There is no need to be too normal to be a doctor

Chapter 166 Rare
With Zheng Chusheng's participation, Chen Gong's research on interstitial medicine has taken a step closer.

On the way back, he opened the diamond treasure chest he had just obtained.

【Ding!Congratulations, your imaging has been upgraded to lv4. 】

When Chen Gong heard this, his face lit up with joy.

My imaging skills are only a little above lv2 at best. I didn't expect that this diamond treasure chest would directly allow my skills to break through to lv4.

Is lv4 great?
In this way, the backbone level of imaging knowledge is enough to give Chen Gong the comprehensive strength to face clinical situations.

This level is enough for him to stand alone in the emergency center hospital.

Even compared to the directors of some hospitals, he is no less generous.

All in all, this time, it was a fruitful experience!

The most important thing is that after Zheng Chusheng joined, Chen Gong's scientific research territory has also increased a lot.

To build a mature translational medicine platform, Chen Gong needs experts in various fields to join.

Only in this way can the construction of this platform be more complete, and the core strength of translational medicine can be better developed.

Only after the translational medicine platform is completed can we usher in a spurt of innovation!

After returning to the hospital.

Before Chen Gong had time to rest, he heard a loud noise from the side.

Looking for fame, he went out and found that Zhao Xi was having a dispute with a man.

"You can't discharge patients so casually!"

"The situation is unclear now. What if the situation becomes more serious?"

"This could be life-threatening!"

The man looked to be in his 50s or [-]s, with slightly sparse hair. Set off by a pair of gold-rimmed glasses, he gave off a "very knowledgeable" expert aura.

That's right!

This person is Sun Jizhou, director of the Second Emergency Department.

Sun Jizhou is 48 years old this year. In this year of his life, he ushered in the development of his life and career. After being transferred from the Children's Hospital, he became the director of the second emergency department.

Although after the construction of the emergency center hospital, there was no detailed classification of the six emergency departments for separate groups.

However, because of Sun Jizhou's innate advantages in the Children's Hospital, after entering the second emergency department, he completely took up the banner of pediatric emergency.

have to say!

This direction is very clever.

This is because it is difficult to register for maternal and child hospitals in Shanhe Province, and the strength of other maternal and child hospitals is uneven and difficult to describe.

Therefore, Sun Jizhou seized this opportunity and exerted his strength instantly!

In less than three months, the walls of the No. [-] Emergency Department were covered with banners.

In fact, in life, there are often several diseases that are easiest to gain banners. The first is obstetrics, the second is gynecology, and the third is pediatrics.

They all say that the quality of our citizens needs to be improved. In fact... doesn't this just show that the quality of our citizens is very high?
We have always been at the forefront of society in caring for women and children.

At least the male compatriots in our country are pretty good.

Therefore, after Sun Jizhou came here, it can be said that he gained both fame and fortune.

Once people have fame and wealth, they will naturally be easily satisfied.

When Sun Jizhou was in the Provincial Department of Maternity and Child Care, he was only a deputy director.

In this way, in three months, Sun Jizhou was full of director style.

in fact……

None of this matters.

The most important thing is to be complacent.

The main reason why Sun Jizhou did not become director at this age is that his own strength needs to be improved.

When he comes here, no one else is better than him, and it is easy to achieve self-aggrandizement.

Now Sun Jizhou felt like he couldn't listen.

Today's time...

In the third emergency department, after Zhao Xi returned from the construction site, he encountered a special patient.

A couple, because their child won't sleep, is always crying, can't get enough milk, and most importantly, has a low body temperature, shortness of breath, and wheezing. The child's face is a little red, and his lips are slightly swollen. Bruise.

This made the couple a little anxious and they rushed to the emergency department.

Although Zhao Xi had gained some knowledge about emergency medicine, his understanding of pediatrics was still insufficient.

Fortunately, during this period, Zhao Xi also had good contacts with staff in other departments.

So I took the patient and his family to the second emergency department hoping to get diagnosis and treatment.

result……

The doctor invited for consultation was also a little embarrassed, so he suggested that Zhao Xi ask Director Sun Jizhou to take a look.

But after Director Sun read it, he also drew blood, and no special disease was diagnosed.

In addition, there were many people in the outpatient clinic. Sun Jizhou also felt that there was nothing wrong with the child. Was his body temperature low?

35.6 degrees Celsius is basically normal.

These cannot be used as a basis for diagnosis and treatment, and the patient's respiratory, heart and lung functions are normal.

In this way, the young couple, holding their six-month-old child, spent the entire morning tense.

It’s past two o’clock in the afternoon, and there is still no diagnosis and treatment result!
So, he found Zhao Xi again.

Zhao Xi's current medical thinking has changed significantly from before.

Naturally, he would not jump to conclusions easily, and according to Chen Gong's judgment, Zhao Xi quickly discovered the child's tongue.

When a child cries, the intensity of tongue movement is abnormal.

After Zhao Xi caught this discovery, he became a little nervous.

He quickly waited for Sun Jizhou to leave the clinic and prepared to ask some questions.

Sun Jizhou was busy all morning and left the clinic at around two o'clock. Not only was he exhausted, but also there were many people at the door.

After Zhao Xi arrived, he asked Sun Jizhou to take a look and check. He also asked Sun Jizhou to check carefully to see if there was any missed diagnosis.

After all, the child's lips are slightly blue now, his breathing is very fast, and most importantly, his body temperature has been slow to come up.

It stands to reason that in such weather, the rectal temperature should at least rise, right?
But... there was no response.

The couple finally came up from the village, originally planning to visit the Maternity and Children's Province.

but……

I couldn’t get through to the call for a long time!

Today, the condition suddenly worsened and the child kept crying, so I called 120 at the hotel and sent him here.

Zhao Xi was also very helpful to the other party, so when he was in a hurry to talk to Sun Jizhou, he didn't care so much.

Sun Jizhou looked at the patients surrounding him, and when he was scolded by Zhao Xi for a while, he suddenly became a little angry.

He looked at Zhao Xi and said seriously:
"Comrade Zhao Xi!"

"You are a lesbian and I don't want to quarrel with you."

"If you think you can treat this disease, go and treat it yourself."

"I know my own level of diagnosis and treatment, and I don't need you to judge."

"How to treat a patient is my business, and how to diagnose is also my decision."

"If you don't believe me, you can choose to leave and choose someone else."

Sun Jizhou's words were lukewarm, but Zhao Xi felt helpless at this time.

"no!"

"Director Sun, I have no objections to you."

"You're the expert, I know it!"

"However, this patient's condition is really not all right. If you diagnose it like this, something may go wrong."

"I hope you can take a closer look, in case you missed something?"

At this time, Sun Jizhou directly picked up the inspection results and report, and said with a somewhat impatient expression:

"I told you, it's okay!"

"This cardiopulmonary function is normal."

"I think it's obviously a normal situation."

Chen Gong heard the sound and walked over.

Although he didn't have lunch at this time, but... when he encountered such a thing, it was more important than eating.

At this time, Wu Xueyu came over: "Director Chen, you are back."

Chen Gong nodded: "Yes!"

"By the way, Xiao Wu, are you okay?"

Wu Xueyu nodded: "It's okay, what's wrong? Director."

Chen Gong smiled and said, "That's right. You go and order takeout for me. I just had surgery and didn't eat."

"A little hungry!"

"Well, just order some rice. The food should be lighter."

This May day is already a bit hotter.

Wu Xueyu glanced at Zhao Xi who was not far away, and then nodded: "Okay director!"

"Sister Xi hasn't eaten yet, let me order together!"

After saying that, Wu Xueyu stood up and left.

Chen Gong walked over at this time.

The couple stood aside with their children in their arms, their faces full of shame and embarrassment.

Seeing Zhao Xi being criticized and accused by Sun Jizhou, the two of them obviously felt very uncomfortable.

They always feel like they are dragging each other down.

Because... this is not the first time their child has been in this situation, and the two of them have also been examined in the hospital.

Indeed, no problems were found!
This time I came here to find experts to see what was going on.

As a result... something like this happened.

At this time, Zhao Xi's eyes were already red with anxiety.

She immediately looked at Sun Jizhou and asked with a serious face: "Director Sun, is there no other way to diagnose and treat diseases besides instruments?"

"Did you perform a physical examination on the child?"

"How many times did you look at the child from beginning to end?"

"I'm not blaming you, I just hope... we have an expert consultation and you can take a closer look and at least give me some advice."

"Instead of just sending people away like this."

"The emergency department is busy, but...every patient who comes is a patient."

"If you are too busy, there is no need to register so many numbers, right?"

"Now that I've registered, can't you at least take a closer look?"

After hearing Zhao Xi's words, Sun Jizhou looked at the people around him and felt a little unable to get off the stage.

He frowned and said, "I'm off work!"

"My skills are limited with this patient, so I really can't find the problem."

"You guys go back, I think it's fine."

"Don't be like these dolls. Children are not as fragile as you think."

Chen Gong walked over at this time, looked at Zhao Xi with red eyes, patted him on the shoulder and said with a smile.

"Okay, Xiao Zhao!"

"Go back first, Director Sun, thank you for your hard work."

"It's really hard to see more than 100 patients in one morning. The number of emergency rooms is more than the number of outpatient clinics."

"However, Director Sun's level is still good."

"Since I dare to make this diagnosis, I can take responsibility for this diagnosis."

"Right? Director Sun!"

Hearing this, Sun Jizhou's heart suddenly thumped.

Of course he knew Chen Gong.

As a rising star in the emergency center hospital, who doesn’t know Chen Gong?

What's more, translational medicine is so popular, it seems to be the future of hospitals!
No, when Sun Jizhou heard what Chen Gong said, he was speechless for a while.

He and Chen Gong stood up and left without saying a word.

At this time, two young people in their 20s hugged their daughters and quickly bowed and apologized to Zhao Xi.

"Sorry, sorry!"

"Dr. Zhao, I'm causing trouble for you."

"Hey... I'm so sorry!"

Zhao Xi heard this and shook his head: "It's okay, this is what it should be. He accepted our consultation and will treat us."

Chen Gong remained silent.

In fact, Sun Jizhou was a man of great ambition and talent, and he was greedy for fame and fame.

Originally, when I was in the maternal and child care department, I was suppressed, but when I came here, I seemed to have a feeling of being a villain.

Emergency department outpatient clinics are generally for emergency patients.

But Sun Jizhou regarded this place as an ordinary outpatient clinic, and even advertised to attract patients.

As a result, many child patients were attracted.

Although it is right to see a doctor, but... in this case, who should emergency patients go to?

For example, the young couple in front of me couldn't register at all after they arrived, and they couldn't even separate themselves. Instead, they went to the third emergency department.

After Zhao Xi finished speaking, he looked at Chen Gong: "What can you do?"

Chen Gong looked at Zhao Xi's anxious eyes and asked, "Take the child to the treatment room and let me see what's going on."

Hearing Chen Gong's words, the couple were obviously stunned.

Because Chen Gong is too young.

He is much younger than Zhao Xi.

Compared to Director Sun just now, I don’t know how much younger he is.

Will this work?
Although the two of them were worried,...they had no other choice at this time.

After entering the treatment room.

Chen Gong asked the family to put the child on the diagnosis and treatment bed.

Then he glanced at Zhao Xi, took off the stethoscope from her neck, placed it on the child's chest and listened.

Soon!
Chen Gong's expression turned serious.

This may really be what Zhao Xi said, there is a problem...

The child's heart rate is very fast, around 160!

Although it is normal for children to have a fast heart rate,... it basically stays between 110-130.

Even if it's a bit fast...it's around 140.And right now, this kid is 160!

This means that the child is suffering from mild hypoxia.

Afterwards, Chen Gong quickly asked: "Have you done a color ultrasound?"

"of heart."

Zhao Xi nodded quickly: "I did it, no problem!"

"Other than a faster heart rate, no cause can be found."

"However, I always feel that there is something wrong with the child's tongue when he cries."

After hearing this, Chen Gong immediately took out a tongue depressor and flashlight from his pocket.

He pressed the child's tongue and observed it.

He was worried about whether there was edema in the throat or other conditions that were blocking the respiratory tract.

but……

After this inspection, no other conditions were found!
What is going on here?
At this moment……

Chen Gong also frowned a little, and the child also took blood tests, but... there were no other abnormalities.

What is going on here?
There should be a reason for this typical hypoxia!

Could it be...the pressure in the abdomen?

At this time... when Chen Gong touched it, he suddenly felt that his body temperature was low!
Zhao Xi looked at Chen Gong with a worried look on his face: "How is it?"

Chen Gong shook his head: "Take off the child's clothes."

"Take armpit and rectal temperatures!"

There is a certain difference between armpit body temperature and rectal temperature. The normal armpit body temperature is usually between 36 degrees and 37 degrees 2, but the rectal temperature is about 0.5 degrees higher than the armpit body temperature, mainly because the anus is closer to the internal organs of the body. .

Therefore, under normal circumstances, the difference between axillary and rectal temperatures is positive.

About 10 minutes later!
Zhao Xi finished the measurement and looked at Chen Gong with a solemn expression.

"The armpit temperature is only 35.1 degrees Celsius."

"And the rectal temperature is only 34.7 degrees Celsius!"

The difference between axillary temperature and rectal temperature changes from positive to negative!
Chen Gong was shocked by the news.

Because the child's rectal temperature was less than 35 degrees Celsius.

This is clearly problematic!

And at this time... Zhao Xi suddenly added: "When I measured it just now, the armpit temperature was 35.5 degrees Celsius!"

"Reduced……"

After Chen Gong listened, this time, he had more doubts in his heart.

Body temperature, heart rate, breathing...all appeared abnormal.

This means there is something wrong with the vital signs!

It seems that no problem has been detected so far, but in fact... there may already be risk factors.

You need to know whether this kind of body temperature will form hypothermic shock if it continues to develop.

It is possible!

The human body will enter a state of shock when exposed to low temperatures.

Hypothermic shock in children can be fatal.

Don't think that a child's fever is the most dangerous thing. In fact...low temperature is often more dangerous!

But the key now is that Chen Gong can't find the cause at all.

what is the problem?

At this time, Chen Gong's mental energy was more concentrated than ever before.

My mind was also thinking crazily about various reasons.

suddenly!

At this time, the child began to cry again.

Chen Gong took a closer look and found that when the child cried, his tongue retractability decreased.

This discovery suddenly gave Chen Gong an idea.

He quickly said to the child’s mother: “Take off all the child’s clothes!”

Hearing Chen Gong's words, the two of them were obviously stunned for a moment.

Then...

They quickly began to take off their clothes.

Time passed by minute by minute.

Chen Gong immediately lowered his head and began to carefully examine the child's body parts.

The child's crying made this process more difficult. He was very uncooperative and seemed to be in some pain when Chen Gong moved him.

The child cried heartbreakingly, and his heart rate skyrocketed.

And the child's mother started to cry.

to be frank!
It is very troublesome to check a six-month-old child.

Because he has no ability to express himself, his only way to express himself is to cry!

But... no one knows how he feels!

This makes diagnosis and treatment more difficult.

This fatal sound echoed in the corridor.

Even Sun Jizhou, who had returned from dinner, couldn't help but frown after hearing this.

Sun Jizhou was not willing to offend Chen Gong.

but……

What happened today made him feel a little uncomfortable.

After waiting for a while, Sun Jizhou returned directly to the office of the director of the second emergency department without saying a word.

He thought, come to me again after you can't make up your mind!
At this time, Chen Gong finally made a discovery during the inspection.

He was surprised to find that there seemed to be some symmetrical hard knots on the back of the child's neck.

This induration is not obvious, or it cannot be called an induration.

But...a skin lesion.

Intractable waxy edema.

There doesn't seem to be anything else wrong except the color and feel of this part of the skin is different.

Even if you don't look carefully, you may not be able to find this feeling.

Fortunately, Chen Gong's perception is relatively high.

Only then was he found.

Because the child is relatively fat, this skin lesion is in the flesh fold on the back of the neck.

Chen Gong quickly asked: "How long has this been?"

The child's parents were obviously stunned when they heard the sound.

how long? !
After the child's mother saw it, she suddenly said: "It seems to have been a while."

"I thought it was caused by the child being too hot and sweating."

"Then the flesh folds were pricked, and then this happened..."

Chen Gong heard this and shook his head.

He felt that he had read about this disease in books.

Chen Gong then started searching for other parts of his body.

Sure enough, not long after, Chen Gong saw some skin lesions on the child's back and shoulders.

These skin lesions are not pitted, but have a slight hard feeling, and have lost the texture and appearance of the skin, and the surface is shiny and waxy.

Chen Gong took a deep breath!

Suddenly he thought of a disease.

Scleredema!
Also called skin sclerosis.

This disease is very special.

Scleredema is a rare disease of unknown origin that usually has a benign course.

It can be said to be extremely rare!

For so many years, there was no record even in the emergency medicine book.

If Chen Gong hadn't read too many books, he might not have thought of it.

This is a systemic rheumatic disease!

Yes, it has something to do with immunity.

It is characterized by the sudden onset of generalized symmetrical severe edema and induration of the skin.

The characteristics of skin lesions are similar to those seen in the edematous phase of systemic scleroderma.

The disease usually resolves on its own within 6 to 12 months, but occasionally it can persist for decades.

The disease does not appear to pose much risk.

but……

But it can also be fatal!

Early symptoms are not typical. Early breastfeeding is poor, crying is low, and reaction is low. After the condition worsens, the body temperature is <35°C, and in severe cases, it is <30°C.

The difference between axillary temperature and rectal temperature changes from positive to negative!
These are the early manifestations.

The lowest body temperature is 30 degrees!
This is a difficult question to ask.

In the advanced stage, there will be multiple indurations all over the body. The indurations are symmetrical, including the lower limbs, buttocks, cheeks, upper limbs, back, abdomen, chest, etc. In severe cases, the limbs are stiff and unable to move.

It may even cause damage to multiple organ functions.

In addition, there is another point, which is hypothermic shock!

Neonatal shock has some special characteristics compared with older children. It is characterized by more complex causes, rapid progression of the disease, indistinct symptoms, and difficulty in diagnosis. When the blood pressure drops and symptoms become obvious, the condition is often irreversible and the mortality rate is high.

Therefore, it is extremely important to understand the characteristics of neonatal shock and make early diagnosis.

Chen Gong was even a little scared at this time!
to be frank……

In this child's case, the induration was not obvious, but the temperature change was obvious.

If the cause cannot be found from the body temperature, this is the key point that may definitely cause the patient to go into shock.

Just then...

Suddenly Wu Xueyu walked in, accompanied by a middle-aged man.

When the other party saw Zhao Xi, he smiled slightly: "Xiao Xi, I'm sorry, I'm late!"

Zhao Xi quickly raised his head and said, "Senior brother, you are here!"

"Quick, help me check this situation."

"This is our Director Chen."

The man also smiled slightly and nodded to Chen Gong: "Hello, Director Chen."

"I am Shi Lei, director of the city's maternal and child pediatric department."

Zhao Xi winked at Chen Gong at this time.

Chen Gong suddenly became enlightened. He finally knew that Teacher Xiao Zhao had started his shaking technique.

but……

Chen Gong was too speechless.

He discovered that Zhao Xi's shaking skills were really powerful. He actually had seniors from dermatology surgery, plastic surgery, to pediatrics?

Who is his teacher?
And this time...

After Zhao Xi explained his condition, the other party obviously fell into deep thought.

Because of this situation, he was obviously silenced.

Regarding the patient's condition, he was really in trouble.

Shi Lei said quickly at this time: "Take your temperature again!"

Soon, the temperature checks began.

After 10 minutes is over!
Shi Lei looked at the armpit temperature and his expression suddenly changed: "It's only 34 degrees?!"

"So fast!"

"Why did it fall so fast!"

After saying that, Shi Lei's expression became more solemn.

He turned around and looked at his family members: "Hello!"

"The child's condition may make him anxious."

"Let me be honest, you need to make several preparations!"

"Arrange the transfer immediately. Go to the Municipal Maternity and Children's Hospital. We need to conduct a detailed examination after admission."

"Putting aside all other symptoms of your child, the body temperature in this situation... itself is extremely dangerous."

"If you don't pay attention to it, you may suffer a big loss!"

"It can even cause hypothermic shock!"

Hearing Shi Lei's words, the patient's family immediately panicked.

The woman's tears burst out at this moment, and she nodded quickly to the man:

"Doctor, could you please save the child?"

"We are willing to pay any amount!"

"what is the problem?"

"The child is fine...why is it like this?"

Hearing this, Shi Lei also said seriously:

“I don’t have an accurate answer for this disease at the moment!”

"Sorry, many clinical diseases are very special."

"But... I feel that it has something to do with immunity."

"I hope that after admission, the child's immune system will be carefully checked."

At this time, Chen Gong had to give a thumbs up, this Shi Lei was really quite capable.

Although there is no exact answer, there are many clues that can be obtained from these things.

At this time, Chen Gong suddenly said to Shi Lei:
"Director Shi."

"I think the child's condition is a bit similar to variant scleredema."

"That's variant dermatosclerosis."

"Look, I found induration in these areas, and... the child's hypoxia, I suspect that the induration occurred inside the tongue!"

"The child's pain is also a painful response to internal tissues and bones caused by rheumatoid factors."

(End of this chapter)