Zhou Can was idle, secretly thinking about where the cause of this obese female patient would be?

There are many causes of sudden pauses in breathing during sleep. For example, genetic factors.

If someone in the family has the disease, the chances of the offspring being inherited are very high. This kind of patient can usually be seen by looking at the patient. For example, the tongue is huge, which is often referred to as the big tongue disease, and the kind that speaks with a little stuttering.

This is the most typical type of heredity.

Almost all patients with large tongues are at risk of apnea during sleep. Their tongue is enlarged and easily retracts to clog their throats.

There is also micrognathia, uvula hypertrophy, turbinate hypertrophy, etc., all of which have the risk of apnea during sleep.

These people are at high risk of the disease.

An experienced doctor can see it by looking at it with the naked eye.

In addition to genetic factors, people who like to drink alcohol and smoke are also prone to this disease.

Excessive alcohol consumption can easily worsen sleep apnea symptoms.

Some were drunk and lay on the ground unattended, and by the time they were found the next day, they were dead. This tragedy is not just one, but has happened many times.

The images of the obese female patient and her parents flashed in Zhou Can's mind one by one, and there were no obvious appearance defects.

Their family's voice is clear, and there is no macroglossia or anything like that.

During the consultation, none of the parents of the female patient mentioned that other family members had the disease.

Then familial inheritance can basically be ruled out.

Smoking and drinking for a long time, she doesn't look like that kind of woman.

Obesity causes narrowing of the airways, which can be largely ruled out. Because she had already undergone surgery in this area, the family made it clear that the patient's symptoms persisted after the surgery.

This suggests that it is most likely not due to narrowing of the airway.

Or she is in a very special situation, and there are other lesions besides the narrowing of the airway.

What could be the cause? Endocrine disorders?

It's a real possibility, and it's quite likely.

Metabolic disorders can also cause abrupt pauses in breathing during sleep.

Zhou Can's diagnostic thinking is basically stuck in this place. For further diagnosis, she must wait for bronchoscopy and contrast-enhanced CT to continue.

At this time, a woman who was attending a table next to her caught Zhou Can's attention.

The woman was holding a toddler as young as one or two years old and was telling the doctor about the child's symptoms.

"Doctor, please help me to see, my son seems to have caught a cold for the past two days. When he breathes, he makes a strange noise, as if something is blocking his nose. And his forehead was a little hot. ”

The woman looked to be twenty-three or fourteen years old, dressed a little old-fashioned, and her skin was dull and rough. But as long as they dress up like this, most of the family's economic conditions are not very good.

And the level of education is generally low.

The living conditions of this group of people are not good, coupled with the fact that they do not pay much attention to health, have a low level of education, and have no concept of medical knowledge at all. There are even some people who are extremely stubborn and old-fashioned.

When you are sick, you don't find a regular doctor for treatment, but like to pray to God and worship Buddha, or superstitious about some earthwork and home remedies.

If she was sick herself, it wouldn't be fine.

Anyway, no matter how she tosses, she is the one who suffers.

What I'm most afraid of is that the child is sick, and she tosses it like this. It is the child who suffers.

Zhou Can could see at a glance that the child's face was already a little cyanotic, indicating that he was already quite sick. At this time, she brought the child to see a doctor, and her heart as a mother is really big.

The person sitting next to Zhou Can was Director Dai Shan of Tuya Pediatrics.

She is estimated to be around forty-one or twelve.

With short hair and an ordinary look, she looks smart and ordinary.

Being able to become a chief physician at the age of about 40 in Tuya Hospital is already a very young chief physician.

Although the deputy senior professional title is uniformly reviewed by the municipal competent department, the senior professional title is reviewed by the provincial competent department. It seems that it has little to do with the hospital, but in fact, there are many subtleties in it!

The chief physicians of BR county-level tertiary hospitals and provincial-level tertiary hospitals seem to be reviewed by the province.

However, there may be a wide disparity in the level.

Take Tuya as an example, when recruiting doctors, they began to get stuck from the level of regular training, and the recruitment requirements were extremely demanding. Every winner is killed from tens of thousands of doctors through layers of competition.

The foundation itself is much stronger than that of the trainees in the county's tertiary hospitals.

In the later stage of cultivation, county-level hospitals cannot be compared.

Whether it is the level of the teacher, or the hospital's scientific research, teaching, software and hardware, diagnosis flow, treatment experience of incurable diseases, etc., almost every aspect of the provincial hospital far exceeds the county-level hospital.

It is conceivable how big the gap between the level of doctors at the same level in county-level hospitals and provincial-level hospitals will be.

But there are no absolutes in this kind of thing.

Some county-level hospitals also have strong chief physicians.

In turn, provincial tertiary hospitals also have average level chief physicians.

In short, Dai Shan was able to be promoted to the chief physician of pediatrics at such a young age, and her strength was definitely not much worse.

The young female doctor sitting next to her, Zhou Can was a little impressed.

Chen Jiaojiao, a trainee in the same class as him.

This girl's results in the regular training recruitment examination are extremely dazzling, and her surgical ability is also quite strong.

After nearly two years of regular training, these regular trainees have gradually begun to participate in the formal diagnosis and treatment work.

Sitting with the chief physician is the prelude to starting to practice medicine independently.

Director Dai stared at the child carefully, and there was not much expression on his face.

"How old is the child?"

"One year and seven months."

"Weaned?"

"Weaned a long time ago, and the child now eats with the adults."

Children from poor families rarely eat milk, and most of them are weaned at about one year old and then eat with adults. Many of the children of wealthy families in the city were on milk as their staple food until the age of three.

There is another phenomenon that is particularly interesting.

After giving birth to a child, female white-collar workers in the city rarely breastfeed the child. On the one hand, they have to work and can't take care of their children at home. On the other hand, they pay great attention to their body shape and shape, and are worried that breastfeeding will bring problems such as sagging breasts and shriveling, which will affect their physical appearance.

As a result, they prefer to spend thousands of dollars a month to buy milk to feed their children.

Until recent years, there have been problems with milk on the market, and scientific studies have shown that children who grow up breastfeeding are healthier and smarter. The number of female white-collar workers in the city choosing to breastfeed their children is gradually increasing.

In addition, the extension of maternity leave has also created favorable conditions for female white-collar workers to breastfeed their children.

The child no longer drinks breast milk, which means that he must rely on his own immunity to fight off the virus when he gets sick.

Zhou Can could faintly hear a screaming sound when the child breathed.

It's like a weird sound when blowing a pipe, and it's like a puppy barking.

"Oops, there's definitely inflammation in the child's throat, and it's likely to be acute."

From the child's cyanotic face and lips, it can be inferred that the child is likely to have a high fever at this time. There are also problems with breathing, and blood oxygen exchange can be severely inadequate.

"Dr. Chen, you take your child's temperature and do a physical examination."

Director Dai said to Chen Jiaojiao.

"Okay!"

Petite, sweet-looking Chen Jiaojiao looks particularly quiet.

Who would have thought that this seemingly delicate young girl was not only a graduate student of Imperial Capital Medical University, but also had strong surgical strength?

She got up and walked to the sick child, smiled at the child, and said in an extremely soft voice, "Good boy, auntie will check on you, don't cry!" ”

I saw her skillfully clip the thermometer to the patient's armpit.

The child then begins to measure the key basic signs of heart rate, pulse, blood pressure, and breathing.

It can be seen that the child's body is still quite strong.

The small arms, as well as the neck, are full of flesh.

The face also looks fat.

"Oh, his temperature is as high as 41.3 degrees! It's scary! ”

After a while, Chen Jiaojiao took out her thermometer and looked at it, and suddenly her face turned pale, and she exclaimed.

A body surface temperature of more than 39 degrees Celsius is considered a high fever.

The child's body temperature was already as high as 41.3 degrees, which was indeed very scary.

This also shows that the child's immune system is frantically burning the energy stored in the body to defend against the virus.

"I reckon his glottis is swollen, and it's very swollen."

Zhou Can couldn't help but say beside him.

Anyway, it's okay, it's better to see the director of the pediatric department to diagnose this sick child.

When the child cries, his voice is hoarse, and there is a slight barking sound with each inhale.

"Dr. Zhou seems to be very good at pediatric diseases!"

Chen Jiaojiao looked at Zhou Can.

She should have been paying attention to Zhou Can for a long time, but her personality is more shy and introverted, so she didn't have a chance to talk to Zhou Can.

Even though the two of them sat between the two adjacent tables, there was no conversation during this time.

"Alas, I'm just a three-legged cat, but I don't dare to say anything good at it. This child's situation looks quite worrying, but it's true. If you can't get effective treatment as soon as possible, you are afraid that your condition will take a sharp turn and the prognosis will be very poor. You see, he's already starting to have four concave signs. ”

Zhou Can is really not good at pediatric diseases.

The child had already burned like this, and even began to show retractions when breathing, which means that the child's condition is deteriorating dramatically.

It was also the child's mother who was ignorant and failed to get the child to the hospital as soon as his condition deteriorated.

I had to wait until it was so serious to come to the doctor.

To put it mildly, the child is about to die, so he came to the doctor, and it is difficult to say whether the child can save his life if he does not mention the crime.

The four-retraction sign refers to inspiratory dyspnea, because it is not easy for air to enter the lungs through the glottis during inhalation, the thoracic and abdominal auxiliary respiratory muscles compensate for strengthening the movement, expanding the chest to help breathing, but the lung lobes cannot expand accordingly, so the negative pressure in the chest cavity increases, so that the chest wall and its surrounding soft tissues, such as the suprasternal fossa, supraclavicular fossa, inferior fossa, substernal xiphoid process or epigastric abdomen, intercostal space are concave inward during inspiration.

Once this symptom appears in a young child, then do not hesitate to send it to the doctor immediately.

By the time the face is cyanotic like this sick child, it is already an early sign of respiratory failure, and the body begins to lack oxygen.

"It's quite serious." Chen Jiaojiao nodded in agreement with Zhou Can's point of view. "Director Dai, what do you think is going to do next?"

The child's mother also panicked when she heard that the two young doctors said that her child was in serious condition.

Anxious eyes looked at Director Dai eagerly.

In the face of a terrible disease, the only thing ordinary people can rely on is doctors.

"The high fever is so severe, and there are four recesses appearing, so I immediately have a laryngoscopy. If a purulent discharge is detected, medication must be taken immediately, otherwise he will not be able to breathe once the throat is blocked. ”

Director Dai gave further diagnostic opinions.

"Mother child, you should take your child to the hospital for treatment as soon as possible! It's all dragged the child's illness like this. Prescribe a laryngoscopy for your child before deciding on the next course of treatment, right? ”

Director Jie's words were critical of the child's mother.

"I ...... I didn't expect it to be so serious. The child has had a cold before, and it will be fine in two days! The child's father is not at home, and I have a total of three children, and I can't pull away at all. Even today, I asked my neighbor to help take care of the other two children, so I took him to the hospital to see a doctor. ”

The child's mother already spoke with a trill.

"Doctor, please hurry up and treat my son! I finally gave birth to three children to give birth to such a son, he can't have anything to do! ”

It seems that this mother is not only ignorant, but also patriarchal.

Although the feudal mentality of preference for sons has been eliminated in many places, in reality, there are too many families who want boys. Many people still think that girls will marry sooner or later, helping other people's families raise children.

"First take the application form to pay the fee, and then hurry up to check the child. I mainly do two projects, blood routine and laryngoscopy, and I came to me as soon as I got the results. ”

Director Dai told the child's mother.

The child's illness is not difficult to diagnose, because it is all on the bright side, and the symptoms and diseases are clear at a glance.

The really hard part is the treatment.

With the current risk of the sick child, there is a risk that the respiratory tract will be blocked by viscous purulent secretions at any time.

……

After about an hour, a nurse came running in a hurry.

"Director Dai, not long ago, the patient with high fever and difficulty breathing was suddenly in danger during the examination, please hurry over and take a look."

The nurse did not say it explicitly, probably in front of many patients and family members at the scene, worried about the bad impact.

"Girl, please take us over for a moment."

After listening to this, Director Dai's face changed slightly, and he stood up and left.

Chen Jiaojiao followed.

It would not be a good thing if a patient died during the examination on the first day of the specialist outpatient activities of the specialists from Tuya Hospital.

"Doctor Zhou, what kind of danger did you say happened to that child?" Deputy Director Shi next to him looked curious.

"It's really hard to say, the most likely scenario is that the bronchi is blocked. You notice that no, the child's face is cyanotic, indicating that the body has been deprived of oxygen. I suspect that most of the child's bronchial tubes were blocked by viscous purulent discharge by that time. This, combined with a swollen throat, further squeezes the bronchial outlet, making it more difficult for the child to breathe. ”

Zhou Can replied worriedly.

The most likely thing about that child is that there is a problem with breathing.

In this case, if it is at home, most of the people will be gone.

In the hospital, as long as the doctor's level is slightly higher and the rescue experience is richer, there is generally no major incident.

At least in Zhou Can's opinion, if this child is treated by him, he can't die.

Director Dai took Chen Jiaojiao to the laryngoscopy and bronchoscopy examination room, only to see the patient lying on the bed, his face was already purple, and his expression was extremely painful.

He wanted to cry, but it was hard to make a sound.

Director Dai has rich clinical experience in pediatrics, and when he saw this situation, his heart chuckled, and his face became extremely dignified.

"Is the sick child's airway blocked?"

"Because the child is still young, it doesn't take long after priing open his mouth and spraying anesthetic, he starts to have shortness of breath, which is extremely laborious. We immediately inhaled him, but it didn't work. ”

The laryngoscopy doctor appeared very calm.

The emergency rescue measures taken were also appropriate.

The level of Xinxiang Women's and Children's Hospital is not bad, and its comprehensive strength is also quite strong. Especially in gynecology, obstetrics, and pediatrics, it is good at it.

"Did you check his laryngoscope?"

Director Dai used a flashlight to shine a flashlight on the child's mouth, which was still propped open by the pry board. The baby teeth have not yet grown, and the patient's teeth are clenched, and his tongue is a little stiff under the effect of anesthetic.

The breath is almost undetectable, the intake is less, and the exhalation is less.

"Roughly under the larynx, the child's larynx was obviously red and swollen, accompanied by inflammation, and it was visible that there was purulent sputum deep in. He didn't dare to go in even deeper, his situation was very scary. Do you want to have an emergency tracheostomy? ”

The child is so young, having a tracheotomy is not only very harmful to the child, but also extremely risky.

Director Dai's brows tightened, pondered for a few seconds, and then asked, "Is your hospital sure of tracheostomy?" In fact, there is a certain degree of discrimination in this remark, which will make the doctors and nurses of Xinxiang Women's and Children's Hospital unhappy to hear it.

But human life is at stake, and it is normal for Director Dai to be worried.

"Our hospital should be fully competent in terms of technical level and hardware conditions for tracheostomy. The only concern is whether the rescue after the trachea incision can be carried out smoothly? Director Meng Chun of our hospital happened to go abroad for further study, there is no experienced rescue in this area, you are a pediatric expert in Tuya Hospital, and you will carry out the rescue after tracheostomy, is it okay? ”

The laryngoscopy doctor explained the real intention of inviting Director Dai over.

Thank you book friends, Xiao Yan Feiyu for your support!

(End of chapter)