Health,  Life

Lessons from the Emergency Room: A Doctor Recalls Battles Against Time and the Unexpected

  Talk about the emergency room, we will think of the tension of racing against time, the rush of walking, the uneasy waiting, and the surprise of turning danger into safety. Here, regardless of wind, rain, snow, dawn or dusk, the struggle between human beings and destiny, the confrontation between reason and emotion, and the joys and sorrows of medicine and life are staged 24 hours a day.
  This year, under the “Life” column, we invited an emergency doctor to listen to his unforgettable stories that happened in the emergency room.
  At 11 o’clock in the night, the emergency room was still crowded.
  Every autumn and winter, patients waiting for treatment in the emergency room are almost all respiratory tract infections with fever and cough as the main symptoms, and the workload of doctors has also increased by 3 to 5 times compared with usual. Everyone was wearing masks, and coughs could still be heard amidst the din.
  A male patient in his 50s sat in front of me. By asking about the medical history, I got important information: sudden onset, high fever, muscle aches accompanied by fatigue and other systemic symptoms. Although the patient has not yet undergone comprehensive tests such as H1N1 antigen testing, his symptoms are almost exactly the same as those of H1N1 infection, and there is a high probability that he is suffering from this disease.
  The patient looked embarrassed and said in pain: “Doctor, I feel so uncomfortable. Can you give me an infusion?” When working in the emergency room, I often hear patients’ needs for infusion. Maybe it’s because in our childhood memories, most of us have elders coaxing and persuading us that “infusion will heal quickly”? In fact, with the development and progress of medical technology and medical concepts, infusion is no longer the first or necessary option in many cases. If patients with influenza A are treated with infusion, not only will they not be cured quickly, but adverse events such as allergic reactions and infusion reactions may occur.
  After the physical examination, I recommend that the patient first undergo some routine examinations such as electrocardiogram and blood routine, and then consider whether infusion is needed.
  ”A sharpening knife is a good job chopping firewood. I will give you a simple examination so that I can prescribe the right medicine.” While explaining to the patient, I turned to tell his wife: “He not only has a fever now, but also feels chest tightness, and his heart rate can’t be heard.” The patient ’s wife is not even up, so it’s better to check
  him out. Although influenza is a common disease, more serious conditions such as myocarditis and lung infection can also occur.” The patient’s wife listened to my words and quickly pulled him up from the bench. Go for a checkup. The two disappeared into the crowd.
  However, whatever I was afraid of would come, the thing I was most worried about happened.
  Less than 40 minutes after they left, my office computer rang a critical alarm. When I clicked on it, it turned out to be this patient. The serum potassium ion concentration in the test results was only 2.9mmol/L (the normal range is 3.5-3.5- 5.5mmol/L), and even more terrible is that troponin I is 1.2μg/L (normal boundary value <0.03μg/L). These two critical values ​​made me shudder, indicating that he suffered from myocardial damage, and it was most likely viral myocarditis.   I immediately called the patient and asked him to rush back to the emergency room as soon as possible. Putting down the phone, I recalled the scene in the past when I provided first aid to a patient with severe myocarditis. I performed multiple defibrillations and chest compressions on him. After a while, he was so busy that he was out of breath. Unfortunately, he still could not be rescued. This time, I want to snatch the patient back from death!   The patient quickly returned to the emergency room after receiving the call. I dragged him into the emergency room and arranged for oxygen inhalation and ECG monitoring to observe changes in his vital signs and complete cardiac ultrasound and other examinations. The patient looked at the medical staff busy around him and was a little puzzled: "I just have the flu. Doctors, are you making a fuss out of a molehill?"   I told him that people are prone to hypokalemia and elevated cardiac enzymes after high fever. risks, even life-threatening. The patient seemed to understand what I said, and laughed at himself: "I asked you to give me an infusion before, but you refused, and now you drag me into the emergency room again. The difference in treatment is huge." "Just   settle down . Just stay calm." In order to relieve the patient's nervousness, I patted his shoulder and motioned him to lie down and rest, waiting for follow-up arrangements. Then, I asked the patient's medical history again, and he gave the detailed course of the disease.   It turned out that he had recurrent fever as early as 10 days ago. He thought he just had a common flu, so he ignored it and took antibiotics to relieve the fever. Three days ago, he went out for a dinner with his friends and couldn't resist the "temptation" to drink a few more glasses of wine. Then he developed a fever again and the fever persisted, so he came to the hospital accompanied by his wife. In addition, the patient also ignored an important piece of past medical history information - he had abnormal blood sugar during a physical examination 5 years ago. Since there were no obvious symptoms such as dry mouth and polydipsia, he never paid attention to it.   The next unexpected situation made me feel like I was facing a powerful enemy. While the patient was being replenished with electrolytes, he suddenly developed malignant arrhythmia and frequent ventricular tachycardia (also known as ventricular tachycardia, which is a higher-risk arrhythmia). The drastic changes in the waveform curve on the ECG monitor screen made me tremble. The sudden arrhythmia directly caused his face to turn pale instantly.   The patient's wife was also frightened and asked anxiously: "He just had a slight fever, why did he become serious all of a sudden?" I didn't bother to answer her question and immediately injected the patient with medicine and carried out other rescue work.   The question raised by the patient's wife is also a concern of many patients. She only has a slight fever, but why is her condition so much more serious than others? In fact, behind every major rescue there is a series of coincidences, and behind every failed rescue there are lessons that we should be vigilant about. For example, the patient in front of me only mentioned that he had a fever for two days at first, and did not mention that he had repeated fevers during these 10 days. He remembered that he was not overworked and stayed up late after the fever, but he kept silent about his secret drinking. —Perhaps he is drinking without telling his wife for fear of being exposed and scolded; he also has abnormal blood sugar, which is more likely to aggravate certain symptoms or restrict certain medications; in addition, judging from his symptoms, it is initially judged that he is infected with influenza A. But there are actually other pathogenic infections.   Fortunately, the drug worked after entering the patient's body, and ventricular fibrillation did not occur (ventricular fibrillation for short, which is a fatal arrhythmia. If not treated, it can be fatal in 3-5 minutes). The patient's face is no longer pale, and the waveform curve on the display gradually becomes stable. After a lot of work, I finally breathed a sigh of relief.   The patient's wife was still lingering outside the rescue room, constantly looking inside, worried about the patient's condition. In the emergency room, the patient who was being treated was also very concerned about his wife's health. He said anxiously: "I didn't expect fever to be so serious! Doctor, please check my wife quickly. If she is infected by me, there will be problems." Trouble."   This seemed to be an inconspicuous episode in the reception work, or even one or two gossips that were easily ignored, but it made a warm current surge in my heart. This seemed a bit disobedient. Middle-aged men also have such a careful side. "Don't worry, there is nothing wrong with your wife. She listens to the doctor more than you do. I have told her how to prevent influenza A!"   After a period of rescue treatment, the patient's condition gradually stabilized, and he was then sent to the general ward. for further treatment. Before transferring to the ward, the patient said to me: "You are an experienced doctor." I smiled at him and said: "I hope you won't take 'minor illnesses' lightly in the future, and recover as soon as possible and go home!"

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