Chapter 1800: 1738 Fall and Shock—Which Came First

"What's the matter?" Zheng Ren asked.

"A female student fell while going downstairs." Su Yun's expression was slightly strange, but she spoke quickly, "She came to the hospital for examination, and it was found that she had right lower lobe pneumonia with a large amount of pleural fluid in the right chest cavity."

"What about Fang Lin's side?" Zheng Ren asked.

Su Yun glanced at Zheng Ren while driving and asked, "Did I tell you that she fell while going downstairs?"

"……"

"Cranial injury, left temporal bone fracture with pneumocephaly, traumatic shock, occipital…… this isn't important." Su Yun said, "Fang Lin went for a consultation, felt something was off, and called me to ask."

"How did you consider it?"

"A large amount of pleural fluid in a 19‑year‑old girl—what would you consider?" Su Yun asked.

"Tuberculous pleuritis—my first impression is that." Zheng Ren said: "But considering the fall, which also caused a left temporal bone fracture and traumatic shock, we cannot rule out that she fell because of the shock."

"Shock, accompanied by a large amount of pleural effusion—I'm considering that too." Su Yun said.

"Let's take a look first." Zheng Ren pondered the patient's condition, his hand unconsciously returning to the state of reading films.

"Boss, if you keep this state on the road, you look really cool, silly cool." Su Yun said.

"Shock, pleural effusion…… what if they're unrelated? Just a simple pleural effusion?" Zheng Ren didn't respond to what he said, but instead muttered to himself.

"If that's the case, it would be simple."

"By the way, how did Fang Lin consider the patient after seeing him?"

"The patient has a left temporal bone fracture with pneumocephaly, but there's a large bruise on the right lower leg; he thinks it might be a vascular embolism." Su Yun said.

"Not bad, Fang Lin." Zheng Ren said, "For thoracic medicine to immediately consider a thrombosis is uncommon. The patient might have a pulmonary embolism…… maybe…… no, it must be a pulmonary embolism!"

"Boss, pulmonary embolism is pretty common, okay!" Su Yun said disdainfully, "It's just that this patient's situation is more special, so Fang Lin ordered a cardiac ultrasound on one hand and called me to consult on the other."

"I think Fang Lin's diagnosis is based on evidence." Zheng Ren imagined the patient's condition in his mind and said, "What's strange is that a young student would have a large amount of pleural effusion, which is rare. Falling and losing consciousness, on the other hand, are quite common."

"Yeah, adding the bruise on the leg, I think Fang Lin's reasoning process is like that."

"Right." Zheng Ren said, "No problem, after the examination we'll probably have a definite diagnosis before we even get back to the hospital. Maybe the thrombolytic drugs have already been used……"

Saying that, Zheng Ren froze for a moment.

Cerebral hemorrhage and thrombolysis are two completely different treatments.

If we use low‑molecular‑weight heparin sodium plus warfarin for thrombolytic therapy, would the left temporal bone fracture cause massive bleeding, possibly leading to brain herniation?

But if we don't treat it, just the clot alone could be fatal!

"When will the car arrive?" Zheng Ren asked.

"3 minutes."

"Tell Xiao Feng to rush to the hospital." Zheng Ren's tone immediately became urgent.

Su Yun froze for a moment.

"Fang Lin, are you with the patient?"

"Call and urge him! Do the cardiac ultrasound right away!" Zheng Ren shouted, "If we find any problem, immediately call a hospital‑wide consultation, with vascular and cardiology departments together."

"I'm considering it might be a pulmonary embolism with fainting; the situation is urgent. We can't use large amounts of anticoagulants—we need an emergency thrombectomy." Zheng Ren said.

Having said what needed to be said, Zheng Ren hung up the phone.

Su Yun also finished his call, saw Zheng Ren's somewhat hurried expression, and asked, "Boss, are we overreacting?"

"Fang Lin's intuition is correct!" Zheng Ren said firmly, "A left temporal bone fracture hardly causes a large bruise on the right lower leg; that's due to deep‑vein thrombosis in the lower limbs."

"So young……"

"Birth control pills might cause lower‑limb venous thrombosis." Zheng Ren said, "Hurry back, keep in touch with Fang Lin."

Saying that, a car with its hazard lights on pulled over not far away, and at the same moment Su Yun's phone rang.

Su Yun glanced at the license plate and then walked over.

Getting in the car, Zheng Ren heard a "ding‑dong" task notification sound in his ear.

【Urgent Task: Misdiagnosis.

Task content: Often people focus on the "main" symptom, especially bleeding. But the underlying disease is more serious, even fatal. Please promptly rescue a patient with pulmonary embolism.

Task time: 3 hours.

Task reward: 10000 experience points, 1000 skill points.】

"Uh…… Zheng Ren hadn't seen a task with such meager rewards in a long time."

However, the appearance of this task mainly served to confirm the earlier guess—whether it was Zheng Ren's, Su Yun's, or Fang Lin's, all were correct.

It's a pulmonary embolism! Not a temporal bone fracture with pneumocephaly.

The so‑called traumatic shock is also a misdiagnosis. The shock symptoms appeared because of the pulmonary embolism; trauma is something for later.

It is the clinical pathological physiological syndrome where various emboli from the systemic circulation detach and block the pulmonary artery and its branches, causing pulmonary circulatory obstruction.

The most common emboli in pulmonary embolism are thrombi; pulmonary embolism caused by a thrombus is also called pulmonary thromboembolism.

The patient suddenly experiences unexplained weakness, pallor, cold sweats, dyspnea, chest pain, cough, etc., and also shows cerebral hypoxia symptoms such as extreme anxiety, fatigue, nausea, convulsions, and coma.

A transient cerebral hypoxia leads to coma, which then results in the fall.

And the large amount of fluid in the right pleural cavity suggests obstruction of the right pulmonary artery, indicating acute pulmonary embolism.

The patient's current blood oxygen saturation is……

Zheng Ren thought, and simply entered the system space to purchase surgical training time.

The system operating room rose up from the ground, and Zheng Ren went straight in.

The experimental subject lay honestly on the operating table, diagnosis——pulmonary embolism, bilateral lower‑limb deep‑vein thrombosis, etc.

Compared to pulmonary embolism, other diagnoses are hardly worth mentioning.

Zheng Ren glanced at the experimental subject's ECG monitor; the blood oxygen saturation was 85%, a very dangerous value.

Let's do the surgery—there's no other way. Zheng Ren took a deep breath and began the thrombectomy.

Generally speaking, after a deep vein thrombosis clot breaks off, it follows the blood flow to the right atrium, then to the right ventricle, and then flows into the pulmonary artery, which would block a branch of the pulmonary artery or a larger pulmonary artery.

This is one form.

Also, small clots in the lower limbs keep breaking off, causing continual blockage of the pulmonary arterioles, ultimately leading to a major blockage.

Another cause is that a clot formed in the right heart system detaches, flows into the pulmonary artery, causing pulmonary embolism, such as congenital heart disease leading to right atrial enlargement forming a thrombus, which then detaches, etc.

The patient before us has a deep vein thrombosis in the lower limbs.

Zheng Ren still has considerable confidence in thrombectomy.

However…… after the thrombectomy catheter passed through the inferior vena cava to the right atrium and right ventricle, he was stunned.