Rebirth 10: This Medical Madman is Unreasonable

Chapter 48 Death Cases Don't Easily Go Out

The results of an electrocardiogram were presented to Chen Zhuoan and others by a "volunteer".

Bedside ECG with built-in interpretation results!

Chen Zhuoan glanced at it and knew there was definitely a problem, but it wasn't a big one.

The patient's main problem right now is breathing!

Fu Yongbing promptly reminded everyone: "Closed chest drainage is ready!"

He was signaling to Chen Zhuoan to quickly order the removal of the syringe from the chest and switch to closed chest drainage.

Patients with hemopneumothorax may also experience respiratory dysfunction if they release too much air at once.

Therefore, it is necessary to manage the gas output as early as possible.

Chen Zhuoan remained remarkably calm: "Wait a moment!"

"The high pressure within the patient's pleural cavity has now been released, so his breathing difficulties should not be considered as a problem of pleural hypertension for the time being!"

Chen Zhuoan looked at the volunteer: "What is the patient's current breathing rhythm? What is their blood oxygen level?"

Chen Zhuoan's question left the volunteers slightly bewildered.

However, they knew the results of routine checkups by heart.

One person was playing the role of a nurse: "Difficulty breathing, airway open, continuous oxygen administration."

"Current blood oxygen level." He glanced at the time.

"88%!"

An 88% blood oxygen level proves that the patient's oxygenation is not a problem.

"It's a problem with the respiratory muscles!"

"Push the patient into the CT room and immediately perform a combined chest and abdominal CT scan!" Chen Zhuoan said decisively.

Fu Yongbing, somewhat anxious, countered with a suggestion: "The patient currently has hemopneumothorax, and the chest X-ray shows obvious rupture of a pulmonary bulla!"

Chen Zhuoan shook his head: "The high pressure in the patient's pleural cavity has been released, and the current blood level is acceptable. It will not compress the lung tissue."

"This patient's breathing difficulties are not caused by hemopneumothorax or pleural hypertension..."

"It must be a problem with the respiratory muscles."

"If he is treated as a typical case of pulmonary bullous tension pneumothorax, the prognosis will not be good."

"Clinical caregiver, escorting the patient into the CT room for a combined chest and abdominal scan."

"Execute the doctor's orders immediately!"

After giving the order, Chen Zhuoan asked the volunteer, "I need the results of the combined chest and abdominal CT scan."

After hearing Chen Zhuoan's words, the volunteers really didn't know what to do.

They instinctively turned to look at the examiners.

The examiner is an examiner; they are not allowed to speak!

Fu Yongbing held the thoracentesis needle, while Su Xiheng, Peng Ying, and the others looked at Chen Zhuoan, waiting for his further orders.

Han Yuanyuan from the radiology department continued to look at the patient's chest X-ray, ready to receive a CT scan at any time!

The volunteers did not provide a report or any film footage.

It is obvious that this patient did not have a chest and abdominal CT scan!

Chen Zhuoan's face gradually darkened: "Give me the results of the combined chest and abdominal CT scan immediately!"

"This is an emergency examination."

"The high pressure in the patient's pleural cavity has been released by the syringe, there is a liquid seal level, and there is no high pressure in the pleural cavity."

"The patient's current pleural fluid volume is manageable and will not cause high hydraulic pressure."

"Therefore, the patient's current difficulty breathing is not considered to be caused by high pressure compressing the lungs; the problem should be considered to be with the respiratory muscles!"

"I need to see the symptoms on the chest and abdominal CT scan before I can even consider, at the very least, a problem related to the nerves that control the respiratory muscles!"

I need the results of a combined chest and abdominal CT scan.

The volunteers still didn't do anything.

But the examiners' expressions began to turn strange; they exchanged bewildered glances.

Chen Zhuoan continued, "If this patient is treated simply as having a hemopneumothorax or a ruptured pulmonary bulla, he will die!"

"Based on the patient's admission examination, intracranial stroke is not the primary diagnosis!"

"I need the results of the combined chest and abdominal CT scan first!"

Chen Zhuoan spoke calmly, his eyes sharp.

The examiners felt a little uneasy under his gaze.

Finally, one of them couldn't sit still any longer: "There's no result."

Chen Zhuoan glanced at the examiner.

Calmly, he picked up the film from Han Yuanyuan's hand again and began to examine it carefully.

"The patient's bedside chest X-ray was taken in the supine position, and it can be seen that the hemothorax is most severe below the level of the chest."

"This proves that the hematoma is moving from bottom to top."

"The patient's bullae are located in the middle of the lung. If they ruptured there, the blood level should be triangular."

Therefore, the patient's hemothorax could only have originated from the diaphragm level, and the patient had a diaphragm perforation or similar injury.

"Send him to the operating room immediately for a combined thoracotomy and laparotomy exploration!"

"Get him to the operating room!"

Chen Zhuoan issued his own medical orders and instructions.

Fu Yongbing: "Closed chest drainage?"

Chen Zhuoan: "We'll do it after an open-chest exploration!"

"Prepare for pre-operative examinations quickly and report the results to me!"

Chen Zhuoan received a prompt response to this order.

All the basic preoperative examination forms were given to Chen Zhuoan.

The patient's coagulation function is normal, so spontaneous bleeding is not considered.

Therefore, there must be something wrong with this patient's diaphragm!

But without the CT scan results, Chen Zhuoan couldn't guess what the problem was!

The rabbit has been anesthetized!

Chen Zhuoan immediately picked up a scalpel and, with the others as assistants, performed a simple thoracotomy and abdominal incision.

The treatment score is not high, so a thorough operation is not required. It is sufficient to perform basic incisions and exposures at the chest and abdomen.

Chen Zhuoan said, "The open-chest and open-abdomen examinations are complete. Here's what was done!"

The rabbit is perfectly healthy; it has no respiratory problems.

Someone handed me a report of what I had seen during the surgery.

It's a thoracoscopy!

If a patient suddenly develops hemothorax, a hospital with advanced technology can treat it using thoracoscopic surgery.

The patient did indeed have a ruptured pulmonary bulla and hemopneumothorax, and the bleeding was quite significant.

However, some clues can be gleaned from what was seen during the procedure.

The amount of blood during the patient's surgery clearly indicated that it was not caused by simple rupture of a pulmonary bulla...

Chen Zhuoan: "During the operation, ruptured pulmonary bullae were observed and hemorrhaged, and they were removed."

"Diaphragmatic rupture was observed during the operation and was repaired."

"Postoperatively, a closed thoracic drain was placed in the chest cavity for an extended period. The lung re-expansion will be monitored."

"Give me the patient's basic condition results for the next day!"

For such dangerous patients, the treatment course may not be a one-day affair.

There may be complications after the surgery that need to be managed.

Therefore, this is the real clinical thinking competition.

However, the volunteer couldn't give any more information, so he just stood there, looking completely bewildered.

Chen Zhuoan didn't say much, but looked at the middle-aged man who had spoken to him earlier, hesitating to speak.

"The patient has recovered and been discharged from the hospital. All procedures completed!"

This death case resulted in death.

And he died very "hastily"!

He didn't even go to the ICU for observation for long, and there were no results the next day.

It is clear that the person handling the case may lack experience, make an inaccurate diagnosis, and fail to grasp the root cause of the patient's breathing difficulties.

Seeing pneumothorax and hemothorax, they only treated the hemothorax, which led to the failure to treat the diaphragm rupture in time.

After Chen Zhuoan finished answering, he noticed that three of the four examiners were looking at one of the examiners with particularly strange expressions.

That look seemed to say, "See? You're going to drag the death records out the door."

Your scalp is tingling, isn't it...?