This doctor has a system

Chapter 291 280. Can you do it instead?

It doesn't matter whether there is such a remark or not. What is important is that this patient does not look very optimistic.

Anyone who suddenly has heart palpitations, chest tightness, nausea, and cold sweats, and then quickly faints to the ground and loses consciousness will not look very optimistic.

This was the case with this patient.

She came from the hospital in her hometown county. As soon as she arrived at the department, the patient suddenly had a problem.

The doctors and nurses were shocked, but the family members seemed a little calm.

"I must want to change my wife." A young nurse secretly said to another young nurse.

"Doctor, don't be afraid. She has been like this in her hometown too, several times." Lao Wang, the patient's husband, comforted everyone and said, "She will be alive and kicking again after a while."

Patient Huang Chunling, female, 54 years old, came to see a doctor because of repeated syncope for one month.

She is an extremely self-disciplined fitness expert. She gets up at around 5 o'clock every morning, puts on headphones and starts exercising for the day. She runs sweaty every day, rain or shine.

"If you have nothing to do, can you make me breakfast or something? Go out for a run every day!" Her husband, Lao Wang, once expressed his protest.

"You said princess please cook."

"Princess, please cook..." Lao Wang.

"Does the princess know how to cook? Are you stupid? You're so smart, you're going to eat shit!" "One, two, one, two." Huang Chunling shouted and went out.

Lazy people don’t understand the joy of fitness. Huang Chunling runs at least 10 kilometers every day. The number of steps in WeChat Moments dominates the screen all year round. There are dozens of trees planted in the Ant Forest in Alipay.

As long as I keep running, the Taklimakan Desert will one day be occupied by my Huang Chunling Lin Lingyan Pavilion sapling!

In the evening, Huang Chunling is even busier. Her home is near the sports park. There is a walking group all year round. Everyone walks happily in white vests and blue pants. Huang Chunling is the most beautiful one walking in the front. Son.

On this day, she was walking as fast as usual when she suddenly heard someone calling her.

Huang Chunling subconsciously turned her head and looked back, and then she felt extremely flustered, her chest was tight, and she was sweating all over her body. She sat down on the ground and fainted three minutes later.

"Help! Someone is dead!"

"It seems like you're still angry, call the police!"

The gang suddenly panicked, and everyone was scared to death. Some people quickly called 120, others called 119, and some familiar people quickly called her husband.

Huang Chunling's husband was playing mahjong when he received the call. "It's impossible. She's as strong as a cow. She can't have problems with anyone!"

Lao Wang was very confident, "Did you make a mistake? Touch! Three."

The caller was speechless, "It's really your wife, Brother Wang. I'm Xiao Zhao, who sells spicy hotpot downstairs in the south gate."

Now Huang Chunling's husband, Lao Wang, panicked. He hurried to the sports park. By this time, Huang Chunling had regained consciousness.

"What's the matter with you?" Lao Wang supported his wife and complained, "Everyone said just now that you suddenly lay on the ground. I almost died of fright!"

"It doesn't look like anything wrong."

"You don't know, I'm playing mahjong and I'm almost losing my mind!"

"I don't know what's going on." Huang Chunling was a little scared, "It's just very uncomfortable. Suddenly I don't know what happened."

The two of them were very worried, there wouldn't really be any big problem!So I quickly drove to the hospital.

"It may be a transient ischemic attack." The doctor in the emergency department looked at the head CT and said, "You didn't find any major problems in this film."

Huang Chunling cherishes her body very much. She works out every day just to live a few more years. She is really worried about the sudden ischemic attack.

The two discussed it and decided to go straight to the hospital for a detailed examination.

After checking again and again, no major problem was found. This situation happened several times. The doctor at the county hospital concluded that this happened every time she turned her neck to the right side.

There was no twitching of limbs, foaming at the mouth, or staring eyes after fainting, and there was no obvious discomfort after waking up.

The patient had a history of "thyroid nodules" and denied any chronic medical history such as "hypertension, diabetes, coronary heart disease".

Physical examination on admission: body temperature 36.5°C, pulse 52 beats/min, respiration 20 breaths/min, blood pressure 143/78mmHg.Fingertip pulse oxygen 98%.The mind is clear and the answers are to the point.The jugular veins are not distended.

The breath sounds in both lungs were clear, and no wet or dry rales were heard in the lower lungs.There was no enlargement of the heart boundary, the heart rate was 52 beats/min, the rhythm was regular, and no murmur was heard.There was no edema in both lower limbs.Abdominal and neurological examination (-).

Except that the blood pressure was a little higher and the heart rate was a little slower, there were no other abnormalities.

The patient's slow heart rate is easy to explain. People who exercise regularly are often in high-intensity, high-load exercise, which makes their myocardial contractility much stronger than ordinary people.

As the myocardium thickens, heart function and ejection capacity increase, people who exercise regularly eject much more blood per minute than ordinary people. This group of people will have a lower heart rate per minute, so their heart rate will be lower. Slow down.

"Her condition needs to be investigated carefully." Gao Feng was very curious about Huang Chunling's condition. It was quite rare for this person to faint at the slightest sign of fainting.

As a bedside doctor, Wang Wenhao completed relevant examinations for the patient, including blood routine, high-sensitivity troponin L, CK-MB, CK, coagulation function, D-dimer, NT-pro-BNP, electrolytes, kidney function, liver There were no obvious abnormalities in function, albumin, blood lipids, hepatitis indicators, thyroid function, and stool routine.

No abnormalities were found in cardiac color ultrasound, chest X-ray, and abdominal B-ultrasound.

On the third day after being admitted to the hospital, Huang Chunling had another syncope attack when she turned her neck to the right while eating. Her blood pressure was measured at 3/81mmHg, and her telemetry ECG limited-time heart rate was 41 beats/minute. The situation was quite critical at that time.

Everyone rushed forward and gave the patient a series of rescue measures including atropine, dopamine and other drugs. After the patient's blood pressure monitor and heart rate increased, his consciousness gradually became clearer.

"This is not a solution." Gao Feng felt that Huang Chunling's situation was too risky, "If it doesn't work, don't let him turn his neck first."

"I emphasized it to her." Wang Wenhao was a little distressed, but he couldn't remember this all the time.

"It's very simple. Ask the neurosurgery department to order a stent for her and fix her head." Bu Zhengyang suggested from the side. His father had a cervical spine surgery last year and wore a stent like this. , after putting it on, the head cannot move at all. If you want to see the back, you have to turn around.

This is a good idea. Before the diagnosis is clear, wearing this will obviously ensure the patient's safety.And Gao Feng already has a specific direction in mind.

Huang Chunling only faints when she turns her head to the right, but not when she turns her head in other directions. What does this mean?
There must be something wrong with the right side of my neck.

"Have you done a color Doppler ultrasound of the blood vessels in your neck?" "Have you done it? No obvious abnormalities were seen, so we say there are plaques." Wang Wenhao explained the examination in a monotonous manner.

"Let the color Doppler ultrasound room do it again for her." Gao Feng couldn't believe the result, so he decided to go into battle himself if necessary.

"Director Gao, you don't trust our work." Director Liu from the color Doppler ultrasound room said cheerfully.

"No way, this patient is special." Gao Feng laughed.

This time Director Liu went into battle in person, and even Gao Feng admired her skills. Some things can easily become perfect after being immersed in them for a long time.

It feels like a mysterious and mysterious thing.

There are 360 ​​lines, and you can always get the top prize. For example, the author's brother-in-law is a supervisor at the construction site. He will know whether the project is up to standard as soon as he touches the envelope.

If it were you, could you do it?

"Hey, this isn't right." Director Liu, who was holding the ultrasound probe, made a surprised voice, "This is the external carotid artery, and this one should be the internal carotid artery. What is this piece inside?"

"Let me take a look." Gao Feng stepped forward and took a closer look.

"Isn't it a carotid body tumor?"

"It's really possible." Director Liu thought for a moment, "Let's do an MRI or enhanced CT scan of the blood vessels in the neck."

Carotid body tumor is a chemoreceptor tumor and a type of parasympathetic paraganglioma. It is a rare benign tumor with an incidence rate of less than 3/10 but a malignant transformation rate of about 5%. It is located in the neck. The bifurcation of the arteries happens to be the location of the carotid sinus and carotid body.

The main manifestation of this disease is a painless lump under the mandibular angle of the neck. Most of the lumps grow slowly. Those with malignant transformation or degeneration within the tumor can rapidly increase in size in a short period of time.However, no lump was felt at the corner of Huang Chunling's mandible, probably because the tumor was still relatively small.

Wang Wenhao communicated with the patient and his family and expressed that he wanted to do further magnetic resonance imaging of the neck.

Huang Chunling agreed without waiting for him to finish his words. She was very frightened these days, especially the last attack, which was much more serious than before. When she woke up, she hugged her husband and cried loudly.

Now I wear a metal brace on my head. I haven't had any syncope after I can't twist my neck. But wearing this thing looks quite funny, and it turns heads a lot when I'm doing activities outside the ward.

And you can’t keep it with you forever, as it will have a huge impact on your future life.

Think about it, if someone does something behind you, you can't turn around immediately and think about it.
It's still a little exciting.
Huang Chunling's husband took the examination form and quickly went to make an appointment. For an MRI examination at the provincial hospital, an appointment must be made at least one day in advance. That person was Gagaduo.Every MRI machine was a bird with broken wings in its previous life. It will never shut down from the first day it enters the hospital. When it breaks down, when can it take a break?

They are the same as the servants of the ancient landlords.

As soon as Huang Chunling did it, Gao Feng couldn't wait to open the image on the computer, and it was time to reveal the answer to the mystery.

"It really is!"

An obvious tumor can be seen at the location of the patient's carotid sinus and carotid body, which is incompatible with the surrounding tissue and does not look good at first glance.

Huang Chunling's diagnosis was now clear. She had a carotid body tumor.

Carotid body tumors can cause local compression symptoms, such as compression of the common carotid artery or internal carotid artery, causing dizziness, tinnitus, blurred vision, and even syncope and other cerebral ischemic symptoms; compression of the recurrent laryngeal nerve, resulting in hoarseness, coughing, difficulty swallowing, and compression of the tongue. Deviation of tongue extension occurs due to inferior nerve, Horner syndrome occurs due to compression of sympathetic nerve, dyspnea occurs due to compression of trachea, etc.

The cause is unknown, but it is generally believed to be related to chronic hypoxia. The incidence rate is higher in people in plateau areas.Long-term chronic hypoxia stimulates compensatory proliferation of the carotid body, eventually forming a carotid body tumor.

"Is it related to running? She exercises every day. Will she suffer from chronic hypoxia when running?" Wang Wenhao guessed.

It’s really hard to say. Some people exercise harder than she does, and no one has carotid body tumors.

"Doctor, what should I do?" Huang Chunling asked. Now that the cause of the disease has been clarified, follow-up treatment is the most important.

"I contacted vascular surgery and neurosurgery for you." Wang Wenhao said to her, "Let's see which department is willing to hire you."

The main treatment for carotid body tumors is surgical resection. However, due to the rich blood supply of the tumor, the special location of the lesion, and the complex anatomical structure of the lesion, the surgical risk is high and there is a lot of bleeding.

It's a big job.

"Doctor." Huang Chunling's husband came to Wang Wenhao alone, "Can you tell her that her disease was caused by exercise?"

"why?"

"Damn, I wake up every day without knowing it, and I'm making noises at home!" Huang Chunling's husband complained, "Running and exercise can be addictive, I'm really convinced!"

"Tell me about her." Wang Wenhao replied.

Are you stupid?Huang Chunling's husband thought to himself, if I say it is useful, I will come to you?

"This won't work. I can't tell whether her tumor is related to exercise." Wang Wenhao simply rejected him, "If you can't do it, let the surgeon talk to her when the time comes."

"Doctor, please help me." Huang Chunling's husband said, "You don't know, I eat out all day long now, and my body doesn't feel better than before."

"That may be due to lack of exercise. If not, you can go jogging with your wife or something."

What you said is simply outrageous!
"I'll give you a banner." Huang Chunling's husband said.

"No, I can't just talk nonsense when you send me a banner." Wang Wenhao was a little helpless, "Besides, who am I? Do I need your banner?"

"2 sides."

"No, why are you like this!"

So good at discovering user needs?Really hammered!Those called Lao Wang are indeed bad people!
"The pathogenesis of your carotid body tumor is not very clear at present." Wang Wenhao said to Huang Chunling, "but research shows that there may be some relationship with chronic hypoxia."

"How could I suffer from chronic hypoxia at such a young age?" Huang Chunling asked.

"Maybe it has something to do with over-exercise. The body's oxygen demand is relatively high when running." Wang Wenhao said, and Huang Chunling's husband showed a smile on his face.

In the future, he may not need to eat so much takeout and street stalls. Only after losing many things can he learn to cherish them. When he was young, he always felt that the food cooked by his wife was really unpalatable.

　Ask for a monthly ticket at the beginning of the month.

　　
　
(End of this chapter)