The three of them came to the patient's hospital room.

After a brief examination, Lu Lei's 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!

In addition to headache and nausea, the patient has no other obvious symptoms! As for the medical history, it is 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?" Li Jiancheng 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 many years of clinical experience, Lu Lei began to analyze it carefully.

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

"ECG?" Suddenly, Lu Lei's eyes lit up.

"You suspect it's a heart disease?" Li Jiancheng glanced at Hou Quanhai, his face was a little unhappy. He knew that this Hou Quanhai had come to teach them in the 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 acute myocardial infarction!" Hou Quanhai said lightly.

As soon as this sentence came out, Lu Lei fell into deep thought.

But Li Jiancheng said with contempt: "It can't be an acute myocardial infarction!" Most of the symptoms of acute myocardial infarction are crushing 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? ”

His meaning is obvious, how is the head pain related to 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 the Hou Quanhai in front of him made the first case in China in front of the hospital, it was very good! But the other party is just a resident doctor after all. I'm a rookie in other clinical experiences.

However, at this time, Lu Lei said with some interest: "Doctor Hou, 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 elderly woman, but she is not as sensitive to chest pain caused by myocardial infarction as younger patients, so I thought I would do an ECG first." Hou Quanhai said ambiguously.

As for why acute myocardial infarction causes headaches? He doesn't know! Anyway, the universal diagnostic surgery 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 your speculation and opinion Dr. Hou, in fact, atypical symptoms often appear in clinical patients, and it is very difficult to diagnose such patients! I met a similar patient three years ago, and the other party also had a headache, but the end result was myocardial infarction! Lu Lei recalled with a look on his face.

"Because the heart lacks nerve fibers that transmit tactile signals, and 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 tissue for somatic tissue, which is why referred pain is often the way heart pain manifests."

"Myocardial infarction is dominated by 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 volume decreased suddenly, blood pressure dropped sharply, and cerebral blood flow decreased, causing reflex cerebral vasospasm, resulting in ischemia and hypoxia of brain tissue. At the same time, the cerebral blood flow is reduced, which causes the intracranial pressure to decrease significantly, which makes the meninges stretched and causes headaches! ”

"Yes, I think so!" Hou Quanhai's face was not red, and he rubbed a wave of popular science heat.

But in my heart, I admire this Lu Lei very much, he is worthy of being the director of the emergency department, and 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 Lu Lei to think of checking an electrocardiogram.

At this time, Li Jiancheng next to him was dumbfounded!

He never thought that the director would agree with Hou Quanhai'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 ECG now?" Li Jiancheng said with a red 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. Such patients are easily misdiagnosed. 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. Lu Lei 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 pull a patient for a CT scan just because of a stomachache, right? Patients or family members will think that you are cheating, 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, Lu Lei sent Hou Quanhai back.

"Dr. Hou, I didn't expect you to have such rich clinical experience, it's really amazing." Lu Lei couldn't help but compliment. To be honest, he didn't expect Hou Quanhai's clinical experience to be comparable to him.

"Ahem......" Hou Quanhai laughed secretly in his heart, where can I compare with the clinical experience of the director, I am all open!