This is not a symptom that I expected before coming here.
Most of the fever types of tuberculosis patients show a low-grade fever, and some patients even show no symptoms of fever or feel insignificant. And this kind of fever, which made Professor Brimmer hesitate to describe it during the discussion, has no obvious cause.
The lower body emerged from the body and appeared unknowingly when Kraft was concentrating on the physical examination.
"Sir, can you hear me?" Kraft stretched out two fingers and moved them left and right in front of the Duke's eyes. He found that his eyeballs followed the fingers at a narrow angle, and at the same time there was uncontrollable shaking and dissociation, which seemed to be there.
What kind of changeable sensory stimulation is acting on the vestibular receptors, inputting information that makes it impossible for the eyeballs to adjust to the corresponding position no matter what.
"..." There are unformed words behind the lips, which collapse into meaningless syllables before they are spoken, and are mixed in an irreducible disorder into an unsettling jumble of sounds like a curse.
Without a thermometer, Kraft put his hand on the patient's forehead to make an assessment. Although the fever was coming fiercely, it still felt like a moderate fever. It had not risen enough to cause such a sudden loss of consciousness and dysfunction, and it should not be like this.
synchronization.
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This overturned the previous first reaction. The disorder of consciousness was not the result of fever, but two concurrent symptoms.
Facing the change, Wilbert and Fernand did not show any panic or surprise. Obviously, this was not the first time such an attack had occurred, and it was self-limiting. Kraft held down the artery in his wrist, and the pulse began to beat rapidly.
Fatigue is just like a declining respiratory system trying to maintain compensation by increasing the frequency of contractions and contractions.
This is a stupid strategy. After all the surplus is used up, it will soon go from the compensation phase to the decompensation phase, and then the organ will kill itself without intervention.
The fever is gradually increasing, and the twitching of the trunk and limbs seems to have acquired independent will, performing high-frequency contractions that do not form effective movements. It is similar to being shivering in the ice and snow in winter. This is exactly the case. This means that body temperature regulation
Moving the fixed point upward, the body treats the current body temperature as hypothermia, and the skeletal muscles produce a large amount of heat through trembling. The two behave similarly.
In this case, there must be something affecting the temperature regulation center. There are many, including infectious factors and non-infectious factors, but generally speaking, acute fever is more common in the former.
Kraft also thought so, although it was a bit far-fetched, lacking rigorous and various laboratory test evidence that he relied on, and it was consistent with the focus theory of Professor Linden, whom he had just despised.
But this is what made him feel a sense of déjà vu. There were one or more infection foci, repeatedly releasing exogenous pyrogens such as endotoxin or the pathogen itself, and then through a series of "It's boring to talk about it in detail."
It’s terrible, but anyway, it’s the mechanism in which white blood cells release endogenous pyrogens, cross the blood-brain barrier, and act somewhere in the hypothalamus through a series of reactions that cause fever.
This is very reasonable. It is not just tuberculosis. The immunity has been weakened by long-term consumption. A concurrent infection has occurred in this body.
What is it?
In the absence of etiology, no one can answer this question for him, and what follows is another question, what is the disorder of consciousness? It does not seem to be caused by fever, but the cause.
Another manifestation of this body.
Kraft tried to change the title, "Your Majesty, can you hear me?
The call was answered, and Duke Westminster raised his eyelids slightly, indicating that he could still respond to the outside world instead of completely losing consciousness. He even tried to fight against the disordered body, manipulating his mouth and tongue to make sounds to prove his
It's normal, but what is sent out is still content that no one can understand, and the preface and the follower are inconsistent.
This made the old Duke feel a little indignant. He raised his trembling hands and tried to write something down. The accuracy was as if he was fighting an invisible enemy. However, these actions failed to achieve his goal after all, as if those
Words are cursed and cannot be conveyed.
"We have tried recording these contents, and Brimer thought we could analyze the disease-related information from them." Fernand couldn't help but remind him. Seeing the hesitation on the face of the internal affairs officer, he stopped him from continuing to guide the Duke, "
But there has been little progress in his research so far. It may really be that the disease has blinded his mind and it is meaningless."
"No, I just don't think so." Kraft temporarily ended the examination, rearranged the patient's coat, adjusted his posture, and finished the servant work he was about to do.
"What should be paid attention to is not only the content of the words, but also that the patient can still speak at this time, but the words cannot express what he means."
【wernicke aphasia】
It’s the most annoying time to look at the dysfunction and guess the damaged part. Facts have proved that the Duke’s brain dysfunction at this time is not widespread and indiscriminate. On the contrary, he has retained part of the monolingual functional area, showing that he can hear but cannot understand.
, expressing a state of confusion.
"We have encountered situations where patients who have injured 'here' in their skulls, unlike other people who have suffered injuries to their heads and become mute, still retain the ability to speak, but they can no longer speak a correct sentence.
"Pointing to the posterior pole of the upper edge of the temporal bone, Kraft explained.
Very good, now there is no restrained dissatisfaction on Wilbert's face. As the castle's internal affairs officer, he does not lack the brain to associate the source of this knowledge. Now this brain feels a little uncomfortable to continue to stay with Kraft.
And the face inevitably showed a slight expression of rejection and fright.
Fernand just nodded noncommittally. He was already past the age of confinement between disciplines, and he also had an understanding of anatomy, and was willing to accept the idea that a certain lesion caused a certain corresponding symptom.
"This shows that during the attack, this area of the patient's skull was damaged, and it was temporary and reversible." But this made him unable to explain anymore, why there can be an intermittent specific area.
Functional dysfunction, and it goes hand in hand with fever symptoms? And it seems that the motor functional areas of the limbs are also affected at the same time.
This chapter is not over, please click on the next page to continue reading! "So what should we do?" Internal Affairs Officer Wilbert actually didn't understand much. He looked at his master, Duke of Westminster's symptoms, worriedly.
The attack was menacing, but the duration of neurological dysfunction was not as long as that of a simple febrile convulsion. After a while, he was able to control his fine movements better. He reached for the steaming chamomile tea, and Wilbert hurriedly approached to help him steady the cup.
.
"The situation is very complicated. This is not a simple wasting disease." Kraft solidified the atmosphere in the room with one sentence, but he did not want these people to think that he could do anything good. "I think that in the original lung disease
On the basis of wasting disease, another disease infection was combined, and there were multiple lesions in the brain."
"I need to know how often these attacks occur and how long they last."
"Well, it's about once a week. The time and length of the attack are basically the same as this one." Fernand answered without any hindrance. His observation and recording awareness is far superior to other people of his generation. "I guess this attack is about to happen, and you will be affected."
Bring just the right amount.”
"What about the severity? Has there been any change?" Kraft touched the Duke's forehead again. The heat was still there, out of sync with the neurological symptoms. "In addition, have you monitored the duration of this fever?"
"It's very difficult. This is often mixed with the heat of wasting disease itself. It lasts for at least half a day, and the cause is unknown."
Indeed, the heat source released into the blood will not be eliminated so quickly. Kraft fell into deep thought. He had ideas, but they were all guesses. And it was foreseeable that he would not get an answer if he continued to think like this.
The scene was a bit tense, with consultation experts discussing endlessly and family members looking worried. The patient was struggling to wake up from the chaos and took a sip of chamomile and licorice tea with honey into his throat that had been dried by the dry hot air.
"Knight Kraft, it seems you haven't learned much from your fathers." The dry voice came from the Duke who had regained control of his vocal cords and mouth. The two professors, who were obsessed with thinking, quickly apologized personally.
"I understand. You are saying that I have two diseases, one is consumption disease that will kill me, and the other, it seems, will not happen yet."
"Yes, but the other one may actually be more deadly. I'm not sure if it's related to the wasting disease or if it's some kind of independent disease. It may form lesions in your body that periodically release toxins.
....." Although he didn't quite understand what the Duke meant, Kraft repeated his findings in a good manner.
However, the patient interrupted him nonchalantly, "I want to treat pulmonary wasting disease first."
"But it's not clear whether the other one will affect the treatment..." Kraft felt that we should reconsider it. It would be too risky to start treatment hastily.
"Treat the wasting disease first."
"It may even lead to more serious consequences..." This must be stated.
"I can decide my own body."
Well, the Duke understood what he meant, but he still persisted.
"Young knight, I even thought you were older than Fernando." The Duke stood up pressing the shoulder of the internal affairs officer. Only then did Kraft notice that he was much taller than he thought. "Easy, I just want to
A cure, a chance to make a bet on the possibility of surviving until the winter after tomorrow."
"Your Excellency, I must point out that it is unlikely that you will win given the complications." Kraft seemed to understand the logic of this idea. It was not that he had not seen this kind of behavior in Old Wood, and he
The relationship with physical obstacles is regarded as a duel, and victory is based on overcoming obstacles and completing the goal, including but not limited to lame bear hunting.
No matter what the risk-benefit ratio is, as long as there is a possibility, they will definitely do it.
To put it nicely, it’s called brave, but to put it another way, it’s reckless. But it’s easy to understand why they made such a choice. The people who live to this position are all senior members of the Survivor Bias Association. They have won gambling all their lives, and their bodies have never let them down.
Disappointed.
"And potentially losing life expectancy under current palliative care."
"Your duty is only to make feasible suggestions for me, not to recommend options, Knight Kraft. I will bear the fruits and consequences of my decision myself."
With a speech that is stronger than armor, you know that you will never be able to escape if you don't hand over the treatment plan today.
"Okay." Kraft took a deep breath, as if he were opening an attic and taking out old antiques that had accumulated dust. "Allow me to introduce you to the artificial pneumothorax."
【Artificial Pneumothorax】
This is really an old antique that is quite old.
"This treatment is based on current surgical findings in humans. Our lungs are actually surrounded by membranes on both sides, and normally the space between them is sealed, like a shriveled water bladder with a cork."
"The risk lies in injecting air into the gap between these two membranes to expand it and compress the lungs." In the narrative, Kraft moved his hands from both sides to the center to indicate this process, "until the lungs
The head collapses, the range of motion is compressed and rested, the body fluid circulation is sluggish to limit the spread of the disease, and the eroded lung cavities are squeezed and healed."
"There is no doubt that this is a risky, traumatic, and incurable treatment. If you insist on it, then I will continue to complete the examination and plan the treatment for you." This is the first time he hopes to take the risk.
Informing can scare away patients.
"why not?"
It seems that the first time is always difficult.
...
...
At the Duke's insistence, the inspection continued.
With the mentality of "this is what happened" and "there's nothing I can do anyway", Kraft started the rest of the physical examination. He had to carefully evaluate the condition of the riddled lungs on one side and indirectly understand the cardiopulmonary function.
If the results are not good, you will inevitably have to consider using your mental senses.
Due to the lack of tools, he had to place his auricle against the patient's chest to listen. This inconvenience triggered his desire to work overtime to make an original stethoscope within three intercostal spaces.
[This will be included in their tuberculosis project funding later]
In order not to use his mental senses, Kraft carefully compared the results of auscultation and percussion, striving to be as close to the greatest degree of accuracy and reliability. However, the objective results still prove that the pursuit of new machines by the ancestors of radiology for many years is indeed due to the combination of machines and people.
There is an insurmountable gap between them.
Kraft still wanted to hold on for a while. He wrote down another auscultation result, moved to the other side, and leaned under the right shoulder blade, roughly at the seventh and eighth intercostal spaces. In the percussion just now, the performance was between skin and skin.
The sound between the drum and the empty urn indicates that there may be a cavity near the chest wall, and its size requires caution.
He listened closely, and a musical rumble broke into his ear canal. He didn't quite recognize this sound.
To be honest, it was too difficult for a person who rarely saw such a degree of tuberculosis to make an accurate judgment at once. And Kraft hesitated for two breathing cycles, still puzzled.
To be on the safe side, he decided to percuss again. As usual, he attached the second joint of his left middle finger and tapped with the middle finger of his right hand, waiting for the sound feedback that echoed in the empty space.
There was a low, muffled sound, muddy, and thick, but it was not the drumming feeling that echoed in an empty jar in my memory.
"What's going on?" Kraft knocked again in disbelief, but the sound was still solid. "How could it be solid?"