The traffic congestion in the morning rush hour is really not covered, and the king pigeon is well aware of it.

Just after eight o'clock in the morning, there were more vehicles near Wuyi Square in Xiangsha City. The bus stop in Wuyi Square is even more overcrowded, with more people getting on the bus and getting off the bus, plus this is the first stop that has just crossed the Orange Island Bridge, and there are more vehicles.

If the king pigeon drove the car directly to this vicinity, it must have to turn around. Although the ambulance has the privilege of emergency duty, but in this road condition any privilege does not seem to have much effect, and will undoubtedly waste a lot of time, so the king pigeon did not follow the navigation route, but turned a few more corners to avoid turning on Wuyi Avenue.

There are too many buses on this side of Wuyi Square, so two stops are set up in a short distance for diversion, and the king pigeon doesn't even need to look at the positioning information to know which station it is - just see where there are many onlookers.

Although it was a working day, although the morning time was tight, there were still many people gathered in front of the bus that had the accident, poking their heads out to check the situation inside, and some even took out their mobile phones, stretched out their arms to take pictures and post on Weibo and Moments.

The arrival of the ambulance attracted a lot of attention, and people turned their eyes and cameras to the ambulance.

Wang Ge parked the cart on the side of the road, turned off the siren lights, and took the cart down with Feng Ji.

"This group of people is really not afraid of being late for work. Feng Ji said.

"It's lively, what's it to be late!" Zhou Hua sighed and shook his head.

"Everyone, let go, the doctor is here!" Wang Ge shouted as he pushed the cart in front, trying to disperse the crowd, while Zhou Hua and Feng Ji followed behind him.

There were many people waiting for the car, and there were more onlookers, and the progress of the three was very slow, and Wang Ge was a little anxious.

"Please don't look around, it's hot, and the patients in the car need to be well ventilated, otherwise it may be dangerous!" continued to shout the king pigeon, and came to the front door of the bus.

Hearing Wang Ge's shout, the surrounding crowd slowly retreated.

The bus driver had just been on work for a short time before he encountered this kind of thing, and although he didn't have to continue working, he couldn't be happy. There are people on the bus who can't get the blame for it! He nervously leaned outside the bus and smoked, blocking people who wanted to enter the car to take pictures.

Zhou Hua entered the carriage directly, Feng Ji followed behind him with a first-aid kit, and Wang Ge put the cart at the front door of the bus and also entered the carriage.

There were only two people left in the carriage, both young girls, dressed fashionably, and very peugeot-looking, two or three years younger than the king pigeon, who looked like college students. Somehow, when Wang Ge saw the two of them, what came to mind was Lin Yanwu's face.

One of the girls, however, was already lying on the metal floor in the middle of the carriage, frowning and speechless, pale and sweating, with a pained expression. The other was comforting her while talking on the phone, as if seeking help from his family.

Zhou Hua hurriedly stepped forward, squatted on the ground and began his own inspection. And Feng Ji didn't need Zhou Hua's advice, opened the first aid kit and took out the blood pressure monitor to measure the patient's blood pressure.

"What's your name?" Zhou Hua asked.

"Oh, my name is Xie Shasha......" The girl who was on the phone seemed to finish talking about the situation here, and as soon as she put down the phone, she hurriedly answered Zhou Hua's question.

"I mean the patient. Zhou Hua was a little helpless, Xie Shasha was too nervous.

She ...... It's called Qian Ping. We are classmates or roommates in a shared room, we are best friends, doctor, you must save her!" Xie Shasha's voice was a little crying, frowning and very anxious, and lowered her head to her friend's ear, comforting her softly. "Don't be afraid, the doctor is here, let's go to the hospital immediately, it's okay, I've already called your family, I've been with you!"

"The heart beats and breathes very fast, but it is difficult to breathe, lack of oxygen, cyanosis, no vomiting, not a craniocerebral problem, no trauma, and no signs of internal bleeding......" Zhou Hua was a little confused, "What is blood pressure?"

"Sixty, eighty millimeters of mercury, it feels like it's going to go down. Feng Ji looked up and said.

"Heart disease, do an electrocardiogram first!" Zhou Hua immediately made a judgment, based on the current information alone, he could not determine what the patient's symptoms were.

"Impossible! Her heart is fine, our school also organized a physical examination before the holiday a few weeks, she has never had a heart disease in her family, and there has never been a problem before!" Xie Shasha shook her head and said.

"Just because there was no problem before doesn't mean it's okay now. An ECG is done not only to confirm the diagnosis, but also to rule it out. The king pigeon patted her on the shoulder and explained. "Don't worry, the doctor will figure it out. ”

The bus driver also boarded the vehicle at this time and stood at the door watching the scene.

"Master, what's the situation?" asked the king pigeon, turning his head to see if there was a grim reaper around him.

In the summer, the sun is shining in Xiangsha City even in the morning, and it is very hot, and many girls have set up anti-ultraviolet flower umbrellas to prevent tanning. Theoretically, this would be a great distraction from the king's search for death, as it is impossible for the king's pigeon to carefully see if each umbrella has a long handle.

But in practice, it is very easy for the king pigeon to judge death. The Grim Reaper's outfit is almost the same, even in the summer, a black suit or a long-sleeved outfit, which can be a stark contrast to the crowd of people in cool clothes around him. And not every god of death will be like Void Purple, obsessed with dressing up carefully, and wants to be closer to ordinary people in terms of clothing.

"I don't know what's going on! There were a lot of people on the bus, and I had just made the bus steady, and before I could open the door, there was a shout in the carriage that someone was fainting. I quickly opened the door and let the other passengers get off the bus, and the girl lay on the ground, at first she was still holding her chest, saying that her chest hurt badly, and then she couldn't speak, so I quickly called 120. "The bus drivers also have very limited information and can't help in any way.

"Sinus tachycardia. Zhou Hua looked disappointed, the performance of the ECG was no different from what he heard with a stethoscope, and the waveform did not change much. "Let's go back to the hospital first, give oxygen, go on ECG monitoring, and use some respiratory stimulants if you have difficulty breathing. "He didn't dare to make too many movements, everything was subject to the completion of the examination in the hospital.

"Be steady, don't move too much. Zhou Hua and Wang Ge walked around to the patient's feet, while Feng Ji put away the first-aid kit and stood at the patient's head, ready to carry the patient.

They can't change the patient's position drastically, so they have to take their time. At the moment when Wang Ge wanted to grab the patient's left ankle, Zhou Hua's eyes flashed, but he found the same here.

The patient was wearing high-heeled sandals, and his left ankle was clearly swollen and black.

"What's going on?Sprain?" Zhou Hua asked.

Xie Shasha, who was sobbing quietly, raised her head to look at it, and then nodded. "Qian Ping sprained her foot. ”

"How long has it been?" Zhou Hua asked again.

"Probably...... A month ago, just after the summer vacation. Originally, we wanted to find a job together to earn some money, and we could accumulate experience when we were about to graduate, but she sprained her foot at that time, and she couldn't go there, so I stayed at home for a month, and I took care of her. Xie Shasha didn't understand, what could this little sprain have to do with Qian Ping's fainting today?

"Did you basically not move after the sprain?" Zhou Hua continued his question, as if he was about to find the answer!

"I lay down for a month, and I basically didn't move. She only removed the bandage cast a few days ago, and it still hurts, and today is our first time going out for an interview. Xie Shasha wiped tears from her eyes. "I didn't expect something like this to happen. ”

"The ECG does not look like myocardial ischemia, excludes myocardial infarction, pain in the lungs, dyspnea, hypoxia, considers pulmonary embolism. Master Wang, you must pay attention to driving smoothly later!" Zhou Hua had already guessed something.

The so-called pulmonary embolism is a blood clot in the large blood vessels of the lungs, resulting in poor blood circulation, in addition to pain, it will also block the blood circulation in the lungs, and the metabolism and carbon oxygen circulation will be hindered.

Over time, oxygen cannot be transmitted to various organs of the human body through the blood, resulting in hypoxia, especially the lack of oxygen in the brain and the lack of oxygen in the heart. If it is delayed for a longer time, the thrombus will completely form and cause a pulmonary infarction, or even a thrombus will be detached from the blood vessels in the lungs and directly enter the heart and brain, resulting in a myocardial infarction or cerebral infarction, and if you don't die, you will lose half your life!

The causes of pulmonary embolism are complex and diverse, and there are not genetic factors like coronary heart disease and myocardial infarction, but a large part of them are due to the patient's long-term immobility, poor blood circulation, or bruises on the joints of the body to form blood clots, parasites in the body and other factors, resulting in blood vessel blockage.

This condition usually occurs in people who have been bedridden for a long time.

Qian Ping's pulmonary embolism is likely to be in two situations, one is that the thrombus has formed as early as the ankle sprain, but it is not serious, and the blood flows into the lungs after activity, and the other is that the blood has been bedridden for a long time and formed a thrombus directly in the blood vessels. There is a 95% low probability of blood clots in pulmonary embolism, and the blood clots are formed in the veins of the lower limbs. Long-term bed rest and the rupture of capillaries in the body caused by sprains accelerate the process of thrombosis. Whatever the reason, it would be fatal for her. This type of acute pulmonary embolism has a high mortality rate, second only to tumors and myocardial infarction.

Don't look at the sprain as just a small illness and details, but Zhou Hua has to find any associations that can match the current patient's symptoms from these details, and make inferences.

Zhou Hua was no longer conservative, and seeing that the patient's breathing was getting weaker and weaker, he carried the patient into the cart with Wang Ge and sent him into the ambulance.

There were no thrombolytic drugs in the car, and equipment was needed to carry out thrombolytic treatment, so Zhou Hua could only hold the patient's breathing and blood pressure as much as possible, so that she could support her to the hospital.

"Qian Ping, hold on, let's go back to the hospital, don't be afraid!" Xie Shasha also got into the car, sat next to her good friend, and said to her.

"Contact the patient's family and ask them to come to the hospital as soon as possible. Do you have your ID card and bank card? Feng Ji asked.

Xie Shasha nodded, "I will do all these things." Trouble you, save her!"

"Rest assured. We will do our best. Zhou Hua and Feng Ji were busy together, inhaling oxygen to patients and conducting ECG monitoring.

"Open two large venous channels, 500 ml compound sodium chloride injection intravenous infusion, pay attention to speed, and prevent pulmonary edema. Two milligrams of norepinephrine diluted with normal saline to twenty milliliters of slow intravenous injection. Zhou Hua looked at the painful look on the patient's face, licked his lips and said, "Push it to settle down, it must hurt badly in the chest." Then he instructed Feng Ji to prescribe some anticoagulant and thrombolytic drugs.

Feng Ji only agreed, but he didn't have time to lift his head, repeating the doctor's instructions, dispensing and administering medicine, sweating profusely.

Wang Ge has already discovered the existence of death in the vast sea of people, and began to drive to accelerate as soon as everyone got into the car, avoiding the traffic jam, and only picked up the intercom until the speed was slightly stable.

"This is the No. 0110 of the Second Affiliated Hospital of Yaxiang, Xiang AGZ689, receiving patients from the bus station of Wuyi Square. The patient's condition was not something that the king pigeon could describe, and he threw the intercom directly behind him.

"Please note from the command center that the patient is suspected of having a sudden, severe acute pulmonary embolism. Request emergency department blood test, arterial blood gas analysis, electrocardiogram test, echocardiography, chest X-ray, chest spiral CT, MRI, radionuclide pulmonary ventilation perfusion scan, left lower extremity also need a deep vein examination, pulmonary artery angiography at the same time, prepare for interventional treatment in the operating room, the patient may need interventional surgery at any time. After Zhou Hua finished speaking, he returned the intercom to Wang Ge.

"Received by the center!" After receiving a reply from the command center, Wang Ge also immediately hung up the intercom and focused on his driving. What reassured him a little was that the Grim Reaper behind him was not so fast, and the speed of the car was just over eighty kilometers per hour, and the distance between the two had already begun to widen.

The series of complicated and diverse inspections in Zhou Hua's mouth frightened Xie Shasha in the car, she could read the words, but she didn't know what they meant when they were combined, and she couldn't ask anything after holding it for a long time, so she had to say, "So many inspections, is it too late?"

"There is still a little time, we will perform thrombolytic therapy and examination at the same time, but the anticoagulant drugs and thrombolytic drugs in the car are limited, and we have to go to the hospital. Zhou Hua knew that he and Xie Shasha would definitely not understand those professional things, but in order for her to be at ease, he could only try his best to explain.

Such an acute and severe pulmonary embolism is the first time Zhou Hua has seen it.

This time, the situation is even more serious than the author Wang Xiaoshui, who was hospitalized due to pulmonary embolism last year, and the interesting thing is that that person was also pulled to the hospital by Wang Ge at the beginning.

Although Liu Ya, the doctor at that time, saw that the patient was fine, he still insisted on giving him a detailed examination, and only then did he find potential signs of pulmonary embolism and pull him to the hospital, otherwise it is still two to say whether the person is alive or not. When Liu Ya held a meeting afterwards, he also shared this case and advised medical workers not to take every patient lightly.

And Zhou Hua remembered every word of his teacher Liu, so that he could discover the cause of the patient today.

Pulmonary embolism not only has complex and diverse causes, but also has a variety of treatment methods, so it is not possible to generalize in the treatment, but to analyze the specific situation and select the most suitable treatment method for the patient's condition in order to achieve the expected effect. The detailed examination can analyze the specific location, size, impact on the body's circulation, the degree of danger, and the cause of the disease in detail, and these factors can also directly determine which way to use in the first aid after the patient is admitted to the hospital, which is of great significance and indispensable.