Zhan Hao was lying on the bed, his face turned a little yellow.

After Sun Lien retorted the doctor from the Second Hospital, he pushed the bed into the rescue room with Zhan Jun and specially placed him near the gate to facilitate the image examination behind him.

"Have you brought the previous cases and examination reports?" Although there was some unpleasant story in the Emergency Department of the Fourth Hospital and the Second Hospital, both parties still recognized each other's test results and reports. Although the provincial prescription network allowed Sun Lien to see what medicine the Second Hospital used for Zhan Hao, the detailed imaging department examination results and some specific treatment details still needed to be obtained by asking the patient's family.

"As you said, I brought it all." Zhan Jun took out a thick book of nailed materials from his bag and handed it over, "Xiao Sun, please see if there is anything that is not detailed enough, I will go to the Second Hospital again."

Sun Lien nodded, took the information and instructed, "I'm going to invite someone to consult now, you go and handle registration procedures for him." Zhan Jun nodded and walked towards the registration window of the rescue hall, while Sun Lien turned around and entered the small conference room.

In the conference room, Xu Yourong, Yuan Ping'an, Pascal, Zhou Ce and Liu Pingchuan were all sitting in their seats. Seeing Sun Lien walking in, they temporarily stopped chatting.

"Please trouble everyone." Sun Lien smiled at them embarrassedly, then placed the information on his hand on a digital projector, and the camera enlarged the information on it to 150 inches and projected it on the wall of the conference room. "This is the patient we need to deal with today."

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Zhan Hao, male, 39 years old. Nine days ago, he was sent to the emergency department of the Second Central Hospital for severe abdominal pain. After admission, he showed that the level of alanine aminotransferase (alt) was 1970u/l, which was much higher than the reference value of 0~40u/l. After ultrasound examination, the acute temporary blockage caused by common bile duct stones was ruled out. The emergency department of the Second Central Hospital determined that Zhan Hao's severe abdominal pain was caused by acute liver injury. However, the cause of acute liver injury is unclear. Quick tests and immune examinations ruled out the possibility of viral hepatitis. Zhan Hao himself firmly denied that he had had experience taking drugs before the onset.

After the emergency doctor at the Second Central Hospital palpated Zhan Hao's abdomen, there was no rebound pain or tenderness, but Zhan Hao's pain attack was very severe, with sweating profusely, his nose and saliva mixed together, his body curled into a forced position, and his expression was extremely painful - but in addition to the accelerated heartbeat and increased blood pressure, his body temperature and even his breathing frequency were within the normal range.

After the B-ultrasound examination confirmed that it was not perforation of the digestive organ, in order to further diagnose and treat, the Emergency Department of the Second Central Hospital used three dulentin for Zhan Hao in a row to try to relieve pain. However, the pain relief effect was very limited, which led to the second diagnostic view of the Emergency Department of the Second Central Hospital - drug addiction attacks?

Fortunately, a quick urine test proved that Zhan Hao was innocent. All his test results were negative. This shows that he had not been exposed to these drugs for at least two months. Subsequent hair tests also confirmed that he had not taken drugs in the past year. This diagnosis is not valid.

Two hours after admission, the emergency doctor at the Second Central Hospital added a diagnostic opinion - intestinal obstruction. Dulingen had poor pain relief, severe pain and tended to become paroxysmal. In addition, Zhan Hao did vomit after admission, and vomiting did not relieve symptoms of abdominal pain. The doctors at the Second Central Hospital suspected strangular intestinal obstruction, which was actually very well-founded.

Although no obvious obstruction area was found on the plain abdominal film, this may still be caused by the premature onset of obstruction and the lack of obvious imaging characteristics. To confirm this diagnosis, doctors from the Second Central Hospital gave Zhan Hao an injection of atropine. While observing the effect of atropine, in order to prevent the rapid progress of intestinal obstruction, fluid replenishment, blood transfusion and antibiotic treatment were also given. In this way, if atropine is not effective in relieving smooth muscle spasm, it is safer to directly open the abdomen directly.

Subsequent observations proved that atropine did have a very good effect. The abdominal pain was relieved quickly, and Zhan Hao's vital signs stabilized. After 24 hours of observation, Zhan Hao was transferred to the Department of Hepatobiliary Medicine and was preparing to undergo follow-up examination. His acute liver injury has not been completely resolved, and intestinal obstruction will not lead to acute liver injury.

On the second day of hospitalization, Zhan Hao developed new symptoms - decreased muscle strength in the lower limbs and decreased vision in the right eye. These symptoms were quickly diagnosed as demyelinating lesions in the nerve center, but the cause is still unknown.

On the fifth day after hospitalization, Zhan Hao was able to stand with support. Although the alanine aminotransferase had decreased, it was still at a level of 435u/l. He could eat and defecate normally, and he did not suffer any acute abdominal pain in these five days.

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"Their treatment idea is a typical internal medicine plan. Try to try and the situation seems to improve." Liu Pingchuan spoke first after listening to the introduction, "It's enough as long as the patient's condition improves. The specific disease he has and why he shows this symptoms is not within their first consideration."

This kind of diagnostic guidance is actually not uncommon, and it can even be said to be the norm. Doctors do not know how many cases they will see each year when they cannot be fully diagnosed. Many diseases show similarities and will show good results for the same treatment. Lucky patients may not know what disease they have until they recover, while those unfortunate... may not know what they died because of.

It must be emphasized that this has nothing to do with the doctor level of the Second Central Hospital. In fact, even if it is as strong as Tonghui, many patients still have "unknown causes" every year. The human body is really a too complex system, and there are too many interfering factors that can affect this system.

"So, we have to figure out what disease he has?" Xu Yourong didn't seem very interested in this case. She shook her head and said, "It has been nine days since the onset of the disease. The Second Central Hospital has used him two antibiotics, hormones, and blood transfusions... If we are the police officers who are planning to start from the crime scene, then his body is the first crime scene that has been cleaned several times. What can this be found?"

Not only Xu Yourong was a little uninterested in this case, Yuan Ping'an didn't quite understand the reason why Sun Lien admitted this patient. "Isn't he already getting better? Now that he is admitted to the hospital, even if we can diagnose what disease he has, it will not be of any practical help to him, right?"

"The main reason why I will take this patient is because the course of the disease is not right." Sun Lien thought for a while and decided to tell the truth to his team members. "His acute abdominal disease can be confirmed as smooth muscle spasm through the time period when the treatment starts. But this cannot be related to acute liver injury. The subsequent demyelination lesions cannot be related to acute liver injury - if smooth muscle spasm is caused by central nerve demyelination lesions, I can accept it. But in general, this patient's disease lacks a unified explanation."

"The explanation is not important. What is important is whether the patient's condition is really controlled." Liu Pingchuan frowned and concluded. "What I worry most now is autoimmune diseases. After all, they used hormones during the treatment process. If the hormones cover up the symptoms, they may continue to develop the disease later."

"Anyway, I think it's better to follow our pace." Dr. Pascal said. He was not very cold about Zhan Hao's theory that he might suffer from autoimmune system diseases. After all, his onset sequence does not conform to the common "recurrence in the kidney or nervous system" law of the autoimmune system. But he still agrees with Liu Pingchuan's remaining point. Although using hormones for treatment in the Department of Rheumatology and Immunity is a very common method, Dr. Pascal always feels that hormones are not the best method. While alleviating symptoms, hormones will also cover up many issues that really need to be paid attention to. Many diseases do have this special "onset-relieving-recuring" fluctuations. There are many causes of this fluctuation, but these diseases have one common feature - the second onset will be very serious and the prognosis is extremely poor.

"Image examination is already done." Sun Lien took out his cell phone and looked at WeChat. "Abdominal CT examination shows that the liver density is diffusely reduced, and small low-density shadows appear on the pancreas head, and the small intestine expands to varying degrees and effusion can be seen."

"This is new progress." A tense air suddenly filled the conference room. A day ago, Zhan Hao's CT inspection results showed that everything was normal.

A shout suddenly sounded in the emergency room outside the door, "The blood oxygen saturation is reduced!" A bed, that's talking about Zhan Hao.

A group of doctors bounced from their seats as if they were kicked in the butt, and everyone rushed to the rescue room.

Zhan Hao started to have abdominal pain again. The severe pain made his cheeks flushed and his breathing was rapid. He curled up on the hospital bed like a big shrimp. At first, he still had some strength to scream. In less than thirty seconds, he could only make a "roar" gasp from his throat. His blood pressure quickly rose to 135/90mmhg, and his heart rate began to increase to 93 times/min, but his blood oxygen saturation was decreasing, from 98% at the time of admission to 95%.

"Give him oxygen, draw blood to do a blood routine, do a five-in-one liver exercise!" In a mess, Sun Lien currently occupies a favorable position and comes to the edge of the bed. He stretches out his hand to pull open the quilt on Zhan Hao and presses his abdomen hard. The abdominal muscles are not tight, and after pressing them down, Zhan Hao does not significantly aggravate the pain. Looking at his face again, sweat gushing out like a spring, and his nose and saliva are mixed in, looking scary. "Zhan Hao, Zhan Hao?! Can you hear me talking?" Sun Lien slapped Zhan Hao's shoulder hard and asked in the loudest voice.

"Can..." Zhan Hao took a quick breath twice, held up a response with all his strength, and then continued to scream. "Help!"

"Zhan Hao, male, 39 years old, with demyelinated lesions in the nerve center, rapid visual acuity of the right eye, acute liver injury, smooth muscle spasm, acute hemolysis, and hemolytic anemia." The status bar has updated three states very much, and there are vaguely two words in front of "hemolytic anemia". The handwriting is slowly deepening, and it looks like "moderate".

"One milligram of atropine, intramuscular injection!" Sun Lien made the decision. Atropine was confirmed to be effective against Zhan Hao in previous treatment, and the pain relief effect was more effective than opioid analgesics. First, stop his acute abdominal symptoms, and then the doctors could find a way to help him. Under forced posture, Zhan Hao could only shrink his body with all his strength and bend it into the shape of shrimp. It is very difficult to draw blood in this state and establish a new venous channel. The indwelling needle on his hand was accidentally pulled out during the abdominal pain attack.

Atropine has a very fast onset of effect, and it reaches the peak of blood drug concentration fifteen minutes after intramuscular injection. The severe spasm was gradually relieved under the action of atropine. Next, it was Sun Lien and others' turn to have a headache.

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"Atropine is so effective, which means that the spasm should be the gastrointestinal tract or bladder. He has not inserted the catheter yet, so it is unlikely to be a bladder spasm." After confirming that Zhan Hao's symptoms have been relieved, Xu Yourong whispered his opinion. "There is a second intestinal obstruction attack in a short period of time?"

"The CT in the CT for a few minutes before the onset of the disease only showed dilation of the small intestine and some fluid accumulation." Yuan Ping'an raised his eyebrows, "Abdominal hernia?"

"If it is an intestinal obstruction caused by an intraventral hernia, it is...strangulating     intestinal   obstruction." Dr. Pascal didn't remember what the Chinese statement of this disease was. It can only be replaced in English. "But this condition is almost impossible to be relieved by drug treatment. If it is really strangulating     intestinal   obstruction, how did he survive the disease without surgery after the last time?"

"The t1/2 metabolic rate of atropine is four hours." Yuan Ping'an suddenly thought of something, "When the Second Hospital treated him, he only got a complete relief after only one injection of atropine, right?"

Sun Lien didn't quite understand what Yuan Ping'an wanted to say, but his memory was not wrong. "I did use atropine only once."

"In other words, this spasm will not last for too long, or in other words, the treatment method used by the Second Hospital within those four hours successfully resolved the spasm." Yuan Ping'an expressed his guess, "He has received blood transfusion treatment, and I suspect he may have severe anemia!"
Chapter completed!