Chapter 260 Intravenous Drug Addicts

Lu Chen looked at the patient's elbow joint, calmed down, and murmured: "This may not be a rash!"

"Not a pinhole?" The nurse on duty frowned.

Lu Chen leaned over and continued: "Look carefully, this may be a pinhole! Some pinholes are a little infected, so they appear like a rash."

As soon as these words came out, everyone was stunned.

Li Qinghua was also surprised.

He leaned forward and took a closer look.

It was really a pinhole, densely packed, just near the patient's left elbow vein.

"The patient also has a lot of such rashes on his right hand, it's really a pinhole!" The nurse on duty turned up the patient's right sleeve again.

She was changing the patient's hospital gown and found these details.

"If it's really a pinhole, it's terrible." Lu Chen frowned and said slowly.

Li Qinghua also nodded in agreement: "Well, then we can't do thrombolysis."

At this time, Yin Xinhua walked into the ward and heard the conversation between the two. He wondered: "Why can't we do thrombolysis again?"

Li Qinghua paused, looked around, and saw that the patient's family was not there, so he slowly said.

"He is very likely to be taking drugs."

Lu Chen also agreed with Li Qinghua's point of view.

There are so many pinholes on the body, there is only one possibility, that is, taking drugs!

When the nurse on duty heard this, she immediately let go of the quilt in her hand, hurried to wash her hands, and changed her gloves.

Lu Chen then exposed the pinhole part of the patient to Yin Xinhua.

Yin Xinhua looked surprised.

Seeing this, Li Qinghua immediately said: "Don't be too scared, just take personal protective measures. If he is really a drug addict, he may have STDs or AIDS, but the possibility is not high. Just be careful."

After speaking, Li Qinghua looked at Yin Xinhua and Lu Chen on the side, "So I think the patient may not have ordinary pulmonary embolism!"

"Well, at least it may not be pulmonary thromboembolism." Lu Chen nodded slightly.

Li Qinghua continued: "If the patient is really a drug addict, then the fever may be related to the infection caused by this. Our CCU had a similar case two years ago, infective endocarditis in drug addicts, causing long-term fever. Infective endocarditis will have cardiac vegetation. If there is vegetation on the right heart, once it falls off, it may also cause pulmonary embolism."

If the patient really has infective endocarditis, then the detached emboli are bacterial clumps and tissues.

This is not a thrombus, so there is no need for thrombolysis!

Thrombolytic drugs are for blood clots, and they are of no help to bacterial and tissue masses. At this time, thrombolysis will do more harm than good.

Although this possibility is very small, it makes sense and can explain the current symptoms of the patient.

Yin Xinhua frowned and said, "But Lu Chen and I have both auscultated the patient's heart and heard no obvious heart murmurs. If the patient really has such obvious cardiac vegetation, murmurs should be heard."

Li Qinghua shook his head and said seriously, "That's not necessarily true!"

"First of all, the vegetation may not be very large. In addition, the patient was breathing so fast at the time that auscultation was easily disturbed."

"Let's call the cardiac color ultrasound teacher over and let them take a look at the heart. After all, we are not as professional as them. They may be able to see cardiac vegetation and pulmonary embolism."

Yin Xinhua nodded: "Now we can only wait for the teacher in the cardiac ultrasound room to come."

Lu Chen took the portable ultrasound machine and looked at the patient's heart several times, but still could not see cardiac vegetation and pulmonary embolism.

There is no way, his cardiac ultrasound skill card is only elementary.

After understanding the patient's condition, Yin Xinhua immediately called the family member's sister over.

"Do you know about the needle hole on his elbow? Does he have any bad habits..."

The patient's sister was confused and almost cursed.

"How could my brother take drugs!"

Yin Xinhua comforted the patient's family: "We just suspect it. Whether he takes drugs can be tested. I also asked you if you know."

The patient's sister didn't speak, and kept pulling her sleeves with both hands.

After a long silence, she continued to speak: "In fact, we haven't seen each other for more than half a year. He definitely couldn't take drugs before, and I can't guarantee it now."

Can't guarantee it now?

As soon as these words came out, Lu Chen, Yin Xinhua and Li Qinghua looked at each other.

They found that the patient's sister looked a little panicked.

Li Qinghua said, "To see if he is taking drugs, ask the laboratory or a testing agency outside the hospital to do a toxicology test. Use the patient's hair for testing. Generally, drug use within six months can be detected. And your brother's arms are full of pinholes. We have reason to suspect this."

The patient's sister almost collapsed on the ground when she heard this, with a hint of crying in her voice.

"My eldest brother is a drug user, but my younger brother is not... Doctor, I beg you to cure my younger brother..."

Seeing this, Li Qinghua whispered to Yin Xinhua, "The patient should be a drug user."

Yin Xinhua nodded calmly.

...

At this time, the ultrasound room doctor that everyone was looking forward to finally came!

The echocardiogram doctor took the probe and carefully looked at the patient's heart several times.

"It really is pulmonary embolism!"

Lu Chen and others immediately came forward.

The echocardiogram doctor pointed to a place on the screen.

"Look, there is an embolism in the pulmonary artery. Although it is not obvious, it is there, and there is a vegetation on his right heart valve. You really guessed it!"

When Lu Chen heard this, he was completely relieved and felt a slight chill down his spine.

It’s really dangerous!

If thrombolysis is performed directly, the consequences will be disastrous!

"In this case, the emboli should be a bacterial clump, not a thrombus." Yin Xinhua repeated.

Li Qinghua nodded and ordered at the same time: "Keep blood culture, monitor body temperature, and apply the strongest vancomycin, which will not dissolve thrombosis."

If the patient is really an intravenous drug user, then the infective endocarditis that occurred this time is likely to be related to intravenous drug use.

The most likely bacterial infection is Staphylococcus aureus, because this bacteria is most common on the skin and can cause infection at any time due to needle holes.

Staphylococcus aureus may or may not be drug-resistant.

But the patient ran out of time and had to cover it with the strongest vancomycin.

Vancomycin is a special class of antibiotics.

Applications must be submitted for this particular grade of antibiotics.

However, this is a special emergency situation.

Li Qinghua skipped the application and directly used vancomycin.

Soon, the nurse brought vancomycin from the pharmacy and gave it to the patient.

…

After Li Qinghua and the doctor in the ultrasound room left.

Lu Chen and Yin Xinhua looked at each other with lingering fear.

It's almost twelve o'clock in the evening. UU Reading www.uukansｈhu.netｔ

Yin Xinhua invited consultations from multiple disciplines, including ICU, respiratory department, ultrasound department and CCU.

After comprehensive consultation from so many disciplines, the correct conclusion was finally reached.

This patient is full of pitfalls.

If you are not careful, you will be in trouble!

On the other side, the ICU and respiratory doctors heard that the pulmonary embolism was caused by infective endocarditis in an intravenous drug addict.

They couldn't believe it at first, and they even came to the eighth area of ​​​​the heart. They were convinced when they saw the patient's arms were densely covered with pinholes.

"Damn, it's really rare to see people taking drugs these days. Drug trafficking should really kill the whole family!"

The icu doctor muttered before leaving the eighth area of ​​​​the heart.

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