The patient, a 37-8-year-old male tourist, was accompanied by a friend.

His brow furrowed, his right hand clutched over his chest, and he sat down in his chair.

"It hurts in my chest." Every nerve in the patient's face was tense, and just by looking at his expression, he knew that he was in real pain.

"Shh, it hurts me." He squeezed a moan out from between his teeth.

"Xiao Xie, give him an electrocardiogram immediately." Wang Zhang's expression was also very nervous.

Xie Baoshu had already aimed at the portable ECG machine on the side when he heard the patient say that he had chest pain, and when he heard this sentence, he immediately moved like a spring.

After helping the patient onto the examination table, fixing the electrodes, and telling him to breathe slowly and relax, he began the operation.

The report was immediately printed, Xie Baoshu only glanced at it, and handed it to Wang Zhang.

Wang Zhang looked at the electrocardiogram and did not have the acute myocardial infarction he was worried about, and his heart was a little calm.

But if you can't see it on the ECG, it doesn't mean that you don't have to.

Wang Zhang opened his mouth and asked, "What kind of pain is your chest pain?" ”

"Is it a dull pain like a big rock pressing down on the chest, or a sharp stinging pain, does it radiate to the back?"

Xie Baoshu nodded secretly in his heart, if he asked instead, it would definitely be the same question.

The symptoms of chest pain are different depending on the cause.

For example, a typical myocardial infarction is a squeezing pain like a boulder pressing on the heart, while aortic dissection is a tearing pain that often radiates to the back.

The patient thought for a moment and replied, "It's just pain, but I can't tell you what kind of pain method it is—hey, hey, it's different from what you just said." ”

Xie Baoshu hurriedly asked, "Your pain is not continuous, but bursting in bursts?" ”

The patient nodded slightly in acknowledgement.

Wang Zhang measured his bilateral blood pressure and found that the difference was not large.

In general, if a patient has a thoracic aortic dissection, blood pressure in the left and right arms is likely to be asymmetrical, and the pressure difference can exceed 40 mmHG.

The patient's pressure difference was small and there was no tearing, and thoracic aortic dissection was much less likely – but not completely ruled out.

Wang Zhang was about to do a further examination when he saw Xie Baoshu's relieved expression.

This kid showed this expression, could it be that he understood his diagnosis and treatment ideas? But isn't he a pediatric resident?

He was secretly surprised in his heart, and by the way, he glanced at Dorjee who was standing on the other side, and saw that his face was as ignorant as ever, obviously waiting for his explanation later, and couldn't help but sigh slightly.

People need to be compared. When he took over Xie Baoshu before, he didn't take him too seriously.

A pediatric resident in a third-tier city has never worked in a general emergency department, and in his eyes, he is no different from a local doctor.

But I didn't expect that this young man with a long horse face was full of stamina.

After just a few days of adaptation, whether it is clinical diagnosis or actual operation, he has improved by leaps and bounds, and in a blink of an eye, he has thrown Dorjee away a lot, and all kinds of performances are about to catch up with the attending doctor he brought out, which shows that he is both talented and has hard work behind him.

Such a young man, even if he looks a little magical, is still likable.

"Have you had surgery before?" Wang Zhang put aside the messy thoughts and continued to ask.

"Nope." The patient replied without thinking.

It is unlikely that it is a pulmonary embolism caused by blood clots in the arteries of the lower limbs.

Because of illness and prolonged bed rest after surgery, there is a risk that blood flow will be stagnant and blood clots may occur. When a blood clot flows into the pulmonary artery, a pulmonary embolism develops.

The patient is young, has no other medical history, and has not had surgery, which can almost rule it out.

Xie Baoshu thought to himself. The four most common causes of chest pain that can lead to rapid death have now been eliminated.

The reason why it is basic is because the results of a simple physical examination are not completely reliable, and it must be confirmed by auxiliary examinations such as blood, color ultrasound, and CT.

But the last type of chest pain that can be quickly fatal, which can be ruled out directly by auscultation, is pneumothorax.

Pneumothorax is caused by damage to the patient's lungs, resulting in air staying in the chest cavity and not being able to enter the external oxygen, causing chest pain and difficulty breathing, which is life-threatening.

Sure enough, Wang Zhang and Xie Baoshu had the same idea, directly took out the stethoscope, and listened carefully to the patient's chest sound in both lungs.

If the patient has a unilateral pneumothorax, the breath sounds on one side will be weak, and a clear echo will be heard if the hand is tapped again.

The patient's breath sounds are symmetrical and there is no sign of tachypnea, so it is not a pneumothorax.

But if it's not the four killers of chest pain, then what else could the patient be?

Xie Baoshu was thinking about it, and Wang Zhang had already issued a long list of checklists.

Complete blood count, myocardial markers, cardiac ultrasound, chest x-ray.

I did everything I could except for enhanced CT.

Other causes of chest pain must be considered after the above conditions have been ruled out based on the results of the examination.

At that time, Wang Zhang will be much calmer. Chest pain caused by other causes, no matter how severe, is not immediately fatal, he can have a lot of time to think and deal with it, and he can also transfer the patient from the emergency department to the cardiology department for more professional treatment.

The first priority of the emergency department is actually emergency treatment.

Diseases that are not so urgent do not necessarily need to occupy resources and affect the treatment of other truly critical patients.

A friend accompanied the patient out to pay for the examination, and Wang Zhang was admitted to the school for two resident doctors.

"Tell me, what do you think of this patient?"

Xie Baoshu held back for a long time, and he had already saved up a lot of experience and wanted to show off it, but Wang Zhang waved his hand to stop him: "Dorjee, you come first." ”

"Ugh." Dorjee scratched his head and hesitated, "Director Wang, what do you want to hear?" ”

Wang Zhang was accustomed to Dorjee's reaction.

"Let me change the question - what are the first possibilities that come to mind when you see a patient with chest pain?"

Dorjee had just learned this question recently, and he answered with confidence: "Myocardial infarction, pulmonary embolism, aortic dissection." ”

"And pneumothorax." Xie Baoshu kindly helped him add.

"So what can you see from the patient as I asked the patient step by step?" Wang Zhang followed the good path.

"I can't say this." Dorjee frowned and thought hard for a while, and suddenly his eyes lit up: "By the way, there is no problem with the electrocardiogram, and the patient has also said that there is no tenderness in the chest - it means that he is not an acute myocardial infarction." ”

"Not bad. However, this situation can only show that the possibility of myocardial infarction is small, not absolute. Wang Zhang affirmed and mentioned: "It depends on the results of myocardial markers." ”

"I see."

"What about the others?"

"Something else? Then you'll have to wait for a while, right? Dorjee asked suspiciously.

Wang Zhang looked at Xie Baoshu: "Xiao Xie, what do you think?" ”

(End of chapter)