"I went to the Municipal People's Hospital 2 weeks ago, when the body temperature was 38.9 degrees, the blood test was routine, the white blood cells were 16,000, mainly neutrophils, and obvious crackles were heard in both lungs. The Municipal People's Hospital was admitted to the hospital with an 'acute lung infection'. ”

"During the hospitalization, the symptoms were good and bad, and in the past week, the condition has taken a sharp turn for the worse, the patient's mental state has deteriorated, the blood pressure is low, the body temperature is mostly raised in the afternoon, and sometimes, the body temperature in the morning is also relatively high, and the change of body temperature seems to be irregular."

"Because of the worsening of the condition, the patient was transferred to the ICU for treatment. After nearly a week of treatment in the ICU, the condition continued to worsen, the confusion was obvious, and the patient had irritability, delirium, and anorexia at the same time. ”

"Because the patient's condition did not improve, the patient's family decided to be discharged from the hospital and came to our hospital for treatment. After consultation with various departments, he received inpatient treatment from our department. ”

It can be seen that in a short period of time, Ye Xiu's grasp of the condition is very thorough and accurate.

Lin Lin listened to Ye Xiu's report while looking at the medical records, and finally looked at Ye Xiu and said with satisfaction; "Good, good."

Lin Lin glanced at the patient and found that the patient had a gastric tube.

"The patient can't eat?"

"He could eat, but not much, so they put a stomach tube in him."

"Chief, remove the stomach tube immediately." Lin Lin frowned and said to Ke Jing decisively.

Ke Jing immediately stepped forward and gently pulled out the patient's stomach tube.

The moment the gastric tube was removed, the slightly irritable patient breathed a sigh of relief. It can be seen that gastric tubes not only bring discomfort, but also bring psychological pressure.

"At what point of the day do you feel better?"

"In the morning, when I wake up in the morning, I feel more comfortable and want to eat something, but I don't eat much."

"In the afternoon, I felt a fever all over my body, as if I had been 'barbecued', I felt dry mouth and anxiety, at this time, I couldn't cough up phlegm, I had no appetite at all, and I was very resistant to eating."

"Is there a lot of phlegm now?"

"I feel like there's a lot of phlegm in it, but I can't cough it up."

"Can't cough up in the morning?"

"Not in the morning, the phlegm is very viscous and difficult to cough up."

"Feeling thirsty?"

"Thirsty, very thirsty, always wanting to drink water."

"Do you smoke and drink?"

"Yes, I smoke a lot and drink a lot. Before the onset of this illness, I was drunk from alcohol, was helped home, slept until midnight, and vomited a lot by the bedside. ”

"Did you feel like you were choking in your lungs?"

"There should have been, I was vomiting and coughing violently."

"How's the poop now?"

"Less, all little, very little urine and urine."

"How many times a day do you pee?"

"I can't remember clearly, it's very rare anyway, and the urine pulled out is a bit like tea."

"Have you ever been so sick before like this one?"

"No, I've always been in good health, and I don't have a lot of colds."

"Okay, you lie flat, I'll check it for you."

"Okay, thank you!" The patient does not seem to be in bad spirits.

Lin Lin first touched the patient's skin with her hands, and felt that the temperature of the skin was slightly higher, and the skin appeared very dry. Lin Lin pinched the skin with her hand and pulled it up gently, then immediately let go, only to see that the skin retracted very slowly.

This should not be seen at such an age. When Lin Lin saw it, her brows furrowed again.

"What is your blood pressure right now?" Lin Lin asked coldly.

"The blood pressure I just measured was 95 mm Hg in systolic blood pressure and 55 mm Hg in diastolic blood pressure." Ye Xiu replied immediately.

"Hmm." Lin Lin answered, and continued to auscultate the patient's lungs.

Chest, back, under armpits...... Involving all the auscultation areas of the lungs, Lin Lin listened to them all. After the internal medicine system examination, Lin Lin did the neurological examination.

In the neurological examination, Lin Lin paid special attention to two signs, one was the examination of meningeal irritation, and the other was to look at the fundus.

"Chief nurse, now prescribe an extra tube for the patient. One is infused with glucose, and the other is transfused with glucose saline. Blood pressure and pulse are measured every 15 minutes and recorded. ”

In addition, pay close attention to changes in urine output, take a graduated urinal and place it next to the bed, and ask the patient's wife to keep a record of the amount of urine per discharge, and the total amount of urine in and out. Before the infusion, a tube of blood is drawn and a complete set of biochemical tests is done. Lin Lin's doctor's advice is clear and unmistakable.

"Okay, I'll arrange it right away." Ke Jing agreed. Lin Lin led everyone out of the room and back to the doctor's office.

"Let's discuss it, speak freely, and don't need me to name names." When everyone was seated, Lin Lin immediately asked everyone to take the initiative to speak.

"I'll start with that." Ye Xiu is very proactive.

"This is a middle-aged man who started with cough and sputum with fever, and his symptoms were progressively worsening."

"During the patient's stay in the People's Hospital, a large number of different types of antibiotics were used, and although they had a certain effect, they were not very significant. The main manifestation is that the patient's body temperature has not returned to normal. ”

"In the last week, the condition has worsened and the patient has started to have delirium and confusion. Curiously, these symptoms, which are severe in the afternoon and evening and mild in the morning, are highly consistent with fluctuations in body temperature. ”

"In the People's Hospital, the patient's blood routine examination showed an obvious inflammatory change after a bacterial infection. Chest x-ray showed obvious bilateral lung floor inflammation, rapid erythrocyte sedimentation rate, high sodium and potassium, and lower and lower blood pressure curves. ”

"To sum up, I believe that the patient's diagnosis is a double lower lung infection. Dean Lin's physical examination and medical history just now gave me a lot of inspiration. ”

"I think this patient still has a problem of volume depletion. The patient's blood pressure was not caused by septic shock in the People's Hospital, but by a serious insufficiency. In the case of septic shock, the patient's mental state should be worse. ”

"The next step in treatment is to change the antibiotics. As for what kind of antibiotics to change, I don't have more experience and would like to hear the opinions of the teachers. Ye Xiu paid attention to all the details of Lin Lin's ward rounds.

Next, the speeches of Li Yun'e, Zhuo Yiming, Ling Xiaoyun and Ding Feng were not much different from Ye Xiu's speeches. At this moment, Ye Xiu is showing her grandeur, and she has a bit of Lin Lin's demeanor when she just graduated.

"This patient has the following characteristics." Because of the time, Lin Lin began to speak.

"First, acute onset, with obvious precipitating causes, a history of suspected foreign body aspiration, followed by cough and fever."

"Second, judging from the records of the People's Hospital, the effect of the patient's treatment in the early stage is still good. The recurrence of the disease was due to the sudden discontinuation of the drug in the middle of the process, and the reason for this is unknown. ”