Chinese medicine: When you do things to the extreme

Chapter 28: Horse-faced Youth (Please collect and read)

The incandescent light shines through the junction of the ward corridor, which is shaped like a "T" and a "口".

Zhou Yanqing was wearing a short-sleeved white coat, standing with his left hand supporting his waist and holding a mobile phone in his right hand, waiting for instructions from his master Gong Yi. The incandescent light made Zhou Yanqing's shadow invisible.

"Yanqing, are you sure this time?" After hesitating for about ten seconds, Gong Yi replied in a thoughtful tone.

Gallop rhythm is an important sign of severe myocardial damage and is commonly seen in heart failure, acute myocardial infarction, severe myocarditis and dilated cardiomyopathy.

If it is myocardial infarction, myocarditis, etc., it will be reflected in the electrocardiogram, but if it is heart failure, routine electrocardiogram examination will not indicate it.

This was not the first time that Zhou Yanqing pointed out that a patient had additional diseases before surgery. Once, when Zhou Yanqing examined a patient, he found a ureteral tumor...

However, the partial obstructive pain of the ureter caused by ureteral tumors is unintentional to the patients and their families.

This time, the gallop rhythm was a manifestation of heart failure, but the patient and his family had never mentioned it before...

Generally speaking, it is impossible for patients to be unaware of this degree of heart failure.

"Master, auscultation of galloping rhythm is an important part of undergraduate study. I shouldn't have heard it wrong. I even checked the corresponding description again on the Internet!"

"At present, we cannot be sure whether this is physiological or organic." Zhou Yanqing's center of gravity leaned slightly to the left and he answered cautiously.

Zhou Yanqing wanted to make sure he could hear the rhythm of the galloping horse without having to improve his physical examination skills.

The appearance of gallop rhythm may also be physiological. If it is physiological gallop rhythm, no special treatment is needed. If it is pathological, the current tendon contracture release and lengthening surgery must be postponed!
"Well, Yanqing, you go ask the patient's medical history in detail again, and then ask the cardiology department for an emergency consultation. You can say that the patient and his family are suspected of concealing the medical history, otherwise the cardiology department may not come. After the emergency consultation with the cardiology department, complete the relevant examinations according to the consultation opinions."

After Gong Yi finished making the arrangements, he said, "Bed 16 is the patient who will be undergoing surgery tomorrow, right?"

"Okay. Master, then I'll ask in detail..." Zhou Yanqing nodded, and several possibilities flashed through his mind quickly.

It would be very troublesome if the patient suspected that he had concealed his medical history and could not get off the stage.

The second is that the patient himself is completely unaware that he has such a disease, and may encounter unexpected events during the operation due to ignorance...

Zhou Yanqing himself was actually more worried about the second type, but Gong Yi was a teacher and the chief physician in the ward. He encountered a lot of patients and basically met all kinds of patients and their families.

……

When Zhou Yanqing walked back into the ward, the horse-faced young man in bed 16 smiled and said, "Doctor Zhou, you're here again? Didn't you just leave?"

Next door, the young man's wife was eating melon seeds and checking her phone. When she heard her husband talking, she put the phone away and said with a smile, "Maybe he called his girlfriend."

Zhou Yanqing walked towards bed 16 at a moderate pace. When passing by the disinfectant, he rubbed his hands once again and said, "Brother, this is what happened. I just listened to your heart and heard something not so good. But I was young and was not sure, so I went out to ask the teacher for instructions."

"I just want to ask you one more question. Do you exercise a lot? When you exercise, how do you feel about your physical strength?"

The criteria for judging heart failure are basic medical knowledge, the most critical of which is the amount of exercise one can tolerate, which decreases from strenuous activities, jogging, climbing stairs, slow walking, etc.

Hearing this, the young man turned his head to look at his wife beside him, blushing and stammering: "This. Um. That, it's quite a lot."

"Doctor, why are you still listening to this... The amount of exercise an adult should do, both active and passive, will not be less." The young man wiped his hair, his mouth was very hard, and he had an attitude of a man who could not say no.

His wife walked away secretly after hearing this, not knowing whether she was shy or felt that she had heard a lie! Zhou Yanqing felt that his face was forcibly pressed by the tires and left wheel marks. He asked calmly, "Really?"

The young man did not have a broken bone, but only a contracture of the patellar ligament, not a broken bone. He stood up with his fists clenched, looking up at Zhou Yanqing: "Doctor, what do you mean!~"

Zhou Yanqing took two steps back, narrowed his eyes, and said calmly, "According to the results of my physical examination, I don't think it's right, but maybe I guessed wrong."

"Forget it. If I feel it's wrong, I won't say it anymore."

"Nothing." Zhou Yanqing shook his head.

It would be strange if patients with suspected heart failure could sustain sustained exercise!
"Doctor Zhou!~ Let me tell you... the way you talk, actually..." The young man shook his head left and right, looking like he was pressing Zhou Yanqing step by step, as if he was about to hit him: "You should have told me in private..."

As he spoke, the young man pointed outward, indicating that he wanted to talk somewhere else.

Zhou Yanqing understood and said loudly: "Don't be angry, it's just a joke. Come with me to the doctor's office and I'll ask about your medical history..."

When communicating with patients, you don't have to be serious all the time. Since the young man drove ahead, Zhou Yanqing also had a corresponding way to deal with it.

As long as the goal can be achieved, appropriate jokes are actually a feasible approach.

……

Four minutes later, Zhou Yanqing called his junior fellow student on duty to the doctor's lounge.

Zhou Yanqing immediately took out a pen and began to write down: "Do you have a physical examination every year? Have you ever had a cardiac ultrasound?"

"A small company like ours doesn't organize regular physical examinations, but we can't compare to a stable company like yours. Your benefits must be generous." The young man shook his head slightly, and then said stiffly:

"No, doctor, is cardiac ultrasound related to that?"

"I went to see a Chinese doctor and took some medicine..."

Zhou Yanqing explained in a calm tone and emotion: "This is not your problem, but your source of motivation may be a problem."

"It's a question of power. If you replenish only a part of the body, it will definitely not work. If the heart pumps too little blood, it will be difficult to sustain any physical work..."

Another ten minutes later, the horse-faced young man frowned and said, "Doctor Zhou, you are kidding, are you? Do you suspect that there is something wrong with my heart function?"

"Yes!" Zhou Yanqing nodded: "Is it true? In fact, we can find out by checking a cardiac ultrasound."

"There are two purposes. One is to assess the risks of the surgery, and the other is to possibly solve the problem you want to solve. A cardiac ultrasound is only about 200 yuan... Even if I guessed wrong..."

The horse-faced young man took a breath and interrupted Zhou Yanqing's words, saying in a hurried tone with a slightly high pitch: "Doctor, please give me the list!"

I think the young man has suffered from this for a long time.

"Well, our main purpose this time is to check for surgical risks during the perioperative period..."

“Hmm, hmm, hmm…” The horse-faced young man nodded rapidly.

(End of this chapter)