(Thanks to [Rose Spider] 2,000 coins, thanks to [skywang074] 1,000 coins!)

Soon the three of them arrived in the patient's room.

After Yan Zhenrong conducted a simple examination, his brows furrowed, and his condition was indeed a little complicated. I have a headache, but there is no abnormality in the CT scan of the head!

The patient had no other obvious symptoms except headache and nausea! As for the medical history, it was only high blood pressure.

It is difficult to judge what disease she has based on these two points alone.

You can't give her a big check-up, can you? Check everything! It's impossible. Not only is it a waste of the patient's money, but it is also a hassle to be examined.

If you have a lot of tests as soon as each patient enters the hospital, you will be complained.

"Director, what do you think?" Qi Jicheng asked cautiously.

"The condition is a bit complicated, so I want to think about what kind of tests I should do to detect problems more accurately. Based on his years of clinical experience, Yan Zhenrong began to analyze carefully.

Ruan Bin, who was standing next to him, couldn't help but speak: "Why don't you check an electrocardiogram for the patient first?"

"Electrocardiogram?" Suddenly, Yan Zhenrong's eyes lit up.

"Do you suspect it's a heart disease?" Qi Jicheng glanced at Ruan Bin, his face a little unhappy. He knew that this Ruan Bin had come to give a lesson to their emergency department.

But now it's the patients in their hospital, and you, a doctor in an outer hospital, shouldn't express your opinion. Unless the director speaks!

"Yes, I suspect it is an acute myocardial infarction!" Ruan Bin said lightly.

As soon as this sentence came out, Yan Zhenrong fell into deep thought.

But Qi Jicheng said with contempt: "It can't be an acute myocardial infarction!" Most of the symptoms of acute myocardial infarction are squeezing chest pain, sweating, and a sense of panic and impending death. However, the patient has no symptoms of palpitation and chest pain, and is conscious, only with a headache. How can it be a myocardial infarction?"

Besides, even if myocardial infarction is suspected, the symptoms shown by the patient do not look like myocardial infarction!

He felt that although Ruan Bin in front of him had made the first case in China in the pre-hospital REBOA, it was very good! I'm a rookie in other clinical experiences.

However, at this time, Yan Zhenrong said with some interest: "Doctor Ruan, tell me your opinion." ”

"Most patients with acute myocardial infarction complain of severe, squeezing pain in the middle and upper sternum, often radiating to the left upper extremity and neck. However, the diagnosis of myocardial infarction becomes difficult when there are atypical symptoms, such as dyspepsia, pain and irritability in uncommon areas, and mental changes. ”

"This patient is an older woman, and she is not as sensitive to chest pain caused by myocardial infarction as younger patients, so I thought I would do an ECG first. Ruan Bin said ambiguously.

As for why acute myocardial infarction causes headaches? He doesn't know! Anyway, the general diagnosis shows that the patient has myocardial infarction and high blood pressure!

In fact, he also wanted to continue pretending, but he had no stock in his head.

"Haha...... I very much agree with Dr. Ruan's speculation and opinion, in fact, atypical symptoms often appear in clinical practice, and it is very difficult to diagnose such patients! I also met a similar patient three years ago, and the other party also had a headache, but the final result was myocardial infarction!" Yan Zhenrong recalled with a face.

"Because the heart lacks nerve fibers that transmit tactile signals, and because pain nerve fibers from visceral and somatic tissues share a common conduction pathway within the central nervous system, the center often mistakes pain from visceral tissues for somatic tissues, which is why referred pain is often the way heart pain manifests. ”

"Myocardial infarction is predominantly headache, and patients with other symptoms are rare, and patients with headache as the only symptom are rare. ”

"I originally analyzed the cause of the patient's myocardial infarction, and the stimulation of the heart transmitted to the cervical sympathetic ganglion and through the thalamus to the cerebral cortex, and the center mistakenly believed that it was caused by the afferent head. After the occurrence of myocardial infarction, the patient's stroke output decreased suddenly, the blood pressure dropped sharply, and the cerebral blood flow decreased, causing reflex cerebral vasospasm, resulting in cerebral tissue ischemia and hypoxia.

"Yes, I think so too!" Ruan Bin's face was not red and he was out of breath, rubbing a wave of popular science heat.

However, I admire this Yan Zhenrong very much in my heart, he is worthy of being the director of the emergency department, he has a lot of clinical experience, it is estimated that even if he doesn't remind him, it won't take long for this Yan Zhenrong to think of checking an electrocardiogram.

At this time, Qi Jicheng next to him was dumbfounded!

He never thought that the director would agree with Ruan Bin's opinion, and he had encountered similar patients?

If the ECG comes out later and it is a real myocardial infarction, then this is a rare patient with headache as the only symptom!

"Director, then go do an electrocardiogram now?" Qi Jicheng said with a blushing face.

If the electrocardiogram showed that it was really a myocardial infarction, wouldn't he have been slapped in the face and knocked down by a resident doctor in an outer hospital?

Other people's clinical practice is even better than that of one of his attending doctors?

"Do it, do it right away!"

Soon, the results of the ECG came out - acute extensive anterior high lateral wall myocardial infarction!

"I didn't expect that three years later, I would encounter a patient with myocardial infarction with such atypical clinical manifestations again. At present, ECG has become the standard equipment in all hospitals, and I highly recommend ECG as a routine examination for patients, and ask in detail whether there are risk factors for coronary heart disease, and if necessary, perform myocardial damage marker examination to improve the diagnosis rate of acute myocardial infarction. Unfortunately~ sometimes patients and families are very opposed to this 'redundant' examination. Yan Zhenrong sighed.

If you have a stomachache, it is likely to be volvulus, or it may be acute gastroenteritis, if you don't get checked, in the end, if it is really volvulus, you will have to have surgery for intestinal necrosis.

But you can't just pull a patient to go for a CT scan just because of a stomachache, right?

It's no wonder that there aren't many medical troubles!

So it's hard to be a doctor these days, unless you have good skills and rich clinical experience.

But doctors aren't gods, are they?

There is always a time to look away.

In the car, Yan Zhenrong sent Ruan Bin back.

"Dr. Ruan, I didn't expect you to have such rich clinical experience, it's really amazing. Yan Zhenrong couldn't help but praise. To be honest, he didn't expect Ruan Bin's clinical experience to be comparable to him.

"Ahem......" Ruan Bin laughed secretly in his heart, where can I compare with the clinical experience of the director?