiang, and bus brother for their encouragement)

Regarding the current situation, Liu Banxia has nothing to do. I have to wait for the CT results to come out to see what happens, but the guy's current situation is indeed a little dangerous.

After waiting for a few more minutes, Xu Hui's mobile phone received a text message, and after he glanced at it, he hurriedly operated it on the computer.

"It seems that there is already a pulmonary infiltration, almost respiratory distress, fever, and pulmonary infiltration caused by pneumonia?" Liu Banxia looked at it and said.

"Let's observe levofloxacin first and see if it gets better. Then let's think about what causes finger necrosis. ”

Xu Hui nodded, "It's the only way to do it first, and it is still impossible to determine whether it is necrosis caused by lung causes or lung causes caused by necrosis." ”

"But the results of the blood test are not too eye-catching, normally they are burned like this, and the white blood cell index is soaring. ”

Xiao Zhang's illness is very confusing, and at present, he can only treat the problems that can be detected first. If it is not found, it must be investigated.

"Are you here?, do you have any eyebrows?" At this time, Shi Lei also walked out of the disposal room.

"Not yet, CT shows an infiltrate in the lungs. It should be caused by pneumonia, and the patient is going to give levofloxacin after pushing it back. Xu Hui said.

"What about you?" Shi Lei looked at Liu Banxia again.

"It's the only way to do it now, but what Brother Xu and I care about the most is that little finger. I'll see what the actual situation looks like in a moment, and see if the pace of development is fast. Liu Banxia said.

Shi Lei nodded, "Then use levofloxacin first." Haven't the patient's family arrived yet?"

"Before it arrived, the patient came to Binhai City to work. Xu Hui said.

Liu Banxia frowned, if the patient's family was at the scene, maybe he could get more information by chatting with the patient's family.

In many cases, the patient himself does not notice the abnormality at all, but the family members are able to see something different from usual.

The patient pushed back, and looked at Xiao Zhang's little finger, which had been blackened a few more shades and traces that had been extended a lot, Liu Banxia was startled.

At this rate, it may take less than ten hours for this finger to completely die.

"Look at his ring finger, is it a little dark on the fingertip?" After looking at it carefully for a while, Liu Banxia shouted.

Hearing his shout, Shi Lei and Xu Hui hurriedly came over. It's just that after they read it, because of the mimeograph on Xiao Zhang's finger, it was a little difficult to distinguish.

"I looked at his freshly washed hands, and it was definitely not that color at the time. Liu Banxia said.

"In the case of such a transfer, I think it is caused by infection. If there are no external factors, then it can only be internal factors, blood?"

Shi Lei's brows furrowed, "We also considered this issue, but we didn't find anything abnormal during the blood test. ”

"Now necrosis metastasis is also a new symptom that we have discovered. We've taken a little blood on our little finger for a blood culture, but it's been too long. You think about it again and see if there's anything else possible. ”

"Then you say, is it possible that the patient's pneumonia is fungal pneumonia? It is precisely because these molds flow with the blood, flow to the ends of the fingers, and then stop causing necrosis?" Liu Banxia said.

"It's also a possibility, do a nasopharyngeal swab test. Keep an eye on the patient's signs at all times, and you, the patient's family, have nothing to do, you personally watch. Shi Lei said.

"Forty minutes later, I will do a bedside chest X-ray, and if the lung inflammation is not relieved, use amphotericin, according to the standard of 0.25mg/KG. I also have an operation, Xu Hui, you can pay more attention to the opinions of this patient's family. ”

Liu Banxia was a little helpless, but this is also a feasible method at present.

If it is really fungal pneumonia, amphotericin is medicated. However, the drug carries risks, even within the prescribed safe doses, which can cause damage to the patient's kidneys.

In fact, in his heart, he felt that it was definitely not ordinary pneumonia, and this levofloxacin was enough to choke and work, but he was now a family member of the patient.

He can't induce the patient's family when he's a doctor, and he can't induce the doctor when he's a patient's family. Otherwise, if something really happens, he doesn't have anything, and other people will be unlucky.

There are two suspicious conditions, one is diffuse intravascular coagulation and the other is fungal pneumonia.

Disseminated intravascular coagulation is not a single condition, but a complication of the rest of the conditions. The most common cause is hemorrhage, embolism, shock, or impaired organ function, which is not consistent with the patient's initial examination.

At that time, Liu Banxia also suspected that the embolism was coming, and the patient's blood vascularization was normal, and now it has metastasized, which means that the possibility of embolism can be completely ruled out and the infection can return to the infection again.

Paying attention to the patient does not mean that you have to keep an eye on it, whether levofloxacin is useful or not, and you can't see it with your eyes, it takes time.

Liu Banxia took a look and walked over to Zhou Li and Qiao Qiao.

"How's it going, is it cured?" asked Jojo.

"Where is it so easy, I haven't found out what the exact disease is yet. And the tips of his ring fingers also had some discoloration, and there were signs of necrosis. Liu Banxia said.

"Ah, can you still save it? Won't you have to cut off both fingers?" asked Jojo in surprise.

"Let's see if it's too late, unless the whole finger is completely necrotic, then it will have to be removed. Liu Banxia said.

"This one is a little different from a carnivorous infection, which develops very quickly, and this one develops slowly. At present, we mainly suspect that there is a problem with the inflammation of the lungs, are we a little confused?"

"No, I'm listening to it interestingly. Jojo shook her head.

"You two can't do it, you are tired here, do you sprinkle dog food for us?" Zhou Li said helplessly.

"I don't have that idea, I just want to talk to Qiao Qiao just to change my mind, so as not to fall into a misunderstanding. Liu Banxia said.

"But how does that fungus get to its fingers? and why can't it go all the way?" asked Jojo.

"It's not the same as poisoning, you can think of something like mold as a boat flowing down the blood in the veins. Where you stop, you will have a seizure. Liu Banxia explained.

"Then what about his lungs? It's been so long, it's long overdue. Jojo frowned.

"Uh...... Eh, Jojo, why are you so good? Liu Banxia was stunned for a moment, and then shouted again.

This sound is not small, and after shouting, he hugged Qiaoqiao and took a bite. After gnawing on it, he put Jojo here, and he ran away again.

"Uh...... Well...... That one...... Actually, it's not usually like this. Facing Zhou Li's eyes, Qiao Qiao blushed and explained thickly.

It's really not like this, to be precise, the two of them have been cheering for a little bit in the past few days, and Liu Banxia's operation just now made Qiao Qiao a little blindsided.

Liu Banxia, who committed the crime, didn't want to do that, so he directly found Xu Hui and pulled out Xu Guosheng in his heart.

"As a family member of the patient, I have a guess, could it be pneumonia and finger necrosis caused by endocarditis?" Liu Banxia said seriously.

"When the germs adsorbed on the valve cannot be adsorbed, they go with the blood, and when they go to the fingers, they cause necrosis, and when they go to the lungs, they cause pneumonia. ”

Xu Hui frowned, "Don't talk about this, it's really possible." Although the patient did not hear abnormal heart sounds during the examination, he may also be in the onset of the disease. ”

"It's really possible, that's why his lung lesions become so rapid. Maybe it didn't come out during the first physical examination, and that's why it wasn't checked. Xu Guosheng also nodded.

With such a guess, Xu Hui also hurriedly started the corresponding inspection. Don't look at this as "the patient's family", it's still very possible.

After all, the germs of a lung infection travel to the hands with the bloodstream, and this explanation is a bit far-fetched. Going back to endocarditis, it's convenient.

Liu Banxia was very relieved, and at first he went into a misunderstanding. Just seeing the inflammation of the lungs, the heart is fine. What if the germs happen to spread widely?

It was Qiao Qiao who reminded him that if the germs were native to the lungs, he should have been able to notice when he first came into contact with Xiao Zhang, and Xiao Zhang did not have symptoms of coughing at that time.

Liu Banxia waited beautifully, he was suspended, and he could only listen. I can help with advice, but I can't really intervene.

After a check, Xu Guosheng looked at Liu Banxia and shook his head, "Negative, not endocarditis." ”

Liu Banxia was dumbfounded, he thought it should be, why wasn't it?

"Although there are still no results of blood cultures, from the current examination, the blood cultures should also be negative. Xu Guosheng added another sentence.

Liu Banxia rubbed his face, and recalled the internal medicine knowledge he had seen in his mind. He is now very firm that the darkening of the patient's fingers is absolutely inseparable from endocarditis.

Because he thought about it, only this situation could be explained, and the explanation for pneumonia was really too far-fetched.

"Damn, let's say, if the blood culture is also negative, is there a kind of endocarditis caused by animal germs?" asked Liu Banxia, who raised his head, with shining eyes.

"High fever, pneumonia, possibly culture-negative endocarditis, psittacosis, psittacosis, can you be infected if you have contact with birds, and the incubation period of the disease can be very long. ”

"Let's go check. Xu Hui glanced at him and nodded vigorously.

Although it is still only speculation, it is a very reliable speculation. No one really thinks about it, after all, it's a bit difficult to see a bird in the city nowadays.

No matter how bold Liu Banxia's guess is, as long as there is a slight possibility, it needs to be verified.