Lin Yuming looked at the image in a daze.

The director of the CT room was also stunned, and he hurriedly looked through the patient's medical records to find the course of the disease.

The diagnosis is not mistaken, it is indeed a pulmonary embolism, but what about the emboli? Where is the image of the emboli?

In the image, there are no embolus at all, but the lungs show a strange feature.

Lin Yuming felt as if he had seen this kind of image somewhere, but he couldn't remember it for a while.

"Director Lin, this is a typical snowstorm-like shadow, and from the image, it is also considered that there is an increase in the load of the right heart. It should be a fat embolism, that's right. Luo Hao said affirmatively.

"Blizzard Shadow?"

"There's no time to explain, let's hurry back." Luo Hao urged, "If the nurse sees the infusion valve closed, open it to dissolve the patient's thrombolysis, it will be fucked." ”

"Uh-huh." Lin Yuming also had no idea for a while.

On the one hand, Luo Hao, on the other hand, is an expert from the Second Hospital of the Medical University, who do you listen to with different opinions?

It must be Luo Hao.

Lin Yuming didn't know when he started, he had great confidence in Luo Hao, even if it was an expert from the Second Hospital of the Medical University opposite, he only hesitated slightly, and voted for Luo Hao.

"You go and convince the experts of the second hospital of the medical university." Lin Yuming sent a task to Luo Hao.

Luo Hao ran to the ward without looking back, "Director Lin, call Corey and say that the film is out!" ”

The hurried voice echoed in the corridors of the CT room, full of the rhythm of emergency rescue.

Lin Yuming laughed.

This hurried look is like a young man.

Always vibrant, always enthusiastic.

He reserved 1 minute for Luo Hao, and when the time came, he called Dean Qiubo.

"What? Don't see the plug? Director Lin, are you sure? Dean Li was surprised when he heard the news.

But half of his surprise was fake.

In essence, Dean Li Qiubo, like Lin Yuming, also trusted the young Luo Hao more than the expert from the Second Hospital of the Medical University.

Hearing the news, Li Qiubo finally breathed a sigh of relief.

"What? No emboli? I'll take a look at the image. Professor Chu said solemnly.

"Right now, wait a minute."

The orthopedic director began to refresh the interface, and soon the images of the 64-row CTA appeared on the screen.

The patient's laboratory report showed elevated dimers, and blood gas analysis showed a partial pressure of oxygen of only 55 mm Hg and a partial pressure of carbon dioxide of 28 mm Hg on oxygen.

Diagnosis of hypoxemia, hyperventilation, type 1 respiratory failure, all this is in line with the manifestations of pulmonary embolism, everything seems to be in place, just waiting for the results of the CTA.

However, when the results of CTA appeared in front of them, the experts of the Second Hospital of the Medical University were stunned.

In the image, no emboli appear.

Damn, what about the damn plugs!!

All of a sudden, not only Professor Chu, but even the director of the Department of Orthopedics was dumbfounded, isn't it a pulmonary embolism?!

It's impossible, the patient is having trouble breathing, he's already in a coma, it's not a pulmonary embolism or something!

Looking at the image in a daze, Professor Chu even began to manually search frame by frame.

"Teacher Chu, the patient is not a pulmonary embolism."

A cheerful, sunny voice appeared behind him.

Professor Chu didn't look back, he was engrossed in looking for the embolus of pulmonary embolism, forgetting that he was no longer in the Second Hospital of the Medical University after a long journey, but in the General Hospital of Mines in Donglian City.

As if attending a hospital-wide consultation in the Second Hospital of the Medical University, Professor Chu heard his colleagues express different opinions.

"It could also be that the embolized artery is small, CTA can't see or it's hard to see at a glance."

Professor Chu explained.

"If that's the case, it could explain the results of the 64-row CTA, and it could also explain the symptoms of dyspnea in the patient. But there is still no explanation for why the patient is in a delirious coma. ”

"That's because ......"

Professor Chu racked his brains to ponder, but he couldn't find an explanation for Luo Hao's problem in his knowledge reserves.

"Immobilization after surgery is a common risk factor for pulmonary embolism, but the results of the examination are not consistent, and the presence of fat embolism syndrome should also be noted given that the patient has a long bone fracture."

"Fat embolism? What evidence do you have? Professor Chu asked.

"Look at the plain X-rays of the 64-slice CTA."

Angiography is done with plain x-rays, but almost no one looks at them. There are more detailed and accurate images, and who would look at rough plain films.

Professor Chu was about to retort, but he hesitated when he saw the blurry image of pneumonia on the CTA.

"What are you considering?" Professor Chu asked.

"Lung blizzard."

“！！！”

Professor Chu hurriedly exited the search state frame by frame and found the plain X-ray.

The patient's pulmonary blizzard sign, which is typical of fat embolism, is extremely evident.

"It's a fat embolism." Professor Chu muttered.

"The patient's skin is all over the body, mainly on the inner thighs of both sides, with pinprick bleeding spots." Luo Hao continued, "This is also the main reason for judging fat embolism. ”

"Pulmonary embolism can induce ARDS, which is life-threatening, while fat embolism, which generally manifests as a local embolic area, appears as bleeding, exudation, and forms interstitial edema and difficulty in gas exchange, while the manifestations of ARDS are more pronounced in the lungs."

"The urine elicited from the patient's urine bag showed signs of mild lipouria."

Luo Hao said all the key signs he observed.

Professor Chu tried to recall the physical examination, but he was a little confused, he really didn't notice the pinprick bleeding point.

Even if I recall it now, I still don't have any impression.

In the office, there was a dead silence all of a sudden.

"Dean Li, can your little doctor not interfere with the expert consultation!" Secretary Chu, who was wearing glasses, was very unhappy and said to Dean Li.

He didn't lower his voice when he spoke, and he didn't hide his dissatisfaction with Luo Hao at all.

Dean Li smiled, but he didn't speak, just stalked his neck.

"Be quiet." Professor Chu glanced at the man with glasses unhappily, and then muttered to himself, "It seems to be a fat embolism." ”

Suddenly, his body paused, "It's not good, the patient is still giving thrombolytic drugs!" ”

"I'm going to stop the thrombolytic drugs." Luo Hao ran out of the doctor's office at a trot.

"Who is he?" Professor Chu looked at Luo Hao's back and asked.

"Xiao Luo is a doctor who graduated from the eight-year bachelor's and master's degree program at Xiehe, and he is a treasure in our hospital." Dean Li judged the situation clearly and explained with a smile, "After he came back, Director Lin and I put him in the medical office. ”

"The medical office? Why didn't you go to the clinic? ”

"In the medical department, Dr. Luo has diagnosed many incurable diseases over the years, and has done practical things for the people of Donglian City."

The next words of Dean Li have been mastered by heart, and when the meeting is held, there is absolutely no mistake, but there is no practical significance.

No one cares what he says, just the background music.

Concord, graduated from eight years of bachelor's, master's and doctoral studies, this is a well-known golden signboard.

I don't know what came to mind, Professor Chu sighed and continued to study the film.

A typical blizzard in both lungs, I just didn't see a blood clot and ignored this.

Professor Chu was a little ashamed, and his old face turned red.

He watched the film hard, not wanting people to see the embarrassment of his blushing face.

Suddenly, Professor Chu remembered something, he hurriedly stood up and strode out.

"Professor Chu!" Dean Li didn't know what was going on, and walked out quickly.

"I went for a physical examination to see the pinprick bleeding spots on the patient's body."

Pinprick bleeding spots!

Except for Secretary Chu, all the doctors present were old doctors, and Luo Hao said that there were pinprick bleeding spots, and no one noticed them during the physical examination.

Dean Li was also curious, so he briefly explained to Secretary Chu, and then followed to see the patient.

Luo Hao came out with a micropump in his hand and collided with Professor Chu.

Dodging slightly, Luo Hao made way for Professor Chu.

Professor Chu glanced at Luo Hao and felt that something was wrong, but he couldn't say what was wrong.

Without thinking about it, Professor Chu went into the ward to see the patient.

Sure enough, there were a lot of pinprick bleeding spots scattered on the patient's body.

These bleeding spots are small and fine, and if you don't distinguish them carefully, you won't notice them at all.

Although, as Luo Hao said, the patient has a little more bleeding spots on both inner thighs, but it is definitely not eye-catching.

Professor Chu looked at the bleeding spot in a daze.

Dean Li followed in, looked at it for a long time, and then asked suspiciously, "Professor Chu, is this it?" ”

He asked, pointing to the bleeding spot on his inner thigh, which was not obvious.

"Hmm." Professor Chu nodded, "Pinprick bleeding points caused by fat embolism syndrome." ”

"That's ......"

"It refers to a syndrome of a series of pathological changes caused by the blockage of the vascular cavity by fat particles in the blood vessels with a diameter of 10-40 microns, which mostly occur in severe trauma and fractures, especially long bone fractures."

"After the appearance of fat embolism, there are severe symptoms for about 24-48 hours - characterized by impaired consciousness, progressive hypoxemia, dyspnea, ecchymosis of the skin.

The clinical manifestations vary greatly and are often complicated by shock, head injury, pulmonary contusion, etc. ”

Professor Chu explained the knowledge points related to fat embolism as if he was giving a lecture to students.

The eyes of the patient's family members lit up when they listened, and at this moment, Professor Chu was as professional as a god, and everyone had hope for the patient's recovery.

"I see." Seeing that Professor Chu also agreed with Luo Hao's diagnosis, Dean Li gradually had a number in his heart, and the stone fell to the ground, and he took advantage of the situation.

"Professor Chu, does it matter?" Dean Li asked.

"At the time of fracture, the adipocyte nucleus venous sinus ruptures, the fat enters the venous circulation as hematoma contents, and the spongy bone particles and larger fat droplets block the smallest pulmonary vascular branches, while the small fat droplets can pass through the anterior capillary bypass of the lungs, into the pulmonary veins."

Professor Chu did not answer Dean Li's question, but whispered to himself.

He has a problem, that is, what he thinks in his heart when he encounters a big event, what he will say.

It's not a big problem, it's harmless, and at most it's a broken evaluation.

"The toxic effects of fat particles can lead to direct damage to lung cells in the endothelial nucleus of the lungs.

On this basis, capillaries leak, perivascular appearance, platelet adhesion and blood clot formation.

Chemical pneumonitis, characterized by pulmonary edema, hemorrhage, atelectasis, and fibrin deposition, is no longer the main contradiction due to the hydrolysis of emboli.

The patient then develops a pulmonary ventilation/blood flow imbalance and impaired diffusion of gas, which eventually leads to hypoxemia and respiratory distress syndrome. ”

Professor Chu was long-winded, and then his voice raised.

"Ready...... How much does the patient weigh? Professor Chu asked.

"180 pounds." A worker replied.

Professor Chu began mental arithmetic.

“30mg/kg，2700mg……”

He quickly figured out the answer and asked the nurse to dispense the medicine and give the prednisolone shock treatment.

"Dean Li, your hospital has a hyperbaric oxygen chamber."

"Yes, yes, it's in disrepair and barely usable."

"As long as it can be used, first give methylprednisolone, and then treat the symptoms. When the patient's condition improves, the hyperbaric oxygen chamber will be sent as soon as possible. ”

With an accurate diagnosis, a series of related treatments are logical.

Methylprednisolone entered the patient's vein with a micropump, and in less than 40 minutes, the dyspnea improved significantly, and the blood oxygen saturation gradually returned to about 92%.

After another 1 hour, the patient was awake.

Although it is only the end of the coma, the person can only open his eyes and cannot speak for the time being, but this is enough for the doctor.

Various neurological examinations have also improved.

All of this proves the correctness of the diagnosis as well as the treatment.

As the patient woke up and the oxygen saturation increased, everyone present breathed a sigh of relief.

Professor Chu wanted to say a few words to Luo Hao, and he felt that this young man was indeed very good.

But when he thought of being fierce to Luo Hao when he entered the door, he was a little embarrassed and blamed himself.

Soon Secretary Chu reported the matter to the leaders of the mining area, and they knew that the patient's condition was stable and his life was fine, and they were very happy to come to see the patient.

The ward was lively.

Luo Hao found a corner to stay and didn't go up to join in the fun.

When the leaders of the mining area warmly invited Professor Chu to dinner, Lin Yuming gave Luo Hao a look.

The two communicated silently, and Lin Yuming knew that Luo Hao didn't want to go and wanted to take care of the patient.

Okay, although the patient is temporarily out of danger, who knows what else will happen.

After all, it is a fat embolism, even if the degree of urgency is less than that of a pulmonary embolism, but it is also an acute and critical illness.

It would be safer to leave Luo Hao behind.

Otherwise, the champagne was opened in the middle of the session, and the patient was eating and drinking, and the patient had an accidental respiratory and circulatory arrest, and he had no place to cry.

When everyone was gone, the ward finally quieted down.

A group of people who were in a hurry just went to eat with a smile on their faces, Luo Hao simply moved a stool to the ward, sat on the side of the patient's bed and looked at the monitor.

The patient's condition was stable, the oxygen saturation was slowly rising, and the symptoms of dyspnea improved rapidly under the onslaught of methylprednisolone.

This is a visible change.

Luo Hao reviewed the task for a while, although the patient had a clear diagnosis and timely treatment, there was no progress in the task.

Forget it, don't think about it for now.

Taking out his mobile phone, Luo Hao sent a message to Chen Yong and called him to the 4th ward of the orthopedic department.

Soon, Chen Yong ran over, and Luo Hao heard him laughing with the orthopedic nurse on duty in the corridor.

Although I was a little uncomfortable at first, I just got used to it.

Luo Hao didn't force it, and he never thought of turning Chen Yong into his own appearance.

After 3 minutes, Chen Yongcai's eyes were full of peach blossoms and he entered the ward wearing a mask.

"Luo Hao, do you have something to do with me?" Chen Yong asked.

He spoke to Luo Hao very hard, with a sense of impatience, and did not speak to the nurse half gently.

"The patient is diagnosed with a fat embolism, and you look at the pinprick bleeding point." Luo Hao sat on a stool with his back against the wall of the ward.

“……”

Chen Yong was stunned for a moment, but he was neither stupid nor stupid, and immediately knew that Luo Hao wanted more clinical experience for himself.

Although the correct diagnosis of fat embolism is not very important to the general surgeon, who knows when it will be used.

Chen Yong carefully observed the subcutaneous pinprick bleeding spots, asked a few questions, and Luo Hao answered them one by one.

Then Luo Hao asked Chen Yong to push the X-ray machine and take a bedside chest X-ray for the patient.

By the time the film was washed out, the blizzard sign of the patient's lungs had disappeared.

But another hour later, filming again, there was another blizzard.

However, Luo Hao did not continue to explain why this happened, but asked Chen Yong to go back to read the book.

……

……

The crowd was full of wine and food.

Professor Chu listened to countless praises, but he knew in his heart that if it weren't for the young doctor from the head of the mine, it would not be certain how the patient would be now.

On the way back, Professor Chu insisted on sharing a car with Lin Yuming. After getting into the car, Professor Chu asked, "Director Lin, is Dr. Luo your nephew?" ”

"Hmm." Lin Yuming nodded proudly while driving.

He knew very well that Professor Chu was in his car to inquire about Luo Hao.

Luo Hao has recently given himself a long face, and after Wen Youren's real-name report, he was thrown to Qianhe County, and now the clinical director sees him and is afraid of +3.

Even the experts from the Second Hospital of the Medical University who were invited to fight the fire were interested in Luo Hao.

The little one, it's really good.

"It is said that the doctor who came back from Concord is in the general ...... of the mine I'm not saying that the mine is always bad, I mean at least a deputy director has to be given, otherwise why would people come back? ”

"Is it my nephew?" Lin Yuming said the word nephew particularly loudly.

"He saw that I had a lot of difficulties, especially when it came to incurable diseases, and if one was not handled well, there would be a large medical dispute, so he stayed in the medical office and was responsible for the hospital-wide consultation."

"A good fighter has no great achievements, this is an important position, but it is difficult for outsiders to know the importance. But there is no name, and there is no development, which is a bit of a delay for young people. Professor Chu said seriously.

"Hey, who made him my nephew."

Lin Yuming became more and more proud.

When Luo Hao was mentioned, he slowly became proud in his heart, he was my nephew, and this thought was booming.

Professor Chu could hear the smugness in Lin Yuming's words, and thought about it, how good it would be if he had such a nephew.

It would be nice if he were his own nephew.

"Dr. Luo is really good." Professor Chu said enviously, "To be honest, I didn't realize it was a fat embolism at the time, and his diagnosis was right. ”

"Professor Chu is polite, in fact, we know in our hearts that Luo Hao just looked at the patient twice before you, if you give you some more time, you can't misdiagnose it."

Although proud, Lin Yuming also lost Professor Chu's face.

This is true, and Professor Chu is full of affection for Lin Yuming.

He intentionally or unintentionally inquired about Luo Hao, but Director Lin concealed it everywhere and was vague.

It's all going to be kept secret? Professor Chu was a little helpless.

The leaders of the mining area have already gone back, and Dean Li has also drunk a few glasses and gone home, and was supposed to send Professor Chu to the hotel to rest, and then return to the provincial capital tomorrow when the patients are stable.

But Professor Chu was not at ease, so he asked Lin Yuming to drive to the hospital halfway to take another look.

When he came to the hospital, Professor Chu entered the ward and saw Luo Hao sitting in front of the patient's bed, holding a clip in his hand, and the A4 paper on the clip recorded dense numbers.

"Dr. Xiao Luo, you have been taking care of patients." When Professor Chu saw Luo Hao's serious appearance, his good impression of him suddenly exploded.

"Teacher Chu, you're back." Luo Hao immediately stood up and began to "report" the changes in the patient's vital signs and the values of the laboratory tests done during this time.

Professor Chu noticed that Luo Hao didn't look at the numbers on the paper, and he was even more surprised.

When Luo Hao finished reporting, Professor Chu's mobile phone rang.

He took out his phone and saw that it was a video.

Shut down.

But before Professor Chu put his phone away, the video lit up again.

Professor Chu was a little irritable, but he had no choice but to pick up the video.

"I'm going to have a consultation at the Donglian Mine, so I'll talk about something later." Professor Chu directly reprimanded in a deep voice.

"Boss, my sister's rat is dead again, I can't cry, we're worried about ......"

Lin Yuming was stunned for a moment.

My sister's mouse?

What's that?

Professor Chu is playing a lot.

But as if he was thinking wrong, Lin Yuming tried to turn his thinking back to a normal trajectory.

"I'll see ......?"

Professor Chu was just about to lose his temper, and a heartbroken cry came from the video.

"Teacher Chu, is the mouse used for the drug test dead?" Luo Hao asked.

"Hmm."

"Look, patient, can I talk to your students?" Luo Hao asked with a smile.

Professor Chu didn't think much about it, and threw this "trouble" to Luo Hao.

Luo Hao walked out of the ward with his mobile phone.

The ward fell silent.

Professor Chu breathed a sigh of relief, picked up the A4 paper on which Luo Hao wrote the values, and read again what Luo Hao had reported just now.

Young people, good memory is also should, when I was young, the phone number book was empty, and all phone numbers can be remembered.

Professor Chu explained to himself in his heart as he watched.

The patient's recovery is indeed good, the medication is symptomatic, and the vital signs are no longer on the verge of life and death, so it seems that there should be no problem.

A few minutes later, Professor Chu left the ward satisfied.

He was very satisfied with the patient's emergency first aid, although the initial diagnosis was not taken by himself, but the various rescue orders were given by himself.

The patient recovers smoothly and is at least 80 ...... No, 70 ...... No, 50% credit.

"Director Lin, Dr. Xiao Luo is really good." Professor Chu remembered that Luo Hao helped him perfunctory students, and praised with a smile, "The level is high, and he is also serious and responsible." ”

"He has obsessive-compulsive disorder." Director Lin explained, "Originally, there was no need to sit at the head of the bed to see the patient, but Luo Hao said that he was worried about going to another place, so it was better to sit at the head of the bed." ”

"Hahaha." Professor Chu smiled.

"It's okay when there are few patients, but once there are many patients, how can you deal with it. You say yes. ”

"Dr. Xiao Luo is still young, it will be fine in a few years."

With that, the two returned to the doctor's office.

The door was not closed, and Professor Chu's bilateral pupils suddenly contracted sharply, as if looking directly at the sun.

Lin Yuming was also stunned, looking at Luo Hao in the office blankly.

(End of chapter)