When patients with acute and serious illnesses are brought to the hospital, the situation is often particularly frightening.

At least when Zhou Can first came to the emergency department for internship, he admitted five critically ill patients in a dying state in one day.

"I remember your name is Xie Yu, right?" Zhou Can talked to the little nurse as he walked towards the emergency hall.

"I didn't expect you to remember my name, I'm so touched!" The little nurse was a little flattered.

Now the doctors and nurses in the emergency department know that Zhou Can is a powerful figure in the department. There is strength, status, and a bright future. Not to mention that everyone respects him, at least everyone has formed a consensus and treats Zhou Can as a heavyweight in the department.

"I'm telling you, it's not scary to look sick like this. The ones that really need to be wary are those who don't look too serious. For example, pulmonary embolism has a very short onset time, and death occurs within a minute or two. ”

Zhou Can pointed at the newcomer.

In hospitals, because the medical staff is a common interest. Especially for members of the same department, if an accident occurs to one person, it may drag down the entire department. Therefore, even if it is the kind of doctor or nurse with a withdrawn personality, as long as there is an opportunity, he will appropriately guide the newcomer.

Medicine can be passed on endlessly, and it is precisely because of everyone's spirit of being a good teacher.

"Dr. Chow is not exaggerating at all, I still remember when I was in my first year as a nurse, I was examining a patient who was under observation. The patient was very cheerful and talkative and took the initiative to chat with me. His children were also by the bedside. I just took his blood pressure and noticed that his blood pressure kept dropping. Obviously, the patient can still talk and laugh without obvious symptoms, how can the blood pressure be so low? I'm going to give him another arm to weigh again. As a result, the patient suddenly convulsed, collapsed on the bed, rolled his eyes upward, and the patient quickly died. Later, it was learned that the patient had an aortic dissection in his body and had ruptured. ”

Jiang Wei also shared her growth experience on the side.

During the formation of aortic dissection, there are generally varying degrees of pain.

However, some patients have a strong tolerance for pain, and they don't care about some less intense pain, and it is easy to ignore it.

There is also an aortic dissection that is the most terrifying.

The time from formation to rupture is extremely short, and this mortality rate is basically 100 percent.

Unless it can be detected in advance, then intervention, such as placing a vascular stent, to close the tear in the inner wall of the blood vessel. Otherwise, the miracle doctor will not be able to save him.

"After being taught, I will definitely be cautious and cautious in the future! I really didn't expect that asymptomatic patients turned out to be the most terrifying. ”

The little nurse was deeply impressed by the words of these two seniors.

At this time, the three of them had already come to the front of the triage table, and they saw a man of thirty-four or five years old, lying on the emergency bed with a pale face.

At first glance, you can tell that it is an emergency patient pulled back by an ambulance.

The patient clutched his chest, his face was pale, his forehead was already sweating, and his hair was wet.

The expression is also extremely painful.

Breathing seems to be very laborious.

Seeing Zhou Can coming, the doctor on duty seemed to have found a savior, and quickly gave up his position and asked Zhou Can to examine the patient.

"Where does it hurt?"

Zhou Can first probed the patient's carotid artery.

In patients with such suspected chest pain, or in patients who suddenly fall unconscious, a probe of the carotid artery can provide a lot of diagnostic information.

For example, the strength and presence of the carotid artery can roughly infer the working state of the heart.

Some patients will also have neck stiffness, which has certain diagnostic significance for meningitis, neuropathy and other diseases.

"This piece hurts so much! It seems that there is also a left shoulder and a piece of back, which is also painful. ”

The patient's voice appeared weak, and he looked like he might choke at any moment.

After hearing this, Zhou Can tried to press the position of the patient's chest.

The patient only snorted twice, and the tenderness response was not obvious.

Some patients are numb to the pain, so they don't know where the pain is. I just know that the big piece hurts.

At this time, it is necessary for the doctor to rely on his own experience and medical knowledge to identify the real pain area.

As we all know, pain is actually a kind of protection for the body.

Pain in any part indicates that the organ or body tissue in that part is undergoing serious lesions. The more severe the pain, the more severe the lesion is, theoretically.

In addition, if there is only a little pain at first, and it lasts for a longer time, the pain gets worse a little bit. Or intermittent labor pain, which can basically indicate that it is a chronic disease.

Only the kind of pain at the beginning, the person quickly can't bear it, and the progress time from mild pain to severe pain is very short, this kind of should be careful.

Basically, they are acute, and the severity is often very high.

Not to mention chest pain and tightness, even if it is acute severe abdominal pain and headache, you must be especially careful.

For example, the most common cerebral infarction, cerebral hemorrhage, acute appendicitis, acute intestinal perforation, etc., if the treatment is not timely, it is easy to lose the precious golden rescue time, and eventually die and become disabled.

Zhou Can pressed the patient's chest, and after the tenderness reaction was not obvious, he had a bottom in his heart.

Most likely, it's not a heart attack.

The doctor on duty may have heard that the patient had chest pain and vomited, so he was a little panicked.

Since the pain area is not in the chest, it means that the chest pain is radiating pain.

When the pain is severe, it can spread to a certain area around it, and it can even shoot far away.

For example, in the case of headache treatment, there is a possibility that a foot lesion may cause headache.

Zhou Can began to press on the patient's abdomen.

"Whew...... It hurts, it hurts......"

When Zhou Can's fingers pressed to the middle of his upper abdomen, a little above his navel, he didn't react much at first. Slightly heavier on the pressure, the patient suddenly let out a scream that changed his tone, his body also tensed suddenly, and the green tendons on his neck appeared.

"It seems that the real pain zone is here. Not superficially in the middle of the upper abdomen, but deep in the abdomen. This location is the area where the stomach and pancreas are located. The stomach is in the more superficial upper abdomen, and the pancreas adjacent to it is located deeper in the posterior. Judging from his symptoms, there is a greater possibility of pancreatic problems. ”

While analyzing the patient's condition, Zhou Can turned his head to look at Dr. Xie on duty.

"Has the patient's temperature and blood pressure been measured?"

Blood pressure and body temperature are two very important factors to consider when examining a patient.

"After the measurement, the body temperature is 37.8 degrees, the blood pressure is a little low, and the systolic blood pressure is only about 80."

Dr. Xie has also been working in the emergency department for more than a year, and it is obvious that he has made great progress compared to when he first came in. At least after receiving the patient, these details have been done relatively well.

However, this person is a dull type of doctor, who is relatively dull in diagnosing diseases, and has an empty stomach of medical knowledge, but cannot use it flexibly.

The patient's body temperature is moderately hot.

The systolic blood pressure is even lower than 80 mm, so it's no wonder that Dr. Chia panicked.

Chest pain combined with low blood pressure, the first thing that comes to mind is aortic dissection.

The normal range of systolic blood pressure is between 90 and 140 mm Hg, below which it is considered clinically low. Above this value, it is called high blood pressure.

Relatively speaking, there are many reasons for clinical hypotension.

For example, long-term malnutrition, hypothyroidism, or taking antihypertensive drugs.

Hypotension with chest pain is the most frightening, and almost all emergency physicians immediately suspect a ruptured aortic dissection and massive bleeding in the body.

Zhou Can has sixth-level hemostasis and sixth-level pathological diagnosis, which has certain advantages for the diagnosis of various internal bleeding.

After the initial diagnosis, he believed that the possibility of heavy bleeding in the patient's body was relatively low.

Many of the symptoms of a ruptured aortic dissection are highly overlapping with this patient's, but this does not necessarily mean that it is an aortic dissection.

Clinically, there are many diseases with overlapping symptoms.

To measure the level of diagnosis of a doctor, it is to see whether the doctor can quickly and accurately synthesize many symptoms, conduct targeted examinations on patients step by step, and then screen out some suspected diseases with high degree of symptom overlap to diagnose the real cause.

It's easy to say, but it's extremely difficult to do.

Almost all doctors have been working in this direction all their lives, constantly learning and accumulating diagnostic experience. In the end, there are less than 1 in 10 doctors who can really reach a high level.

With the advantage of the system, Zhou Can can use one or two years to reach the realm that others need to achieve in twenty or thirty years, or even longer, which is his biggest advantage at present.

Many doctors spend twenty or thirty years to raise hemostasis to level six, but they can't raise all other medical skills to this level at the same time.

This leads to a certain one-sidedness in their diagnosis.

The scope of knowledge is destined to be narrow.

Zhou Can broke this routine and could upgrade multiple medical skills to level six or above at the same time. It is equivalent to combining multiple chief physicians with more than 30 years of diagnosis and treatment level into one at the same time, which is quite terrifying.

It's definitely not as simple as one plus one equals two.

In fact, since recently, he has been almost invincible in the departments of emergency, pediatrics, and cardiothoracic surgery, and has solved many difficult cases that the chief physicians have not been able to solve after consultation. This is enough to see how good he is at possessing multiple sixth-level medical skills at the same time.

Knowledge is infinite.

He didn't let that stop him.

On the contrary, he was still working hard to improve his various medical skills, striving to push them to the seventh-level level.

At that time, not to mention the world's first, it should be difficult to find an expert comparable to him in China.

Doctor Xie watched Zhou Can examine the patient, and he didn't dare to have any urging, but he was so anxious that he secretly stomped his feet.

My dear mother, the patient's condition is so urgent, and the symptoms coincide with the rupture of the aortic dissection, what is Dr. Zhou still thinking about?

He's not in a hurry!

Whether it was Doctor Xie or the nurse next to him, no one dared to urge Zhou Can.

Without the presence of the chief physician, Zhou Can is the absolute leader.

He is the highest-ranking doctor on the scene.

This is true even in the presence of the attending doctor.

"Moderate heat in body temperature, low blood pressure, severe pain deep in the middle of the upper abdomen......" Zhou Can's brows were furrowed, he needed to quickly clear the fog and find the real cause.

At least a clear direction of diagnosis is required.

If it is not a ruptured aortic dissection, it will undoubtedly waste valuable rescue time if it is examined as this disease.

When everyone's patience was consumed little by little, the family members finally broke out first.

"This man is dying, can you ask an older doctor to treat him?" Young doctors are inexperienced, they are grinding, there are no results for a long time, they have been working like this, they are not in a hurry, our patients' relatives are in a hurry! ”

The family members were emotional.

"The bun has meat and is not on the folds, and the doctor is not necessarily inexperienced and low at a young age. Dr. Chow is one of the top performers in our department, and he is concentrating on diagnosing the cause of your loved ones, so don't disturb him. Otherwise, delaying the patient's treatment will definitely not be the result you want to see. ”

Jiang Wei once again stood up to relieve Zhou Can.

She is like a shield against attacks and grievances from her family.

"Our director is in the ICU to treat a critically ill patient, and as soon as the situation is a little more stable, he will rush over. Dr. Zhou looks young, and his level is not lower than that of the director, so please be patient. ”

Dr. Xie also helped Zhou Can speak and maintain Zhou Can's image and status.

No one will teach you this kind of thing.

It is a skill that is automatically evolved from the job title. Those who can learn and use it well will soon be promoted and reused, and they will be promoted step by step. People with elm pimple heads are likely to work for the rest of their lives and remain at the bottom.

After being comforted by the two, the family's mood calmed down a lot.

Zhou Can has been thinking intently about the real cause of the patient, and has not paid attention to the abuse of the family.

"Are you feeling thirsty?"

He asked the patient suddenly.

"Well, I'd love to drink water!"

The patient struggled to answer.

At this time, the patient's breathing became much more rapid, which was very heavy, which made people even more worried.

"When did you start feeling sick?"

"It seems like I didn't feel well when I woke up the morning before."

"Did you untie your little hands today?"

"Not yet."

"Do you have the urge to urinate now?"

"It doesn't seem to be!"

After listening to the patient's answer, Zhou Can nodded.

"He had a thin pulse, a fast heart rate, moderate heat, low blood pressure, and a sharp pain deep in his upper abdomen that lasted for a long time, and was worsening, even radiating to his back and shoulders. It was also accompanied by thirst and oliguria, which indicated that there was probably something serious wrong with his pancreas. Acute pancreatitis is initially suspected, and blood is immediately drawn for routine blood tests, and a fasting blood glucose is checked at the same time. Then immediately send to the ultrasound room for an abdominal ultrasound. ”

After having a diagnosis, Zhou Can was like the commander of the three armies, issuing an order for a series of problems.

Perform a series of laboratory and ultrasound examinations for the patient quickly.

"It's not an aortic dissection!"

Dr. Xie was stunned when he heard it.

I really didn't expect Zhou Can's initial diagnosis to be acute pancreatitis.

Dr. Xie deeply felt the gap between him and Zhou Can.

"If there is no problem, arrange for an inspection immediately, and you must not delay. You take the patient to do these tests, and when you have the results, you immediately come to me or the chief physician on duty. ”

Zhou Can knows that the mortality rate of acute pancreatitis is quite high, and he will never dare to be careless.

(End of chapter)