Today is really a great way to memorize words. After Sun Lien returned to his office, it took him a while to get rid of the depression caused by the two police comrades and the overly nervous mother.

The next outpatient clinic is relatively relaxed, and most of the patients are relatively easy to solve problems - sprains, fever, abdominal pain. Anyway, the emergency process of the four hospitals is quite perfect, and diseases such as chest pain and stroke, which require rapid response, will not send patients to Sun Lien's emergency clinic for treatment.

The acute and emergency clinic is the main channel for treating patients in the fourth and third levels who are not critical. This kind of department is usually busy when there is a large influx of patients in the emergency department – such as on weekends when the outpatient clinic is not open, or after hours. Like today's usual working day, Sun Lien's things are really not too much.

"That's right, you can take your medicine on time when you go back, and drink more water than usual. After seeing off an ordinary flu patient transferred from the fever clinic, Sun Lien shook his head again, pressed a button on the computer, and waited for the next patient to enter the consultation room.

It was 5:20 p.m., and the white-collar workers and outpatient doctors were off work. Normally, from this time in time, Sun Lien can see a lot of young people in professional clothes in his consultation room - these are migrant workers who have just gotten off work.

After a few years of medical practice, Sun Lien gradually had a feeling. Modern young people are, in a way, similar to those who have retired and don't want to come to the hospital. When they are unwell, their first reaction is never to come to the hospital. The elderly will choose to carry it or take some home remedies or even empirical medicine, while the young people ...... They choose to carry it and then carry it, but they can't bear it, and they may go to netizens who don't know Coco at all, or simply Baidu.

Where do the 996 social animals have time to come to the hospital? I can't ask for leave, and my rest time is so precious, how can I use it for such things as seeing a doctor?

And deep down, there's a little deeper fear.

What if it's a serious illness? What if it's a sick person who needs to be hospitalized? What if it's ...... What if I miss work because of hospitalization, so that I am excluded by my colleagues and fired by my boss?

Young people living in big cities are much more stressed than others seem. The current working environment is very different from that of my parents' generation, and the pressure of life is many times higher than that of my parents' generation. Under the triple blow of life pressure, emotional pressure and work pressure, today's young people are extremely aggrieved - the sudden collapse of office workers that are common in the news is just the tip of the iceberg.

Entering the consultation room was a female patient who looked to be about the same age as Sun Lien, wearing a small suit and professional clothes, and stepping on high heels of about six centimeters. When she walked into the ward, Sun Lien was keenly aware of a somewhat strange stiffness. After a little more observation, Sun Lien suddenly noticed something different - her head has been maintained at a slightly left angle, and it basically does not turn.

If nothing else, it's probably a stiff neck. Sun Lien quickly made a judgment based on his own experience, and then frowned slightly, feeling that his judgment might be a bit problematic.

Would a young man who looks like a white-collar worker come to the emergency department because of stiff neck......?

"Doctor, my neck hurts. The young female patient was straightforward about her topic. "It hurts terribly. ”

The content displayed on the status bar was basically the same as the female patient's complaint, "Wang Li, female, 28 years old, neck pain progressively worsened (68.14.33), neck movement was limited (65.05.21)". However, there is also a somewhat concerning content behind it, "Horner syndrome (54.44.39)".

Horner syndrome?Sun Lien twitched his eyebrows slightly, which should be a symptom of Shennai. Could it be that Ms. Wang's neck pain is related to some neurological pathology?

"How long has it been painful?" Sun Lien decided to complete the patient's medical history before making a decision. After a more complete grasp of the patient's condition, it was easier for him to decide whether to transfer Ms. Wang to Shennei or to the outside of the spine first.

"About three days, right? I went swimming three days ago, and I probably twisted my neck while swimming...... As a result, the plaster has not been good in the past few days. Wang Li looked a little helpless, "Originally, exercising was to reduce illness, but it turned out to be good now - I just exercised myself to get sick." ”

Sun Lien took a closer look at Wang Li's face, and sure enough, he found that her right eyelid was slightly lower. And it looks like her eyeball on one side is a little more deflated than on the other.

This should be the Horner syndrome suggested by the status bar.

Horner syndrome, also known as "pediatric cervical sympathetic nerve palsy syndrome", is more common in children. However, there are many such symptoms in adults - the main external manifestations are drooping of the upper eyelid on one side, the pupil is constricted but responds normally to light on the drooping side, and there may also be symptoms such as indentation of the eyeball on the drooping side.

Horner syndrome has very clear indications of the area of the lesion – it occurs when any part of the pathway from the sympathetic center to the eye is compressed and disrupted. That is, the area of the lesion should be located between the cervical T2 segment of the spine and the cervical T1 segment to the eye.

Considering that the patient complained of obvious and severe neck pain, Sun Lien was more inclined to think that T1~T2 was problematic. But what exactly is the subject remains to be clarified - after all, the status bar does not clearly indicate the location of the lesion. There are three types of Horner syndrome depending on the location of the injury.

The central type is more common in hypothalamic lesions, and patients generally have contralateral hemiplegia or dysesthesia, and thalamic lesions generally have ataxia, vertical gaze paralysis, and dyspnea.

If it is a central type, then it is unlikely that Wang Li will be able to walk into the consultation room wearing high heels - she should be found out by her family or colleagues that something is wrong, and then be sent directly to the emergency room by 120.

Preganglionic disease is more common in interpulmonary lesions, and generally has ipsilateral shoulder pain, paresthesias in the inner arm, forearm, fourth and fifth fingers, and muscle weakness. Considering that Horner syndrome has been present for less than three days, and the patient himself has not mentioned paresthesias, this is not very likely.

The postganglionic form occurs mainly on distal lesions at the bifurcation of the common carotid artery. Such Horner syndrome is often accompanied by symptoms such as trigeminal neuralgia and facial paralysis and neuropathic deafness.

The nervous system is a very delicate system, and compression, lesions, and injuries can cause a range of symptoms. What Sun has to do now is also very simple – identify the type of lesion and then determine whether the patient needs referral, hospitalization, or emergency surgery.

"Well, I'll give you a check-up first, take a CT scan to see if there is any damage to the bone part of the cervical spine. Sun Lien thought about it for a while and decided to start simple. Patients complain of neck pain after exercise, then damage to muscles, ligaments, and bones is possible. It is easier for patients to accept these things first and then consider them on the nerves.