The boy closed one eye in pain, raised one leg and said, "It's pressed, it hurts!" The nurse was holding a blood test sheet in her hand, with a healthy blush on her face. Her curiosity was piqued. Small body, big energy! But after seeing the faces of high school boys, she lost interest. "Dr. Xu, the blood routine is out. Take a look." The little nurse turned to Xu Qiu. Dr. Xu from the emergency department is so eye-catching. Xu Qiu took it and glanced at it. Hb (hemoglobin) 75g/L. Low. Normal male is greater than 120. Plt (platelets) 34*10^9. Low.
The normal value is 100~300*10^9. WBC (white blood cells) are 120*10^9. very high. The normal value is between 4~10*10^9. At this time, the resident doctor who almost gave him aspirin also came over and said, "Dr. Xu, the list of chest pain patients is also out. I'll bring it to you for a look." Xu Qiu also took it. The attending doctor stretched his neck and took a look, then glanced at the boy on the bed, and said with some surprise: "Hey, why are the white blood cells so high?" White blood cells can phagocytose antibodies produced by foreign bodies, heal body damage and resist bacterial invasion. In short, it is a guardian of health. People with low white blood cells are more susceptible to infections. At present, the white blood cells of boys are far beyond the normal value, reaching 20 to 30 times that of ordinary people. Seeing that the attending doctor was interested, Xu Qiu said, "The patient has anemia, bleeding, chest pain, and severe infection. Do you know what tests should be done next?" The attending doctor's mind was racing rapidly. After a while, he confidently gave an answer and said: "Do a plain scan of the chest and abdomen to see if there is any malignant tumor?" Xu Qiu shook his head. This attending doctor is still not sensitive enough... However, it’s not his fault. Doctors in each department do not know much about diseases in other departments. Xu Qiu walked to the boy's bedside and said, "Take off your pants." The boy looked at the nurse hesitantly.
The nurse wasn't interested either, so she turned around, pulled up the screen, and stepped outside. The boy then took off his pants neatly. The attending doctor's eyes widened. "What now?" Xu Qiu asked. The attending doctor stared and guessed: "Hydocele? No, no, it won't have such serious systemic symptoms. Epididymitis? hernia? It doesn’t look like it either! The patient only had unilateral testicular enlargement! Tumor? " Xu Qiu couldn't stand it anymore and said calmly: "Leukemia." The attending doctor was suddenly startled, slapped his thigh and said: "Yes, acute leukemia! No wonder there are so many white blood cells. Those were not white blood cells at all, but the blood routine mistook leukemia cells for white blood cells, thus causing the patient's white blood cell stasis... However, how can there be unilateral testicular enlargement? This symptom usually appears during the remission period of chemotherapy! " Routine blood tests mainly analyze changes in the number and morphological distribution of blood cells in the blood. Leukemia cells are very similar to white blood cells. A blood test cannot tell the difference between the two. The white blood cells of normal people range from 4 to 10 units. The "white blood cells" of boys are 120 units. In fact, they are leukemia cells. At this time, the boy on the hospital bed was already frightened. To ordinary people, the word leukemia is synonymous with an incurable disease. Xu Qiu took back the examination list for the chest pain patient and walked to the emergency room. At the same time, she told him: "Communicate with the family members and do a bone marrow biopsy. I will come back after handling the patients over there." The attending doctor stood up straight and said: "Okay!" He glanced at the little nurse outside the screen and was about to ask her to help. As a result, the little nurse immediately turned around and ran away after Xu Qiu. "Damn it, if I didn't have to take care of the patients, I would follow Dr. Xu!" the attending doctor muttered. … On the way to the emergency room, Xu Qiu read through the checklist. Electrocardiogram: The ST segment is arched and elevated in multiple leads.
This is typical of pericardial effusion. But it’s the second checklist that’s crushing. Five values of cardiac enzymes: LDH: 520IU/L, AST, ALT, CK, CK-MB, etc. all increased to varying degrees. Troponin is also high. And this is the characteristic of myocardial infarction. Cardiac enzymes and troponin are usually found in cardiac muscle cells. When a myocardial infarction occurs, the patient's myocardial cells will be destroyed, and myocardial enzymes will flow into the blood, causing these values to change. Xu Qiu frowned. EKG supports pericardial effusion, Another myocardial infarction occurred biochemically. The key is that the treatments for the two are completely different. Pericardial effusion is better, as long as it is not complicated by pericardial hemorrhage and effusion, it can be stabilized temporarily. If it is a heart attack, If the diagnosis is not made quickly and the blood vessels are not opened in time, the patient will soon suffer from cardiogenic shock. When Xu Qiu rushed to the rescue room while thinking, she found that deputy chief He Hai was already inside. "Xu Qiu, are you responsible for this patient?" He Hai put his hands behind his back and smiled. He was the one who specially hired Xu Qiu. Because of this, the hospital rewarded him and lowered the conditions for him to be promoted to a senior position. Originally, he was promoted to deputy director not long ago, and it would take at least three or four years to become a senior professor. In addition, there is still a thesis stuck. Now, he only needs to practice for two and a half years! He Hai smiled and said: "If I had known it was you, I wouldn't have come all the way here. You can definitely handle it." However, since he was here, he also looked at the case, frowned immediately, and asked: "Xu Qiu, what do you think?" Xu Qiu: "Contradictory." He Hai: "It is contradictory... Well said, you can see the problem at a glance!" Everyone in the emergency room was very upset. Damn it! You can also brag about something that anyone with a discerning eye can see?
Don't be a licker! At this time, Xu Qiu remembered that the patient had undergone radiofrequency ablation, so he said: "It may also be related to surgical damage." He Hai nodded: "Yes, radiofrequency ablation for atrial fibrillation has a lot of energy, and it is normal to damage the surrounding myocardial tissue. It may even penetrate the pericardium." Xu Qiu flipped through the medical records left by the patient's family. Hypertension, smoking for more than 20 years. He frowned and said, "It could also be coronary heart disease or acute myocardial infarction." He Hai touched his chin and agreed, "Indeed. Carbon monoxide and nicotine in cigarettes can directly damage the vascular endothelium. It is the most direct cause of coronary heart disease and myocardial infarction." Xu Qiu was silent for a moment. What exactly is this deputy director here for? Can you provide some substantive advice... He Hai seemed to realize that this would undermine the dignity of the deputy director, so he coughed twice and said, "Let's do a coronary angiography. After completely excluding coronary heart disease and myocardial infarction, it will be clear whether it is pericarditis or pericardial effusion." Everyone was a little embarrassed. Coronary angiography is a minimally invasive examination and must follow the surgical process. Punch and enter the heart, inject contrast agent through a specific cardiac catheter, and then observe the coronary artery. After signing the informed consent form, making an appointment for the operating room, and completing the coronary angiography, if the patient really has a myocardial infarction, it may be a bit too late. But now it seems that there is no better way. At this moment, the man on the bed suddenly cried out again. "It hurts..." His voice was hoarse, like a beast dragging its body. Everyone in the emergency room was startled. But Xu Qiu raised his head. He thought of a faster and more effective way than coronary angiography!