The patient is in critical condition, and the moment he took off his pants in the ICU, he had decided to live and die.

46-!---- year-old male patient with a fever for 3 daysIn their home bought a point of anti-fever medicine, the effect is not too good, or has a fever, the highest body temperature to 39.5 degrees C, plus some cough, chest tightness, muscle soreness, even if he does not want to come to the hospital, his wife will carry him overWho burned to nearly 40 degrees C still at home? The wife counted him downIf this is the occurrence of this year, we are afraid to be afraid of fear, because to be alert to the new crown pneumonia, good is this is the previous case, specifically to tell you a word, so as not to misunderstandingWhen the high fever is still afraid of cold, hot days wearing two long sleeves feel shiveringNo way, had to come to the hospitalGo straight to the emergency roomEmergency department old horse doctor saw the patient, with stethoscope to listen to the double lung, left lower lung some wet tone, combined with the patient has fever, cough, chest tightness and so on, consider pneumonia should not runThere is a wet tone in the lungs, indicating that there is some liquid in the trachea, air in and out of the airways crossthe liquid, will produce blisters, the doctor heard this blister sound is called wet Luo soundWhy is there fluid in the trachea? Because of inflammation, inflammation will seep out of waterSo consider having pneumoniaIs it pneumonia, make a chest piece at a glanceBefore doing chest tablets, the old horse or habitually to the patient to do electrocardiogram, good, electrocardiogram did not see the typical heart attack, severe arrhythmia performance, only the heart rate is slightly faster, 110 times / scoreThis is related to the patient's fever, in general, the body temperature increased by 1 degree C, the heart rate will increase by 15 times / point or soThe patient's brows were crumpled and he was not in good spirits and appeared to have to be hospitalizedThe old horse saidWhether it's pneumonia or other diseases, it's not appropriate to go home and rest It's not good to get an accident at home, the old horse won't have to mix it up in his life Patients are somewhat reluctant, want to take some medicine back to eat just fine, really can not in the emergency department needle, needle after home, need a needle when come again The patient bargained with the old horse The old horse raised his face and said he had to be hospitalized My job is to get you in hospital As for whether you want to take time off to go home, ask your doctor in the hospital department to give you permission The patient's wife is reasonable, white the patient a glance, said that since the hospital came, listen to the doctor You see you're burning like this, I can't take care of you when I get home I'll have to take a few blood tests, and when the results come out, I'll arrange for you to be hospitalized The old horse said while prescribing Although the patient is not very good in mind, but the vital signs are stable, blood pressure is good, everything is still under control Soon the chest was finished and, unsurprisingly, there was some slight inflammation in the patient's left lung Not serious, but there is This inflammation can explain the patient's fever, chills, cough Doctor, I have no strength all over my body, my hands and feet are sore The patient said to the old horse with a sad face I know, the common cold may also be like this, pneumonia may also be like this, now chest tablets suggest that you have pneumonia, so you certainly are not a common cold, hospitalization is necessary The old horse's head did not lift it The results of blood extraction also came back, the blood routine saw a little higher white blood cell count, platelets a little lower, 98X10E9/L (normal is 150-300) There is liver function suggests that transaminase is higher, ALT 60U/L, and nothing else Well, myocardial enzymes and troponin are also a little higher Such test results can not be said to be too poor, nor is it completely normal, have to be observed, if necessary review The old horse told the patient Pneumonia is certainly there, as to whether it is caused by bacteria or viruses, we have to look further Also, be wary of heart problems The old horse's remark frightened the patients and their families Have a heart problem? They were surprised The old horse stopped his pen and explained, I mean it's possible, not necessarily You this myocardial enzyme a little higher, may be the heart cells have inflammation, such as myocarditis, may be the muscle cells of the hands and feet have inflammation, or the liver has inflammation, temporarily difficult to say, have to be admitted to the hospital observation, perhaps nothing Normal human heart muscle cells, limb skeletal muscle cells, liver cells and other tissues will have a lot of proteins, some proteins we call enzymes, various enzymes, such as this transaminase, cardiomyase When these enzymes rise, we need to consider that these cells (the liver, heart, skeletal muscles, etc.) have inflammation, and when the cells are destroyed, these enzymes leak out and the blood test increases Old horse on hand there are many patients, hastened to contact the respiratory medicine, the patient of pneumonia in front of the breathing medicine for further treatment Old horse also vaguely feel that the patient is not necessarily ordinary pneumonia, or not just pneumonia But the task of the emergency department is to identify critically ill patients for early intervention, and as to what the patient's final diagnosis is, it is not up to the emergency department The strength of the emergency department is not the final diagnosis Like a hunter, specialists usually aim first and shoot And the emergency doctor, regardless of 3721, first to the direction of the bird call, and then to aim There are pros and cons After all, emergency doctors do not allow delays, many times in the short term can not be clear diagnosis, but the patient a little hesitation may be gone, must first deal with, and then slowly check the diagnosis Now, it's the turn of the Respiratory Medicine After taking a respiratory medicine, the patient was treated with pneumonia To be precise, it was treated with bacterial pneumonia, with some antibiotics, and with pullazolin bartamin Pneumonia is a big diagnosis, and any inflammation of the lungs can be called pneumonia Pathogen microorganisms (e.g bacteria, viruses, fungi, liksubasals, etc.) can cause pneumonia, and physical and chemical factors (gastric acid reflux, reflexive damage, etc.) can also cause pneumonia Among them, the most common is bacteria caused by pneumonia, bacteria, but also with streptococcus pneumoniae, pneumocoplasma pneumonia, haemophilus influenzae and so on are the most common Because these bacteria are most common, clinicians are initially treated empirically with antibiotics that kill the bacteria Unfortunately, they didn't work this time On the third day of hospitalization, the patient still has a fever It burns to 40C, and the breathing is slightly short, a little worse than when it came This can make the patient and the family members very bad This is what broke the hospital, a fever toss for a few days, this is not playing with human life? Also said what three A hospital, I do not look like community doctors, people give me a burst down when you can retire heat The patient complained with the doctor in charge of the bed, and the tone was not very good The doctor had to comfort him, saying that the condition is somewhat complicated, treatment is not overnight, give some patience Wait a minute These platitudes are fed up with the patients and their families It doesn't work Several doctors in the department quickly gathered and held a small meeting Come on, what do you think the patient's diagnosis is? The deputy director asked Is pneumonia, if so, why after a few days of treatment effect is still not good Also, all did what to check, there are no abnormal results Tube bed doctor a little aggrieved, said to consider bacterial pneumonia, after all, patients have fever, blood elephant high (blood white blood cell count high), chest tablets also suggest pneumonia, diagnosis of pneumonia should be no problem As to why the effect is not good, one may be that antibiotics are not covered with pathogenic bacteria, let's not try to replace the antibiotics The second possibility is whether the patient will have no other disease Other doctors also generally agree with the doctor who is in charge of the bed Is there a problem with the heart? The deputy director asked I see the patient these days myocardial enzymes, troponin are high, and transaminase has been high, there is no reason to find, why is so Is this the case with normal pneumonia? Our department can treat hundreds of pneumonia patients in a month, how many pneumonia patients will do so I didn't think so The deputy director's tone was not very good The patient does a heart color super, heart function is no problem And patients usually walk at home, work are ok, heart function is not a problem We also do two e-cardiograms, are normal Basic exclusion of heart attack, myocardial disease and other conditions Is it possible for myocarditis? Patients have chest tightness, shortness of breath, fever, sore limbs, can you use the inflammation of the heart muscle to explain? If it is myocarditis, most of which is caused by the virus, do we have good antiviral drugs? Can you try it? Has this possibility been spoken to the family? Comrades, communication should be done well Communication before the accident, than after the accident said ten thousand words useful ah This patient in case is a severe myocarditis, all of a sudden there is no, how to tell people The deputy director said in a long speech Of course, the deputy director said the possibility of myocarditis can not be ruled out There are many possibilities before the patient is diagnosed in a day And, as he said, even viral myocarditis, we don't have very good antiviral drugs The doctor thought so, but he certainly couldn't say that in his mouth Had to nod, seriously really approved Originally, the most common cause of fever is infection, but the infectious disease itself can write a book of thousands of pages, to determine the site of infection, infected bacteria or have a certain degree of difficulty Also to consider connective tissue disease, is rheumatic immunity that set of dozens of hundreds of diseases, but the current test results are normal, so basically do not consider Tumors can also be hot, but the fever of tumors is rarely heated at 40 degrees C, so it can also be basically eliminated But tumor-related markers still need to be examined thoroughly Also, infectious diseases should be considered? The deputy director added A patient with high fever, coming to respiratory medicine, absolutely has to rule out common infectious diseases Strictly speaking, infectious diseases can also be considered as an infectious disease, but only a special pathogen infection, such as dengue fever, disease, hook disease and so on, and, are you not afraid of AIDS? This is also need to be ruled out, right? Not necessarily have to do the relevant examination to exclude ah, ask more medical history can also seven seven eight ah This weather in Guangzhou, dengue fever still have to be vigilant The deputy director is right But the patient's dengue antibody checked, are negative, and the patient has no rash, no one in the family gathered to develop the disease, do not support dengue fever The doctor said What about the disease? This disease is not uncommon High heat, limb pain, chest tightness, cough and other patients to consider normal ah, this is not a rare disease in our Guangzhou It is misdiagnosed every year Is the result of the Transfield test back? The deputy director asked We may hear less about the disease Many animals (mainly a variety of mice, such as weasels) have a very small, the length of but 1mm, the disease-worm lik subsomatic seogenous microorganisms will be infected with the disease, and the disease is parasitic on these rodents, these rodents are found in weedy grass forest If humans do farm work in the field or rest in the wild, they may be bitten by an injury, thus spreading the disease, which causes the disease After the invasion of the human body, the disease-worm like transderinphades will cause inflammation of small blood vessels throughout the body, there will be fever, if the respiratory tract attacks, it is coughing, chest tightness, if the attack on the heart, then there will be myocarditis, if the invasion of the liver, there will also be hepatitis, transaminase, etc , patients have fever, fear of cold, inevitably there will be pain in the limbs, can be explained ah, so we must be alert to such infectious diseases as worm disease may be The deputy director stressed The reason for this emphasis on this disease, because last month in the branch misdiagnosed a disease of the disease, we get gray face If you misdiagnose again, it's a shame to say Director, we checked the test, negative The doctor whispered The exophdtest, which is an examination that can detect whether a patient has an antigen in the blood of a like subplasm, if any, verifies that it is a disease caused by the riker, such as the disease This is a classic check item The tube doctor started these examinations, but unfortunately the results were normal The deputy director heard that the result was normal and slightly glanced Also asked, carefully check the body, groin, armpits and other places there is no scorching You may not know that this disease is a very typical characteristic, is the first part of the disease-worm like celiac bite person will have red dots, and then will be ready to ulcers, scorched, and is not itchy, very special, and the part is often fine skin meat, moist and dark place, such as yin, groin, armpits and so on The armpits were checked, but the groin did not look closely The doctor in charge of the bed said with a squeal Deputy director's face also eased down, everyone is busy is not easy, also not good to blame anything But the check is still to be done In case this patient groin really has scorched, then other blood pumping what test can not do, direct diagnosis of disease, is not time-saving effort? After all, the deputy director led the team to check the room, specifically to see the patient, explained the illness with him, told him to give some patience, your situation may not only pneumonia, there may be other problems, you do not have to worry, while the treatment while observing The deputy director's words are not very big, but the patient listens or is useful Attitude softened a lot when it was on board The deputy director pulled up the curtain, told the patient to look at his lower body, to look at the groin, look at the penis and so on See if there are ulcers, scorched moles, etc The patient was embarrassed, said no oh, bath also did not pay attention The patient is breathing a little short of breath at this time, but the general communication is still no problem Say not good, I look at the rest assured, the deputy director smiled and said Signal editing him to lie down, gloves are also brought, can not help the patient do not cooperate The patient had to untie the belt, take off his pants, and let the deputy director look carefully The deputy director said nothing, left left and right turned over, is not found a thing The skin is still intact and no obvious scorching is found But in the end, let the patient lift his ass and look near the anus, and neither The deputy director died After the inspection, everyone went back to the office The deputy director told the doctor to take the bed, please the infective doctor come and see if there is any possibility of infectious diseases Also, we're going to do it again to see if there's any change The patient is breathing a little short of breath now, and I'm afraid pneumonia is getting worse Before leaving, also let the tube bed doctor adjust the antibiotics, with an additional medicine Before the infectious physician could see it, the patient's condition changed that night The nurse hurried into the office and said that the breathing difficulties in the 38-bed (on him) had suddenly increased and she was sweating Also said stomach pain, howl As soon as the doctor on duty heard it, he became nervous Of course he knew that the patient's diagnosis was unknown and that it was a headache Suddenly come out like this, but don't do anything wrong Come to the patient's bed, see the patient's mind is still clear, but the forehead is sweat beads, cover the stomach, shortness of breath abnormal, electrocardiogram prompt blood oxygen saturation reduced to 90% The on-duty doctor hurriedly asked the nurse to bring the mask over and give him oxygen Then check the patient's abdomen, the patient's abdominal tenderness is more obvious, this is the problem ah, the afternoon is good The doctor on duty, the second monk, was confused After another detailed examination, the patient's right upper abdomen seemed to be more pronounced, Murphy appeared to be positive Murphy tested positive, meaning the patient had inflammation in his gallbladder The swollen gallbladder is close to the abdominal wall, inflammation spreads to the abdominal wall, and at this time we press down at this position of the gallbladder, which is surprisingly painful because it compresses the inflamed gallbladder So a positive For Murphy often means acute gallbladderitis But the patient had no previous B-super.