Creatine kinase is an important kinase in the human body, which is mainly used for the detection of cardiovascular and cerebrovascular diseases such as myocardial infarction. In general, if an elevated creatine kinase is found in a blood count, the first thing doctors think is that the patient may have a heart attack.

"Electrocardiogram, blood check, X......-ray after hemostasis" Sun Lien was arranging follow-up examinations, Gao Yan, who had been lying on the bed honestly, suddenly jerked, and the whole person's back left the bed, with his head and feet as support points, and his back bent and arched!

The nurses who were busy next to Gao Yan were taken aback, this action did not seem to be something that normal people could do. After a few seconds of arching posture, Gao Yan suddenly softened as if the bones in his body had been removed, and then began to have severe generalized muscle spasms, rigidity, and tremors. Foaming at the mouth, convulsions all over the body, cyanosis of the complexion. This is a classic sign of a generalized seizure.

There was no need for Sun Lien to remind them, the nurses pounced again at the moment of Gao Yan's seizure. They quickly untied Gao Yan's clothes with their hands and feet. He turned his head to the side to prevent vomit from blocking his airway.

Gao Yan's seizure lasted about a minute or so. All the medical staff leaned back, quietly waiting for Gao Yan's seizure to finish. Contrary to common belief, seizures, while scary, don't actually require much intervention. Especially for doctors, when a patient has a seizure, it is only necessary to monitor the respiratory tract. There won't be a doctor trying to pry open a patient's mouth and stuff something like cotton into it – if you bite your tongue during a seizure, there's no point in intervening. On the contrary, it is easy to hurt the lower jaw in the process of priing open the mouth, and even pry out two teeth directly. As for the practice of pinching people, even Chinese medicine practitioners will not recommend it.

Seizures are another powerful reminder of the patient's symptoms. Abnormal electrical activity in the cerebral cortex is the main cause of epilepsy symptoms. Epilepsy with elevated creatine kinase, and high cerebrospinal fluid pressure. Then the direction of suspicion should be meningitis or intracerebral hemorrhage.

"Let's go for a CT scan to see if there is a brain hemorrhage. "It takes at least 10 minutes for the results of the blood routine to come out. Before that, the first thing to do is to ensure Gao Yan's life - cerebral hemorrhage can be fatal in a short period of time. "Xiao Guo, you go outside to find Security Officer Liang and ask him to take his family members to register first. ”

The precious type O negative blood hung up, and Gao Yan's vital signs were stable. But no one knows whether this stability will be maintained for a long time, or whether it will collapse in an instant without warning.

Time, time, and most importantly, time. Sun Lien made a decision, the registration can wait a little longer, and the CT must be done immediately. If the cause of the symptoms is a cerebral hemorrhage, if the bleeding continues to expand and cause brain herniation, the person cannot be saved. He used a penlight to check Gao Yan's pupils on both sides, which were equal in size and responded well to light.

"Brother Sun......" Xiao Guo, the nurse who ran out of the door, ran back again, "Brother Liang said that the family is gone!"

Sun Lien's eyes widened, "Didn't he follow along?"

Security Liang did follow the woman all the time. It's just a four-legged husky that can run faster than a two-legged person, I don't know how much. After a few turns, the husky disappeared with the woman.

"I used to run so fast!" Liang Baoan, who was in his forties, wiped the sweat on his head unconvinced, panting as thick as a cow, "In the past ten miles and eight towns, none of the young descendants can outrun me!"

"Anyway, I can't find the family now. Nurse Xiao Guo said helplessly, "I'll look to see if he has an ID card on him, if not, I'll pay for the arrears first, right?"

The Fourth Central Hospital is a regional emergency center, and every year there is a special fund allocated by the provincial government to support the admission of patients in arrears. Although this fee is basically not enough every year, fortunately, there are some charities that donate and support, at least not to lose money every year.

Gao Yan's ID card is in his pocket. Xiao Guo went out to register Gao Yan, and Lao Wutou, who was stationed in the Fourth Central Hospital, finally rushed to the rescue room. He asked for Xiao Guo's used up ID card, and unlocked his mobile phone with Gao Yan's fingerprints, and began to look for the phone number of relatives in the call directory. And Sun Lien and others pushed Gao Yan to the CT room.

The results of the urgent CT were straightforward—no abnormalities were found, and no hemorrhagic foci were found.

"Think about meningitis. Xu Yourong said in a low voice, "I'll check his cerebrospinal fluid pressure." ”

Intracranial inflammation almost always causes an increase in cerebrospinal fluid pressure. An increase in cerebrospinal fluid pressure means increased pressure in the ventricles, which puts the brain in a compressed state.

The brain is a very delicate organ. As long as there is the slightest mistake, it can manifest all kinds of strange symptoms. Both hallucinations and epilepsy can be caused by increased pressure in the ventricles — or symptoms caused by encephalitis affecting a specific area.

As soon as the patient was sent back to the emergency room, nurse Xiao Guo brought a piece of good news. "The system found records of the treatment received by the patient two days ago, the patient had a high fever of 402 degrees Celsius two days ago, went to the community hospital for examination, and received an intravenous infusion of antibiotics. ”

Thanks to the implementation of the networked digital case system in Ningyuan City. All community hospitals and large hospitals in the city have achieved medical record sharing. Xiao Guo just took Gao Yan's ID card and went to register a number, and got the record that he had just received treatment a few days ago.

"Complaints, high fever, chills, headache. Upper respiratory tract infection was diagnosed, cefuroxime was given intravenous infusion, cefaclor orally oral, and ibuprofen orally. Xu Yourong quickly browsed the treatment methods of the lower hospitals, "Antibiotics are ineffective, viral encephalitis?"

Cefuroxime is a second-generation cephalosporin and a commonly used antibiotic against unidentified bacterial infections. It has a very good effect on most bacterial encephalitis. But it is clear that it does not help Gao Yan's symptoms at all.

If it is not bacterial meningitis, then the object of suspicion naturally becomes viral meningitis.

"Please come to the Kaminai for consultation. Sun Lien thought about it for a while and made a decision. "I'll do a physical examination first, and then Dr. Xu, you should hurry up and do a lumbar puncture to measure the pressure of cerebrospinal fluid. ”

Doctors in the emergency department and doctors outside the gods have the same hobby of holding a small rubber-tipped hammer and knocking it around on a patient. This somewhat comical act is actually an important check. By tapping or scratching different parts, the patient's reflex behavior is normal. Reflexes that are too small or too large, and changes in the reflex area, all indicate different symptoms. In cases where viral meningitis is suspected, reflex testing is a valuable test.

Sun Lien used the wooden end of a cotton swab to scratch the outside of Gao Yan's right foot. And the thumb of Gao Yan's right foot contracted slightly. Then Sun Lien, with the help of Xiao Guo, moved Gao Yan's thighs to a position close to the edge of the bed, so that his calves hung down naturally. Gently tap his quadriceps with a percussion hammer.

Gao Yan's calf kicked out violently after the tapping.

Xu Yourong narrowed his eyes, "Knock it on your knee and take a look." ”

Sun Lien did so. With a slight knock on the percussion hammer, Gao Yan's calf kicked out again.

Also positive for Chaddock's sign. Hyperreflexia of the tendons of the lower extremities.

This means that Gao Yan's central nervous system has been damaged.