Many aspiring people who aspire to embark on a medical career will encounter a problem at some point in their studies, a question that is often asked by their teachers about priorities and unavoidable choices.

Suppose one day, you and your unjust colleagues are unfortunately in a situation where time and manpower are limited, but multiple patients come at the same time, the situation is as follows:

Option 1: Accompanied by a male friend, a young female patient who complains of dizziness, headache, blurred vision, chest tightness and chest pain, dyspnea, abdominal pain and nausea, weakness of the limbs, and has congenital heart disease, immune disorder, wind and heat in the lungs, spleen and stomach disharmony, and kidney yin deficiency, pear blossom cries to you with rain and complains of discomfort.

Option 2: A work-related injury patient who was sent by a worker, sat in a random place in the corridor and smoked a cigarette, silently holding a tissue to think about something, but the tissue contained two fresh fingers.

Option 3: The big brother who may have just fought bravely in an irregular drinking place, had a few openings in a broken wine bottle on his head, turned his skin and flesh outward, covered his face with blood, and cried bitterly and howled louder than the trumpet broadcast.

Option 4: Picked up by the old man at home, no crying or fussing, "everything was fine before, I didn't have any serious illness, I coughed for a few days without fever, come and see", now the young child who breathes fast and the color of his lips is suspected to be a little dark.

Option 5: A middle-aged man who is driven by his or her children, lying silently on a chair next to him, with no obvious external injuries on his body, ignoring the noisy surroundings and enjoying a baby-like sleep.

Option 6: Everything is fine, but the dean is his father.

Okay, the question stem and options are as above, it is forbidden to call for consultation and ask superiors, please independently select the object that should be viewed and processed as soon as possible within ten seconds, you can select multiple and sort.

When the time comes, all the trained doctors must have chosen what they think is the best answer.

I'm sure most people have a hard time not laughing out loud when asked, but their mentors usually don't interrupt the laughter.

Because they don't realize that they might be in it one day. For example, the scene that Kraft is in now.

The core logic of this outrageous problem is that there is a problem with the treatment of vital signs and states of consciousness first.

"Hurry, hurry, hurry!" Kraft dragged the wounded too close to the wall, away from the god knows if a brick and a half of the building would fall, "I'm a doctor, I'm here to help!" ”

"Wait...... No, don't mess with the patient yet. ”

The unlucky guy who was rubbed by the gargoyle shards should have only broken bones, and the wails were full of anger. Because it was at the center of the incident, the crowd dispersed from here, but avoided being stepped on a few times.

After a brief examination of the affected area and a closed fracture of the humerus of his left arm, Kraft left him where he was and quickly ran to the injured ones who were enjoying a "baby's sleep".

It was right not to let the non-specialist move the patient immediately. The second patient he met was lying in a strange way, his neck stiffened, and he made a gurgling sound when he saw someone coming.

Still conscious, but unable to speak because of limited neck movement and pain.

The strength and direction of the trauma he received were quite tricky, and it seemed that he had squeezed out the cervical dislocation, and if he really moved it at will, he would let the cervical spine swing at will and not be able to shake out a high spinal cord injury.

"Put this one away, I'll take the tablet to move it later!"

Skipping the injured limb and howling injuries, Kraft prioritized his time to focus on the already silent ones that needed to be dealt with in a hurry.

"Broken ribs are all down a little bit later. Wait, why is there a broken one, a flail chest? Wait for me to fix it. "It can be handled, and it needs to be controlled as soon as possible.

"So many bleeding spots, traumatic asphyxiation. The heartbeat is still there, go slowly, and next time remember not to be squeezed, I still hold my breath. "The squeezing caused a sudden increase in pressure in the chest cavity caused a special kind of injury, but fortunately there was no stopping.

"I'm unconscious, but my heart rate and breathing are stable, and I don't see any trauma, stay and see!" It can be light or heavy, and there are no signs of fatality for the time being.

"It seems to be a pneumothorax, closed, no difficulty breathing except for pain, let's wait for the needle from the clinic to come." The decision on whether to deal with it will be made after the assessment.

"I don't feel conscious, I have a trauma on my head, and my breathing is fast and slow. It's broken, tidal breathing, there's something wrong with the skull. "It's a big problem, but it can't be dealt with for the time being.

Vardin saw a confident professional temperament in this guy, instructing those who could still stand up in the square to do what was asked, completely out of sight.

His behavior was so natural that no one objected or questioned his identity, and those who were a little hesitant accepted the situation with suspicion because the others did not, allowing a medical school man to mix.

There was no need to introduce where he came from, and in the case of disorder, Kraft took over the command of the scene, and by the way, sent Wattin to the clinic to get tools and shake people.

There were no labels and pens on site, so they relied on the reverse folding of the patient's trouser leg to mark and classify. This method sometimes does not work, and some people who wear robes may have no pants to fold and have to fold sleeves instead.

Fortunately, there are not many patients who are serious enough to require immediate treatment, and most of them are flesh wounds.

In a short period of time, Kraft circled the field, sorting out fractures that needed to be reduced or fixed, those that seemed to have problems that needed to be left for observation, and a few cases that could really be life-threatening.

By the time Brother Wattin arrived with Coop and the toolbox, Kraft had already treated the first patient in the makeshift chamber with a borrowed piece of cloth, and had compressed and bandaged the man with multiple broken ribs.

"Just in time, there's a pneumothorax patient over there, and the lung compression is a bit heavy." Kraft took the toolbox and assigned the newly arrived Koop a task by the way, "You've done a lot of thoracentesis lately, go and vent him." ”

"Me?"

"Yes, you do it, I'm going to deal with it first." Without wasting a second, the professor opened the box and asked him to click on the tools himself, and walked to the quieter area.

I have only had time to make a rough judgment, and now I have entered the step of detailed inspection.

When there are a lot of patients, it is not so appropriate to rely on psychiatric surrogate imaging to make a diagnosis.

However, fortunately, in the era when imaging technology was not so developed, doctors also had to see patients, and a systematic physical examination method was formed to indirectly reflect the degree and type of damage to the nervous system.

They have long and awkward names, such as Kernig's sign, Bruzinski's sign, Babinski's sign, Oppenheim's sign, Hoffmann's sign, Chaddock's sign, etc., but all they do is lift their heads, lift their feet, or scratch the soles of their feet with sharp objects, and then observe the reflexes of the body.

For those who are proficient in operation, it basically only takes a few minutes to complete a set.

The one who had previously judged the situation to be more serious was indeed not very good, in addition to confusion, there were already quite obvious pathological signs, low voice, speech, and pain response, and a deep degree of coma.

Even if you rely on the positioning of your spiritual senses and find a way to solve the hematoma oppression, it is estimated that there is no chance to pull people from the hands of death.

The church staff who helped brought the light source, and he opened the patient's eyelids to make one last check of the pupils.

Under the illumination of the lantern, the patient's eyes are repeating a small movement—a slight upward turn and back to their original position.

The amplitude of the movement was indeed less pronounced, and it lasted only a few breaths, and the swaying of the firelight would have missed it if it had not been carefully watched.

"Nystagmus?" It seems to be a manifestation of intracranial injury, which, combined with abnormal breathing patterns, should reflect the involvement of the posterior cerebellum and brainstem.

But is nystagmus like this in intracranial injuries? To be honest, he is not a neurologist, and he still has some doubts about this, but he has limited time, so he can only go to the other patients first, and take advantage of the brightest light to check everyone's pupil light reflex.

"Huh?" When he opened the eyelids of another deeply unconscious patient who did not respond significantly to pain, Kraft let out a slightly surprised voice.

The patient's eyes also made a slight repetitive upward movement before jumping back into place.

[So coincidental?] 】

Another nystagmus, and it's all downward vertical tremors. It makes people a little self-doubting, what is the biased clinical knowledge point that will not be talked about in the book, or is it a coincidence?

It could have been a coincidence, but what he had learned told him that the probability of a standard vertical nystagmus appearing in two patients in a deep coma at the same time was extremely small.

The unbelieving Kraft opened the eyelids of another unconscious patient and began to watch and wait.

When he was about to laugh at his inexplicable thoughts, the eyes that stared at the ceiling jumped down a few times inconspicuously.

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