r18novel Chapter 470
Chapter 470
And the patient's parents were completely fried!
Three turns and four times, the operation did not stitch well!
Quack!
Finally, the emergency doctor thought of this morning's big round, and quickly promised the patient's parents that he would arrange the patient for the big round in the morning and let a bunch of chief doctors help diagnose.
This allowed the patient's parents to temporarily calm their anger.
thereupon
This morning's rounds, there was this scene.
The surgeon looked puzzled: "I obviously have no problem with suturing, but the patient always bleeds..."
Director Zhang Guofeng: "This case is indeed strange... Everyone expressed their opinions, what do they think of this disease..."
Lin Feng was the first to raise his hand.
"Have you ever checked your coagulation indicators?"
Surgeon in chief: "This is certain, I have done one before surgery, and the set of coagulation function indicators checked are basically normal, and the individual indicators are a little higher, but considering that it is caused by bleeding, it is not particularly significant..."
Lin Feng shook his head: "What I'm talking about is a more perfect coagulation function index, the specific value..."
When a surgical patient inquires about "coagulation function", only several commonly used indicators such as "prothrombin time" and "activated partial thrombin time" are all comprehensive coagulation factors.
In general, a normal number of these indicators means that the blood clotting is basically normal.
No one will directly check the value of each specific coagulation factor, which is more troublesome and of little significance.
But
The patient in front of you has repeated attacks!
Then it is better to do a more detailed coagulation index.
The other doctors looked at Lin Feng.
There was no questioning in the eyes, but respect and expectation.
Surgeon in chief: "Doctor Lin, what do you mean?" "
Lin Feng: "I just think, is it possible that there is such a thing as hemophilia?" Or vitamin K deficiency? Or coagulation abnormalities due to severe liver disease? "
These three,
can lead to coagulopathy.
Hemophilia, famous!
It is the kind of disease where there is no way to heal and the blood does not stop.
However, because hemophilia is rare, doctors generally rarely consider it.
A doctor asked: "Dr. Lin, if you have hemophilia, it should be impossible, right?" If it is hemophilia, the patient must not be in his 20s and not know, right? "
Lin Feng shook his head: "If it is a mild hemophilia, the performance is usually not obvious, and the patient may not really know that he has hemophilia." "
......
The next patient...
......
In the afternoon,
The patient with "steel door bleeding" came back with the test results.
Liver disease and vitamin K deficiency were ruled out, and finally the cause was found in "hemophilia".
Coagulation factor results show that the patient is "hemophilia - type A"!
"Impossible, how can it be hemophilia?"
"Doctor, are you mistaken?"
The patient's parents, in disbelief.
Hemophilia is so famous that basically no one knows about this disease.
Typical hemophilia is relatively easy to bleed, bumps will have bruises, and even tooth bleeding can not be stopped.
Although the parents did not believe it, the family accepted this fact in the face of the results of the examination.
Since the patient suffers from hemophilia, then this 'medical malpractice' really cannot be blamed on the surgeon.
The next treatment is easier.
Although hemophilia is 'scary'.
But
There are many clinical ways to treat hemophilia, and the efficacy is also very significant.
Some of the most commonly used treatment methods are alternative therapy, through the infusion of "plasma" and "cryoprecipitate" and other blood products, can supplement some of the missing coagulation factors in the patient's body, and then can achieve the purpose of correcting the patient's coagulation function abnormalities, so as to achieve the effect of hemostasis.
Recently, due to the big earthquake, all the blood donations were sent to the front line, so the hospital is very nervous about blood use.
Therefore, the patient was not used fresh plasma, but ordinary plasma, so the supplemented coagulation factors were not enough, and the patient had hemophilia, so he repeatedly bleed.
......
......
End of the big round,
It was already 9:30.
Lin Feng returned to the consultation room,
"Whew..."
Sitting on the seat in the consultation room, Lin Feng had a feeling of being separated from the world.
Cosmopolitan!
Finally, you can start diagnosing patients, which is much more interesting than surgery.
The process of stripping away the cocoon and finding the cause is always intoxicating.
Familiarly turning on the calling machine, the first patient walked in.
The first patient,
Be a pregnant woman!
Lin Feng: "????? "
Shouldn't pregnant women go to obstetrics and gynecology?
This pregnant woman herself is relatively thin, about 160, and the overall is thin.
But her belly was very bulging and she looked like she should be full-term.
"Hello, Dr. Lin..."
"Say, what's the situation?"
"Dr. Lin, it's like this, I'm 34+3 now, I just went for baby B-ultrasound, B-ultrasound showed amniotic fluid depth of 9.3cm, amniotic fluid index 230... This should be a little overhydramnios, checked Baidu, said that there may be fetal malformations, I am a little afraid, so I came to find you..."
Lin Feng wondered: "You should go to the obstetrics and gynecology department, right?" "
The pregnant woman is embarrassed: "It's like this, I am the second child, I almost died when I had the first child, amniotic fluid embolism, although I was looking for a director to help me give birth, but in the end, it was the director's student who gave birth to me, so the second child I want to find a doctor who has enough time and is not so busy to help me give birth... Dr. Lin, do you have time? "
His face was full of trust in Lin Feng.
Pregnant women clearly already have extensive experience.
Describe all the situation clearly to Lin Feng at once.
Her words, the message is as follows:
The first child is amniotic fluid embolism, which is a very dangerous disease in which amniotic fluid enters the bloodstream (see thrombosis, cerebral infarction for risk). Therefore, she is likely to have amniotic fluid embolism in her second child, that is, she is a high-risk mother.
The fetus is only 34 weeks old, but Lin Feng sees that the pregnant woman's big belly is almost the same as full-term. Amniotic fluid is obviously a lot.
Pregnant women are divided into three situations: too little amniotic fluid, suitable, and too much. Don't think that more amniotic fluid means that the fetus is nutritious, no, too much will be a big problem.
Causes of polyhydramnios: gestational diabetes (changing osmolality), or fetal malformations (such as fetal esophageal atresia (written in chapters 370-371), inability to swallow amniotic fluid, resulting in polyhydramnios).
Polyhydramnios is easy to cause many complications: pregnancy-induced hypertension syndrome, abnormal fetal position and premature birth, placental abruption, umbilical cord provexation, postpartum hemorrhage, etc... All very serious.
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PS: End of update
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