After raising a cat, the goddess doctor became popular in the interstellar

Chapter 617 The Cause of Chest Pain

The patient was a 37-year-old male tourist who was accompanied by a friend for consultation.

His brows were furrowed, his right hand was clutching his chest, and he sat down on the chair.

"The chest hurts." Every nerve on the patient's face was tense, and he could tell from his expression that he was really in pain.

"Hiss, it hurts to death." He squeezed out a groan from between his teeth.

"Xiao Xie, take an electrocardiogram for him immediately." Wang Zhang's expression was also very nervous.

Xie Baoshu had already looked at the portable electrocardiogram machine placed beside him when he heard the patient complain of chest pain. Hearing this sentence, he immediately started to move like a spring.

After helping the patient onto the examination table, fixing the electrodes, and telling him to breathe slowly and relax, he started the operation.

The report was printed immediately, and Xie Baoshu only glanced at it before handing it to Wang Zhang.

Wang Zhang has seen the electrocardiogram, and there is no acute myocardial infarction that he was worried about, so he feels at ease.

But if you can't see it on the EKG, it doesn't mean you don't have it.

Wang Zhang asked, "What is the cause of your chest pain?"

"Is it a dull pain like a big stone pressing on the chest, or a sharp stabbing pain, did it radiate to the back?"

Xie Baoshu nodded secretly in his heart, if it was him who asked the question, it would definitely be the same question.

Chest pain caused by different causes, the symptoms are not the same.

For example, a typical myocardial infarction is a crushing pain like a boulder being pressed against the heart, while aortic dissection is a tearing pain that often radiates to the back.

The patient thought for a while and replied: "It's pain, but I can't say what kind of pain method it is—hiss, hey, it's different from the ones you just mentioned."

Xie Baoshu rushed to ask: "Your pain is not continuous, but intermittent?"

The patient nodded slightly in acknowledgment.

Wang Zhang measured his bilateral blood pressure and found that there was not much difference.

Generally speaking, if a patient has thoracic aortic dissection, the blood pressure of the left and right arms is likely to be asymmetrical, and the pressure difference can exceed 40mmHG.

This patient's small pressure difference and the absence of tearing radiating pain make thoracic aortic dissection much less likely—but it cannot be completely ruled out.

Wang Zhang was about to do further medical examination when he saw Xie Baoshu's relieved expression.

This kid showed such an expression, could it be that he understood his own diagnosis and treatment ideas?But isn't he a pediatric resident?
He was secretly amazed in his heart, and by the way, glanced at Dorji who was standing on the other side. Seeing that his face was as ignorant as ever, obviously waiting for his explanation later, he couldn't help but sighed slightly.

People need to compare.When he took over Xie Baoshu earlier, he didn't take him too seriously.

Pediatric residents in third-tier cities have never worked in general emergency departments, and they are no different from local doctors in his eyes.

But unexpectedly, this young man with a long horse face has full stamina.

After just a few days of adaptation, he made rapid progress in both clinical diagnosis and practical operation. In a blink of an eye, he left Duoji by a large margin, and his various performances were almost as good as the attending doctor brought by himself. It is obvious that he has both talents. , And hard work has been done behind the scenes.

Such a young man, even if he looks a bit uncanny, is still likable.

"Have you ever had surgery before?" Wang Zhang put aside his messy thoughts and continued to ask.

"No." The patient replied without thinking.

It is unlikely to be caused by pulmonary embolism due to arterial thrombosis in the lower extremities.

Because of illness and long-term bed rest after surgery, blood flow may be sluggish and thrombosis may occur.A pulmonary embolism occurs when a blood clot travels into the pulmonary artery.

The patient's young age, no other medical history, and no surgical procedures almost ruled this out.

Xie Baoshu thought to himself.Three of the four common causes of chest pain that can quickly lead to patient death have now been eliminated.

The reason why it is basic is that the results of a simple medical examination are not completely reliable, and auxiliary examinations such as blood, color Doppler ultrasound, and CT must be used to help make a diagnosis.

But the last type of chest pain that can kill quickly can be directly ruled out by auscultation, that is, pneumothorax.

A pneumothorax is a life-threatening condition in which a patient's lungs are damaged, causing air to remain in the chest cavity, preventing outside oxygen from entering, causing chest pain and difficulty breathing.

Sure enough, Wang Zhang and Xie Baoshu had exactly the same idea, directly took out the stethoscope, and listened carefully to the chest sounds of both lungs of the patient.

If the patient has a unilateral pneumothorax, the breath sound on one side will be very weak, and if the chest cavity is tapped again, a clear echo will be heard.

The patient's bilateral breath sounds were symmetrical and there was no sign of tachypnea, so it was not a pneumothorax.

But if it is not the four killers of chest pain, what else could the patient be suffering from?
While Xie Baoshu was thinking, Wang Zhang over there had already issued a long list of checklists.

Blood routine, myocardial markers, echocardiography, chest X-ray.

Except for enhanced CT, everything else that can be done has been done.

After the above-mentioned diseases must be ruled out according to the examination results, other causes of chest pain should be considered.

At that time, Wang Zhang will be much calmer.Because no matter how severe the chest pain caused by other reasons is, it will not be fatal immediately. He can have a lot of time to think and deal with it, and he can also transfer the patient from the emergency department to the cardiology department for more professional treatment.

The first priority of the emergency department is actually emergency treatment.

Less urgent illnesses may not necessarily take up resources and affect the treatment of other truly critical patients.

A friend accompanied the patient to pay for the examination, and Wang Zhang enrolled two residents.

"Tell me, how do you understand this patient?"

Xie Baoshu held back for a long time, and wanted to show off his accumulated experience, but Wang Zhang waved his hand to stop him: "Duoji, you come first."

"Uh." Duoji scratched his head and said hesitantly, "Director Wang, what do you want to hear?"

Wang Zhang is used to Duoji's reaction.

"Let me change the question-what possibilities do you immediately think of when you see a patient with chest pain?"

Duoji had just learned this question recently, and he answered confidently: "Myocardial infarction, pulmonary embolism, aortic dissection."

"There is also a pneumothorax." Xie Baoshu kindly added for him.

"Then I asked the patient step by step just now, what can you see from it?" Wang Zhang said persuasively.

"Well, I can't say it." Duoji frowned and thought hard for a while, and suddenly his eyes lit up: "By the way, there is no problem with the electrocardiogram. stem."

"That's right. But this kind of situation can only show that the possibility of myocardial infarction is small, not absolute." Wang Zhang said while affirming, "It depends on the results of myocardial markers."

"I understand."

"What about the others?"

"Others? Then we'll have to see the test results for a while?" Duoji asked suspiciously.

Wang Zhang looked at Xie Baoshu: "Xiao Xie, what do you think?"

(End of this chapter)