Yuezhou Fourth Hospital, Emergency Department, night.
"Section Chief Chen, Chen Xia, you little brat, hurry out! There are a few more emergency patients being sent in, and we're overwhelmed."
Du Guobiao, director of the emergency department, was shouting anxiously outside the door.
In the lounge, Chen Xia, who was sleeping on the table, raised his head in confusion and looked at his watch. It was 1:30 in the morning.
"Got it, Lao Du. I'll be there right away."
Chen Xia answered, quickly picked up the teacup on the table, took a sip and prepared to go out. It was a full cup of wolfberry and wild ginseng.
In the two months since BJ came back, his waist has never been healed. It hurts every day, he has dark circles under his eyes, and he feels weak when walking.
No, this must be caused by working night shifts frequently, and it is definitely not caused by newlyweds fighting in bed every day.
Pushing open the door of the lounge, the emergency room outside was filled with noise. At this midnight, only the emergency department of the hospital would be so lively.
Chen Xia stopped Wu Shaochen, a young doctor, and asked, "What's wrong? What patient?"
Wu Shaochen reported in a low voice:
"An elderly male patient, 75 years old, was just brought in by his family. He reported having a history of lung disease, developed cold symptoms three days ago, and had difficulty breathing half an hour ago.
Physical examination: temperature 37°C, blood pressure 210/120 mmHg, pulse 40 beats/min, heart rate 130 beats/min, pupils 2.5 mm equal in size, photosensitivity, jugular vein distension, lungs covered with dry and wet rales, and mild to moderate edema in both lower extremities.
"Oh, his blood pressure is so high, it's like his blood vessels are about to explode. Let's go and check on the patient."
In fact, according to normal operations, Chen Xia is not qualified to be a "senior doctor". According to his education equivalent to that of a technical secondary school and correspondence course at a junior college, he should have been a small role who helped out and listened on the side.
But who told him to be the section chief? His rank is higher than that of Du Guobiao, the director of the emergency department. Does he have to listen to Wu Shaochen and other little brats?
Wait, it seems Wu Shaochen is older than him...
In the past two months, Du Guobiao saw that Chen Xia's medical skills were quite good, so he did not regard him as a novice doctor, but thought that Chen Bingkun had taught his son everything he knew.
This hospital is really brave now. If it were in the future, not having a practicing physician's license would be a problem.
Chen Xia walked over with a stethoscope while looking through the medical records. The patient was an obese old man lying on the sickbed, gasping for breath and sweating profusely, but fortunately he was conscious.
"Old man, where do you feel uncomfortable now?"
The old man pointed at his chest and spoke incoherently: "I, I, I feel stuffy here, I can't breathe, I feel dizzy, I'm going to die."
After saying this, he coughed violently, and the old lady beside him quickly caught the cough with a handkerchief.
Chen Xia took a look and saw yellow pus in the sputum.
So I took out a stethoscope and pulled open his clothes to take a look. The anterior-posterior diameter of the old man's chest was obviously increased, and the intercostal space and the inferior angle of the sternum under the xiphoid process were widened. This is a "barrel chest", so I had a clear idea now.
A careful auscultation revealed a noticeably prolonged expiratory phase, a smaller proportion of moist rales, and a louder pitch. Palpation revealed a weakening of the bilateral vocal fremitus, further confirming his suspicions.
The old lady was very anxious after seeing this: "Doctor, please save this poor old man of mine! Oh my, what should I do?"
Chen Xia quickly comforted him, "It's okay, it's okay. This old man has a lung infection, and his blood pressure has risen. We will give him medicine right away, and it will gradually get better."
Arriving at the doctor's workstation, Wu Shaochen quickly asked, "Chief Chen, should we use blood pressure medication right away?"
"Let's deal with the infection first. The old man has an acute infection of COPD. The shortness of breath is caused by airway spasm, and the high blood pressure is secondary. We must first treat the infection, and the blood pressure will drop on its own."
Wu Shaochen knew that he had to give medical advice now, so he immediately took out a notebook to prepare to record it.
"Start with oxygen and NS 250 mL to open an intravenous line. Immediately have the patient get a chest X-ray and a blood test. Don't forget to do an EKG."
"Okay, I'll do it right away."
When Chen Xia saw Wu Shaochen running to the nurse's desk, he felt a headache. Although he had an idea of the diagnosis, he lacked the necessary auxiliary examination reports and was deeply afraid of misdiagnosis.
If this old man were to live in the future, he would have to use an ECG monitor immediately, but now there is one, so his vital signs cannot be monitored dynamically.
A plain CT scan of the lungs showed nothing. It's impossible to determine the extent of inflammation or hidden pathogens that can't be detected by X-rays.
There is no emergency blood gas analysis. Therefore, it is impossible to determine whether the patient has acid-base imbalance and its type, and it is also impossible to determine whether there is respiratory failure and what type of failure it is.
In the past few months since coming to the emergency department, Chen Xia has wanted to throw things countless times.
As a doctor in my previous life who couldn't treat patients without machines, I had no auxiliary examinations and relied entirely on experience, and I had no idea what was going on.
I’m afraid that if I’m not careful, the disease will be delayed. Well, just wait for the overwhelming number of complaints from the patient’s family members.
What drives Chen Xia crazy is not just the lack of necessary auxiliary examinations, but the lack of clinical drug types.
Those familiar and very common medicines in the previous life were not even seen in 1982.
Chen Xia's space hospital has all the medicines. It's okay to take them out privately, but this is a hospital. If he takes out some medicines for no reason, he will be caught and sliced sooner or later.
So he had to use some very common and very mediocre drugs, and finally got a very mediocre therapeutic effect.
It is true that even a good cook cannot cook without rice.
Without auxiliary examinations, equipment, medicines, and an experienced team of assistants, relying on just one doctor is useless.
Now even if you ask Ling Ran from Yunhua Hospital and Zhang Fan from Cha Su Hospital to come over, they still can't do anything and can only watch helplessly.
An hour passed and the examination report finally came out. Chen Xia saw that there was indeed inflammation. So what was he waiting for? He took the medicine immediately.
Here it comes, the headache has finally come.
According to the treatment plan of the emergency department in later generations, at this time, two groups of antibiotics should be used together to "reduce inflammation", and then an emergency methylprednisolone injection should be given, and nebulized inhalation should be performed to relieve spasms and asthma. With this treatment, the patient's symptoms can be explained immediately.
Let’s get back to the topic. These medicines are not available now.
What to do?
Just eat it cold.
Chen Xia could only receive one set of penicillin injections and one set of dexamethasone injections.
Wu Shaochen weakly reminded, "Section Chief Chen, why don't you use aminophylline?"
Chen Xia slapped his forehead and said, "Use it, use it. There's no medicine left anyway."
It’s not Chen Xia’s fault that he forgot. Aminophylline was rarely used in his previous life because it had too many side effects and its clinical efficacy was uncertain. Doctors in the respiratory department no longer used this drug.
However, in the 1980s, aminophylline was still the main clinical anti-asthmatic drug, and it could even be said to be the main drug.
It's better to adapt to local customs than to do nothing. This is the only way Chen Xia can comfort himself.
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