After giving the patient an emergency gastroscopy, the condition was quite bad.

The patient's whole gastric mucosa appears pale, which means that the patient has gastritis and the condition is severe.

This condition occurs only when there is erosion, ulcer, inflammation, edema, and oozing on the surface of the gastric mucosa.

No wonder the patient's body looks emaciated, and the patient's father reports that the child only knows how to play games all day, go out and fool around, and does not eat much at home. With gastritis so severe, symptoms such as nausea, vomiting, indigestion, acid reflux, heartburn, etc., are sure to occur.

In this case, how can the patient eat food?

However, gastritis is often formed because of irregular diet. Hungry for a meal, full for a meal, or drink on an empty stomach, specializing in spicy, barbecue, and so on.

In short, in general, gastritis is self-inflicted.

When you are healthy, you don't care about it.

Eventually, the most severely affected organs could not withstand it and began to malfunction. That's when you're sick.

Gastroscopy showed that the patient had a linear mucosal old hemorrhagic lesion on the posterior wall of the gastric fundus, superficial erosions could be seen on the curved side of the gastric body and the folded wall ridge, and flocculent secretions and recent bleeding spots were attached to the surface.

The gastric antrum and duodenal bulb are normal.

A rapid urease test was performed on the patient and was negative.

At this point, the cause is basically clear.

It's bleeding from the stomach.

After discussing with Zhou Can, Ai Li decided to use blood transfusion and intravenous infusion to stop the bleeding drug first.

Almost all responsible physicians prioritize medication when treating diseases. Surgery will only be considered if medical treatment is ineffective.

Because any surgery will cause harm to the patient's body.

"Doctor Zhou, do you think it's okay to use batrazyme for hemostatic drugs?"

"With only one, it's a little too thin. Why don't you add tranexamic acid! ”

Zhou Can replied.

Batrazyse is an immediate hemostatic drug, which is used more for this emergency internal bleeding. Tranexamic acid has a long-lasting and powerful hemostatic effect, and it is a drug that inhibits the fibrinolytic system, mainly used for surgical bleeding caused by hyperfibrinolysis and obstetric and gynecological bleeding.

In addition, it also has a strong ability to penetrate the blood-brain barrier, so it is also commonly used to stop bleeding in the central nervous system.

After dealing with the patient, Zhou Can hurriedly entered the operating room.

He told Elle that if the above treatment methods are ineffective, the patient will discuss a new treatment plan at that time.

……

At about 12 o'clock in the afternoon, Zhou Can finished the operation and went to the canteen with his team members to eat.

As soon as I passed the triage desk, I was stopped by Dr. Ellie.

"Doctor Zhou, is this just an operation?"

"Yes! There are a lot of emergency surgeries today, so it's a bit late to do the next surgery. ”

Some surgeries need to be dealt with as soon as possible and cannot be delayed.

For example, hemostasis and suturing of traumatic wounds.

There is also the replantation of severed fingers.

Finger replantation surgery was rarely performed in the emergency department because of the technical requirements of this procedure. Only Dr. Koh can do it alone. And the operation took a long time.

In the unlikely event that Dr. Hui performs finger amputation surgery on a patient who needs urgent surgery, there will be a shortage of manpower.

Emergency surgery, especially wound suturing, dog bites, falls and other emergency trauma treatment, need to be handled by the emergency department. This type of patient, if pushed to a specialist department, will be scolded to death.

Don't look at a few years ago, Director Xie went directly to Vice President Ye because he had a few more surgeries in the emergency department.

In fact, Tuya has never lacked the source of ordinary minor surgery.

For this famous tertiary hospital, which enjoys a certain reputation in the province and is also ranked among the best in China, the annual outpatient and emergency volume is now rising at an alarming rate.

Each department can be completely 'full', and even many specialized departments have to refuse to get rid of some mild patients because of too many patients in the outpatient and emergency department, and 'indigestion'.

Therefore, there is a very contradictory need for specialist departments, the fewer simple patients with mild symptoms, the better, and the more patients with medium difficulty and above, the better.

If the hospital department wants to generate income, it is mainly mainly for patients with severe diseases and difficult treatment.

Because of this type of patient, the beds in the department can be guaranteed to run at full capacity to the greatest extent.

If the emergency department pushes some patients who can be treated with simple treatment to a specialist department, they will be scolded. At the end of the day, it's all about profit.

Today's emergency department operating room has begun to flourish, with an ordinary operating room, a 100-level operating room, and an endoscopic operating room under construction.

The surgical team has also increased from the initial few people to 256 people.

Including more than a dozen surgeons and more than a dozen surgical nurses.

Now, even if either Zhou Can or Dr. Xu is on vacation, there is no problem that the emergency department will not be able to function.

"Doctor Zhou, can you please help me see the patient with upper gastrointestinal bleeding again? After 1000ml of blood transfusion, the patient has now improved. However, the bleeding did not stop, but instead he developed a high fever, and his body temperature rose to 39.4 degrees. ”

Elle was a little embarrassed and made a request to Zhou Can.

She, an attending doctor in her fifties, has asked a resident doctor in her twenties for help, and this is already N times.

In other words, she's used to it.

"I'll go with you to see the patient!"

Zhou Can can only put the patient first.

"Doctor Zhou, I'll cook for you first, can you wait for you?" Qiao Yu silently took care of Zhou Can in life.

Now that the time itself is late, she is worried that it will be too late and the food in the cafeteria has been sold out.

"Eat first! After a while, I'll be done and I'll go over to cook by myself. ”

Zhou Can realized that this patient with gastrointestinal bleeding was more difficult to deal with.

I don't know how long it will take yet.

Why do I have a high fever in just three or four hours after taking the drug?

Following Elle to the emergency room, I saw the patient lying on the bed, her eyes closed, and her face still a little pale. However, compared to when I was first admitted to the hospital in the morning, the situation has improved significantly.

The amount of blood transfused is as high as 1000ml, which is actually quite impressive.

"Did you use ranitidine?"

After seeing the patient's condition, Zhou Can asked Dr. Ellie.

The first diagnosis system is currently implemented for such rescue patients admitted to the emergency department. Whoever receives the treatment, who is responsible.

Novice doctors are especially afraid of receiving critically ill patients.

However, as long as there is a doctor at or above the attending level on duty, when he hears that a patient needs to be rescued, he will immediately rush over and take over the patient. There is no such thing as having a novice doctor resuscitate a critically ill patient and leaving the senior doctor alone.

"Used!"

Ellie nodded.

Ranitidine is commonly used to treat duodenal ulcers, gastric ulcers, reflux esophagitis, Zol-Ellison syndrome, and other hyperacid-secreting disorders. It is also sometimes used to treat Helicobacter pylori comorbidities.

The cause of the patient's current fever is a major problem for Ellie.

This is also the main reason why she asked Zhou Can to come over to help with the consultation.

"The patient's other vital signs were fairly stable, there were no chills, only a high fever, which was really weird. The presence of intestinal infectious diseases cannot be ruled out. ”

Zhou Can's brows furrowed slightly, and he began to make every effort to diagnose the cause of this patient.

Blood transfusions are unlikely to cause high fever, and this factor can be ruled out.

Ai Li was very cautious in administering medicine to patients, and only used two hemostatic drugs that she had discussed with Zhou Can. Ranitidine for stomach ulcers is commonly used.

It stands to reason that the possibility of high fever caused by medication is also low.

But the patient did stay in the hospital for three or four hours before he developed a high fever.

From the nurse's physical record to the patient, it can be clearly seen that the patient's body temperature is showing a relatively stable slanted rise within four hours.

It's not that the fever comes all of a sudden.

The first suspicion remains the issue of medication.

Zhou Can's current pathological diagnosis is level five, which is close to the senior level of the deputy chief physician. The pharmacological syndrome differentiation is also level 5, which has just reached the intermediate level of deputy chief physician not long ago.

Compared with pathological diagnosis, there is a significant gap.

The patient was less transfused than 1000 ml, and the heme barely recovered to a relatively ideal level. But his anemia did not improve significantly.

Zhou Can couldn't help but pick up the patient's emergency gastroscopy report again.

It stands to reason that the amount of bleeding caused by gastric mucosal erosion cannot be very large, and even if the bleeding continues for up to a month, it is unlikely to cause severe anemia or even sudden shock in the patient.

What's the problem?

At this time, Zhou Can had begun to suspect that the patient was not simply gastritis bleeding.

In addition, erosive hemorrhagic gastritis can generally stop bleeding spontaneously quickly, and this disease is better self-limiting. However, the patient continued to have black stools for more than a month, and there was a contradiction between these two points.

Further confirmation that the patient did not have isolated gastritis bleeding.

His brain was racing, wondering if the source of the patient's bleeding was elsewhere.

It can cause severe anemia and even shock in patients, indicating that the amount of bleeding is very large.

If there is heavy bleeding in the stomach or duodenum, the blood will flow back into the stomach, and the patient will vomit coffee-like stomach contents, or even vomit blood directly.

For example, Zhuge Liang recorded in the Chronicles of the Three Kingdoms directly scolded Wang Lang until he vomited blood and died on the spot.

believes that Wang Lang died of a broken heart, which is certainly unscientific.

The heart is in the chest cavity, and it is difficult for the cardiovascular rupture to cause direct vomiting of blood. Usually, only when there is bleeding in the upper gastrointestinal tract or upper respiratory tract, will the blood be vomited directly.

Upper respiratory tract bleeding is more often caused by the presence of blood foam.

For example, when encountering an emergency patient who suddenly vomits blood and falls to the ground, doctors often determine the specific source of bleeding based on the color of the blood spit out of the patient's mouth and nose and whether there is foam.

Bleeding from the lungs, often foaming at the blood, accompanied by coughing. It is mainly coughing up blood.

Bleeding from the stomach and duodenum is direct vomiting of blood.

The patient did not have clinical symptoms of vomiting.

The possibility of massive bleeding in the upper gastrointestinal tract in a short period of time can be ruled out.

However, before this shock, the patient suddenly had a nosebleed, which is also a place to be alarmed.

The pharynx and nasal cavity of the human body are very complex.

The nasal mucosa is rich in blood vessels, and people are very prone to nosebleeds when they are on fire or when their nose is attacked.

Sometimes the bleeding is heavy and quite scary.

However, patients and their families did not report frequent nosebleeds. This reason can be deferred.

It is imperative to quickly identify the true source of the patient's bleeding.

Don't look at the patient's vital signs after being resuscitated, the current vital signs are stable, but if the real cause of the massive bleeding is not found, the danger can occur in an instant.

After the patient was admitted to the hospital, through infusion and blood transfusion, the symptoms of high fever appeared.

Is this a coincidence, or is there another reason?

There are only three kinds of drugs for infusion, whether it is ranitidine for the treatment of gastric ulcers, or batralase and tranexamic acid to stop bleeding, which will not cause the patient to have a high fever in a short time.

At least with Zhou Can's clinical experience and understanding of pharmacology, it is unlikely that a hyperthermic reaction will occur.

Does a blood transfusion cause a high fever?

This is the first time I've heard of such a thing.

"Doctor Ai, call the nurse who gave the patient infusion and nursing to the office to discuss the condition."

Zhou Can needs to rule out the possibility of hyperthermic reaction caused by infusion and blood transfusion.

For example, there is a problem with the saline used for infusion.

This must be checked first.

Some saline solutions may have problems during storage or manufacturing for a variety of reasons.

For example, flocculent matter appears in the bottle.

Experienced and attentive nurses will not only check the infusion bottle before giving the patient an infusion, but also deliberately shake the infusion bottle to see if there is a problem after the saline inside is mixed with the liquid medicine.

Normal saline is the largest category of drugs consumed in hospitals.

When procuring hospitals, each manufacturer also has its own magical powers.

It cannot be ruled out that after some unscrupulous manufacturers get the order from the hospital, the quality of the salt water sold to the hospital is substandard.

Of course, manufacturers are also afraid of accidents and want to do long-term trading, so in terms of quality, especially safety, they will definitely try their best to control it.

Just the workers who do the work, or the manufacturer's technology is not up to standard, and the hardware facilities are old and malfunctioning, which may lead to problems with the brine produced.

Not every bottle is faulty.

As long as one bottle out of 10,000 bottles has a quality problem, it is a ticking time bomb.

When used on the patient, the unlucky patient is likely to have an accident.

In the office, the nurses who gave the patient infusions, Dr. Ai Li, Zhou Can, and the three began to discuss the patient's condition.

Zhou Can is the leader.

"When Mr. Zhao gave infusions to patients, did he check the medicine bottles?"

This kind of thing, in front of patients and family members, Zhou Can will never ask.

That's why Elle and the nurse were called to the office.

"I checked it out and didn't find any problems. Director Niu repeatedly ordered us to be careful and careful in clinical care and dressing changes, and safety was the top priority. We take special care when we give each patient an infusion. ”

Zhao Qian and Zhou Can are also old acquaintances.

She's really hard at work.

At present, I have been promoted to nurse, but I still have a long way to go if I want to be promoted to chief nurse.

The promotion of a nurse is not easier than that of a doctor.

It is relatively easy for a doctor to become a doctor.

Nurses now want to be promoted to nurse supervisors, either to improve their qualifications or to go to graduate school. Of course, related households are not included in this list.

Society is a society of human feelings, especially in China, and in some units, human relations are particularly widespread. For example, a railway company, or a hospital, with high wages and easy work management positions, basically belong to the world of the second generation.

Regarding Zhao Qian's work style, Zhou Can understands it well.

She usually works hard and works hard.

Since she had carefully checked the infusion before the infusion and there was no problem, it could basically rule out the possibility that there was a problem with the infusion potion itself.

Zhou Can thought about it and felt that the patient was likely to have multi-source gastrointestinal bleeding.

What is multifocal bleeding?

It means that there is bleeding in multiple places.

It is likely that the bleeding site extends beyond the upper gastrointestinal tract.

The small intestine and the upper part of the colon should be the focus of investigation. Gastric juices should also be monitored.

Because the patient has melena for more than a month, the possibility of heavy stomach bleeding cannot be completely ruled out.

Unless there is a strong basis for a diagnosis, no possibility should be ruled out. At most, it is more likely to be a certain one, and it is just a priority investigation.

In particular, this kind of difficult cases with high difficulty in diagnosis are often caused by some reasons that are easy to ignore.

The essence of difficult cases is that they are relatively rare causes and diseases, and cannot be solved by borrowing the content of textbooks.

It is necessary for doctors to make flexible diagnoses based on clinical experience.

"Dr. Ai, I recommend that the patient first have a regular aspiration of gastric juice to monitor the bleeding in the stomach. At the same time, some auxiliary tests are used to further investigate the possibility of bleeding sources in the small intestine and colon. ”

Zhou Can gave specific suggestions for further diagnosis.

(End of chapter)