The patient is a thirty-seven-year-old male tourist who came to see a doctor accompanied by a friend.
His brows knitted together, his right hand kept covering his chest, and he sat down on the chair.
"My chest hurts." Every nerve in the patient's face was tightly stretched, and it was clear from his expression that he was really in pain.
"Hey, it hurts me so much." He squeezed out a moan from between his teeth.
"Xiao Xie, do an electrocardiogram on him immediately." Wang Zhang's expression was also very nervous.
When Xie Baoshu heard the patient say that he had chest pain, he had already glanced at the portable electrocardiograph lying nearby. When he heard this sentence, he immediately started to move like a spring.
After helping the patient onto the examination table, fixing the electrode pads, and instructing him to breathe calmly and relax, he began the operation.
The report was printed out immediately. Xie Baoshu only glanced at it and handed it to Wang Zhang.
Wang Zhang looked at the electrocardiogram and found that there was no acute myocardial infarction as he was worried about, so he felt a little relieved.
But just because it can’t be seen on an electrocardiogram, doesn’t mean it’s definitely not there.
Wang Zhang asked: "What kind of pain does your chest pain cause?"
"Is it a dull pain like a big stone pressing on your chest, or a sharp stabbing pain? Does it radiate to your back?"
Xie Baoshu nodded secretly in his heart. If it were him who asked it, it would definitely be the same question.
Chest pain caused by different causes has different symptoms.
For example, a typical myocardial infarction is a squeezing pain like a stone pressing on 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 just painful, but I can't tell what kind of pain it is - eh, hey, it's different from the ones you just mentioned."
Xie Baoshu rushed to ask: "Your pain is not continuous, but comes in bursts?"
The patient nodded slightly in acknowledgement.
Wang Zhang measured his blood pressure on both sides and found that the difference was not big.
Generally speaking, if a patient suffers from thoracic aortic dissection, the blood pressure in the left and right arms is likely to be asymmetrical, and the pressure difference can exceed 40mmHG.
This patient has a small pressure difference and does not experience tearing radiating pain, so the possibility of thoracic aortic dissection is much smaller - but it cannot be completely ruled out.
Wang Zhang was preparing for further consultation and physical examination when he saw Xie Baoshu's relieved expression.
With this expression on his face, could this kid understand his diagnosis and treatment ideas? But isn’t he a pediatric resident?
He was secretly amazed, and took a look at Dorje standing on the other side. Seeing that his expression was as confused as ever, obviously waiting for his explanation later, he couldn't help but sigh slightly.
People need to compare. When he took over Xie Baoshu before, he didn't take him too seriously.
Pediatric residents in third-tier cities have never worked in a comprehensive emergency department, and in his eyes they are no different from local doctors.
But I didn't expect that this young man with a long horse face was full of stamina.
After just a few days of adaptation period, he made rapid progress in both clinical diagnosis and practical operation. In a blink of an eye, he was far behind Duoji. His performance was almost as good as that of the attending doctor he brought up. It was obvious that he had both talents. , who worked hard behind the scenes.
Such a young man, even if he looks a bit uncanny, is still lovable.
"Have you had any surgery before?" Wang Zhang put aside his messy thoughts and continued to ask.
"No." The patient replied without hesitation.
Then it is unlikely to be pulmonary embolism caused by arterial thrombosis in the lower limbs.
Long-term bed rest after illness or surgery may cause sluggish blood flow and produce blood clots. Pulmonary embolism occurs when a blood clot flows into the pulmonary artery.
The patient was young, had no other medical history, and had not undergone surgery, which almost ruled out this condition.
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 ultrasound, and CT must be carried out to help confirm the diagnosis.
But the last kind of chest pain that can quickly lead to death can be directly ruled out through auscultation and examination, and that is pneumothorax.
Pneumothorax occurs when the patient's lungs are damaged, causing air to stay in the chest cavity, preventing external oxygen from entering, causing chest pain and difficulty breathing, which can be life-threatening.
Sure enough, Wang Zhang and Xie Baoshu had the same idea. They took out their stethoscopes and listened carefully to the patient's chest sounds in both lungs.
If the patient has a unilateral pneumothorax, the breath sounds on one side will be very weak, and if you tap the chest with your hand, you will hear a clear echo.
The patient's breath sounds were symmetrical in both lungs and there was no shortness of breath, so it was not a pneumothorax.
But if chest pain is not the fourth killer, 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, cardiac ultrasound, chest X-ray.
Except for enhanced CT, everything else that can be done was done.
The above diseases must be ruled out based on the examination results before other causes of chest pain can be considered.
By then Wang Zhang will be much more calm. Even if the chest pain caused by other reasons is severe, 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 in an emergency is actually emergency treatment.
Diseases that are not that urgent may not necessarily occupy resources and affect the treatment of other truly critical patients.
A friend accompanied the patient to pay for the examination, and Wang Zhang admitted two residents to the school.
"Tell me, how do you understand this patient?"
Xie Baoshu held it in for a long time. He had accumulated a lot of experience and wanted to show it off, 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 was used to Duoji's reaction.
"Let me change the question - when you see a patient with chest pain, what possibilities do you think of first?"
Duoji had just learned this question recently, and he answered confidently: "Myocardial infarction, pulmonary embolism, aortic dissection."
"There is also pneumothorax." Xie Baoshu kindly added for him.
"So just now I asked the patient step by step, what can you tell from it?" Wang Zhang said calmly.
"I can't tell you this." Duoji frowned and thought hard for a while, and suddenly his eyes lit up: "By the way, there is nothing wrong with the electrocardiogram. The patient also said that there is no pressure in the chest - it means that he is not suffering from acute heart disease. stem."
"That's right. But this situation only shows that the possibility of myocardial infarction is small, not absolute." Wang Zhang affirmed, while mentioning: "The details also depend on the results of myocardial markers."
"I see."
"What about the others?"
"What else? Then we have to look at the test results for a while, right?" Duoji asked doubtfully.
Wang Zhang looked at Xie Baoshu: "Xiao Xie, what do you think?"
(End of chapter)
