Text author: Egawa
The emergency department is a place with a very low fault tolerance rate, and a new crown epidemic has made the medical risks faced by emergency departments everywhere unabated.
And the story I'm going to tell today has to do with another risk in the emergency department. The incidence of this risk is lower, but the hidden dangers may far exceed the doctor-patient dispute itself.
This is the criminal case encountered in the process of diagnosis and treatment.
1
It goes back four years.
There were many bars and nightclubs near the hospital where I was at the time, and two or three blocks away was a gathering area for expatriates, and on weekends and nights, the intercultural intercultural interculturalism combined with the catalysis of alcohol naturally led to various fusions and collisions in the jurisdiction.
At that time, we were most afraid of encountering in the emergency department, in addition to mental illness, which was this kind of drunken accident.
The story of "fusion" will not be pressed for the time being, first of all, let's talk about "collision".
Unlike the former, for most emergency department physicians, "collision" means literally.
Most of these patients are flesh-and-blood young men, who have hidden various superhero dreams in their hearts, sometimes encountering friction, sometimes meeting the girl they like, and after a few glasses of wine, they have performed live to make their dreams come true.
The plot is slightly on the line alone, more friends may also directly open the group, fortunately now the security is clear, everyone can not come up with any equipment, most of the troublemakers let the enthusiastic masses press before the death, generally at most is a skin trauma.
But that night was a little different.
Before I took over, I felt that the atmosphere was a little wrong, and there were two groups of people sitting in the emergency hall that day, which was in stark contrast to the non-stop crowd of people, and I could smell the wine in half a corridor, and there were police cars flashing lights outside the door.
As soon as I walked into the internal medicine clinic, I received a medical record clip from the surgeon, which turned out to be a drunken fight between two groups of foreigners, and the injured on both sides were sent over by the front and back feet.
Logically, the emergency department has the working principle of emergency department, internal and external women's and children's bones, oral, ear, nose and throat, and each department has the indications of each department, which is clearly written in the textbook.
Whether it is a common trauma or multiple injury, most of them are still within the scope of surgical orthopedic treatment. But the criminal law teacher also said that there must be exceptions to the principle.
"If you are undecided, please consult the internal medicine department" is an exception to the emergency department.
2
"They all said they were going to die." The surgical colleague pointed to the door of the debridement room.
I looked up and there were two young men sitting on a stool in the doorway, both in their early twenties, Asian.
One of them had a bandage around his right elbow, the other had no obvious trauma, and the girl next to him wiped his nose with a tissue from time to time, probably a little bleeding from the nasal cavity. Next to the two men stood a police officer, one of whom was constantly answering the phone.
I took a closer look, and the two injured men had fair faces, their eyes were bright, there was no obvious open trauma, the heart rate and blood pressure contained in the medical records were normal, and it did not look like they had a lot of internal bleeding.
"What's going on with these two people?" I asked my colleague.
"Bare hands fighting, the outer courtyard only did X-rays, said that the communication was not smooth, let 110 with a turn, the film looks at the bones nothing." But the man," the surgical colleague pointed to the injured man who was wiping his nose, "it is said that he vomited a few mouthfuls of red stomach contents on the road, but the specimen was not retained, and the OB was not delivered." (Note: OB is the occult blood test)
"What kind of wine are they drinking?" I asked my surgical colleague.
"It is said to be a mixture of red wine and foreign liquor."
"Why is it always said?" I closed the medical record clip.
"Doctor, will you show me first?" I've been waiting here for a long time." Before my colleague could speak back, the patient in the internal medicine clinic interrupted me.
I turned my head to see a slightly chubby middle-aged man sitting on the ECG bed in the examination room, holding a medical record in his hand. The man looked a little nervous, holding a transparent plastic bucket in his arms, which contained a small half bucket of clear yellow liquid, which looked like cooking oil.
I muttered in my heart, but I didn't have time to think about it, and I asked the patient in the clinic to wait, ready to ask about the history of the two traumas.
I showed my badge to the police, who nodded and pointed to the law enforcement recorder on my chest to remind me that I was still recording.
"Can you talk about Chinese?" I asked the injured person, and the medical records showed that his surname was Park, and he should theoretically know some Chinese characters.
"They don't say Chinese." The police replied.
"Does that speak English?"
"They also suck at English." The policeman helped him and replied, "The translator went to the front to register, and will come back later."
I was still a little undead, pointing to the young man surnamed Park, "Pain?"
The young man hesitated, nodded his head again, and pointed to the position of his right upper abdomen. I pressed down on the ribs with my three fingers, and the boy's expression became obviously painful.
"I have already opened the three routines, full-abdomen CT and surgical sets," the surgeon said, "you see what else you have to look up in the internal medicine department, hurry up and write an opinion and I'll help you open it, your office is about to explode."
When I looked back, the internal medicine clinic was already in a mess.
3
To be honest, in the two years I was in the emergency department, the triage mechanism of internal medicine has not been very scientific.
The main class of internal medicine is not only responsible for the three sections of the pre-hospital, the consultation room and the rescue room, but also the consultation of other subjects in the emergency department, and if you delay a little time, it will be difficult for the patients behind to see it.
"Check the liver function, coagulation function and myocardial enzymes again, send OB when you have vomit, and pull one on the ELECTROCARDI." As I spoke, I quickly wrote down my comments on the medical records. "Liver contusion and laceration are not excluded, young people are highly compensatory, symptoms come slowly, and blood clotting collapses and it is finished."
Young people fight with no weight, a punch down the liver and spleen rupture is judged to be a serious injury, in the case of symptoms are not obvious, liver function and coagulation function is an important indicator to determine the injury.
Some time ago, I just experienced a patient with abdominal pain, I did not check the liver function before taking the drug, and then I almost dissolved blood on my hand, and now I still have palpitations.
"Before the results come out, put the rescue room, open the venous passage, and go to the heart prison." I told the nurse as I left.
When I returned to the clinic, the patient holding the oil drum was already sitting next to the computer, and I subconsciously took the stool back half a step before sitting down, and the outpatient system showed that his surname was Yao.
"Mr. Yao, what are you uncomfortable about?" The patient gave me a new medical record, and there was no other valuable information except for the crooked name on the cover.
"Doctor, I..." The middle-aged man hesitated, supposedly worried about something.
"Well, you say don't worry, I'm listening." I avoided his gaze and deliberately made my tone light.
The emergency department stayed for so many years, I also learned a little bit of the skin of people and broken things, generally this kind of hidden patients, most of them are difficult to say, at this time the doctor should find a way to reduce the patient's vigilance, otherwise it is difficult to ask the real situation.
"Doctor, I was poisoned."
"Huh?" I didn't hold back for a moment and looked up at him.
"Here's the thing," the middle-aged man wiped his nose, which seemed to be a little itchy, "I had a girlfriend some time ago, and then broke up." After the breakup, she sent a bucket of oil to our house."
"Is this the barrel?" I pointed to the oil drum in his arms.
"Right, right," the patient put the oil drum on the table, "our family is halfway through eating, and we find that there is sediment underneath.
I followed the direction of his finger and saw that there was indeed some light-colored insoluble matter at the bottom of the oil drum, but I couldn't see what it was.
"You suspect you've been poisoned, so why don't you call the police?" After all, I've seen too many hysterias in the emergency room, and I still don't believe it.
"I've reported it!" The middle-aged man was a little excited, "We immediately called the police, the police said let's hurry to the hospital to check it out, my parents also hung up the emergency number, just in the back." 」
Saying that the patient waved his hand, pointing to two old people not far away, the old man looked mentally normal, also holding a new medical record in his hand, and was waiting in line for a call.
"Do you have any symptoms?" What's going on your arm?" I noticed that the patient had a petechiae on his forearm, not very dark in color, not higher than the skin.
"Oh, this one hit the table." The patient wiped his nose again, "I just feel very tired, I have no strength in my whole body, and my heart is stuffy." Brushing my teeth is still bleeding a little."
"Tell you this Mr. Yao, let's not say if it is really poisoned," I said, while examining his body - unsurprisingly, except for a few ecchymosis, no positive signs of the nervous system were found, and it is estimated that it is a hysteria - in the emergency department, hysteria is a symptom that needs to be constantly considered and guarded against.
I patiently explained to him, "We are not a specialist hospital here, we can't do poison identification, and we don't have many heavy metal related tests." If you want to be sure that I see it here, I can only give you a routine examination to see if there is any organ damage. If nothing is found, it is recommended that you go to a specialist hospital for examination."
"Okay, well, we thought this hospital was coming first, didn't we?" The middle-aged man picked up the inspection application form and suddenly remembered something. "Doctor, if you don't give my parents a single ticket, let's open it together, anyway, we are all together."
I was secretly crying bitterly in my heart, thinking about how this hysteria was still contagious, when the nurse in the rescue room came to save me.
"Dr. Jiang, that foreigner vomited blood."
4
"I'm really afraid of what's coming."
I quickly handed over the consultation room to the deputy class and trotted into the rescue room, where the young man surnamed Park was holding the edge of the bed and spitting something on the ground. The amount of vomit is small and sticky, and it is also full of alcohol, and there is indeed a bright red in it, which is not much like the texture of red wine.
"Did the patient urinate after he came in?" I asked the nurse.
"He said he wouldn't let him get off the ground and intubated him, but he wouldn't, and he still hasn't solved it."
"Open another channel for hydration, send a cross-matched blood, and let the surgeon take a quick look at the CT."
The injured person's face began to be a little pale, and the heart rate also floated up, fortunately, in the case of dual-channel rehydration, blood pressure can still be maintained in the normal range, and expansion has played a role.
After dealing with the few remaining patients in the rescue room, the time was already midnight.
The injured person's vomit OB suggests a weak positive occult blood, although not particularly typical, but I am ready to contact a gastroenterologist for consultation.
The advantage of emergency department is that there is no need to make the diagnosis particularly detailed, and the main task is to stabilize the patient's vital signs first and give the specialist a chance to fight for treatment.
"Isn't that right?" The surgeon walked into the rescue room, "I've seen his film, and the abdominal organs are fine."
"That may be a simple gastrointestinal bleeding", to be honest, let me look at the image of the head and chest is OK, to see the abdominal cavity is indeed inferior to people, stress bleeding after heavy drinking is not uncommon, this bleeding is not easy to see on the image.
"Have you seen the dentist?" The surgeon asked the nurse.
"What is the mouth for?" I wasn't impressed with this consultation either.
"He was hit on the gums and had bleeding teeth when he came."
At this point, I also began to feel that something was wrong, but I couldn't say what the problem was. I turned to the nurse and asked. "Did his blood come out?"
"Just came out, and reported a critical value." The nurse handed me the critical value register for signature.
Sure enough, the patient's INR registered on the book exceeded 4 (the normal value is generally 0.8 to 1.3), indicating that the patient's coagulation function has collapsed, if it is not taking anticoagulant drugs, that is, liver function is seriously damaged, really to be identified, at least a minor injury of the second degree.
"Wait a minute," the surgeon glanced at the register, "this surgical patient's surname is Park, not Yao."
"Huh?" I took another closer look, this highly abnormal coagulation function report did belong to a patient surnamed Yao, but I had no impression, how could such a serious patient not be in the rescue room?
"Yao XX! Who is Yao XX?"
I rushed down the hallway and shouted.
"It's me, Doctor."
I saw a middle-aged man by the wall slowly standing up, holding a plastic bucket in his right hand and wiping his nose with his left hand, "I am Yao XX."
He removed his hand, and a wisp of blood flowed from his nostrils.
He was really poisoned.
5
Entering the rescue room, complaining about the serious illness, inhaling oxygen and supervising the plasma, the three patients came down to the middle of the night.
Chronic poisoning, resulting in prolonged coagulation function, but also the common people can get the drug, most of them are anticoagulants, after asking for instructions on the second line, we gave the patient a family antagonists, to determine the safety of transport after all into the ward.
On the other hand, the hospital also informed the police of the situation in time, and the police controlled the suspect for the first time, which was Mr. Yao's ex-girlfriend.
Later, I heard that the girl confessed during the interrogation that because she had a grudge against the man, she deliberately gave the cooking oil that had been stocked with rat poison to the ex-boyfriend's family to eat after the breakup.
Fortunately, Mr. Yao's family did not have any underlying diseases, except for subcutaneous ecchymosis and a small amount of mucosal bleeding, and no important organ bleeding was found, and he was discharged from the hospital quickly after using antagonism therapy. At the same time that the family was discharged from the hospital, the girl was also taken compulsory measures.
The foreigners who fought after drinking that day also ruled out liver contusion and gastrointestinal bleeding, and finally discharged from the hospital with a diagnosis of soft tissue contusion and oral bleeding, and both sides of the riot were treated by the police.
Later, I met Mr. Yao twice in the emergency department, and he came back with his family to review the coagulation function, and when I told this story, he and I both had palpitations.
Until long after I was not a doctor, I still could not forget the lesson this incident taught me.
Clinical work really can not have a little self-righteous psychology, for young doctors, the mindset is both a life-saving strategy, but also an endless abyss. In the long run, no matter how lucky the doctor is, it is only a life of peace.
Although I am no longer a doctor, my new role now involves the EAP (Employee Assistance Programs), so I am often consulted by some colleagues about physical and mental issues.
Many people told me that after breaking up with my partner, I would feel unwell and asked me how to adjust and what department I should hang up to see a doctor.
Out of professional habits, I usually put down my pen and cautiously ask, "After the breakup, did your ex still give you anything?"
Finally, happy Valentine's Day, folks. (Curator: Gyouza, Beatrice)
Title, illustration Source: Figureworm Creative