The patient coughed blood repeatedly, and i didn't think it was making a fuss.

March's spring breeze mixed with some chills, with the new crown pneumonia gradually under control, came to see more patients gradually up, but also a lonely nightwith a wave of hoking sound from the corridor, subconsciously copied the stethoscope out of the door, the mother and son two pushed a middle-aged man, the blood on the pillow is clearly visiblea brief look at the patient's vital signs, the pulse oxygen is only 50, the heart is trembling, tonight some busy ..In the panic, learned the following medical history:the main complaint:hemorrhage 3 hourscurrent medical history:3 hours ago patients have no obvious cause of hemorrhage, bright red, volume of about 50 ml, accompanied by cough, cough, cough, no fever, no pain, nausea, vomiting; no chest pain, no abdominal pain, diarrhea and other symptoms, no treatment, no abdominal pain, diarrhea and other symptomspast: intermittent chest tightness, cough, coughing sputum for 5 years, each by cold or winter symptoms aggravated, the local hospital diagnosed as chronic obstructive pulmonary disease, irregular treatmentpersonal history, marriage and child-bearing history, family history is nothing specialcheck body:, mental health, lip purple, barrel chest, double lung tactile speech tremor weakened, double lung breathing low, double lung can smell and a small amount of dry, wet, no chest friction, heart rhythm, heart rate 90 times / minute, the valve hearing area is not smelled and murmurs, double lower limbs without edemaunderstand these, followed by the urgent blood: blood routine: white blood cell count: 11.5 x 10 x 9/L, absolute value of neutrophils: 9.99 x 10 x 9/L, lymphocyte absolute value: 1.4 x 10 x 9/L, eosinophilic cell absolute value: 0.06 x 10 x 9/Lcoagulation function: coagulation enoriginal time (PT): 12.3 seconds, international standardized ratio: 0.90, fibrinogen: 93mg/dl, D-dipolymer: 15 ng/mlcalcitonin:0.26 ng/ml;Blood Gas Analysis:CO2 pressure: 113.9mmHg, oxygen sub-pressure: 60 mmHg, actual bicarbonate root: 52.5mmol/L, standard bicarbonate root: 42mmol/Lbecause the patient's current carbon dioxide pressure level is high, oxygen pressure is low, immediately give non-invasive ventilator-assisted ventilation, electrocardiogram monitoring, communication with the patient's family, inform the risks associated with hemorrhageconsider the patient's hemorrhage volume is larger, at first give melamine, white eyebrow snake venom coagulase static droplets and Yunnan white medicine capsuleoral, thinking so strong hemostatic drug joint application, patients hemorrhage should soon improve itmillion did not expect, an hour later the patient's family ran to me and said, doctor, go and see, my father is running out of speed..Trotting to the patient, see the patient is spitting blood in the mouth, while opening his mouth gasping, eyes turned, exposed two white eyeballs are very scary, a look at the indicator finger pulse oxygen 35%, good blood pressure heart rate, blood pressure is stable, anxious lying under his nikotami and Loberin breathstimulants, 5 minutes later the patient finger oxygen began to climb up, this is a little breathat that time in mind, the patient carbon dioxide pressure is so high, oxygen pressure is so low, is it bleeding blocked the atmospheric passage? Of course there are also components of long-term COPDSo what's the cause of sudden hemorrhage? And the amount of bleeding is still so large, is the bronchial dilation? Or is it a ruptured vein after a cough? There is no problem with the function of clotting, one question after another lingers in the mindso, thinking about a while to wait for the patient's vital signs to stabilize a little before checking a chest CT to see what the lungs are doing nowwatching the patient point to the gradual rise of vasculature and tend to stabilize, the monitoring state did a check:
lung infection is not very heavy ah, there is no sign of bronchial dilation, what is the reason?back to the ward, the patient is still repeated hemorrhage, no way, so the application of the pituitary after the leaf is pumped in, the results are still disappointing ..Want to maintain it first, as long as the pulse oxygen no longer dropped on the line, so to the next day, get up the first thing, is to visit him, all indicators are OK, but the blood continues again gave him a review of the blood indicators to see what changes: blood routine: white blood cells: 11 x 10 x 9/L, absolute value of neutrophils: 8.2 x 10 x 9/L, lymphocyte absolute value: 0.5 x 10 x 9/L, etonic granulocytes absolute value: 0.05 x 10 x 9/L coagulation function: coagulation enoriginal time (PT): 16.5 seconds, international standardized ratio: 1.26, fibrinogen: 52mg/dl, D-dipolymer: 16 ng/ml Blood Gas Analysis: CO2 subpressure: 80mmHg, oxygen subpressure: 70 mmHg, actual bicarbonate root: 50mmol/L, standard bicarbonate root: 39mmol/L see this, the heart sank, the old problem did not solve, the new problem appeared; the patient's fibrin original fell off, and then immediately stopped the white eyebrow snake venome, because before encountered the use of white eyebrow snake venom blood clotting enzyme to reduce the fibroprotein, and applied for cold precipitation for his use but there's an indicator that caught my eye, that is, the absolute value of lymphocytes, it fell off overnight, is it doing wonders? then with a tentative attitude to give Paramiwe application, and so when he saw him the next day, like a change of person, mental state is much better, hemorrhage is obviously much less, it is really it - viral pneumonia, happy had read an article about hemorrhage caused by viral pneumonia, and I didn't expect to experience it firsthand Mr Source: The Voice of Medicine