bookpower Chapter 559
Chapter 559
This female patient in front of me,
CHEN Meijuan,
Chest pain, chest tightness, suspected coronary atherosclerosis (coronary heart disease).
Now suddenly fainted and fell to the ground, what are you most afraid of?
The most afraid of coronary heart disease outbreak, coronary artery blockage, resulting in myocardial ischemic infarction.
"Right away, pull an ECG!!"
Soon, the ECG results came in.
There is no graphic of acute myocardial infarction ...
Or?
What about arrhythmias? (ventricular tachycardia, bradycardia)
It will cause significant inhibition of heart function and cause cerebral ischemia and hypoxia...
But
This requires ongoing testing to be able to detect it later.
Therefore, 24-hour ECG monitoring is necessary.
At this time, Lin Feng ordered the nurse to measure the patient's blood pressure for Chen Meijuan. 90/50mmHg。
For a hypertensive patient, it's a bit low.
Considering the use of nitroglycerin in the front, it expands the coronary arteries of the heart, increases the blood supply and oxygen supply to the heart, and at the same time expands other blood vessels in the body...
Hypotension can also occur.
Then consider hypotension, especially "orthostatic hypotension" (note: hypotension is more likely to occur when the position changes suddenly).
If "orthostatic hypotension" is low to a certain extent, the patient will have cerebral ischemia and lack of oxygen, and will faint all of a sudden.
in a word
Possible arrhythmia: requires prolonged testing
・Possible "orthostatic hypotension", discontinuation of nitroglycerin.
"First guardianship ... Look at the situation..."
After Lin Feng finished his order, he continued to return to the consultation room to receive patients.
......
Next patient,
The patient is a 1-year-old child.
"Dr. Lin, help me see my son... These past few nights, I always wake up in the middle of the night and suddenly cry..."
"Pointing to the throat, crying ..."
"I asked him if he had an itchy throat and he said yes..."
The two parents looked nervous.
In the first few days, they thought that there was no big problem, because after the baby ate, he stopped crying, and as a result, he cried for a few nights, and he couldn't help but worry, so he ran to the hospital today.
"Throat discomfort?"
Lin Feng's first reaction is to have foreign bodies in the throat, such as shark fins.
"He should have started eating, cooking and so on, right?"
"There you have."
"Have you ever eaten fish or something?" Will it be fish bones and chicken bones? "
"There are fish and chicken..."
Lin Feng nodded.
There are possibilities such as fish bones.
"Do you have a fever?"
"No..."
"Eat sharply? Resist? "
"This one doesn't seem to resist..."
Lin Feng: "??? "
What the heck?
Not resisting eating is to exclude laryngitis, foreign bodies, because this will make swallowing uncomfortable.
Then do an individual examination.
In general, if a child has a foreign body in the throat,
The first step is the tongue depressor.
Use lights, tongue depressors, and see if you can find anything.
If the tongue depressor is not found, proceed to the next step.
The second step is: X-ray,
However, X-rays are not sensitive to some foreign bodies and may not be able to be photographed.
If the X-rays can't be removed, then proceed to the next step.
Step 3 – laryngoscope.
This requires anesthesia, and generally do not want to give this to children.
If it really doesn't work, then use nuclear weapons - ultrasound, CT.
But in fact, CT radiation is large, basically do not shoot children, and children will move around, and can not take CT.
Lin Feng took out a sterile tongue depressor,
The father held the child vigorously.
At this time, the 1-year-old child naturally began to be afraid, began to cry, and opened his mouth.
It happened to be used by Lin Feng with a tongue depressor.
Take a look.
Inside the throat, I saw seven or eight white white spot ulcers.
Lin Feng saw these white spots.
Judge it at once.
"It's angina herpes!"
Not a foreign body at all, but herpes angina.
Lin Feng was a little surprised.
This "angina herpes" is an acute infectious pharyngitis caused by an enterovirus characterized by acute fever and herpes ulcers of the pharyngeal isthmus.
It is a relatively serious infectious disease that is transmitted and endemic in the child group, which is very contagious and spreads quickly, mainly invading children aged 1~7.
Fever, headache, abdominal pain...
These are symptoms of angina herpes.
If it develops to a little more serious, it is the famous "hand, foot and mouth".
"Hand, foot and mouth", in the past, was a serious infectious disease that made hospital departments have to be blocked, which shows its terrifying nature.
But the child in front of him, suffering from "angina herpes", did not have a fever, headache, and what kind of fragrance he ate...
Awesome!!
This kid is physique and barbaric.
Lin Feng said to his parents: "The child is suffering from "angina", this thing is infectious, try not to let him contact with other children in the past few days, and other children at home should also be isolated..."
The parents were shocked: "Huh? Is it so serious? "
Lin Feng: "It's quite serious, its infection period is 2 weeks, you calculate the time..."
Parents: "That doctor, trouble to prescribe a medicine..."
Lin Feng thought for a while: "Children don't take so much medicine, I'll prescribe an 'Open Throat Sword Spray'..."
The parents quickly thanked him: "Thank you Dr. Lin..."
After Lin Feng got this patient,
suddenly
The tube bed nurse ran in.
"It's not good, Dr. Lin, that patient has fallen!"
“？？？？"
Lin Feng's face became serious.
Isn't nitroglycerin already stopped? Other similar drugs were also not used.
Why did it fall again?
Lin Feng got up and walked quickly towards the ward...
。