"Come, sit down. ”

Zhang Tianyang involuntarily stood up and helped the patient sit down.

The new patient was an old man, 65 years old.

Looking at people, Zhang Tianyang feels that he is 75 years old.

The old man half-bent over with the support of his wife, and walked in tremblingly.

But the moment he saw the old man, Zhang Tianyang felt the breath of being seriously ill.

This is not a metaphysics in which a magic stick pops up in the corner of the Taoist temple, folds his hands and says, "This benefactor, your seal hall is black".

It is a kind of intuition that arises subconsciously after visiting the hospital all year round and seeing a lot of patients with all kinds of mild or severe conditions.

It's like how many doctors stare at someone when they walk down the street, how they look at them and how they think they're sick.

In fact, there are traces.

Many details show the old man's critical condition.

When he raised his head slightly, Zhang Tianyang could see that his wrinkled face was oozing with sweat like tiny droplets.

His bare arms take on the color of normal elderly skin, some darkened, with many brown age spots.

But his face was pale, and his wrinkles were much worse than usual because of the pain.

When he was helped to sit down, the old man was still holding his stomach.

Another patient with abdominal pain, so painful that his face was pale and he broke out in a cold sweat.

"Shock. ”

This word, which had been mentioned countless times just now, reappeared in Zhang Tianyang's mind.

Another one?

"I had stomach aches, diarrhea, and probably ate expired mung bean cakes. ”

Without waiting for Zhang Tianyang to inquire carefully, the old man took the initiative to explain his main complaint.

The last little brother has kidney stones, and this old man has diarrhea, both of which are generally not serious, but can be fatal when they are serious.

"When did you start having diarrhea, what does the poop look like? Describe the color and shape. How many times have you been there since you started?"

Zhang Tianyang quickly chose the direction for further consultation.

The patient's complaints are clear, epigastric pain and recurrent watery diarrhea began seven hours ago.

This is actually a very common complaint in the emergency department.

After all, the temperature in Guangdong Province is on the high side, the recipes are extensive, and there are many large and small restaurants around the East Hospital.

In the past two days alone, Zhang Tianyang has dealt with many patients with diarrhea as the main symptom.

For example, the first aunt who received a consultation today also complained of diarrhea.

At that time, Zhang Tianyang prescribed some medicine and let her go.

But this old man is different.

First of all, his basic conditions don't look good.

Coupled with the obvious "acute facial", pale skin, and cold sweat, it is enough to be listed as a key object of observation.

Zhang Tianyang spoke quickly, quickly and briefly asking about the medical history.

"Did you have any nausea and vomiting?"

"Do you have dizziness and headaches?"

"Do you have a fever?"

"Do you have chest pain and tightness?"

"Do you have weakness in your limbs?"

"Is there a history of hyperglycemia and hypertension in the past?"

"Are you allergic to drugs?"

His heart had already been pinched, and according to his judgment, this patient had a big problem nine times out of ten.

However, the medical history that should be asked still has to be asked, and only when the medical history is clear, can the cause be found more quickly and accurately, and the cause can be treated.

"What was your blood pressure just measured at the nurse?"

Glancing at the medical record book handed by the patient, Zhang Tianyang instantly bounced up from his seat.

It reads in black and white, "Blood pressure 84/46mmHg".

This old man is already in a state of shock!

"Senior brother, there is a patient who has diarrhea and shock for seven hours! The blood pressure has dropped to 84/46!"

Dr. Chen was explaining his condition to the patient he was treating, and he immediately popped up when he heard this.

"Rescue room!"

"Good!"

"Help! Call the nurse in the emergency room to set up the intravenous access!"

The white meat shield accepted the task at Zhang Tianyang's signal, and automatically and consciously ran to the emergency room to notify the doctor, and at the same time pulled the nurse who had just been pulled over by him to rush back.

Zhang Tianyang and Dr. Chen, together in two white coats, put the old man on the treatment bed and lay down on him, and gave him a physical examination.

The family member who came with the old man was an old lady, who had been looking anxious, and finally couldn't help it at this time.

"Can you infuse some anti-inflammatories?"

"If it's bacterial diarrhea caused by unclean food, antibiotics must be given. ”

Zhang Tianyang conducted a serious and quick physical examination, and casually replied to the family's words.

"And his blood pressure is now low, he is already in a state of shock, and he has to go to the emergency room to deal with and observe immediately. ”

As he replied, his heart raced.

There are many causes of diarrhea, and although this old man has a high possibility of bacterial diarrhea, other causes cannot be completely ruled out.

Specifically, it is necessary to look at the blood picture to see if the infection index is elevated.

From the point of view of blood pressure, the shock is a real hammer.

But what exactly causes shock?

I don't know!

Is it possible that it is a simple hypovolemia caused by repeated diarrhea?

Are there any concomitant electrolyte imbalances?

Could it be that the bacteria in the food enter the bloodstream, causing the shock of the infection?

I don't know!

But it's all possible!

The specific cause must be examined and the results can be determined.

The most important thing now is to treat the symptoms first, relieve the hypovolemic state, and closely monitor the patient's vital signs.

There is a string in my heart that is tightened.

Although the old man looked able to talk and walk, he was already in shock.

Coupled with his history of hypertension and diabetes in the past 20 years, his underlying conditions are not good.

What Zhang Tianyang is most afraid of is that on the basis of secondary shock, he will develop more serious diseases later!

For example, diarrhoea can lead to electrolyte imbalances, which can lead to serious cardiovascular events.

If it really comes at that time, whether you can save it or not is a matter of two words!

The white meat shield had already rushed back with the nurses in the emergency room with all their gear.

Zhang Tianyang immediately gave way and helped the nurse expose the veins of the patient's upper limbs.

"Quick, give him intravenous access!"

"Rapid drip of saline, immediate rehydration!"

I had diarrhea for seven hours, and God knows how much water the old man pulled out, and now the total circulating blood volume in his body is definitely reduced.

Make up the water first, and then talk about anything else.

Dr. Chen stayed in the consultation room to greet the patient, while Zhang Tianyang slipped and jumped out.

The emergency room has been greeted and the bed has been vacated, and now he has to find a way to get the patient in.

Soon, he found the flat car he wanted, and hurried back to the door of the clinic all the way.

"Let the patient lie down! Advance to the emergency room for monitoring now! I'll pull an electrocardiogram for him right away!"

Zhang Tianyang yelled at the consultation room.

"That nurse, help draw blood! Blood routine, liver and kidney function ions, six infections, two cardiac enzyme spectrums, all draw! The doctor's order will be opened!"

All health workers are on standby, and the trigger is imminent.

Everything is ready, just wait for the patient to go to bed.

But after the urging, the old man was still sitting on the innermost treatment bed in the consultation room, covering his stomach without moving.

The old lady who came with him frowned and stopped Zhang Tianyang, who was about to carry the old man into the car.

"Doctor, don't bother. ”

She spoke unpleasantly, but with persistence, and a slight impatience and distrust.

"We just ate a bad stomach, and the infusion was fine, and we didn't do a checkup. ”

As if afraid that a few white coats would not hear clearly, the old lady repeated it again.

"We're not sick, we're just sick from eating. ”

Finished!

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