bookpower Chapter 309
Chapter 309
Because the old man's condition is more urgent,
So Lin Feng directly entered the green channel, so that the imaging department could hurry.
......
After 20 minutes,
The CTA results are in.
10 years ago, the aortic dissection location was next door to the soft tissue of the esophagus, and the two were next to each other!
The distal end of the originally inserted arterial stent punctures the arterial vessel wall and punctures the esophageal wall next door and enters the esophagus.
Why poke? According to CTA, the arterial stent and the distal blood vessel, a large and a small, the blood vessel is relatively narrow, and the diameter of the arterial stent does not match, and it breaks down for a long time.
This check results can be explained:
Why do old people vomit blood!
Because arterial blood, through that opening, flows into the wall of the esophagus!
Then the esophagus is upset, coughing,
Cough up the blood inside.
Lin Feng was relieved to see the result, it was a kind of luck to find the reason so quickly. But at the same time there is a rise in vigilance.
The mouth of this artery + blood vessel can cause massive bleeding and even shock at any time!
Push the elderly out of the imaging department,
The son outside quickly ran over and asked nervously:
"Dr. Lin, how is my dad?"
Lin Feng: "I found the cause, it was an arterial stent that broke the arterial blood vessel, and then created a gap in the esophagus... Fortunately, you sent it in time, otherwise when the mouth is bigger, the arteries will bleed heavily, and you may be directly shocked..."
Lin Feng took the CT film and explained it in detail to his son.
When the son heard this, his heart jerked.
"Doctor Lin, what next? Admission? "
"Admission definitely means admission, but the priority is to pay the fee and then go for surgery... I'll tell you about the surgery now..."
Lin Feng began to describe the operation in detail to his son in front of the photo:
"In your dad's current situation, the anterior blood vessels are thick, the distal blood vessels are narrow, and the distal diameter does not match the size of the original stent. (The stent is large and the distal blood vessels are small.) ）"
"So, you need to put two more stents and do this operation together!"
"The specific surgical plan is: first choose to implant a stent with a diameter that matches the distal blood vessel in the distal vessel, and then select a stent that matches the original stent model, and confine it to the small stent just implanted... In this way, the mismatch between the end of the original stent and the distal blood vessel can be completely solved. "
Lin Feng explained the plan 3.
"That is, two brackets to put?"
The son hesitated at once.
If he remembers correctly, making a bracket for this thing, it's very expensive ...
One is tens of thousands!
The son asked in shame, "Doctor Lin, do you have to put two stents?" Doesn't one work? "
Lin Feng shook his head and patiently explained:
"If I choose a bracket that is consistent with the original. There will be a disadvantage: the model is too large, and there will still be a new stent distal to burst the distal blood vessel. "
"And if you choose a new stent that matches the distal vessel. There will be another disadvantage: the model is too small, the new bracket and the first bracket, contact position, there will be internal leakage. "
Lin Feng was very patient, and even drew on the picture so that his son could understand.
Of course, Lin Feng also understood his son's behavior.
Because arterial stents are really expensive.
The price ranges from 10,000 to 100,000 ...
The most expensive is the fourth generation of stents, which are absorbable stents, that is, implanted arterial vascular replacement, which can be absorbed by blood vessels...
The son suddenly thought: "Dr. Lin, can't that stent be taken out 10 years ago?" Take it out, will that breach be easily repaired soon? "
Lin Feng sweated furiously.
"I want to make it clear to you that the implanted stent cannot be removed. You wonder, why is it called "implantation" and not placement? This is because the stent grows with the vascular tissue, making the stent part of the blood vessel. "
"In addition, the role of an arterial stent is like a house that is going to collapse (arterial blood vessels), and it is supported by a frame (arterial stent), and if the frame is removed, the house will collapse."
When my son heard this, he also knew that this money could not be saved.
Lin Feng urged: "Let's decide quickly, your father's situation will be dangerous at any time..."
Lin Feng has seen too many cases on the eve of surgery, thinking about it, and finally dragging the patient to death.
The son gritted his teeth: "Then do it... Just follow Dr. Lin's plan! "
......
Next
Sign......
Choose the bracket, and finally choose the bracket with 13,000 pieces...
Payment......
Then Lin Feng took the patient to the interventional department to do arterial stent interventional surgery.
Contrast machines, arteriography ...
Piercing the guidewire catheter...
Feed in bracket 1...
Feed in Bracket 2...
Because the patient's blood vessels are more troublesome, it took 3 programs to send the guidewire before it was sent.
The total time took more than 3 hours...
End surgery...
......
"The operation is done..."
"Thank you, Dr. Lin!"
Lin Feng instructed: "In the past few days, your father should not eat, just use the vein to inject nutrients..."
Son: "Okay..."
Lin Feng: "The next treatment, do not need to be too troublesome, just need the digestive tract mucosa to heal, and review the CTA after four days to see if there will be internal leakage..."
Son: "Okay, good..."
Lin Feng: "There is another problem, after doing arterial stents, there may be thrombosis in the stent. is one of the complications during and after stent surgery..."
"Phased: within 24 hours, 24 hours to within 1 month after surgery, 1 month to 1 year after surgery, more than one year... You must keep an eye on your dad's ECG monitor and tell the nurse if something is wrong. "
The son looked serious: "Okay, okay..."
......
After getting this patient, it was almost noon.
Lin Feng canteen to eat,
The aunt made Lin Feng full of meat under the resentful eyes of many doctors and nurses...
......
After eating,
Keep visiting...
An old man, in a wheelchair, pushed in.
Still sucking oxygen masks!
Lin Feng was shocked, this was the first time he had seen such a 'scene'.
Hurry up and ask about the condition!
Patient, male, 58 years old,
・ Fever, cough, phlegm, chest pain, shortness of breath since 1 month ago...
5 days ago, CT did not find lung cancer or tuberculosis after examination in other hospitals. But pneumonia was found and antibiotic treatment was given, and the effect was found to be almost zero.
Lin Feng listened to the patient's complaint,
“.............................."
How this patient,
So similar to a female patient with "hantavirus"?
Similarity 99%!!
It's all the same symptoms!
All pneumonia has no therapeutic effect!
"Do you have rats in your house?"
Lin Feng went straight to the point.
"Rats?"
The daughter who accompanied the old man shook her head repeatedly: "My family is on the upper floors of the community building, and I have never seen mice..."
Lin Feng nodded, that can probably rule out the "Hantavirus".
However, when pneumonia is identified, but the treatment effect is not good, it is necessary to be vigilant.
"Go for a chest CT enhancement, collect sputum, do tuberculosis..."
Lin Feng looked at the CT film of the hospital in front of him, obviously there was no lung cancer, and he did not see pulmonary tuberculosis, but in fact, tuberculosis could not be ruled out, and some tuberculosis CT could not be seen.
......
Two hours later,
CT enhancement results come out...
No lung cancer, tuberculosis...
But!
Sputum smear, "acid-fast bacilli" was found...
Confirmed to be tuberculosis!
(Why didn't tuberculosis be found in the previous hospital?) It may be because the CT result determines that there is no tuberculosis, or the sputum smear does not find "acid-fast bacilli", because even if there are acid-fast bacilli, it may not be possible to detect it once or twice. ）
So
This old man is: tuberculosis patient!
The next treatment is simple: anti-pneumonia + anti-tuberculosis medication...
......
A certain construction site.
A group of workers are unloading goods, moving tiles piece by piece into the building, waiting for the next step of decoration.
While unloading, chat.
"Strange, why did you say Lao Zhang didn't wake up yet?"
"Yes, now 15 hours have passed, and I am still sleeping..."
"How much alcohol did Lao Zhang drink last night?"
"It's not clear... 1 bottle of white? "
"Anyway, Lao Zhang drank very hard..."
"When I was eating at noon just now, I called him, and he didn't wake up..."
"You say, will something happen to Lao Zhang? He used to drink alcohol, didn't he try to sleep for so long? "
"This..."
"Wouldn't it be bad luck if you died here?"
"How about sending it to the hospital?"
"Tell the foreman..."
"Yes, tell the foreman..."
Soon, the foreman heard the news and rushed over.
"Where is Lao Zhang?"
"Inside the iron shack..."
Rushing to the iron shack, as soon as I entered, I saw a worker about 50 years old, with a little gray hair, and his skin turned purple red from perennial days.
is 'sleeping'.
This worker is Lao Zhang.
At 8 o'clock last night, a group of co-workers drank, and then Lao Zhang went to sleep, and then he has not woken up until now.
It's been 15 hours!
"Lao Zhang, wake up..."
The foreman patted Lao Zhang's face,
After seven or eight shots, Lao Zhang just didn't wake up.
The foreman one clucked...
It's over!
Something went wrong!
Hurry up and call 120!!
10 minutes later, the Beep ~~~120 ambulance arrived, and then Lao Zhang was put on the ambulance and rushed to the nearest Harmony Hospital.
The construction site is a small society, and the news cannot be concealed.
Soon word began to spread throughout the construction site, and Lao Zhang drank too violently, did not wake up for 15 hours, and was sent to the hospital.
For a time, the entire construction site was 'panicked' and had no intention of working.
......
Lin Feng's side,
After seeing a patient, then going to the toilet, coming back...
Beep beep beep ~~~~~
An ambulance drove outside the emergency department.
Lin Feng walked over quickly.
Watching a flat car push off the car, there was a patient in his 50s lying on the bed, connected to the line of the electrocardiogram.
Lin Feng walked over: "What's going on?" "
The doctor who accompanied the car said quickly: "Dr. Lin, this patient was picked up from the construction site, and his co-worker said that he drank alcohol last night, and then it was 15 hours, and he hasn't woken up yet..."
"On the way, I did a partial check on him..."
"Deep stun..."
"The eyes don't react to light..."
"Low blood pressure, only 80/56..."
"Arrhythmia..."
"Check the whole body, there are no wounds..."
"The initial judgment is that it is a cerebral hemorrhage..."
Series
He spoke out very quickly.
Lin Feng nodded: "Okay, thank you... I'll send him for a CT right away..."
At this time, Lin Feng looked at another co-worker who came with the car.
"You're his colleague, right? Go to the window to pay the bill, hospitalized..."
The worker stammered: "Okay, okay..."
Ran to the window quickly, but when he asked, he found that he still had to register an ID card, but he didn't bring an ID card...
"I didn't have an ID card..."
"Do you know him? Look at where he lives, you should be able to find your ID card, and let people send it over quickly..."
"Oooooh, yes..."
"By the way, I still have to prepare 10,000, admission procedures..."
"Huh? Ten thousand? So much? "
The co-workers stayed where they were all at once.
......
On the imaging side,
Lin Feng personally got on the CT machine,
Brain CT...
Soon, Lin Feng found a high-density clump-like shadow in the patient's brain.
Cerebral hemorrhage!!
In addition, Lin Feng also found a certain "brain occupancy".
That is, the blood that comes out 'squeezes' other brain tissue into other positions.
This condition is generally accompanied by "cerebral hypertension".
That is, this patient, there is "cerebral hemorrhage", "cerebral mass position", "cerebral hypertension", it is estimated that there will soon be "cerebral edema", "cerebral infarction"...
Lin Feng quickly pushed the patient back to the emergency department.
Lin Feng asked Xiao Ai: "The patient's friend, have you completed the admission procedures?" "
outcome
Xiao Ai said, "Doctor Lin, the patient's friend, ran away..."
Ran ???
Lin Feng: "..........................."
The whole person is Spartan!
Lin Feng hurriedly instructed: "Call the police, let the police come, and let the police check the phone number of his family, call his family... The patient must have surgery, as soon as possible! "
10 minutes later, the police arrived, then found the patient's identity information, and found the family's phone.
Call your family...
"Hello?"
"Is it Zhang Jifa's wife?"
"What's wrong?"
"I'm a police officer from the Imperial Capital XX Police Station here, your husband has a brain hemorrhage and needs surgery..."
Uncle Police explained again, video, and made relevant proofs.
The wife said: "I'm sorry, I have nothing to do with him anymore, bye..."
Hang up!
Uncle Policeman: ".............................."
Lin Feng: "..........................."
Nurses: ".............................."
Lin Feng: "Hurry up and make other calls, the patient's condition cannot be delayed, and he will suffer a cerebral infarction at any time!" "
Then, call the patient's brother.
Repeat the process above.
The brother finally said: "Excuse me, let's discuss..."
Hang up.
Police officer: ".................."
Lin Feng: ".................."
Nurses: "....................."
Silent......
At this moment,
Lin Feng looked at the patient on the hospital bed, motionless and faint.
My heart suddenly went cold.
Lin Feng seemed to hear the beating pulse in the patient, which was gradually weakening...
The hot heart is about to become cold...
。