These reports showed that serum troponin, myoglobin, and plasma D-dimer were significantly elevated, and BNP was slightly elevated.
This further confirmed Chen Xia's speculation.
Several senior directors now look at Chen Xia with admiration. A young doctor who is not from a professional background actually has such insights, which is a level that even ordinary attending physicians cannot achieve.
Du Guobiao smiled and said, "Then tell us what your inferences are."
Chen Xia explained: "My thinking is this: first, the patient is a young woman with an acute onset of illness. She usually has no emotional problems, no sleeping pills at home, and was washing clothes early in the morning. This rules out sedatives, sleeping pills, or drug abuse causing disturbance of consciousness.
Second, the main clinical manifestations of patients are impaired consciousness and shock. After the shock is corrected, the consciousness is significantly improved, indicating that the impaired consciousness is basically caused by shock. The types of diseases that cause impaired consciousness are nothing more than the following:
1. Diabetic emergencies, such as hypoglycemia, diabetic ketoacidosis and hyperglycemic hyperosmolar coma, can be excluded by combining blood sugar and blood gas.
2. Electrolyte imbalance: especially severe hyponatremia, blood sodium 147mmol/L, eliminated!
3. Poisoning: There are many poisons in this category, and it is the most difficult to identify. However, based on the medical history, we can temporarily rule it out, or there is no clear evidence of poisoning.
4. Hepatic encephalopathy, pulmonary encephalopathy and uremic encephalopathy can also be largely excluded. However, if the patient's coagulase is obviously abnormal, attention should also be paid to abnormal liver function, such as hepatic encephalopathy caused by acute liver damage.
5. Epileptic seizures are automatically excluded, needless to say."
The three senior directors and several junior doctors nodded in unison.
Chen Xia continued:
"We can actually figure out a clue: a young woman with an acute onset of the disease—previously healthy and with no special hobbies—who had been sitting for a long time washing clothes and taking oral contraceptives before the onset of the disease.
Main clinical manifestations: impaired consciousness + shock. Consciousness problems are most likely caused by shock! Temporarily summarized as shock - positive situation: jugular vein distension is a possible sign of increased right heart load or large amounts of pericardial effusion.
Tachycardia + hypoxemia + electrocardiogram changes + slightly elevated myocardial enzymes + significantly elevated plasma D-dimers are manifestations of thrombosis and activation of the fibrinolytic system.
Then pulmonary embolism can explain almost all of the patient's current conditions."
The three directors burst into laughter after hearing this.
Du Guobiao patted Chen Xia's shoulder fiercely: "It is true that a tiger father will have a dog son. Xiaoxia, you are so surprising. You have convinced me."
Feng Runguang and Yu Guocheng also looked at the surprising young man in front of them with admiration.
At this time, the patient returned from the examination. Wu Shaochen rushed into the office and shouted, "The test results are out, and it is highly suspected to be a pulmonary embolism."
Chen Xia sighed, "What a shame! It would be much better if we could just do a triple CT scan for chest pain. That would confirm it. We wouldn't have to rely on experience and guesswork like we do now, piecemeal evidence. It's time-consuming, laborious, and prone to errors."
What is CT?
The young doctors were already used to Chen Xiashi's frequent baffling phrases, so they all took their places. Now that the diagnosis was settled, the next step was treatment.
Just when everyone thought that the matter was over, the real show had just begun.
When Bai Hua was leaning over the table writing the emergency medical record, the patient's husband's younger brother, or brother-in-law, quietly appeared behind him.
The young man was shocked when he saw the words "Due to oral contraceptives, leading to estrogen..." on the medical record.
My eldest brother has been away from home for a year, why is my sister-in-law taking birth control pills?
With three parts of doubt and seven parts of uncertainty, he quickly ran to Li Guizhen's bedside and asked everyone, "The doctor said that my sister-in-law's illness was caused by taking birth control pills."
As soon as these words were spoken, the scene fell silent, especially the four old men, whose bodies trembled noticeably.
Li Guizhen's father-in-law grabbed his youngest son's hand and asked, "Are you damn sure your sister-in-law is taking birth control pills?"
The younger son said aggrievedly, "Really? That's what the doctor wrote in the medical record."
The old man let go of his youngest son, walked to Bai Hua with a grim face, snatched the medical record he was writing, and started to look through it.
The more he watched, the angrier he became, and his whole body began to tremble more and more violently. Everyone present knew that things were going to get bad.
"Li Guizhen, you little bitch, I'll fuck your grandma!!!"
Chen Xia was discussing pulmonary embolism with three senior directors in the office when a fight broke out outside.
When several directors heard the sound and opened the door, a stool flew past their ears, scaring them into breaking out in a cold sweat.
In the emergency room, Li Guizhen was lying on the hospital bed, twisting and turning excitedly, while relatives from both sides had already started punching and kicking her, twisting into a ball.
Especially the mother-in-law and my own mother, this pair of in-laws even pulled each other's hair and refused to let go, completely tearing each other apart.
"Well, this shameless bitch actually stole a wild man, and you old woman actually dared to hit me, I will fuck your Li family ancestors for eighteen generations."
"Old Li, we thought we treated your daughter well, and this is how your daughter repays us?"
"What nonsense are you talking about? Go back and call someone. Damn, this bitch actually stole a man. Who is it? This matter is not over today!"
The two policemen did not leave. When they saw the two sides fighting, they quickly stepped forward to try to stop them. But at this time, the man was already completely furious and would not listen to much.
No one knew which coworker took advantage of the situation and revealed something to the man's relatives, but several big men rushed into the office and pulled Zhu Hongzhong out.
"Everyone, look quickly! This is the adulterer, and he's the deputy director of the Huangxingji Fan Factory. Fine, you're worse than a pig or a dog! Beat him to death!"
"Help, police, help!"
Now, the emergency department has turned into a "martial arts film + family ethics drama". The noise of fighting even attracted patients and their families from the outpatient department.
Chen Xia roared, "If you want to beat them up, go out and beat them up! Anyone who smashes up our emergency department will be arrested and sent to labor camp."
The two policemen turned around and looked at Chen Xia with a wry smile on their faces: "Captain Chen Xia, why did you let them fight outside? You should have stopped them from fighting each other."
Chen Xia said with disdain: "Stop it, bullshit! This man and woman already have families, yet they still do something like this. They deserve it."
In 1982, China was still in a fairly conservative era, especially in rural areas like Ke Town. Although there were certainly many hungry men and women secretly having affairs, being caught in an affair was definitely big news.
This shocking gossip in the emergency department spread throughout the hospital in an instant, and then spread throughout the entire Ke Town.
The final outcome was naturally that Zhu Hongzhong was expelled from the party and removed from office, and Li Guizhen, who was lying on the hospital bed, was also expelled from the fan factory, and both families chose to divorce.
Although Li Guizhen was rescued this time, because the thrombus was not completely dissolved before, she fell ill again and died three years later.
Zhu Hongzhong was disgraced and exiled from his hometown, and no one ever saw him again.
This is exactly what happens when there is a cause...
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