Think fast enough, careful enough.
Reduced risk of patients being misdiagnosed.
Tell me about my personal experience in the emergency room.
Girls, doctors, 26 years old, coughing blood, boyfriends.
I thought I was dying. Very scared.
Call your boyfriend and send her to emergency.
I measured her blood pressure, which was basically normal, and the heart rate wasn’t too fast to comfort her.
She was speechless, her lips were shaking, and she was nervous, and she kept asking me what was going on.
Something’s wrong.
I’m warning her not to rush. She’s stable in all aspects of vital signs.
Later.
She told me she coughed more than three months ago, but it’s only a few days, or a little medicine.
Okay. It’s the best night of the night.
A sip of blood followed by a second, a third, and a tissue of blood.
I told her to stay in the rescue room for safety.
The rescue room has all kinds of patients, but it’s serious. She can walk. It looks like a rescue room.
The lightest one in there.
But I don’t know. I’m afraid she’ll be bled or bled again the next second.
She could be a time bomb.
Once she’s in place, I need to know if she coughs or vomits.
If it’s from the respiratory tract, like the blood from the lungs, the trachea, the bronchial cough, it’s called.
Blood.
It’s disgusting if it comes from vomiting blood from digestive tracts like oesophagus, stomach, 12-finger intestines.
Blood.
I told them it was different.
“I must be blood. She said to me, “I first coughed hard and then I felt coughing.
I didn’t think it was blood. I almost fainted. I’m sorry.
“Are you sure there’s no food residue in the blood that comes out? I’ve confirmed repeatedly.
“None. I’m sorry.
If there is no food residue in the blood coughed out, then it’s basically disgusting. After all, the patient has just finished his dinner, and if it’s indigestion, it’s bound to have food disability.
Scum out.
And I quickly confirmed the fact that she had no chronic abdominal pain, abdominal swelling, anti-acid acidic acid.
Symptoms like gas.
That means she probably doesn’t have stomach ulcer, a 12-finger ulcer.
Come on, it’s really not vomiting.
That’s really blood.
Blood comes from the respiratory tract.
I say you’re lucky, just a little bit of blood. The day before yesterday, a patient started to bleed.
Not before rescue, suffocation.
I’m saying this to make her know that blood can be dangerous.
But I didn’t think it was going too far.
Scared.
I’m going to go on and say that you’re in little blood.
I got the nurse to open her veins.
Kind of.
If she’s really bleeding, we won’t have time to give her a shot.
It can also be tested for blood.
I gave her a good look at her heart and lungs, and I didn’t notice anything unusual.
She’s a little more stable, asking me what it might be.
I told her there were a few of the most common reasons for this.
One is bronchial extension.
Besides, common pneumonia is possible. It’s basically lung problems, but heart and one.
There’s blood in some vascular diseases.
In the short term, the cause of the disease is not clear enough to be investigated.
Her boyfriend said all the checks were checked.
I asked Dr. Pepe to push her to go to the CT to see the lung.
And tell her boyfriend, if there’s blood in the middle of it, be careful to protect the respiratory tract.
Don’t let her choke.
I can’t walk on my own. There’s an emergency that needs to be handled.
They’re back after the CT.
Fortunately, everything went well, and the film and the report went on.
The chest CT saw that there was a little glass grinding in the upper left lung, which didn’t look good.
But it’s not clear. It’s probably pneumonia. It’s probably tuberculosis.
It could be lung cancer.
“There are so many possibilities?” Her boyfriend doesn’t seem to like my advice.
I’ve seen a lot of this, and many patients and families think that we’ll be able to determine what’s happening.
One or two more inspections at the most require an accurate response.
Yes, most patients can do it because it’s simple.
But it’s not easy for this woman. The C.T. report is ambiguous.
Not much, not much.
And then the blood test results came back, and the white cell count was higher, and the rest was not abnormal.
The electrolyte of the liver and kidney function is normal.
I suggest we go to the hospital, take a breather, and tomorrow we can think of an enhanced CT.
Clarity, not even a fiber bronchial mirror.
Of course, it could be a common pneumonia, and a few days of antibiotics might be enough, so there’s no blood.
Usually, normal pneumonia doesn’t get blood, but if it happens to affect the blood vessels,
It’s not surprising that it’s possible to start a bloodbath.
“Can I go home? I feel better. The patient asked me.
“That’s not good. Blood can’t be small enough to take risks. “I simply turned her down.
She was scared to death. How could she have come home?
Her boyfriend was more careful, agreed to my advice, hospitalized.
I gave her something to stop the bleeding and let the respiratory surgeon come down and see the patient.
He also states that the cause of the blood is unknown and requires further hospitalization.
“Let’s do it. I’m telling you.
Then I learned that the patient had bled again after he had had respiratory surgery.
And when the blood levels were not too small, the on-duty doctor jumped, and the various anti-ventilating drugs went up, the next day, the patient was given a CT-enhanced chest scan to see if there were any lungs.
Cancer.
Our doctor hasn’t identified the cause, but the patient and her boyfriend are already terrified.
They think that lung cancer is very likely, but there’s two things.
Let life fear:
First, the patient ‘ s aunt died of lung cancer;
Secondly, the patient moved into the newly renovated new house for two months and she herself considered that formaldehyde was too much.
It’s because last night’s chest CT was flat, it wasn’t clear about the tumor, so it’s remade.
Scan it, you need to inject it. Last night I wanted to give the patient a CT boost, but it was late.
It’s not easy to go to the Video Section for an enhanced scan.
One is the lack of staff to free people to give the patient a specialized shot;
And the other thing is, it’s gonna take a little more time to enhance the scan, which could be a potential for patients.
The threat.
It’s not like lung cancer.
There is a high risk of pneumonia or tuberculosis.
So the respiratory physician gave the patient a round of tests on the nodules, including the PPD test, the end.
Nuclear antibodies, T-SPOT tests, repeated searches for anti-acid fungi, etc., but the results were negative.
This suggests that tuberculosis is virtually impossible.
Typically, a typical tuberculosis can be diagnosed by video.
Typical times.
This female patient’s lung is not very typical, so no one dares say it’s a knot.
Nuclear.
The end result proves that she may not really be tuberculosis.
Plus, she’s kind of obese. She doesn’t act like she’s always cold and weak.
It’s a typical tuberculosis man. Typical tuberculosis patients are thinner, soft, fine.
Like Linda.
If it’s not lung cancer or tuberculosis, then it’s normal pneumonia.
As a matter of fact, the respiratory surgeon has been treated for pneumonia, and it’s been used all along.
The antibiotics are holding.
It’s been almost a week, and it’s getting better.
The patient doesn’t cough, the blood is gone.
Their director was unsure and reviewed another CT and found that there had been a significant reduction in the lung.
That’s right.
This confirms once again that the patient is just a common bacterial pneumonia, not lung cancer.
The bronchial extension is not tuberculosis or other acute diseases.
If it’s lung cancer, tuberculosis, you can’t get any better with a week of antibiotics.
Lung cancer can grow with impunity.
Besides, the bronchial expansion of the CT is typical, not at all.
The patient was happy to hear that it was pneumonia. A hundred years ago, in the age of lack of antibiotics, pneumonia could have killed people. But now, no.
Most pneumonia can be easily dealt with.
The patient was finally discharged.
But not long ago, there was an accident.
After almost a month, I’ve forgotten the patient.
Soon I ended the ER and went back to the ICTU ward and moved the bricks.
I was on night shift that night.
Respiratory’s calling us, saying there’s a big bleeding patient.
We have custody here, no beds.
I had an empty bed, and after I had the nurse ready to take care of the patient, the horses came to breathe.
Physicians.
I’ve been thinking about it all the time.
Just waiting to die.
Maybe we should get a second-line doctor to help. Maybe we should stop the bleeding under the optic mirror.
Top gas tube intubation.
It’s a mess at the Respiratory.
There was blood on the patient ‘ s bed, on the covers and on the floor, and it was clear that there had just been blood.
Patients are breathing a little fast, blood pressure’s on EK custody, high, high heart rate, blood.
An oxygen saturation of 98%, which is a condition of oxygen in the nose tube. At first look, it seems okay, better than I thought.
His lips are a little pale, his face is fine.
Moon, the blood doctor I saw in E.R.
Didn’t we say we were cured?
And it’s obviously much heavier than last time.
The respiratory doctor told me that the patient was diagnosed with pneumonia last time, but was home tonight.
Blood again.
After completing her chest CT, the emergency doctor sent her to the respiratory medicine.
Just after the bed, the patient coughed, followed by the floor and the blanket, and the patient coughed.
A few bloodslides, almost bursting out.
That’s scary.
Respiratory second-line teacher also returned, directing rescue.
In this context, three are most critical.
First, stop the bleeding, either with the medicine or with the fiberglass.
Squeeze it, though it’s hard.
Second, immediate blood transfusions are resistant to shock and the patient ‘ s blood pressure is stabilized.
Thirdly, and most easily ignored, is the need to make sure that the good patient has a clear respiratory tract.
Don’t let the patient choke on the clot. If he chokes, it’s over.
I agree with you very much.
But it’s easy to say, it’s hard to do, but it’s hard to do.
The patient’s boyfriend was there, panicking, rushing to go to ICU.
Last time we thought it was pneumonia, it’s probably not just pneumonia.
Pneumonia? “No, I’ve been a doctor for 30 years. I’ve never had pneumonia. Two.
The cable teacher told us.
So the patient should have hidden problems and no cause.
I called out the patient’s boyfriend and talked to him about ICU.
I was careful to say it was blood, but the cause of the disease was unknown.
Cover.
We’ll try to cure her and stop the bleeding, but we can’t guarantee it’ll work.
Come on.
He didn’t recognize me. I was armed with a mask.
“I don’t care. He said, “Save the patient is your problem. Last time you said it was pneumonia.
No, I don’t understand. Now, my wife.
You have to help me. I’m sorry.
He is ambivalent, angry and helpless, trying to blame us and asking for us.
After the quick communication of fees and other attentions, I asked my superior to get ready.
Get the patient to ICU.
It was not expected that the patient himself would recede, that she had blood on her mouth, that she was afraid to go to ICU, and that it was too scary for me to go straight to tell her that if there was a serious haemorrhage, it would have to be an intubation of the trachea, a simulator, etc. Only if ICU can do it will there be a chance.
“If anything happens, it’s a dead end. The doctor on duty added a sentence.
This has worked, and the patient is no longer in conflict.
The second-line doctor told me that the stoves seen on the CT of the chest were not close to the atmosphere. If it was local bleeding, it would be difficult to stop it under the mirror.
I’ve seen CT too. It’s hard.
It may be difficult, but if there is no other way, or if there is no other option, the attempt should be made. There was consensus.
When ICU arrived, it continued to use herbal antivenoms and pyrethroids.
The pyrethroid chlorophyll is a drug that reduces the flow of blood in the lungs, thereby reducing haemorrhage.
I told the patient’s boyfriend that it would be better to sign if you were not a direct relative or a real couple.
He told me that his family was in the province, that it was at least tomorrow, and that he was now in charge of any rescue measures.
Her boyfriend indicated that, had it not been for such a big deal, they had planned to get married.
I asked my superior physician and the Medical Section, and in that case, the patient ‘ s boyfriend and other immediate family members will sign it.
“Do what you have to do and go on.” The medical section says:
I told my patient’s boyfriend that the most important thing right now is to stop the bleeding.
Life is in danger.
The patient’s boyfriend is already very anxious at this moment, and the whole person is restless and I understand him.
I told him it would take some time to determine the cause.
And tell him that I was the last one to see a female patient at the E.R.
I took off my mask.
He did a fight and finally recognized me.
I told him the patient’s condition was a little complicated, and we’re trying to find out.
The most important thing tonight is to stop the bleeding as soon as possible.
If she can’t cough in time, she’ll probably have blood coagulation.
Blocks block the airway and cause asphyxiation, which endangers life.
The patient’s boyfriend has been anxious to ask us, so far.
I’ve already used two or three of the herbals, and I’m giving her a blood transfusion.
We can’t stop the bleeding, or we’ll give it to her if it’s repeated.
The pipe’s in.
Put her down with a tranquilizer, then insert a thick-finger pipe from the mouth.
The trachea.
And then we’ll go down with a fiber bronchor and see where the bleeding is, and we’ll find a way to kill it.
It also protects the unblooded lung and does not allow the blood to flow back into it to cause suffocation.
The patient’s boyfriend seems to know better than to nod.
“Is this going to happen soon? I’m sorry.
“We can wait and observe. After all, bronchial tube intubation and fiber lenses are also at risk and may increase haemorrhage. If she can stop the bleeding herself, don’t risk it. I said:
I went back to the ward and stayed in front of the patient’s bed.
Patients panic and ask me when I can get out of ICU.
“One day I can’t stand it. It’s so depressing. She looked around and she was breathing.
Yes, ICU patients are very dangerous, and almost all patients are inductive tubes and respirators.
There are also blood purification machines, machines that are ticking and ticking, constant and sharp alarms, hasty sound and footsteps of doctors and nurses, which are really purgatory for a conscious young patient.
I comforted her, said to watch for two days, and if there’s no bleeding, we go back to respiratory medicine, and your boyfriend can stay with you.
A young nurse next to me asked me what it was like to give this patient. I said that pulmonary haemorrhage could be used, that it constricted part of the blood vessels, reduced the amount of blood flowing into the lungs, and thus reduced the engraved blood to stop the bleeding.
“I thought this drug could be used only for obstetrical and gynaecology patients, and I saw a lot of post-partum haemorrhages in my obstetrics practice, and it used to be used. She said:
“Does it cause menstruation? Does it cause menstruation? She kept asking me.
Well, it’s a question-and-answer little girl.
Neither will I. I shake my head.
This knowledge, which overlaps with the gynaecology and endocrinology, is more complex, and I am half-aware.
The blood meds are running out, they are running into 2u red cells and 400 ml plasma, and the patient appears to have stabilized and no more blood.
The blood routines reviewed indicate that the haemoglobin has returned to 98 g/L, which is almost the normal level of the patient, as she herself is slightly anaemic.
Blood pressure is normal. Heart rate is not that fast.
Before, the heart rate was estimated to be related to haemorrhage and stress, and now when it settles down, you all have a little relaxed.
After a round of patients, I’m going to take a break and I can’t get my eyelids fixed.
But I couldn’t sleep. The bloodied female patient was a time bomb here. She called the second-line doctor and asked how the patient was.
I’ve been so busy, I’ve expressed my concern.
The tube intubation is a fiberglass.
Doctor 2 wants me to calm down.
The patient is so sober right now.
Zoo.
We’ll discuss it tomorrow, if we can.
That’s all.
Not long ago, the nurse came in and called me and said the patient was having a period.
“I know, I just knew. I said, “I’d like to see more.
A moment. You put two more clean dressings on her. It’s better than a sanitary towel. I’m sorry.
“No, she said it had to be a sanitary towel. The nurse firmly told me.
I tried to call her boyfriend, but I turned it off. Nobody answered.
Come on, do it.
I couldn’t sleep either. I just got up.
“Can you do something? Like you little girls, who’s got a stock? Give it to her.
Snips. I’m sorry.
The nurse took a look at me and said we wouldn’t use it if we had any. I know the girls are kind, and it’s painful to see this young girl sick.
I’m trying to help her. She’ll do whatever she wants.
We’re all girls of the same age.
Okay.
In that case, let her put together her wound dressing.
Something like that.
I’m going to convince her myself. Where did you find her a sanitary towel in the middle of the night? The only hope.
Her boyfriend didn’t answer the phone.
And the patient told me that her boyfriend should be at the door.
“I told him to go back to bed at this late hour.
Word. I said:
She insisted that I look at the door. If her boyfriend was out there, he’d go back with some security.
Come here with the towel.
I can’t help her, I don’t want her to get too excited.
So promise her to look outside.
Looking outside, it really surprised me.
Her boyfriend was really there, lying on the stool in the hallway.
He was a little surprised to see me, and then he was nervous.
“Not blood again, is it? He asked me. I told him not to panic. It’s nothing. I just wanted you to go home and get some sanitary towels.
Aunty’s here. We’ve run out of sanitary towels.
That’s all he’s got.
“And you’ve got to keep your phone open, remember to charge, and if anything happens, you can’t be found. * And I *
Tell him.
He scratched his head, a little embarrassed, and said it was a coincidence every time I was in the hospital to go home and get my sanitary towel.
Okay.
Every time I wonder.
“Only the last time I was in hospital, I didn’t have enough sanitary towels. I went out and bought them. He says:
“The menstruation last time? “I feel a little unsettled.
“Yes. I’m sorry.
After he left, I was standing there and my brain was moving at speed.
I seem to have found something.
I’ve been in hospital twice because of blood.
The menstruation was due to vaginal haemorrhage, which was caused by the fall of the uterus.
If there’s lung bleeding at the same time, what does that mean? I almost got excited.
It’s an endometriosis.
It’s a gynecology disease, but it’s not impossible.
Endeminal membrane isoplasia, which is the membrane that was originally only inside the uterus.
Parts, most commonly other organs of the pelvic cavity, and in rare cases may appear in the gastrointestinal tract, or
It’s like the patient in front of you.
If it’s a gastrointestinal hemorrhaging, it’s abdominally abdominally swollen with menstruation; if it’s a different lung.
Bit, that’s gonna follow the menstruation cycle.
In any part of the world, the membrane of the uterus is bleeding from the menstruation cycle.
Isn’t that blood?
Is it really an endometriosis? I can’t believe I’ve never seen this.
Everything is just theoretical knowledge.
I went back to the room and saw that the patient’s vital signs were stable, and I felt better.
If it’s really an endometriosis, then it’s a logical bleeding.
At the end of the period, my little heart was finally down.
I’d really like to call a second-line doctor and ask her to come and assess it, but it doesn’t matter.
There’s no need to bother her. The second-line doctor’s been busy all day.
It’s like a menstruation. It’s just not in the genitals, it’s just whistling.
That’s really what they think.
I think it’s a good possibility, but I’m not going to tell the patient or his family until tomorrow.
After reporting, a gynaecologist was consulted and it was determined that this was the subject of communication.
Soon, the patient’s boyfriend came with a sanitary towel. I’m even a bit preposterous. Is it possible that the hemorrhaging of the alien tissue in the lungs after the bleeding of the uterus? I hope so.
Whether or not the speculation is reasonable, the patient did not bleed at midnight.
Everyone had a good night.
The next day I reported to my superiors, especially when you heard that the blood had happened twice during the menstruation cycle.
But no one dares to be prepared for any great blood.
We’ve got respiratory and gynaecologists here, and we’ve checked the patient’s chest CT several times before and after, almost in the same spot.
Glass grinding, CT-enhanced mammograms were considered to exclude lung cancer, bronchial expansion and other examinations to exclude tuberculosis, lung pathologies caused by some self-immunological diseases, etc.
The gynaecologist said that, in terms of the patient ‘ s blood flow, it did correspond to endometriosis.
I asked the patient carefully, and the patient remembered, and it was true that the blood was in the menstruation cycle, but the patient himself did not realize that it was related to the menstruation and did not deliberately tell the doctor.
Respiratory physicians were troubled and said that the medical history had not been sufficiently detailed at the time of the first hospitalization, without asking the patient about his period of menstruation, so that it had been omitted.
People comfort him and say it’s a rare case of common membrane heresy that goes to places like ovaries, dysentery bands, pelvis cavities, and so on. It’s easy to diagnose membrane heresy.
Let’s go out and make a CT.
Yeah.
This is not an ordinary inflammation. You can’t use antibiotics.
They’re all falling out of blood.
The gynaecologist’s words are very good, and we agree.
Reminiscent of last night’s bloody scene, the respiratory surgeon and I still have a problem.
In fact, it was the first time a patient was hospitalized, thinking it was bacterial pneumonia.
Biotonin, later on, the symptoms improved, and the chest review CT stove was significantly improved.
Turn around.
Now look at it, it’s probably the same thing the gynecologist mentioned.
It’s not about our drugs.
And the nurse reminded me that the patient had a period of menstruation, because I had no experience.
Thinking about the patient’s blood may be related to menstruation.
But if I had experience like this, I wouldn’t be stupid enough to talk to a nurse about the efficacy of pyrethroids.
Okay.
It’s really interesting.
After careful assessment, it was also the patient’s strong demand. We moved the patient out that day.
To the respiratory internal ward.
It would have been more appropriate to go to gynaecology, but if there was blood in the patient, the gynaecologist might not have been able to cope with it if the gynaecologist had told the patient and his family that it was blood caused by endometriosis.
The patients and their families couldn’t believe it until they checked the Internet and learned that they did.
When you’re sick, you trust a gynecologist.
After the menstruation, when the chest CT was reviewed, it became clear that the stove was almost gone.
Figuring out.
“What do we do with it? You can’t spit blood on your menstruation? “The patient frowns and asks about gynecology.
Doctor.
There are two ways, one of which is to operate, open the chest and cut the uterine membrane of the lung.
However, there is a risk that it may not be clean and that there may be post-operative bleeding.
“I don’t think about it. It’s scary. The patient says:
The second way is to take the pill, not to allow menstruation.
The pill includes estrogens and gestation hormones. Menstruation can’t be done.
It’ll bleed out.
That’s a good way to go.
“I can’t keep using contraception. I’ve got plans to get married and have kids. “The patient is bitter.
Worried.
The gynaecologist laughed, said it wasn’t always. It was about a year.
There’s probably no more bleeding. If there’s still bleeding, you’ll have to change your medicine, or test it.
Consider surgery. When I went to the respiratory ward to see the patient, she stopped bleeding and the pill started taking.
Okay.
Before I left, I told her boyfriend you saved your wife.
Actually, I’m talking about him letting me know that the patient was in both cases related to menstruation.
Think I’m talking about him taking care of her and saying he should take care of his wife.
You guys.
I didn’t plan to tell him that it was because of his unintentional reminder that we made the correct diagnosis. Yes
It’s like we don’t have the level, ha ha. In fact, we don’t have the experience.
Then I heard from the gynecologist that the first month after the patient used the pill didn’t get much blood.
Two months without blood, for a year.
A year after the cut, there’s still no blood.
The baby was born later.
Almost three years now, it has been reported that there is still no menstruation.
It appears that the pill really starved the uterine membrane tissue in the lungs.
Bless her.
Cope classroom: What is an endometriosis?
What’s with the membrane? What are the typical symptoms?
Endometriosis is a gynaecology disease, only for women and certainly not for men.
(This is still to be stressed). Because, by definition, this disease is a change of uterine membrane position.
If other organs have an endometrium, it’s an endometriosis.
Bits out.
Why is there an endometriosis?
It’s not very clear at this point, either.
Some of the obstetrical and gynaecology operations have resulted in an intrauterine membrane incision, etc.
That’s why we don’t understand.
Because many organs have uterine membranes, it’s a symptom of different organs.
It’s different. In general, it’s possible to have abdominal pain, pain, menstruation, etc.
Differing dents in the palace can also lead to sexual discomfort and even the possibility of infertility.
The intestinal abdominal abdominal diarrhea constipation; the urinary anecdotes, etc.
People like the ones we’re talking about, they’re different in the respiratory tract, they’re coughing, they’re blood.
What about membranes? How?
Checking is mainly ultrasound. Ultrasound can see ovarian anatomy and bladder, rectum, etc.
Bit of an alien.
The abdominal lens is the best diagnostic method in the world.
Conduct a live tissue check.
In addition, blood can be sampled, and the serum CA125 may be elevated during uterine membranes.
(Standing doesn’t mean it’s got to be anaesthesia. There is a choice between medication or surgical treatment.
The drug is mainly a inhibition of ovarian function and a deterrent to the development of endometriosis. For example, with a non-mixed body.
Anti-inflammatory drugs, oral contraceptives, pregnancy hormones, etc.
The operation is mainly for the removal of the stoves and is applied in cases where the treatment of drugs is ineffective.
It is now considered a gold standard for the identification of abdominal lenses and for surgical and pharmaceutical treatment.
Is the membrane membrane animation affecting fertility?
It is possible that research has shown that about 40 per cent of patients are not pregnant. It’s an endometriosis.
If you’re not pregnant, you’re the first to have surgery.
Okay.
Signature.
We don’t know when the next one will be, even if it’s not blood. It’s really bad.
The patient had a heart attack.
Even when asked about menstruation, it is estimated that it will not be possible to link them.
Come on, that’s not their thing, so it’s better to go back to respiratory.
The treatment of membrane isomers is more complex and must be conducted under the guidance of a gynaecologist.
