120 emergency doctors are slightly embarrassed.

"Just a cold that doesn't heal to diagnose myocarditis? Let's go back. Meng Qingfei waved his hand and pushed him away impatiently.

"Doctor Meng." The 120 emergency doctor glanced at Meng Qingfei's badge and said with some embarrassment, "Tell me what the results are." ”

After saying that, he left a contact number.

Meng Qingfei did not refuse, wrote down the phone number and began to check the body.

The patient is a 32-year-old male, 176 cm, approximately 65 kg.

He complained of having dinner with a colleague at 12 noon, and after drinking half a glass of liquor, he developed chest pain, chest tightness and discomfort, and vomited, and the vomit was stomach contents, and no coffee-like objects were found.

Physical examination: heart rate 102 beats per minute, blood pressure 154/103 mmHg, and no positive signs on the rest of the examination.

The patient was in poor spirits while lying in bed, and although his vital signs were stable, he did look very problematic.

After Meng Qingfei finished asking for medical history and physical examination, he stood beside the patient and did not speak, and Ji Xiang noticed that the fingers of his right hand were constantly pinching like fortune tellers.

The thumb quickly clicked on the other fingers, and if the other hand was equipped with a peachwood sword and the words were in the mouth, the taste would come.

Ji Xiang was curious about what Meng Qingfei was doing.

Although the patient looked very uncomfortable, he was not too anxious, so Ji Xiang did not go to the system operating room.

After calling for other examinations, Meng Qingfei briefly left the emergency room and returned to the consultation room to meditate.

"Teacher Meng, can I disturb you?" Ji Xiang asked.

"You say." Meng Qingfei's fingers were still pointing.

"You're ......"

"Differential diagnosis." Meng Qingfei said, "The patient's chest pain has been nearly 12 hours, and the pain is so obvious, there is a high probability that there is an organic problem." ”

"Differential diagnosis I, aortic dissection.

In general, patients with chest pain and elevated blood pressure should first rule out aortic dissection.

However, the blood pressure deviation of the left and right upper limbs of the patient is not large, and the pain of dissection is generally tear-like or knife-like, so the abdominal macrovascular examination can be completed to rule out first, and the thoracoabdominal aorta CTA examination can be done if necessary.

Now that the enhanced CT is off work, I can't check it, so I won't consider it for the time being. ”

"Second, the ...... of viral myocarditis"

"Third, spontaneous pneumothorax ......"

"Fourth, the ...... of acute pancreatitis"

"Fifth, the ...... of myocardial infarction"

Meng Qingfei was "talking to himself", and the thumb of his right hand kept pointing on the other fingers, as if he had made a differential diagnosis every time.

But he never found the right answer.

Soon, emergency serum troponin returns, indicating a negative test, can temporarily rule out viral myocarditis and acute myocardial infarction.

At this moment, Meng Qingfei was even more puzzled.

Ji Xiang also felt that the patient was very strange, and went to the system operating room with his attention.

Meng Qingfei's lips had already begun to move, and he was muttering, concentrating on the differential diagnosis.

His level is not bad, the condition of patients in the emergency department is generally relatively simple, unlike the patient in front of him who doesn't even know who to consult with.

"Teacher Meng, I want to see the patient." Ji Xiang said suddenly.

"I've just checked it out." Meng Qingfei replied casually, "What do you think?" ”

"When you first examined, the armpits of both upper limbs of the patient were not seen."

"Oh, indeed, but not all ......" Meng Qingfei was doing a differential diagnosis with eighty percent of his mind, and originally wanted to casually tell Ji Xiang that not all places should be checked.

It's like if you have chest pain and you go to see your lower body, you have to be beaten to death by the patient and the patient's family.

Even if you don't get killed, if you are posted to the media by a good deed, there is a high probability that it will be a social death.

However, Ji Xiang's sentence only began at the beginning, and Meng Qingfei thought of a lot.

"You mean there might be a problem with the mediastinum?!"

Ji Xiang's words opened Meng Qingfei's train of thought.

"The rest of the place looks fine for the time being, and the only thing missing is the armpit." Ji Xiang replied calmly.

Meng Qingfei's eyes lit up suddenly, he strode out, came to the emergency room, opened the patient's clothes, and told the patient to raise his arm.

When his hand touched his armpit, a slight feeling of holding snow was transmitted, and Meng Qingfei looked at it carefully, and there was indeed an atypical feeling of holding snow.

"Damn, it's really not about internal medicine, go check an emergency CT." Meng Qingfei hurriedly said to the nurse, "There are some problems with the patient's condition, I will send the patient for examination, and some patients will ask Lao Li of the internal medicine department to help me take a look first!" ”

After speaking, he hurriedly went out to open the order, remembered something, turned around and said, "Call the general chest and ask them to prepare the bed." ”

Ji Xiang really admired Meng Qingfei.

Chest pain, armpits are not a must, and spontaneous pneumomediastinum is extremely rare.

mentioned it himself, Meng Qingfei was as good as a stream, and listened to it.

He was really like a stream, like the water of the Yellow River, overturning all his previous assumptions.

His unobstinate thinking is impressive, and his brain spins extremely fast, only a little slower than the system NPC.

"Xiaoji, you stay, if there is a patient take a look at Lao Li of internal medicine first, don't let it go, wait for me to come back and see." Meng Qingfei hurriedly finished speaking, pushing the patient all the way to run wildly.

The oxygen bag on the flat car almost didn't fall off, and Meng Qingfei disappeared around the corner with the oxygen bag in his arm.

"Xiao Meng's diagnosis is not bad, but he is a little impatient." The internist had already been called up, stood in the corridor, and saw that Meng Qingfei had disappeared, and gave a gentle comment.

Ji Xiang was a little regretful, he also wanted to know the patient's final diagnosis, but Ji Xiang didn't say no, but stayed according to Meng Qingfei's meaning.

"You are Ji Xiang, I heard that you broke the record for so many years in the big competition." Dr. Li of the Department of Internal Medicine looked at Ji Xiang and asked.

"It just so happened." Ji Xiang smiled.

"Little Mente likes you, by the way, the patient who contracted tetanus a while ago is said to have been diagnosed by you?"

"It just so happened."

Dr. Li of the Department of Internal Medicine took a deep look at Ji Xiang, one thing can be a coincidence, one after another coincidence, there must be something wrong.

"What did that patient diagnose just now?" Dr. Lee of Internal Medicine asked.

"I don't know, I just said something, Teacher Meng seems to have a diagnosis." Ji Xiang pushed 369, no matter what others asked, he said he didn't know.

"It's our internal medicine, but ...... Alas. Doctor Li sighed, and suddenly smiled again, "We all know that Xiao Meng's diagnosis is good, and there are patient nurses from other hospitals who come to consult directly to Xiao Meng." It's okay, we're worry-free. ”

"Xiao Meng looks at Jiao'er Langdang, it's actually quite good, you are also very powerful, there are so many doctors in the emergency department, you take a fancy to Xiao Meng, I see that you always follow him on duty."

"Teacher Meng spoke interestingly, when I first came to Guipei, Teacher Meng told me that the bathroom in the emergency department had been opened, and patients with urinary stones were willing to go to the toilet here."

Ji Xiang said with a smile.