After hanging up the phone, Dai Yunyang thought for a moment and decided to report the suspected case of unknown pneumonia to the director Wu Hao.

Dai Yunyang came to the director's office and told his wife Ai Fenfei's phone reply about his findings, and said that the three patients he had been treated, Master Da, Cai Liya and Ma Laohan, all met the requirements of the notice and reported suspected cases.

Wu Hao's expression became solemn, and he confirmed again: "You mean, these three patients are the unknown pneumonia mentioned in the notice of the Health Commission?" ”

Dai Yunyang said: "I am not sure, but the patient is a merchant in Seafood City, or has a history of direct contact, has obvious symptoms of pneumonia, the total number of white blood cells is reduced, lymphopenia, and there is no obvious improvement after antibacterial treatment, and the patient's condition is progressively worsening." Among them, the pneumonia image of Ma Laohan, a critically ill patient, has developed into multiple ground-glass opacities in both lungs. These conditions are met. My wife also feels like it, especially Cai Liya, who has done pathogen screening and has ruled out known pathogens. ”

Wu Hao nodded: "Since this is the case, then report these three cases according to the regulations, and at the same time, isolate the patients first according to the requirements." ”

Dai Yunyang agreed and reported as required.

………………

Early the next morning, Dai Yunyang came to the emergency department of the main city hospital.

As soon as I arrived at the door, I saw that the hall was full of patients, and I looked quite anxious and a little puzzled.

Seeing that Wang Bingbing was busy at the medical guidance desk, he walked over and said, "Why are there so many patients today?" ”

Wang Bingbing had been busy registering just now, and he didn't pay attention to his approach, thinking that he was a patient. When he heard the voice, he looked up and said happily, "Doctor Dai is here?" ”

She hurriedly took a medical mask and handed it to Dai Yunyang, and waited for him to put it on before continuing: "It's just strange, there are a lot of patients today, and many of them are fever patients, coughing and fever." ”

At this moment, a patient came to the medical guide desk and asked, "Nurse, I have a fever and cough, I need to take my temperature with you first, right?" ”

"Yes, patients with fever have to fill out a form to measure their temperature. You fill out the form first. "Say it and hand him a form.

Dai Yunyang asked the patient casually: "Why don't you go to the fever clinic?" ”

"There are too many people over there, too lazy to wait. I thought there were few people in the emergency department, and the results were all about the same, alas, it was certain that I was late for work this morning. cough cough cough ......"

Hearing that the patient was coughing very badly, Dai Yunyang hurriedly waved his hand at Wang Bingbing, turned around and came to the emergency department.

Intern Zhao Guang was already waiting there, and also said, "Teacher, there are a lot of people today!" ”

Dai Yunyang nodded, at this time, the mobile phone vibrate, and when he took it out, he saw that it was a message sent by Director Wu Haoqun: "There are many fever patients in the emergency outpatient clinic today, and the rotation is temporarily canceled, and all staff are on duty to receive treatment." If other departments can get away, they all go to the emergency clinic to help receive patients. ”

This situation is rare, unless there is a mass poisoning or injury incident, and a large number of patients come at once, which will send a mass message asking for the rest or the medical staff who can walk away to help.

Dai Yunyang's emergency internal medicine department is better, and the emergency surgery and emergency room are often crying.

The emergency department was not calm, a middle-aged woman came to see the emergency department with the support of her husband, and was sitting next to Dai Yunyang before she could speak, and a mouthful of blood vomited out, on the table and on the ground, fortunately, Dai Yunyang and the intern Zhao Guang opposite were wearing masks, and blood was splashed on their faces.

"Send to the emergency room!"

Dai Yunyang didn't care about wiping the bloodstains, stood up and helped her husband help the sick woman to the emergency room, and everyone waiting outside the door quickly got out of the way. One by one, they looked in horror as blood flowed all the way.

Zhao Guangfei rushed into the emergency room to inform the preparation, and a patient with hematemesis gave first aid.

The head nurse, Xiong Shengnan, hurriedly instructed the nurses to prepare. At the same time, nurses Xiao Juan and Wang Bingbing rushed over to help the patient into the emergency room, lay on the hospital bed, and immediately went to ECG blood pressure detection, oxygen inhalation, whole blood biochemistry, contact the blood bank for blood preparation, establish a peripheral deep venous fluid path, and rehydrate and expand the volume.

At the same time, Dai Yunyang began to inquire about the medical history, and learned that the patient had vomited blood shortly after eating at home, almost the size of a rice bowl, chest tightness, shortness of breath, unwilling to lie flat, and no abnormalities were found in the community hospital.

When I asked the patient and her family, I learned that the patient had no respiratory diseases such as tuberculosis in the past, and she had no cardiovascular diseases such as congenital heart disease. On the first day, I had two teeth extracted at the dentist and took amoxicillin to reduce inflammation.

The blood pressure dropped seriously on the examination, the body temperature increased slightly, the pulse and breathing accelerated, and the questions asked by Dai Yunyang were basically answered by family members, the patient was very irritable, turning over and over on the bed, and several times she had to tear off the infusion tube on her hand, and the head nurse Xiong Shengnan took it upon herself and fixed the patient's hands and feet on the bed rail with cloth tape.

Dai Yunyang saw that her lips were mildly cyanotic, and he auscultated her and found that the breath sounds were low and there were crackles in both lower lungs.

Wu Hao, a critically ill patient, was about to arrive as soon as possible, and after asking Dai Yunyang about the basic situation of the patient, he groaned: "The patient's blood oxygen saturation is only 90%, he doesn't like to lie flat, and there are wet rales in both lower lungs, which may be acute left heart failure, so do a bedside cardiac ultrasound examination immediately!" ”

Dai Yunyang agreed, and immediately asked the nurse to push over the bedside color ultrasound machine and did color ultrasound for the patient, but the heart structure was normal, there was no regurgitation, and there were no signs of pulmonary hypertension, which did not support Wu Hao's previous judgment.

Wu Hao shook his head: "Actually, I wasn't sure before I did it, because since the patient is coughing up blood, the amount of blood has reached a state of shock, and the color is bright red, not pink foamy sputum, which does not quite match the signs of acute left heart failure." ”

Dai Yunyang nodded: "Before I did it, no one could hold it." ”

Wu Hao thought for a while, and then said, "Could it be a pulmonary embolism?" ”

Dai Yunyang nodded: "It's possible, but the patient had a chest X-ray in the community hospital before, and no pulmonary embolism was found." ”

"It's not necessarily reliable, it's safer to do it again."

Bedside chest x-ray quickly yielded results, diffuse effusion from both lungs.

Wu Hao's face was even more solemn, and he asked, "Have you done the blood gas analysis and D-D dimer test?" ”

Both of these can be used to diagnose pulmonary embolism, and Dai Yunyang has arranged for an examination beforehand. Nodding his head, he said, "It's done, but the results haven't come out yet." ”

"Okay, wait for the results first, and at the same time rehydration and expansion, whole blood, plasma and suspension red blood cells, anti-shock therapy, and wait for the results to come out."

Dai Yunyang hesitated for a moment and said, "Actually, I think it's probably not a pulmonary embolism." ”

"Oh? Let's talk about it. ”

"The patient suddenly coughed up a large amount of blood, which affected circulatory stability, but the physical examination showed no signs of acute pulmonary hypertension. - Of course, I'm just a feeling. ”

"It's good to feel good, and that's what the emergency doctor wants. The slightest negligence is fatal. ”

"Well, so I also have an idea, if the patient vomits blood after eating, will it be poisoned? But the patient's family has also been eating, and I asked just now, and their family is fine. Moreover, the patient coughed up blood, which is not consistent with the tendency to bleed in multiple parts caused by common rat poison. ”

"I can't say for sure, it's not necessarily ***. It's always good to check it out, the emergency doctor has to think broadly, who knows which cloud has rain? Immediately send blood for poison testing and coagulation routine to see if it is poisoning. ”