In front of Monday's eyes, the high-tech black panel appeared.

The patient's physiological indicators are clear.

Age: 18 years and 215 days.

Height: 187cm.

Weight: 68kg.

Heart rate: 103 beats per minute.

Blood pressure: 156/105mmHg.

Alcohol content: 85mg/100ml.

Current conditions: pressure chest pain, dyspnea.

……

These data are swept away on Monday, and the most important thing is to look at the cause given by the system on Monday.

Keep looking down on Monday.

……

Condition: pneumomediastinum

Etiology: Spontaneous esophageal rupture. Severe vomiting after drinking alcohol and a full meal, resulting in a tear in the muscular layer of the lower esophageal wall due to the difference in pressure between the inside and outside of the esophageal wall caused by negative pressure in the chest cavity.

It turned out to be this disease.

It dawned on Monday.

Spontaneous esophageal rupture refers to the sudden full-thickness rupture of the esophagus in healthy people, because most of them occur after drinking alcohol and vomiting, so some people call it esophageal rupture after vomiting.

This condition is clinically rare. First described in 1724 by the Dutch physician Herman Boerhaave, also known as Boerhaave syndrome, a patient of an admiral who suffered a rupture of his esophagus after overeating and vomiting. It is more common in young men.

As for why vomiting in general can cause spontaneous esophageal rupture. Under modern medical cognition, there is no exact statement.

This condition is a very rare clinical problem.

According to relevant statistics, there is only about 1 in 75,000 hospitalized patients.

Because it is extremely uncommon, the misdiagnosis rate can be as high as 80%.

For example, a large tertiary hospital such as the Central Hospital may not encounter one case a year.

The clinical mortality rate of the disease is more than 10%, and the mortality rate gradually increases as diagnosis is delayed.

The best solution to this disease is surgical intervention

In addition to exhausting gas mediastinum caused by esophageal rupture, the chest cavity should be drained, and if the esophagus rupture is large, the esophagus should be surgically repaired.

It is clear that it is this disease.

Monday had a clear idea of how to check it.

Bai Mingming and Liu Zhengqing just suspected that the patient was suffering from acute pancreatitis, so they proposed to distinguish between epigastric ultrasound and urine amylase.

This is completely useless for the determination of spontaneous esophageal rupture.

The site of onset is in the esophagus.

The main symptoms are in the chest, and if you do a chest CT, you will immediately see the problem.

Of course, the judgment given by the system cannot be directly said on Monday.

It is still necessary to carry out the inspection step by step.

However, Zhou Zhou can use his influence to make the examination move in the right direction faster.

Zhou Zhou immediately decided: "In addition to the abdominal color ultrasound, let's do a chest CT." ”

Bai Mingming thought that the chest CT was done on Monday to see if the patient had the possibility of pneumothorax.

So he said: "Team Leader Zhou, Dr. Liu and I have heard about his lungs just now, there is no problem, and spontaneous pneumothorax is not very likely." ”

Zhou Zhou insisted: "Anyway, I have done so many examinations, and there is not much more, since it is chest pain, let's have a good chest examination." ”

Speaking of this, Zhou Zhou looked at the wall clock on the wall and continued: "There are relatively few people who do the inspection at night, and it is estimated that after the inspection, it just so happens that we have not yet left work. ”

Liu Zhengqing came up at this time: "After doing so many examinations, and no cause has been found, will the family have any opinions at that time?" ”

Zhou Zhou said: "Human life is at stake, this family must understand." I'll be in charge of explaining the situation to them. ”

Monday is no small intern now.

In terms of status, he is the leader of the four groups.

The head of the emergency department of this group, if there is a controversy, it has to be listened to.

And Zhou Yisheng's technology is also obvious to everyone, and he also has prestige.

So Bai Mingming and Liu Zhengqing didn't talk any more.

The three tests are about to begin.

The nurse begins to prepare the wheelchair.

At this time, Monday will fulfill what he has just said.

He walked to the door of the rescue room.

The parents of the boy, who were waiting at the door, immediately hula and surrounded them as soon as they saw that the doctor had come out.

The two of them asked in a rambling voice.

"Has the cause of my son's illness been identified?" asked the boy's father anxiously.

"Not yet, but soon after he comes out, do a few more tests, and I think there will be results soon." "Monday said.

"You still have to do inspections, can you do it, it's been more than an hour, and I've just done two inspections, and I'm going to do another inspection." What will you do but check?" said the boy's mother, dissatisfied.

"Thank you for your understanding. His condition is peculiar. But I assure you that this inspection has been done and there will definitely be results. "With the help of the system, Zhou Zhou is naturally full of confidence.

Doctors' confidence is sometimes the most important signal for patients and their families.

The boy's parents also asked Bai Mingming the same question just now.

Bai Mingming's answer was obviously evasive.

The attitude is very ambiguous.

But this later doctor, it seems, is confident.

The boy's parents were relieved.

Subconsciously, they decided that Zhou Zhou must be a better doctor who could diagnose his son's illness.

Of course, this is not because they are familiar with Monday, but because Monday gives them hope.

Between words.

The boy was in a wheelchair and was pushed out by the nurse to check it out.

His parents no longer had time to pester Zhou Sheng, but followed in the footsteps of the nurse and went together.

……

An hour later.

Twelve o'clock in the night.

It's time for the four groups to get off work.

Liu Jing, Li Weiwei, Su Quan and others went home from work.

in the rescue room.

Zhou Yisheng, Bai Mingming, Liu Zhengqing, and Cao Xin have not left yet.

They were waiting for the boy to check it out.

Bai Mingming looked at the time and said, "Team Leader Zhou, Team Leader Liu, it's time to get off work, you guys go first." I'll just stay here. One group also went to work, if I can't figure it out, I'll go to Wu Jianxing and Sun Zheng. ”

Naturally, Monday will not go.

Spontaneous esophageal rupture.

Such a rare case, the report came after a while, and he didn't feel at ease to hand it over to someone else to deal with.

I won't go, but others ......

Zhou Zhou looked at Cao Xin and said, "Cao Xin, why don't you go first." On the first day I came to the emergency room, I asked you to work overtime, which is too much to say. ”

Cao Xin came to the emergency department to exercise himself.

If you want to leave work early, you might as well stay honest!

He immediately said: "I'll be fine when I go back, I want to see what kind of disease this patient is and study hard." ”

On Monday, I looked at Liu Zhengqing again.

Liu Zhengqing didn't speak, but he didn't mean to leave at this time.

He didn't take over this patient. Now it's off work again. If it had been before, he would have patted his ass and left immediately.

But thinking that he will be leaving the emergency center soon, the words are good, people leave their names, and geese leave their voices. Seeing that no one wanted to leave, he was embarrassed to go first.

Zhou Zhou had no choice but to say, "Okay, since everyone is not leaving." Then let's wait for the patient to come back. Looking at the time, it should be soon. ”

As Monday spoke, the nurse took a stack of reports and pushed the boy back to the emergency room.

……