333. Tuberculosis and massive hemoptysis

Author: Hao Xifeng

333. Tuberculosis and massive hemoptysis

Tuberculosis has a long history and has coexisted with humans for thousands of years in a sporadic state. The description of it in medical books is also very vague, and it seems more like a physical trouble than a fatal disease.

It was not until the Industrial Revolution in the 19th century that the urbanization movement accelerated, and the urban population increased sharply on an unprecedented scale. A large number of laborers poured into the city to compete with each other for the upper class to use the remaining living space. The environment was harsh, and the medical level was poor, making this period of time a

This is an excellent opportunity for the spread of tuberculosis.

They can spread to all classes of society, and poor people have become the main targets of invasion because of their low resistance. From the Battle of Waterloo to the outbreak of World War I, the mortality rate from tuberculosis among adults aged 20-60 was 97%.

The complexion of tuberculosis patients is usually pale, and the characteristic flush only appears in the afternoon, so people call tuberculosis the "white plague".

Everyone knows about the "White Plague", everyone wants to cure the "White Plague", and everyone has no way to deal with the "White Plague", including the top doctors in the world. They don't even know the cause of the disease, and

The battle against the plague had already been overwhelmed by the wave of defeat before it even began.

Twenty years later, after Koch proposed the concept of Mycobacterium tuberculosis, they realized that all the efforts of doctors in the past century had been on cotton.

In fact, even Kavi has to be among them.

In the 19th century, there were no isoniazid, rifampicin, ethambutol, sodium para-aminosalicylate, and streptomycin, and tuberculosis was difficult to contain. Even the diagnosis he was good at would be limited by the lack of imaging and difficult to make.

Make a clear judgment.

It's just that Kawei is stubborn by nature, or it can be said that most top doctors have this problem. And he has more experience and methods to fight the white plague, which allows him to struggle to take a leg away from the tide of failure.

, reluctantly took a difficult step, stepping on the dry shore that only the winner deserves.

"Is it tuberculosis and hemoptysis?"

"Yes, yes!" The nurse's clothes were covered with splattered blood, and she looked very nervous. "There's too much bleeding."

"Karen!"

Just when Kawei was about to call the people, he realized that his team was in the surgical theater, and the pituitary extract solution that could immediately stop bleeding was left there together with other equipment and medicines. The nurse in front of him was too unfamiliar, and he could not trust him

, you can only do some basic first aid knowledge by yourself.

He casually pulled off a piece of tablecloth, took a pillow, some pieces of gauze and a stethoscope, and ran out with the nurse.

The patient was in his forties, his face was pale, and he was kneeling on the ground with his hands on the ground. There was a small pool of blood in front of him. It didn't look like a large amount, but it made a difference when you add the blood in front of the nurse.

Kawei quickly stepped forward and covered the blood on the ground with gauze. He felt for the pulse with one hand and put on a stethoscope for auscultation examination.

The radial artery pulse is brisk, the breath sounds in the right lung are low, and there are areas where the breath sounds disappear. The patient is lucky, at least there is still hope for treatment.

"Put him down and get the stretcher."

"Lie down? He can't sleep flat. He feels chest tightness and shortness of breath as soon as he lies down, and he may even have more hemoptysis."

As soon as he finished speaking, the patient was already lying down easily with the help of Kawei. It was just that he was not lying on his back but on his side, or according to Kawei, it is called the affected side position. This sleeping position + the upper cushion is underneath

The compression can play a certain role in compressing and stopping bleeding, and can be regarded as a first-aid measure. [1]

"The amount of bleeding is not small, it is estimated to be 200ml, and a few more people will come!"

The patient's settlement comes second. As long as the patient can choose to lie on the affected side according to Kawei's method, subsequent bleeding can be effectively reduced.

But this can only provide temporary relief, and it is impossible to require patients to choose this sleeping position all the time. Moreover, the course of tuberculosis is extremely long, and it is very unrealistic to rely on side-lying compression alone.

With hemoptysis to such an extent, there was no chance based on the medical standards of the 19th century. Kawei hoped to give it a try with surgery, which would at least extend his life and buy time for lung resection in the future. But what was in front of him was not just the weak patient with hemoptysis.

The body, and the difference between the medical and surgical rooms.

"Dr. Kawei, thank you for your help. Leave the rest to me."

Apparently the nurse not only found the surgical ward closest to the corridor, but also went all the way to find the internist: "My name is Sneed, and I am his attending physician."

"He needs surgery." Kawei didn't explain to him.

"Haha, Dr. Kawei is really a typical surgical thinker. Everyone he meets wants surgery to solve the problem."

Sneijder smiled and asked the nurse to start cleaning the corridor, and with the help of other assistants around him, he squeezed out Kavi's position: "This is a very serious form of tuberculosis. Ordinary medical treatment is difficult to achieve, let alone surgery."

Kawei had no choice. Surgeons were inherently lower than internal medicine, and this was not the municipal general hospital where he dominated. As long as the other party opened his mouth, he had no room to refuse.

Of course, with his current status, it is still okay to make some necessary suggestions if he cannot refuse.

"I was just wondering why the medical patient came to the surgical ward. Where are you going?"

"Go to the electrical stimulation room." Sneijder pointed to the front door, "You can see it when you walk out of the door. I passed here simply because this road is the closest."

It was the familiar electrotherapy again, and Kawei was already numb: "Is the electric shock effective?"

"The effect is still there, the key is whether you can persist." Sneijder glanced at Kawei and thanked him again, "Thank you Dr. Kawei for your help. If you need help from the internal medicine department next time, please feel free to ask."

Kawei smiled and said, "No need for next time, I need your help now."

Sneijder:???

"I advise you not to help the patient up."

"You mean to use a stretcher?" Sneijder looked at him doubtfully, "Although hemoptysis is a troublesome symptom, electric shock combined with bloodletting therapy should be able to achieve certain results."

Kavi:???

After being reminded by the other party, he saw that there were bandages and gauze left on the patient's calf to stop bleeding after being bitten by a leech.

"The amount of bleeding caused by hemoptysis is so huge, why do we need to use bloodletting? Isn't bloodletting on the limbs the same as spontaneous bleeding in the lungs?"

"Of course it's different. Hemoptysis will only occur when the lungs are too sticky and wet, which means there is too much fluid in the body." Sneijder should be considered an old-school student in traditional medicine, and he is already comparable to some physicians at the Municipal General Hospital.

Comparable, "I heard that Dr. Kawei has not experienced systematic medical teaching, I think."

"I have graduated from the University of Vienna." Kawei interrupted his guess.

"oh?"

Sneijder was a little surprised, but after a quick adjustment, he was ready to use his degree to continue suppressing it. However, the patient did not give him this chance. As soon as he was helped up by the nurse, he started coughing again after taking two steps.

"Dr. Sneed, he's coughing up blood again!"

"Hurry and help him to the electrical stimulation room."

Sneijder firmly believed that moderate electric shock could alleviate the symptoms of tuberculosis, and he also firmly believed that hemoptysis would not cause too much harm. The real trouble was the impact of tuberculosis itself. But it was easier said than done. The patient's body simply could not support it, and

Once it fell to the ground.

"Where's the stretcher?" Sneijder finally gave in, "Hurry up and get a stretcher!"

"I'm coming."

"Come, let's carry him up together."

Kawei saw that he ignored the position he had placed, and sighed: "You must immediately apply pressure and stop the bleeding according to the position I just placed, otherwise the person will die soon!"

"Don't worry, this is not the first time he has coughed up blood."

Sneijder still refused to listen and stood beside the patient to help, preparing to put the patient on a stretcher. However, several drastic changes in position further aggravated the patient's pulmonary bleeding, and he coughed again.

The blood was like exploding shotguns, spraying blood dots of different sizes on his face and clothes, and also dissuaded the nurses and assistants on both sides.

The two approaches brought about two completely different results. In the eyes of others, there is no need to judge which one is better by academic qualifications.

Nurses and assistants have no right to treat patients, and anyone who wants to keep their job will not question Sneijder's treatment plan at this time.

But seeing that the patient was about to be tortured to death, the nurse who just called for help thought of an impossible solution: "Dr. Sneed, the electrical stimulation room will not allow him to receive electric shock treatment while hemoptysis. The patient who did this last time has already

."

"I know!" Sneijder took out a handkerchief and wiped the blood on his face, "Forget it, send him back to the ward and observe him for a while."

The nurse agreed quickly, but her hands and feet slowed down significantly. She looked at Kawei with an expression of "I've tried my best, help him quickly."

Kawei didn't have time to look at her expression. In his heart, the hemoptysis patient was already his patient: "Dr. Sneed, surgery is not what you think. He can completely relieve the symptoms of hemoptysis through surgical treatment."

"What do you want to do? Stuff cotton into his chest to stop the bleeding, or cut out his lungs?"

Kawei was a little surprised: "These two answers are quite close."

"Don't be ridiculous, surgery will only cause more bleeding, and he won't even survive until the ether effect ends."

Kawei simply judged the amount of hemoptysis in the subsequent two times, checked his heart rate and current mental state, and said: "The situation is not bad now, the surgery is still effective, at least I can ensure that the number of hemoptysis is not too much. But if it passes

During this period, the surgery will only become more difficult."

Sneijder looked at the blood wiped off the handkerchief and said nothing.

"Even if we don't need surgery, I still have medicines that can stop the bleeding." Seeing that he didn't continue to refute, Kawei knew that his words had an effect. "You should know better than me what the final outcome of hemoptysis caused by tuberculosis will be."

The construction of the new urban areas in Paris attracted a large number of laborers and also increased the infection rate of tuberculosis.

Although Sneijder has not yet reached the level of director, he has taken on a large number of tuberculosis patients, and he understands the frustration of not getting good results despite all his efforts. Looking at it from another perspective, his persistence is actually the same as that of Kawei.

Yes, it is essentially different from the old stubborn who still insists on opposing after seeing the effect.

"Surgery. Are you sure surgery can solve it?"

Kavi nodded.

While wiping the blood on his body, Sneed looked at the patient lying on his side. After struggling for a moment, he said: "What are you going to do? Can you give me a plan to convince me to support you?"
To be continued...