On the evening of the 20th, Gu Lin's "relatives" came. Chen Xia finally had a week's break, so he fell asleep early.
In the early morning, the phone in the living room rang desperately, ring~~~ring~~~ring~~~
Chen Xia opened his eyes, jumped out of bed, and ran outside to answer the phone without even putting on his clothes.
Anyone who has worked as a doctor knows that when the phone rings in the middle of the night, something's definitely going on, and it's not a small matter. It often means a patient in the department has had a serious problem, or there's been a major casualty in society.
In his previous life, no matter how insignificant Chen Xia was, he simply refused to work overtime. He still did his job well and never shirked responsibility for emergency surgery in the middle of the night.
This isn't just a question of medical ethics, it's also about...if Old Lady Yin finds out, she'll definitely beat him to death...
"Hello, I'm Chen Xia, where are you from?"
"Mr. Chen, hurry up, the chickenpox patient has suddenly fainted and is in shock. We are trying to save him."
The call was from Wu Shaochen. The poor young doctor actually lived and worked in the emergency room 24 hours a day, keeping an eye on this patient. As soon as anything happened, he would call for help.
"Okay, I'll be there right away. Please notify the doctor on duty in the internal medicine department and ask Director Du to come over if necessary."
After Chen Xia hung up the phone, he hurried to the room to change clothes. Gu Lin was lying on the bed with a big letter "L". The loud ringing of the phone did not wake her up. This girl is indeed a sleep god.
Chen Xia covered her with the quilt and left on tiptoe.
When he arrived at the emergency department, Director Du had just arrived.
As soon as the family members saw the attending doctors arrive, they immediately knelt on the ground and cried loudly, "Doctor, help, what happened to my husband?"
Director Du and Chen Xia ignored the family members and urged, "Wu Shaochen, report the patient's condition immediately."
"Director, Mr. Chen, the patient said he needed to defecate around 2:20 a.m., but suddenly fainted after coming out of the toilet. He was covered in cold sweat, was apathetic, and had rapid breathing.
I took his temperature and found it was normal, his heart rate was 180, and his BP was 105/80. He was immediately given oxygen via mask and two intravenous lines were opened to give him fluids to combat shock.
The patient is now unconscious, unresponsive, breathing rapidly, and his body is cold and wet. He is breathing pure oxygen through a mask. An emergency check showed that his blood oxygen saturation is 80%, his blood pressure is 65/53, and his heart rate is 163.
There are scattered petechiae and ecchymoses all over the body, and there is bleeding from the chickenpox. Auscultation of the heart and lungs is normal, the abdomen is bloated, the liver and spleen are not palpable below the ribs, and no bowel sounds have been heard for two minutes.
Why did he suddenly go into shock?
Chen Xia's mind was full of questions. This was really terrible. The previous diagnosis was not clear, and now the condition suddenly worsened.
The disease cannot be diagnosed and the cause cannot be found, so we can only treat the symptoms, which is only a temporary solution for emergency cases and not a cure for the disease.
Director Du quickly said, "Draw blood immediately. Expedited biochemical and blood gas analysis, blood count, urine test, coagulation function, and D2. Continue anti-shock treatment. Chen Xia, call a full hospital consultation immediately. This patient is not a simple case."
Chen Xia knew what was going on. The patient was in shock, with petechiae and ecchymosis on the skin and mucous membranes, and especially some patchy necrosis. This was either disseminated intravascular coagulation or subcutaneous bleeding caused by severe liver disease.
No matter which situation it is, it is enough to be fatal. The key lies in the unclear diagnosis. If the cause of the disease cannot be eliminated, any treatment will be ineffective. The patient's condition progresses too quickly.
Chen Xia immediately called the hospital director Gu Wei, and then made internal calls to the heads of each department one by one.
In less than 15 minutes, President Gu, Deputy President in charge Yang Jingye, Director of the Respiratory Department Feng Runguang, Director of the Cardiovascular Department Yu Chuncheng, Director of the First Department of Surgery Qiu Fangjue, Director of the Gastroenterology Department Xuan Yongda, Director of the Infectious Diseases Department Ren Yuanfei, and Chief of the Medical Department Qian Jun all arrived.
The hospital-wide consultation has begun.
While Chen Xia was reporting his condition, emergency examination reports came out one by one.
Chen Xia took a look at the report and couldn't help but gasp. He swallowed and read out the value on the report:
The patient's blood test showed white blood cell count 25, neutrophil count 90%, platelet count 73, red blood cell count 4.9, and hemoglobin 151.
Blood biochemistry: Alanine 5309, aspartate 6721, total bilirubin 28.4, creatinine 402, urea nitrogen 15, uric acid 640, glucose and blood lipids normal, creatine phosphokinase 760, lactate dehydrogenase 8378, serum creatine kinase-MB isoenzyme 180, amylase 402.
The D-dimer level is greater than 20,000, the plasma prothrombin time is greater than 240 seconds, and the coagulation time is greater than 240 seconds, all exceeding the maximum measurable values."
After hearing Chen Xia's emergency laboratory test report, everyone gasped. The only thought that flashed through everyone's mind was: "This patient is hopeless. All the indicators are seriously exceeded."
Dean Gu asked with a stern face, "Xuan Yongda, Qiu Fangjie, Ren Yuanfei, and Du Guobiao, you either participated in the entire treatment or attended the consultation before. Now let's talk about your opinions.
Xuan Yongda was the first to answer, and his expression was also not very good:
"The patient currently appears to have severe fulminant hepatitis and is in acute liver failure. But why has she not had jaundice? One of the clinical hallmarks of acute liver failure is progressively worsening jaundice. This patient has been ill for four days and has no signs of jaundice or liver percussion. Therefore, I may have misdiagnosed her previously and I am reviewing this."
Dean Gu waved his hand and said, "Now is not the time for self-criticism. What do you think of the request to save people, Du Guobiao?"
Director Du thought for a moment and said slowly:
The pathophysiology of acute liver failure is mainly due to the disorder of coagulation factor synthesis, while DIC is characterized by hyperfibrinolysis, which manifests as a progressive decrease in platelets and fibrinogen.
This patient's condition suddenly changed this morning, with a significant increase in D-dimer, but no obvious jaundice, and signs of circulatory failure, which clearly supports disseminated intravascular coagulation rather than acute liver failure.
Qiu Fangjue then added:
"The patient's current shock is probably caused by infection, namely sepsis. Because it was not given enough attention before, sepsis was not diagnosed and treated in time, and further deteriorated into severe sepsis.
Then he developed septic shock, and now he has disseminated intravascular coagulation and multiple organ failure. As for where the infection is located, I wonder if it could be severe acute pancreatitis."
Yu Chuncheng spoke fourth: "The patient's D-dimer level was significantly elevated, especially at the beginning when liver enzymes and other tests were not that high. The magnitude of the increase is difficult to explain by infection.
The patient is young and has no known tumor. Such a high elevation clinically warrants consideration of embolization. Considering the patient's admission symptoms of abdominal pain and cessation of bowel movements, mesenteric artery embolization should be considered."
Vice President Yang was a little dissatisfied: "You have been doing consultations and examinations for a long time, but you still don't know the specific cause of the patient's current condition? This is simply dereliction of duty!"
Dean Gu rolled his eyes at him and asked, "Feng Runguang, what do you think?"
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