Section 40
In Zhang Yi's sight.
The patient's right lower limb had some urate crystals deposited around the joint behind the Achilles tendon.
It was gout that didn't go away.
The primary pain locations of gout are in the feet, in the big toe or heel.
Because urate crystals have weight, they will sink.
Chen Fang took a look and guessed it was gout.
"Zhang Yi, please write a check list and check for uric acid first."
"Take another picture to see if there are tophi on the heel."
"OK."
Zhang Yi did as he was told, typing on the computer.
After a while, two orders came out.
"Doctor, what's my problem? Baidu said it's gouty arthritis? Is this it?"
Chen Fang nodded: "It's probably this. Do you usually drink a lot?"
The patient's wife immediately showed a disgusted face and complained:
"It's more than amazing! You can tell by looking at his belly. He used to be very thin! Now he's all fat because of drinking!"
"How long have your feet been hurting?"
"Well... I started feeling vaguely uncomfortable a month ago, and the pain started at midnight last night." The patient replied despite the severe pain.
Chen Fang glanced at them: "Okay, I understand. You go and check first. If the uric acid is high, it can be diagnosed as gouty arthritis, and then you will have to be hospitalized."
The patient and family members nodded repeatedly and took the list for examination.
After washing his hands and disinfecting, Zhang Yizheng was preparing to call the second patient.
I heard a nurse shouting outside the clinic:
"Someone comes to the emergency department quickly! A patient has fainted!"
Zhang Yi and Chen Fang looked at each other and quickly walked out of the consulting room.
"What's wrong? What's going on?" Chen Fang asked.
"Hurry up to the outpatient clinic to pick up the patient. There is a patient who was receiving an infusion in the outpatient clinic. He fainted just after the infusion. Hurry up and rescue him!"
The two walked quickly to the outpatient infusion room.
I saw a middle-aged woman about forty years old lying on the flat car.
The patient was semi-conscious and agitated, and two nurses were trying to hold her restless hands down.
"what's the situation?"
"The patient came for infusion with stomachache and fever at first, but suddenly became like this just after infusion of a bag of clindamycin. If the fever reaches 40 degrees Celsius, you should rush to the emergency department and rescue him first."
Outpatient clinics generally only see patients with mild symptoms.
Therefore, patients with this type of rescue still have to be taken to the emergency room.
The two men took the patient back to the emergency room one after another.
The emergency room nurse was notified in advance and had all the beds and ECG monitors and oxygen ready.
"First draw blood, check blood gas, blood routine, liver and kidney function, PCT, then do a blood culture, and do an abdominal CT as well. It's an urgent test!"
As soon as he lay down, Zhang Yi quickly ordered the nurse.
This patient is not just suffering from abdominal pain and fever.
In Zhang Yi's sight, this man's abdomen was already full of black water.
A closer look revealed that the bile duct was blocked due to stones in the gallbladder and common bile duct.
Induced cholangitis and acute pancreatitis!
It looked like it had been a few days, otherwise there would not have been abdominal effusion.
The three organs, the gallbladder, liver, and pancreas, are all located next to each other.
If something happens to one, the other two won't be able to escape.
When stones grow in the bile ducts, the flow of bile cannot be blocked, causing inflammation.
The bacterial-laden bile then accumulates and flows back into the liver and pancreas, inducing acute pancreatitis and impaired liver function.
Acute pancreatitis can cause reflux of pancreatic juice into the abdominal cavity.
If the abdominal effusion is dragged back, it will infect the peritoneum and cause peritonitis.
If it drags further and the bacteria enter several arteries and blood vessels in the abdominal cavity, it is acute sepsis.
Drag it further...
No, if we drag it on any longer, there will be no more people left.
Therefore, the first rescue method at the moment is to drain the abdominal effusion first.
Take the effusion for culture to see what bacteria are causing the infection, and then prescribe appropriate treatment.
However, Zhang Yi could see it, but no one else at the scene could see it.
So Zhang Yi could only wait for the test results to come out.
Chen Fang examined the patient and said, "It should be acute cholecystitis? Let's give him Suprosen and Colbitux first."
Zhang Yi nodded, using antibiotics first would indeed alleviate the problem.
Soon, the blood test came back.
Liver function:
Total bilirubin: 84 (0-21).
Direct bilirubin: 51.30 (0-4).
Alanine aminotransferase: 86.71 (7-45).
One row down, they all exceeded the standard.
pct:
pt international standardized value: 1.26 (0.8-1.2).
Fibrinogen: 4.96 (2-4).
d-dimer quantification: 5.31 (0-0.5).
Another row of red!
Blood gas and lactic acid increased to 4.9!
Chen Fang took a look and diagnosed it as biliary pancreatitis.
But Zhang Yi shook his head: "No, not necessarily. I think it is bile duct stones combined with cholangitis, and sepsis cannot be ruled out."
"Because biliary pancreatitis is not that serious."
Clinically, many diseases have many similarities.
As a doctor, you must find the differences among these similarities and then accurately determine the cause.
After speaking, Zhang Yi walked to the patient's bedside.
At this time, the fluid has been transfused, but the patient's mood is still restless.
blood pressure hg.
Breathe 34 times/min.
Heart rate 113 beats/min.
Vital signs were very abnormal.
"Teacher Chen, I suspect she is in shock! It's infectious shock!"
Chen Fang was stunned: "Shock?!"
Good man, this is not a joke.
Then, Zhang Yi reached out and pressed the patient's abdomen.
The tension was very high.
"Hurry up and arrange a puncture, Teacher Chen, I feel he has abdominal effusion."
Coincidentally, the results of the abdominal CT came out.
A few people saw that there were indeed stones in the gallbladder and bile duct.
And there were a lot of free dark areas in the abdominal cavity.
If this is not effusion, what is it?
Chen Fang glanced at Zhang Yi calmly.