When the Doctor Uses A Hack-Chapter 743: The Final Link!
Thursday night, Chen Cang's night shift.
An old man stumbled in, "Doctor, I want to buy some medicine."
Chen Cang was momentarily stunned and quickly got up, "What medicine?"
The old man spoke with a bit of shortness of breath, breathing rather rapidly.
"Ah... ah... aspirin enteric-coated tablets!"
It took the old man a long time to finally get the words out.
After finishing, the old man continued, "Right, I also want to get an electrocardiogram done, my heart has been feeling unbearably uneasy lately."
Chen Cang looked at the old man's face and was immediately taken aback!
The old man was tall, but also quite overweight, walking unsteadily, moving step by step with difficulty.
But, that wasn't the key issue, the most important thing was the old man's complexion - yellow and swollen, with dark red cheeks!
This might not seem like a typical symptom to others.
But Chen Cang, seeing the old man's breathlessness and hearing his request for an ECG, immediately furrowed his brow!
Upon noticing his purple lips and a dark tongue...
A name was on the tip of his tongue!
Rheumatic heart disease!
This means rheumatic heart disease, and the old man's facial appearance was the classic mitral facies, also known as the face of rheumatic heart disease.
Chen Cang quickly called for Xiao Lin, "Xiao Lin, help me support the old man inside."
Xiao Lin put down what he was doing, quickly nodded, and helped the old man into the emergency room.
The old man lay down on the bed and finally breathed a sigh of relief.
Chen Cang couldn't help but ask, "Old sir, have you had any illnesses before?"
The old man took a few breaths, and Xiao Lin, being very observant, quickly put him on oxygen.
Only then did he say, "I... I have heart disease, rheumatic heart disease, for many years."
Upon hearing this, Chen Cang knew it was as he suspected.
Then, Chen Cang hurriedly picked up a stethoscope and placed it on the old man's apex to listen to the heart's activity.
The heartbeat was irregular, with the strength of the heart sounds varying.
Chen Cang frowned immediately, the old man might have atrial fibrillation.
Not just atrial fibrillation, but Chen Cang could also hear a crescendo rumbling murmur at the apex during diastole, a classic auscultatory sign of mitral stenosis.
Meanwhile, Xiao Lin had pushed the ECG machine over.
An electrocardiogram was produced.
Chen Cang looked at the ECG and his brow furrowed immediately.
The situation didn't look too good. Aside from the rheumatic heart disease, this atrial fibrillation could become severe at any moment, leading to complications.
With this in mind, Chen Cang quickly said to the old man, "Do you have other conditions like hypertension or hyperlipidemia..."
The old man nodded, "Yes, I have those... but I've been on medication for them, and the control is alright. I was hospitalized in the fall for a stroke. After being discharged, I have been maintaining myself with medications, like aspirin..."
The old man was very clearheaded, speaking slowly but logically.
That was a good sign!
Chen Cang measured his blood pressure and it was normal, but he felt that he should still remind the old man.
However, after purchasing his medication, the old man was determined to leave and shakily made his way home.
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Chen Cang looked at the elderly man, filled with worry.
Xiao Lin was even more concerned, saying, "Doctor Chen... Could something happen to him?"
Chen Cang frowned, "It's hard to say."
Around 9 o'clock, the emergency phone suddenly rang.
"An elderly man in Anju Community, unit 9012, has suddenly developed speech difficulties and impaired mobility; he needs timely rescue."
Chen Cang nodded quickly, and without any hesitation, Xiao Lin got up and left.
The second-line duty staff also hurried to take over Chen Cang's shift.
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Considering the patient's condition, Chen Cang diagnosed it as possibly a cerebral infarction, but he couldn't rule out bleeding. Cerebral infarction generally wouldn't be life-threatening unless it involved a major vessel in the brainstem; however, bleeding could be unpredictable.
After the car arrived, Chen Cang, Xiao Lin, and the driver, Old Yang, went up the stairs together.
When Chen Cang and Xiao Lin saw the elderly man, they were stunned!
Wasn't this the same elderly man who had come to the emergency room for medicine just earlier?
The man's spouse was in a state of panic. After Chen Cang calmed her, he quickly took the elderly man back to the hospital.
Just as they arrived at the hospital, Chen Cang suddenly heard the system's notification sound.
[Ding! Chain task - Truth Triggered!
The final link: Save the elderly man, investigate the cause of illness, and upon completion of the task, you will receive a rich reward!]
After hearing this, Chen Cang was momentarily taken aback.
So this was the final link of the task?
By now, Chen Cang was considering not just the rich instance rewards, but also what the truth was!
Could VOLB antitussive syrup be the key factor in the causing the illness?
This time the clue was very straightforward. The likelihood of a cerebral infarction was seventy to eighty percent, and with hypertension, rheumatic heart disease... With so many underlying diseases, the possibilities were too great.
That's why it was even harder to judge because even without the antitussive syrup, the old man had a high probability of falling ill.
However, now wasn't the time to dwell on this. Chen Cang hurriedly had the elderly man brought in.
He was sent straight for an MRI scan.
The results showed multiple old ischemic lesions in the patient's brain, but there was a new acute cerebral infarction in the right frontal lobe!
Generally, if a cerebral infarction is suspected, an MRI of the brain is performed first; if bleeding is suspected, a cranial CT is preferred. These tests are more targeted for diagnosis.
Chen Cang called Doctor An from the department of neurology for a consultation. While treating, it was also necessary to find the cause of the disease.
When Doctor An learned that the patient had rheumatic heart disease with mitral valve stenosis, he also frowned.
He directly told the elderly man's wife, "Normally, blood flows smoothly inside the heart, but when the mitral valve is narrowed, blood cannot flow from the left atrium to the left ventricle at the normal rate. Blood accumulates and swirls in the enlarged left atrium, the flow rate decreases, which may lead to the formation of small blood clots, thereby laying the groundwork for a stroke."
"At the same time, prolonged mitral valve stenosis can lead to changes in the structure of the heart, such as dilation of the left atrium, and the dilation of the left atrium is closely linked to atrial fibrillation, which in turn is the most common cause of cardiogenic embolism."
Now it seemed like the truth had come to light.
The patient himself already had conditions contributing to blood viscosity; with mitral valve stenosis, thrombi were likely to form, and the onset of atrial fibrillation had given the thrombus a place to go.
Everything was a reasonable explanation!
At that moment, Doctor An suddenly said to Chen Cang, "Director Chen, we shouldn't be focusing on the acute cerebral infarction right now. As long as we quickly improve the blood circulation in the ischemic area for a cerebral infarction, that's all that's needed—anticoagulation and thrombolysis can be done at the same time."
"But... the key issue is still the mitral valve problem."
"If we don't address the patient's mitral stenosis and control the primary disease, the cerebral infarction will recur, and not just once or twice."
Upon hearing this, Chen Cang nodded in agreement. Indeed, according to what the old man had said, he had already experienced two cerebral infarctions since the fall.
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