Before Chen Xia could sit down and drink some wolfberry tea, the door of the emergency room was slammed open.
Chen Xia was speechless. The gate of the emergency department was the most troublesome place for the General Affairs Department. In 365 days a year, it had to be repaired at least 765 times, and there was not a single peaceful day.
"Doctor, doctor, please save my mother!"
Several middle-aged men rushed in carrying a patient, shouting as they ran. The nurse on duty immediately arranged the patient to an empty bed.
Chen Xia put down the cup and trotted over.
The patient was an obese old lady who was breathing rapidly, sweating profusely, and her consciousness was a little blurred.
"Are you family members? What's the old lady's condition?"
"My mom caught a cold the day before yesterday and had a slight fever. She complained of feeling weak. We prescribed some cold medicine at the health center, but an hour ago she suddenly started complaining of shortness of breath and chest pain, and later became unable to speak."
Chen Xia immediately called out, "Wan Lu, quickly measure the temperature, blood pressure, and blood sugar. Lin Xingchen, quickly open an intravenous line. Hurry! The patient is in shock and in critical condition."
Then he turned around and asked the family, "What chronic diseases does your mother have? Such as high blood pressure, diabetes, heart disease, etc."
The patient's son quickly said, "My mother has high blood pressure and a bad heart. She often gets out of breath when she walks."
Wan Lu then urgently reported: "The patient's blood pressure is 210/120 mmHg, body temperature is 38.5°C, heart rate is 125 beats per minute, respiratory rate is 40 breaths per minute, and blood sugar is 7.1 mmol/L."
Chen Xia complained, "Fuck, why is there another case of high blood pressure?"
While complaining, I did a physical examination:
The patient was drowsy, had rapid breathing, a fast heart rate, equal-sized pupils and photosensitivity, distended neck veins, dry and wet rales in both lungs, and mild to moderate abdominal distension in both lower limbs.
Chen Xia checked around and quickly wrote down a few checklists and handed them to the family: "Hurry up, get a blood test, a chest X-ray, and an EKG."
The patient's family hurriedly pushed the patient to do a check-up.
The little follower Wu Shaochen quickly came over and asked, "Mr. Chen, is this patient's high blood pressure also caused by a lung infection?"
Chen Xia shook his head. "This old lady is in a more serious condition than the old man just now. When you examined her just now, didn't you notice that her venous veins were distended?"
Wu Shaochen shook his head and touched his head awkwardly: "I didn't notice."
"Damn, your technical secondary school education was wasted. Let me test you. Explain to me the concept of left ventricular failure."
Wu Shaochen was sweating and quickly replied, "Left heart failure refers to heart failure caused by left ventricular compensatory dysfunction. It is relatively common clinically and is characterized by congestion in the pulmonary circulation."
“What are the specific clinical manifestations?”
"Exertional dyspnea is the earliest symptom of left heart failure. It also causes paroxysmal dyspnea at night, and patients often have to sit up to breathe. Oh, and by the way, there will also be pink, foamy sputum, and moist rales in both lungs."
Chen Xia asked again, "What about right heart failure?"
"Right heart failure is primarily a manifestation of systemic congestion, manifested as lower limb swelling and gastrointestinal congestion. In severe cases, there may also be hepatomegaly, ascites, jugular vein distension, and even pleural effusion."
Chen Xia patted Wu Shaochen on the shoulder and said, "Not bad, young man, you have a good grasp of the basic knowledge, but theory still needs to be combined with practice. Think about that old lady just now and compare it with it."
Wu Shaochen suddenly became excited. "Oh, I see. The old lady has symptoms of heart failure, right?"
Chen Xia nodded: "Well, the boy is teachable, much smarter than that idiot Bai Hua."
Wu Shaochen smiled broadly at the compliment, "Haha, thank you Mr. Chen for your guidance."
He had forgotten that Chen Xia was younger than him and not a professional. It was a great wonder in the Fourth Hospital that such a person became a teaching teacher in the emergency department.
The patient's examination report was delivered immediately.
Chen Xia then instructed in a serious manner, "This patient has acute heart failure. The underlying disease is hypertensive heart disease, and the trigger is a respiratory infection."
Wu Shaochen knew that he was about to give medical advice, so he quickly took out a pen to take notes.
"The patient's blood pressure is 210/120 mmHg. The first step is to dilate the vasculature and lower the blood pressure. Immediately administer sodium nitroprusside via intravenous drip. Simultaneously, to reduce afterload, administer a morphine bolus. Also, perform a penicillin skin test immediately. If negative, administer antibiotics."
Wu Shaochen suddenly asked, "Section Chief Chen, if you have heart failure, why don't you have diuresis?"
"Just now I said you were smart, but now you're stupid. The patient has recently had a fever, shortness of breath, and dry skin, which means his blood volume is insufficient. How can he use diuretics?"
Wu Shaochen didn't give up and asked again: "If there is heart failure, should we use some cardiotonic drugs like diltiazem?"
Chen Xia rolled his eyes: "He has high blood pressure, not low blood pressure, why should he use positive inotropic drugs?"
"Could this old lady be suffering from a pulmonary infarction?"
"The clinical symptoms are quite similar, but the X-rays don't support this diagnosis. It's a pity that we don't have CT, MRI, angiography, or radionuclide scanning. Otherwise, we could have confirmed the diagnosis immediately."
Chen Xia looked depressed. The hospital in his space had all these machines, but he didn't know how to operate them. So many advanced instruments were wasted.
Wu Shaochen was already impressed by the young section chief in front of him and gave him a thumbs up repeatedly.
Chen Xia frowned. "Why don't you go get the doctor's orders? What are you standing there for? Be careful or you'll get beaten to death by the old lady's four sons."
Wan Lu chuckled, Wu Shaochen chuckled twice, and ran to the workstation to write a medical order.
After treating the two patients with hypertension, Chen Xia walked to the door of the emergency operating room and watched Du Guobiao performing surgery inside with a little envy.
Ever since he was rushed to the emergency department by his father-in-law, he insisted on going to the emergency surgery department, but neither Lao Gu nor Lao Du agreed, believing that the risk of performing surgery without experience was too great.
As a result, he was sent to the internal medicine team, which was clearly not his strong point. Chen Xia leaned against the door of the operating room, holding a thermos cup, feeling a little depressed.
There’s nothing I can do, my hands are itchy.
I yawned and looked at my watch. It was already 3 a.m.
Chen Xia was feeling a little hungry, and was just about to go to the office to take a break and eat something, when suddenly the door of the emergency room was pushed open again with a "bang".
Chen Xia was so depressed, she kept cursing her father-in-law in her heart. He could have gone to any other department, even the obstetrics and gynecology department, but why did he have to come to the emergency department? This was torture.
"Doctor, hurry up, my friend has fainted and won't wake up no matter how hard we try."
A middle-aged man was crying hysterically, and Chen Xia's heart was in suspense again.
Even those who were dozing off were suddenly awakened. When such cries are heard in the emergency department, it often means that a critically ill patient has arrived.
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