Tell a real case.
One afternoon, a young patient, Ms. Yu, came to the emergency room complaining of fever and cough for 5 days.
When she first started to have a fever, Ms. Yu went to the health center in front of her home for a check-up and chest X-ray. The doctor at the health center looked at the chest X-ray and told Ms. Yu that there was some inflammation in the lower left lung, and the blood routine results showed that the white blood cell count was high, which might be pneumonia.
At that time, the doctor asked Ms. Yu if she could come to the hospital**, and when the patient heard the doctor's tone, he felt that it was not necessary to be hospitalized: "My husband is so busy at work. I am the only one at home who takes care of the elderly and children. Doctor, if you don't have to be hospitalized, you can just prescribe me some medicine to eat. ”
Seeing that Ms. Yu's condition was not too serious, the doctor at the health center prescribed her a little antibiotic and told the patient to come back for follow-up if she felt unwell.
After returning home, Ms. Yu fell asleep after taking the medicine. After taking the medicine for two days, Ms. Yu felt that the symptoms of cough had been reduced, but she had some chest pain and shortness of breath.
After taking medicine for another day, Ms. Yu felt that her chest pain was even worse, and it hurt even to take a deep breath. It's not a problem that I've been weak and my legs are weak. So on the fifth day of fever, she and her family went to a tertiary hospital.
After the doctor in the emergency room understood the patient's condition, he asked her to do a chest CT examination, and at the same time checked the coagulation index, D dimer, cardiac enzymes, and troponin to assist in the evaluation of cardiopulmonary diseases.
Ms. Yu hesitated: "Why do you come to a big hospital and have so many examinations to do?" I wondered if the medicine prescribed by the health center was not good, so I just needed to change the medicine. Why is it so troublesome now?”
The doctor patiently explained: "Don't underestimate chest pain. Viral myocarditis may also cause chest pain, chest tightness, and early manifestations are fever and cough. If you have viral myocarditis, you may die suddenly. It's safe to get a check-up. ”
As soon as he heard the doctor's words, the patient was also a little frightened. Originally, I just thought that I had a cold and a fever that was a little severe, so my lungs were a little inflamed. Ms. Yu didn't dare to talk too much, so she obediently went for an examination.
CT results came back quickly, with patchy opacities in the patient's left lower lung, a small amount of pleural effusion, and no mass. The blood draw report showed that the patient's D-dimer value was high. In general, an elevated value indicates that there is a thrombosis in the blood vessel that is being dissolved. However, in the event of pneumonia, local blood vessels are destroyed, and bleeding, coagulation, and fibrinolysis processes are carried out in the body, which also causes this value to increase.
Doctor, why the hell do I have chest pain?The patient asks cautiously.
The proximity of the lesion to the pleura may cause chest pain. It may be that oral antibiotics aren't working hard enough to cover your pathogen. Let's take a look at the needle first. The doctor's words relieved Ms. Yu, it is not a viral myocarditis that can die suddenly.
It didn't take long for the unexpected to come quietly.
It turned out that the patient sitting in the infusion hall was coughing and hanging needles. But this time, the patient actually coughed up blood!Panicked, Ms. Yu hurriedly called the medical staff.
The shocked ** didn't take this matter to heart, but if the pneumonia patient coughed violently and coughed up a small amount of blood, it was nothing. But the doctor was a little worried.
In young women, chest pain, coughing up blood, and elevated D-dimer. It may be pneumonia, but the possibility of pulmonary embolism cannot be ignored.
When asking for medical history, Ms. Yu categorically told the doctor that she had no family history of cancer, no congenital diseases, no contraceptive pills, and no previous experience of long-term bed rest or fractures. So instead of prioritizing pulmonary embolism, doctors consider it pneumonia.
Just in case, further testing is done to rule out pulmonary embolism. The serious doctor talked to the patient and the patient's husband: "The CT CT I just did can only see the lung tissue clearly, but the blood vessels can't see clearly. Looking back now, it may be pneumonia or inflammatory exudation caused by pulmonary embolism. I recommend that you go for a CTA to make a clear diagnosis. ”
Patients and their families are a little unhappy when they hear the doctor's "doubt", "possibility", and "exclusion": "Why didn't you do this CTA in the first place?"If you can't find it out after this is done, what kind of checks do you have to do?Isn't it good to go straight to it in one step?”
The doctor explained: "All patients are in place in one step as soon as they come up, and all the examinations are done once, and that is what is called really treating patients as leeks." In addition, the amount of blood that the patient coughs up is very small, and if he starts to cough up blood in the future, no one can guarantee it. ”
Seeing that the family couldn't figure out the situation, the doctor directly told him: pulmonary embolism is that the pulmonary blood vessels are blocked by blood clots, which can even lead to the death of lung tissue. If the blockage progresses to the point where the heart pumps too little blood, the person can go into shock or even die. As one of the three major cardiovascular diseases, it is an acute and critical diseaseBecause the typical manifestations are chest pain, dyspnea, and cough, many patients cannot be detected in time, so the fatality rate is very high!
In the past, I couldn't see the blood vessels clearly, but now only this CTA can confirm whether it is a pulmonary embolism!As soon as the patient's husband heard what the doctor said, he also calmed down and agreed to the examination.
When the CTA results came out, almost everyone broke out in a cold sweat. It is good to insist that the patient improve the examination, otherwise it may harm a young life!It turned out that the left lower lung patch shadow seen by CT was really not pneumonia, but an exudative lesion caused by pulmonary embolism!Fortunately, only a relatively small blood vessel was blocked, and the degree was not very serious, so the patient did not have a complete lack of oxygen, but some chest tightness and chest pain. After the diagnosis was confirmed, the patient underwent follow-up**.
Why do young patients with good looks get pulmonary embolism?
It turned out that Ms. Yu had already given birth to two daughters, but her family had always hoped that she could give birth to a son. Due to family pressure, Ms. Yu has been secretly taking oral contraceptives for the past two years. So when the doctor asked, she told herself that there was no long-term oral contraceptive.
But what she didn't know was that our human body has a sophisticated blood clotting system, and the blood does not clot excessively or bleed excessively. But over-estrogen supplementation can upset this balance. The main components of birth control pills are estrogen and progesterone, which can increase the risk of blood clots.
Like Ms. Yu, without the guidance of a doctor, if she takes oral contraceptives for a long time, the probability of suffering from venous thromboembolism, stroke, and myocardial infarction will increase!
dr.X said.
This case warns us that if we do not follow the doctor's instructions and take medicine indiscriminately for a long time, it will be very harmful to the body. After arriving at the hospital, he denied his medication history, which was also easy to affect the doctor's judgment.