paranoianovel Chapter 727
Chapter 727
Lin Feng breathed a sigh of relief.
Piriformis fistula on the left side and no abnormalities on the right side.
Basically, the diagnosis can be diagnosed.
However, for further judgment, the patient was subsequently sent for a new CT.
Neck CT, because the patient has just done hypopharyngeal angiography, swallowed the contrast agent, and there is still a little contrast agent into the piriform fossa fistula, CT is still very clear.
The diagnosis is now definitive, and the patient is piriformis fistula.
As mentioned earlier, this piriform fistula is a very rare disease.
If it is not a well-informed emergency physician, it is basically not recognized as this disease.
The neck is repeatedly red, swollen, hot and painful, and most doctors will only consider thyroiditis, lymph node tuberculosis, or local abscess, cellulitis, thyroid-hyoid cyst, and so on.
In addition to the doctors of the otolaryngology department, there are only those who can think of piriform fistula.
In severe piriform fistulas, a lump in the neck may rupture, and an internal fistula and external leakage will form a penetration, and food or fluid from the throat may flow out through the fistula.
After learning the news of the diagnosis.
The patient and his parents burst into tears with excitement, and after tossing for so long, the question finally came to light.
Then it's time to develop a treatment plan.
Lin Feng's plan is to continue to fight the infection for a period of time and control the infection.
After entering remission, surgery is performed.
Left piriformis fistulectomy under general anesthesia!
Lin Feng handled the whole process.
During the operation, Lin Feng further judged the existence of a fistula.
Directly from the outside of the neck, Meilan (a very blue, blue-to-blackened contrast preparation) is injected, and wherever Meilan goes, it is the path that the fistula walks.
The surgery was very successful.
The patient was discharged after a period of recuperation.
In the later stage of the patient's review, the patient went well, and there was no redness, swelling, heat and pain in the neck.
......
Another day with clear weather.
Lin Feng had just rounded the patients in the emergency ward.
Back in the office, before I could sit down.
A bed doctor hurriedly ran over again, and when he saw Lin Feng, he hurriedly said: "Doctor Lin, the patient in bed 6 has a new condition!"
Hearsay.
Lin Feng immediately stood up.
Having just inspected the ward, he still had an impression of the patient in bed 6.
It was a middle-aged man, fifty years old.
In the past ten years, he has been diagnosed with type 2 diabetes, high blood pressure, and diabetic kidney.
10 days ago.
Because the patient has a skin lesion on the left foot.
It hurts a little, but it's not very painful, but the blister on the sole of the left foot is broken.
The patient is also very nervous, mainly worried that this is what the doctor repeatedly told him about his diabetic foot.
So I rushed to the hospital.
At that time, after a simple examination, it was found that the superficial sensation of the skin of both lower limbs of the patient was reduced, that is, the tingling pain was not obvious, which was obviously a manifestation of nerve damage.
It is also a complication of diabetes.
Diabetic foot was eventually diagnosed.
On the advice of the doctor, the patient chose to be hospitalized.
The main reason is that the patient's left foot wound is not well disinfected, and if the wound is allowed to heal as soon as possible, it is likely to spread, and finally the whole foot may have problems!
At the same time, hospitalization can also better manage the patient's blood sugar, blood pressure, etc., with some nutritional drugs, try to increase some help.
Diabetic foot is very troublesome, now it has damaged the neurovascular, don't just watch the foot rot.
Diabetic foot can also be accompanied by infections and antibiotics must be given.
During hospitalization.
The patient's glycated hemoglobin was 7.5%.
Far from up to par.
The patient took the medicine on time, but he couldn't control his mouth.
Of course, it is better than before, and the blood sugar monitored before will appear 8, 9, 10!
Today, Lin Feng just finished inspecting the ward.
The patient's wife bought a few buns and prepared to give the patient a little, although the appetite was not very good, but breakfast was still to be eaten, and the patient was just about to open his mouth to take a bite, only to find that his mouth began to struggle.
The mouth can't open wide!
This condition was discovered by the patient's wife.
No matter how much the patient tried, his mouth just couldn't open wide, as if he was shackled.
I can only barely eat a small bite of the buns, and I feel that I have no strength when I bite it!
From time to time, I have a headache and feel that my neck is hard.
The tube bed doctor just discovered this situation and immediately came to inform Lin Feng.
After coming to the ward.
Lin Feng did not wait for the patient to speak, so he stepped forward to examine him.
Mainly some meningeal irritation was examined.
After the examination, he asked softly, "Is there any vomiting?"
"No vomiting! I just don't feel like I have a good appetite!" the patient shook his head.
The patient has a headache and a hard neck, and must be vigilant for intracranial infection.
Then he asked the nurse on the side: "Does the patient have a fever in the morning, and has he had a fever recently?"
The nurse shook her head repeatedly.
When intracranial infection occurs, it is likely to invade the meninges, and inflammation and stimulation of the meninges will lead to neck stiffness.
This is also a red flag.
However, yesterday, the patient's white blood cell count was normal, not like a bacterial infection.
If there is a bacterial infection, especially an intracranial infection, then the white blood cell count in the blood will definitely be significantly elevated!
Without waiting for Lin Feng to continue to ask.
The patient's wife said: "Doctor, my husband is also uncomfortable with his mouth, he can't open it soon, and eating is about to become a problem!"
Hearsay.
Lin Feng immediately looked at the patient.
At this moment, the patient was very cooperative and tried to open his mouth, wanting Lin Feng to check it, but he couldn't open it wide.
"Open wider!" said Lin Feng softly.
The patient immediately showed a bitter look on his face and said softly: "This is already the largest!"
Lin Feng immediately examined the patient's mouth and found that the muscles around his mouth were abnormally tense.
Then he whispered: "Relax, relax! I won't hurt you!"
"I'm already relaxed!" the patient replied immediately.
Swish~~
"Tetanus!"
Lin Feng's mind immediately appeared this condition.
Then he immediately asked, "Have you suffered any trauma recently?
Tetanus is usually a specific infection associated with trauma.
The germ is tetanus bacillus, an anaerobic bacterium that may come into contact with tetanus bacillus when the human body is traumatized, because this bacillus is widely distributed in nature, especially in soil.
This is also the reason why Lin Feng asked whether the patient had a history of trauma.
The patient shook his head.
Lin Feng continued to ask, "Then how did you come to your broken foot?"
"Doctor, it's really a fart. I've always been wearing shoes and I've never had any trauma!" said the patient with a helpless look.
The patient has no obvious trauma, especially without deep assassination, etc. to create a hypoxic environment, basically there can be no tetanus!
But the patient's situation is very similar to the symptoms of tetanus!