1557 What the hell is an epicial aortic ulcer?
“Doctor, is my husband’s illness serious?” A middle – aged woman came out of the emergency room with an internier.
Zheng Ren was still in a daze when he heard someone talking.
Heavy!” The doctor said with certainty,”it’s a bleeding digestive tract. There’s a tap inside that’s bleeding profusely. Do you think it’s serious?”
As the emergency physician spoke, he looked up and saw Zheng Ren. He greeted,””President Zheng, is the director alright?”
“I’m fine. ” Zheng Ren laughed.”What patient?”
“She’s nauseated and vomiting. Her blood pressure is rather low. Considering that it’s upper gastrointestinal bleeding, prepare to admit her to the hospital. “
This was a common situation. TIPS was targeted at patients with portal hypertension, and stomach and intestinal mucous ulcers, rupture, and bleeding were also targeted.
If it were not for vomiting blood due to cirrhosis with portal hypertension and gastrone vasculatosis, the bleeding artery would not be too large. After being admitted to the hospital for gastrointestinal decompression, injection of hemostatic drugs, and even worse, oral kidney iced saline solution, it would take about two to three days.
“What’s the blood pressure?” Zheng Ren asked casually.
“75/50mmhG。”The emergency physician took the patient’s family to open the hospitalization form and left Zheng Ren with some data.
Fortunately, although the blood pressure was in shock, it was not particularly low.
Zheng Ren peeked his head out and saw a middle – aged man lying on the bed in the emergency resuscitation room. His face was pale, and the value on the electrocardiogram …
Why was his blood oxygen saturation level so low? There were also some problems with the wave form of the electrocardiography.
Zheng Ren felt that something was amiss and entered the room to take a look.
The system’s panel was frighteningly red, and the diagnosis was that there was a large amount of pericardium effusion and an epicidal aortic ulcer.
Uh … What kind of illness is this?
Zheng Ren knew that the doctor from the emergency Department of Internal Medicine had made a mistake. As for why he made this mistake, he didn’t think about it for the time being.
He immediately opened a drawer of the console, which contained a mercury sphygmomanometer and a stethoscope.
Zheng Ren picked up the stethoscope and started to listen to the patient’s heartbeat.
He could hear a large amount of wet Luo sound in his lungs, and his heart sound was low and far away. It was undoubtedly cardiac tamponade.
As he was a man, Zheng Ren did not check to see if there was any condition of the patient who had changed his appearance.
Cardiac tamponade was also divided into several types: acute and chronic. If it was a traumatic case, when a large hole was torn in the heart, the blood would be piled up in the pericardium cavity, and it was classified as acute cardiac tamponade.
Heart and kidney dysfunction could lead to fluid circulation disorders and chronic cardiac tamponade.
It was understandable that there would be cardiac tamponade or even cardiac tamponade. However, what kind of stupid diagnosis was epineurium aortic ulcer? How did it come?
Ulcers could also occur in the aorta. This situation referred to the rupture of the aortic endocartical plaque, which formed an ulcer and penetrated the inner elastic layer.
However, the patient from the big pork trotter had an epictis aortic ulcer.
Inflammation? Or something else?
Just as he was thinking about this, the emergency internal medicine doctor came out after writing the hospitalization form for the digestive Department and asked the medical staff to send the patient to the hospital.
She saw Zheng Ren doing a physical examination by the bed and asked,””President Zheng, what’s wrong?”
“Don’t be in a hurry to be hospitalized. Get a lung CT scan. ” “What’s her medical history?”Zheng Ren asked.
The emergency physician was stunned for a moment. It was obvious that he had an upper gastrointestinal bleeding. Why didn’t President Zheng let him be admitted to the hospital? why did he have to do a lung CT scan?
“Male patient, 42 years old. He came to our hospital for treatment after three hours due to repeated nausea, vomiting, and breathing difficulties. ” Although he had his doubts, the emergency physician still habitually reported his medical history.
The power of a senior doctor was no joke, and he had long since gotten used to it.
“The patient suddenly had difficulty breathing three hours ago. He felt a slight tightness in his chest, accompanied by several times of nausea and vomiting. Each time, there was a small amount of stomach content and a small amount of coffee – colored things. There is urinary incontinence, and the feces are yellow. “
“Nauseated? Brown?” Zheng Ren asked.
“Yes, the latent blood is positive. I think it’s caused by bleeding in the upper gastrointestinal tract. Since he didn’t vomit blood, the bleeding shouldn’t be too serious. ” The emergency physician said.
Zheng Ren was deep in thought.
Something was not right.
Based on the patient’s medical history, the emergency physician’s diagnosis was correct.
The things he vomited out were sent for examination, and there was a positive blood test, so he was diagnosed with upper gastrointestinal bleeding. All of this was logical and there was no problem.
But why would he have difficulty breathing?
Seeing that Zheng Ren was staring at the patient in a daze, the emergency physician said in a low voice,””President Zheng, hurry up and send him to the Gastroenterology Department. If the bleeding can’t be stopped, he’ll need to undergo emergency treatment.”
It was the emergency department. After a diagnosis was made, they would be sent to wherever they should be.
They were all being resuscitated in the emergency department, so they were too busy to handle this.
There were dozens of emergency patients outside, and when they met a bad – tempered or urgent patient, they would directly open their mouths and curse.
Even getting beaten up was not uncommon.
It wasn’t as if he had never been slapped in the face during emergency treatment.
“Go get a CT scan of the patient’s lungs. I’ll bring the patient for a checkup,” Zheng Ren said, shaking his head.
The emergency physician did not know why Zheng Ren insisted, but she did not hesitate. The senior doctor had already said so, and she had also given her own opinion. Since he did not listen, then she would just follow the senior doctor’s orders first.
If the sky collapsed, there were senior doctors to hold it up, so what was there to be afraid of?
“What patient, boss?” Su Yun returned to Zheng Ren’s side after dealing with the female student.
“It’s very strange. Listen. ” Zheng Ren passed the stethoscope to Su Yun.
“Eh? Strange?”
“According to the patient’s medical history, the patient is diagnosed with upper gastrointestinal bleeding. But from the auscultation, there are problems with both the lungs and the pericardium. I plan to bring the patient to do a CT scan first. “
Su Yun took the stethoscope doubtfully and started to listen.
In less than a minute, he raised his head with a serious expression and said,””There’s a problem. Hurry up and get it checked.”
“You diagnosed him as bleeding from the upper gastrointestinal tract?” Su Yun asked.
“Nausea, vomiting, vomit, latent blood test positive.”
“President Zheng, the CT scan order is done. Will you be taking it with you?” The emergency physician asked.
“Yes.”
The patient’s family was a little dumbfounded. They had just been told that he would be hospitalized in the Department of digestive medicine. The doctor had also described the condition as very serious, and that he might die if he was a little later. Why did he have to do a checkup now?
“Doctor, what’s going on?” The patient’s family member asked anxiously.
“Have you suffered any external injuries recently?” Zheng Ren didn’t explain and asked as he helped the patient onto the Gurney in a flurry of motion.
“Recently? No, I don ‘t. ” The patient’s family member said,”he was injured once a few years ago. His collarbone was fractured, and he had surgery.” Nothing much happened recently, everything’s normal. “
Zheng Ren took a glance. There was an old surgical scar on the patient’s left sternum, which had been there for a long time.
‘That’s strange. There’s no external injury, so where did epictis aortic ulcer come from?’
Zheng Ren started to ponder according to the diagnosis of the big pork trotter.
But no matter how he thought about it, it was a dead end. He had no idea at all.
Zheng Ren and Su Yun pushed the Gurney and jogged all the way to the CT scan room with the examination partner.
It was not until the patient was on the bed and began to do a CT scan that he could finally catch his breath.