The patient is seven years old, pale, slightly short of breath, and has a pre-test body temperature of 38.3 degrees Celsius.
The child's mother was not young and looked tired.
"My son has had a fever since the beginning of school. The highest temperature reached 39 degrees. I thought he had a slight cold and gave him isatis root granules for a few days, but he still has a fever."
It has been half a month since the school started on September 1st. Having a fever for such a long time is not a good sign.
The child's mother is also very worried. The child has been ill for such a long time and only came to the hospital today.
Tao Le frowned and asked about some of the children's symptoms.
"I eat a little less than before, but it's okay. There's no nausea, vomiting, or diarrhea. I'm sleeping okay too. Apart from a high body temperature, I don't have any other symptoms, so I figured it's nothing serious."
When she said these words, the child just sat aside, his energy was listless, and he was not at all lively like a boy of this age.
Tao Le swallowed back the accusations. There is no point in doing things right without admonishing them, and letting things go by the wayside.
She gave the child a careful physical examination. There was no rash or edema on the child's skin, and no superficial lymph nodes were palpable.
The blood pressure of 110/80 is normal, the breath sounds in both lungs are clear, and the heart rate is uniform and powerful.
However, a jet murmur can be heard between the third and fourth ribs on the left edge of the sternum, conducting to the precardium, armpit and back. The heart rate is 155 beats/min and the breathing is 35 beats/min. This is extremely abnormal.
A normal person's heart rate is 60-100 beats/minute, and a child's heart rate is around 100-120. It may be higher during exercise, but this child's heart rate is over 150 beats/minute just sitting here.
The same goes for the respiratory rate. Normal people breathe 16-24 times per minute, and this child obviously exceeded it.
"Has the child had a history of heart disease in the past?" Tao Le asked the child's mother.
"Oh, I was diagnosed with some kind of septal defect when I was very young. It seemed to be about 5 millimeters missing. But when we saw it later, it was fine. We thought it might have healed on its own, so we didn't come to see him again."
Tao Le couldn't help rolling her eyes and took a long breath again because of the mother's big heart.
Ventricular septal defect is a congenital heart disease! Even if the defect is not big, whether it has really grown or not, you have to go to the hospital for a checkup. How can you be so self-righteous?
Patients with congenital heart disease are very susceptible to IE, which is infective endocarditis! The mortality rate of this disease is as high as 10% to 20%!
Tao Le opened the golden finger. Sure enough, as she expected, the child did have IE, and it was caused by viridans streptococcus infection.
Because the infection lasted too long, a complication developed: glomerulonephritis.
The holographic image also shows the appearance of the child's heart and its surroundings, which is really shocking:
Not only did the ventricular septal defect not heal, it also expanded to 7 mm, causing blood to shunt from the left ventricle to the right ventricle.
There were multiple vegetations formed by infection in the right ventricular outflow channel, pulmonary valve and aortic artery, and the left and right ventricles of the heart were enlarged.
Tao Le immediately placed a check list: blood routine, blood culture, urine routine, three items of rheumatism, electrocardiogram, and cardiac color ultrasound.
"Go for a check-up right away. Except for blood culture and rheumatism, which can be done a little slower, come back as soon as the other results come out and be prepared to be hospitalized."
"Ah?" The mother looked surprised: "Doctor, just prescribe a sling bottle. Why do I have to be hospitalized?"
Tao Le rubbed his eyebrows and expressed his suspicions: "Your son has a history of congenital heart disease and has not been treated. Now it is highly suspected that he has infective endocarditis. This disease, even if it is hospitalized, has a high mortality rate." It’s also very high, if you don’t go to hospital.”
She shook her head. When the child's mother saw this, she didn't say anything more, picked up the list and took the child out.
Tao Le looked at it and saw that there were no new patients behind him for the time being, so he might as well go out with him.
She still remembers the family members of the meningitis patients last time. This time it is also a matter of life and death and cannot be taken lightly.
Fortunately, the mother hesitated outside for a while and went to the cashier to pay.
Tao Le put her heart in her stomach and returned to the clinic to find the hospitalization notice. She contacted the inpatient department and learned that there were beds, and then returned to the office to wait.
Until noon, the patient did not appear again.
Tao Le calculated the time. It had been an hour and a half since she placed the order, which should be enough.
She turned on the computer, and the test results had been sent back simultaneously, which was no different from the golden finger.
But where are the children now?
Tao Le came out and asked the pre-examination nurse. There were not many people today, and the nurse remembered the mother and son very clearly.
"I came back just now, but it seems that I registered Director Sui's number again and went to Clinic No. 1."
"I understand." Tao Le understood. It turned out that when the patient's family members saw how serious the test results were, they immediately disliked her for being too young and wanted to switch to a specialist for diagnosis and treatment.
Tao Le doesn't think there's anything wrong with this approach. What she cares about is whether the child received timely treatment. As for which doctor saw it, does it make any difference?
It was crowded during lunch time, and there were fewer people in the canteen than usual. When Tao Le was halfway through eating, Deputy Director Sui Jie sat down next to her with a plate.
"The patient just now was treated by you before, and then he went to my place." She spoke very directly:
"You have seen the test results, right? They support infective endocarditis. I have already issued a hospitalization notice and sent the child to the hospital."
"That's good." Tao Le was very happy. Director Sui explained the follow-up to her honestly and honestly, and the child was successfully admitted to the hospital for treatment, and she felt relieved.
Sui Jie glanced at her and saw that the smile on her face was sincere. She was not dissatisfied at all because the patient was changed halfway, and she couldn't help but smile at the corners of her eyes.
"No wonder everyone praises you, Liu Ping and Lao Cao. With your clinical experience, you don't look like someone who just came to the training program." She said:
"As for the child just now, the clinical indications on the surface are not obvious. Not everyone can think of IE. I also asked the mother of the child. It was you who took the initiative to ask whether the child had congenital heart disease. If so, No, she even forgot about it."
Tao Le was a little embarrassed. She has a golden finger in her pocket. She can think wildly and then treat things down-to-earth.
But other senior doctors are different. They really rely on their rich experience and superb level to diagnose and treat patients.
"I also suddenly thought of it. It was just a coincidence." Tao Le said.
"There are no coincidences in medicine, only clinical intuition. You will definitely become a good doctor." Sui Jie said with a smile:
"When the patient is hospitalized and the inflammation is cured and meets the conditions for surgery, he will ask a cardiac surgeon to perform surgery to repair the interventricular septum."
"If you're not interested then, go on stage and take a look?"
There must be this, it must be!
Tao Le smiled with crooked eyebrows: "Okay, I want to go. Thank you, Director Sui!"
Thanks to Dugu Guardian for the 100 starting point coins!
(End of chapter)
