Internal Medicine Internship

Outside the internal medicine clinic.

"Qin Feng, are you coming or me?"

After the three arrived, Wei Dajing looked at him and asked.

"It's up to you, I'll study, hehe~"

Qin Feng glanced at Zhang Chen next to him, shook his head and smiled.

"Cut! You are still so polite, so be it."

Seeing his eyes, Wei Dajing immediately understood, a sly look flashed in his eyes, and he pouted.

After the three of them sat down, Qin Feng consciously took a seat a little later than Zhang Chen.

You play, I'll watch.

In one afternoon, about a dozen patients were admitted, all of which were relatively simple questions.

Only one was found to be gallstones, which were about 1.5 cm in diameter and needed to be removed minimally.

"Qin, how is your study?"

When sitting bored, Zhang Chen took the initiative to turn his head and looked at Qin Feng behind him and asked,

"Show me your notes."

"It's okay, I feel like I've learned a lot."

He froze for a moment, then nodded quickly.

But looking at his notes was a little embarrassing, with only two or three lines.

It is mainly about the basic situation of two or three patients and an overview of possible symptoms. As for the treatment plan, the diagnosis in his heart is faster.

The results are also consistent with the inspection results, and there is no need to record.

However, Zhang Chen only glanced at it, his brows suddenly wrinkled, and his face was a little unhappy.

He had never seen such a careless intern before, how could he not even remember the patient's condition?

And only two or three patients are suspected of being sick. Although they are all correct, how can this work?

So irresponsible!

"Qin, what did you write? Why is there nothing?"

Zhang Chen slapped the note back into his hand in disgust, and said in a serious tone,

"Do you know that the most important thing for a doctor is..."

Just as he reprimanded and Wei Dajing was about to stop him, two young men in sports vests suddenly walked into the door.

One of them groaned while covering his stomach, looking painful.

"what happened?"

At this time, regardless of the reprimand, the three all looked at the patient. Wei Dajing asked when he saw it.

"Doctor...I..."

Pfft!

The boy just uttered two words, when he suddenly twitched a few times, and fell to the ground with his eyes closed.

He passed out! Also with a slight twitch!

"Hey hey hey! What's wrong with you? Can you hear me?"

The three were startled, Wei Dajing hurried over, patted the boy on the ground and shouted.

He didn't respond.

He hurriedly started a quick basic check and came to a few conclusions.

Nausea and vomiting, stomach cramps, and a low-grade fever.

Dizziness, unconsciousness.

"Is it a gastrointestinal infection?"

Zhang Chen subconsciously said that this was the first judgment he made.

Qin Feng nodded when he heard the words, because these symptoms were indeed very similar to the signs of gastrointestinal infection.

"Not necessarily, some food poisoning is consistent with these symptoms, and it may also be poisoning."

He thought for a moment and said.

"However, it is still not possible to determine whether it is poisoning or gastroenteritis, and further examinations are necessary."

"Good!"

When Zhang Chen heard his words, his eyes lit up, and he nodded in approval with a little satisfaction.

Qin Feng touched his nose, this guy is really aggressive.

Don't forget to show confidence at this time.

Impressed...

In fact, this problem is very simple. As long as medical students have seriously studied internal medicine textbooks, they can roughly judge it.

It's just that these two diseases are often easy to confuse doctors under normal circumstances.

Because the symptoms of gastroenteritis and food poisoning are too similar!

Gastrointestinal infections are generally caused by viral infections that primarily attack the body's digestive system, causing symptoms.

Food poisoning is caused by bacteria, viruses or parasites contained in food, which may enter food during production and operation.

Therefore, although the mechanisms of these two diseases are different, the actual symptoms are actually similar.

This is why both diseases are so difficult to diagnose!

"Nurse, take him first..."

Wei Dajing just opened his mouth and called out.

"Yuck~"

Just then, the sick boy suddenly started vomiting while in a coma.

A mouthful of blood-stained vomit spewed out directly onto the clothes of Wei Dajing and Zhang Chen ahead.

And Qin Feng was not affected because he stood behind them.

The two frowned slightly, but they didn't move. Zhang Chen was still examining the patient, and he didn't care about the dirty and unpleasant smell on his body.

"Good." Qin Feng nodded slightly when he saw this.

Although it is really annoying to pretend to be forced, the professional level is still quite solid.

But then, he was attracted by the vomit splashing on the ground.

"Blood~"

When the three of them saw this, their minds froze at the same time!

If it is just vomiting, diarrhea, and unconsciousness, these are not too serious.

But now there is a situation of vomiting blood, which means that the disease is probably more serious than they thought!

"What is your relationship with the patient?"

Zhang Chen immediately looked up at the sluggish boy beside him and asked in a deep voice.

"Ah? I...I'm his classmate."

The boy came back to his senses when he heard the words, and said quickly.

"Then has he had any abnormalities since last night? Special symptoms such as vomiting?"

When the boy heard Zhang Chen's words, he fell into deep thought.

After a moment he shook his head.

"I haven't found it, it's normal! We also drank a cup of soy milk together in the morning and ate two buns."

The voice fell,

Wei Dajing and Zhang Chen looked at each other and frowned.

What's going on here? If it is a gastrointestinal infection, or food poisoning, it is absolutely impossible for the disease to develop so fast!

"Has anything similar happened at the school recently?"

Qin Feng asked.

The boy shook his head again.

"No, never heard of it."

...

For a while, the three fell into silence, and now there is no other way but to check first.

Wei Dajing quickly billed, took blood, vomited tests, B-ultrasound...

In order to rule out all possible symptoms, a detailed examination is necessary.

At this time, the nurse had already pushed the stretcher, and the three and the boy worked together to lift the patient and put it on the stretcher.

"Take him to check first, and notify his parents to come over quickly."

"Okay, I'll call right away."

Hearing Wei Dajing's words, especially the checklist in his hand, the boy panicked and nodded vigorously.

Take out your phone and start calling.

"Wait a minute!"

Just when the nurse was about to push the unconscious boy away, Qin Feng suddenly stopped him.

Everyone's eyes turned to him at the same time, Zhang Chen's face became sullen, and he was about to open his mouth to reprimand.

He saw Qin Feng suddenly lift up the unconscious boy's clothes, exposing his upper body.

Suddenly, everyone's expressions changed!

I saw red swellings floating on the upper body of the boy, the big ones were the size of a thumb, and the small ones were like soybean grains.

Distributed in various places on the chest, it looks a little oozing.

The boy classmate's face instantly turned pale when he saw this, and he subconsciously took a few steps back.

"Angioedema!"

At this time, Qin Feng, Zhang Chen and Wei Dajing said in unison.

Angioedema, also known as angioedema, giant urticaria.

This disease mostly occurs in places where the skin tissue is relatively loose, usually limited edema.

"This is....."

Wei Dajing frowned and didn't react.

"It may be [food-dependent exercise-induced allergic reaction]!"

"Food-dependent exercise-induced anaphylaxis?"

Qin Feng and Zhang Chen spoke almost at the same time.

The words fell, and the two looked at each other subconsciously, especially Zhang Chen.

He looked at him in surprise, the reaction speed is so fast!

Because this kind of disease is really uncommon, even some internal medicine doctors will never meet one in half their life, and they can only see it occasionally in books.

This is a very special disease, because the reason it induces is unbelievable!

Although he is a food allergy, he needs certain predisposing conditions.

sports!

Some people develop a dangerously high-risk severe allergic reaction within 4-6 hours of vigorous exercise during gastrointestinal digestion after eating foods such as seafood, high-fiber foods such as celery and spinach, and wheat.

In mild cases, the body itching is unbearable, rash appears, etc., and in severe cases, symptoms such as dyspnea and laryngeal edema obstructing the trachea may occur.

If the rescue is not timely, it will easily lead to life-threatening!

However, many physicians will treat this situation as a general allergy, and they will never think of such a special disease.

The judgment made by Qin Feng and Zhang Chen is also because of the sportswear on the boys, because there is nothing wrong if they don't exercise.

It's so amazing!

"Hoo~ho~ho~ho~"

There was a low, muffled sound in the throat of the boy on the stretcher.

The two looked at the same time, and the patient's face was flushed at this time, and his lips showed signs of puffiness.

Breathing with mouth open, tracheal gasping seems to be a little difficult.

These are the symptoms of allergies!

And now, all the symptoms and signs point to a point.

Completely consistent with the symptoms of food-dependent exercise-induced anaphylaxis!

"Did you just go through a lot of exercise?"

Qin Feng asked immediately.

The boy standing beside him nodded.

"Yeah, there is a sports meeting in our school today, and I just finished running 1,500 meters."

"For sure, this should be a food-dependent exercise-induced anaphylaxis."

Zhang Chen nodded and said firmly.

And Wei Dajing, who was on the side, finally remembered it, and couldn't help being a little surprised.

"Really, I didn't expect to encounter such a strange special allergy."

Qin Feng stepped forward and held the unconscious boy's wrist, his skin was a little cold, his pulse rate was fast, and his heart rate reached at least 180!

Bean-sized sweat also appeared on his forehead, and it began to drip down, and his face became pale.

Palpitations, chest tightness, profuse sweating, pale face.

Anaphylactic shock!

"It's too late to check, go into the emergency room to save people first!"

Qin Feng said nothing, and rushed into the rescue room with the nurse pushing a stretcher.

Anaphylactic shock is already very serious, and the immediate allergic reaction of the immune system modifies the vascular microcirculation and increases tissue permeability.

If it is delayed any longer, people will be completely useless!

Zhang Chen and Wei Dajing, who were behind them, also ran all the way and rushed into the rescue room.

"I've dealt with this condition, here I come!"

When Zhang Chen saw this, he wanted to take the equipment and said loudly.

Qin Feng reached out and stopped him.

"Wait, you go and change your clothes first, I'll do it first."

After he finished speaking, he pointed to the white coat and shoes and pants on him, which still had residual vomit.

In the process of rescue and treatment, aseptic operation should be ensured as far as possible to avoid cross infection.

This is common knowledge for medical students!

Zhang Chen looked at himself, understood in an instant, and withdrew his hand.

But he didn't leave, but stared at Qin Feng with a look of surprise.

he comes?

How could an intern possibly operate on this particular allergy?

It's shock now!

But Wei Dajing, who was on the side, didn't speak. Instead, a surprised expression appeared on his face, and he took the initiative to go to a place with a good view to start watching.

...

Zhang Chen was speechless when he saw this scene. He didn't even care about teaching the doctor?

What if this happens?

This is life!

"Refill immediately!"

Qin Feng ignored his worries and frustrations, and immediately instructed the nurse to put a retention needle on the unconscious boy.

According to the principle of shock, rapid rehydration was carried out, first fast then slow, first crystal and then glue, and potassium was increased.

After shock occurs, because the microcirculatory perfusion of vital organs can be drastically reduced, fluid replacement is the key!

Disinfect, wear gloves...

A needle was inserted to establish a vein channel. In addition to the retention needle, Qin Feng opened another one.

After one minute, the solution is completed, normal saline, balanced salt solution, glucose...

These can rapidly increase the return to the heart and the pumping output of the heart, stabilizing the shock.

Subsequent infusion of plasma, albumin, etc. to reduce crystalloid extravasation of blood vessels.

As the fluid entered the body, the data on the monitor began to fall back.

The heart rate slowly dropped from 202 to 130, and in just 3 minutes, the shock was basically controlled.

On the other hand, Zhang Chen was already shocked!

He opened his mouth slightly and stared at Qin Feng in surprise.

"How... how is it possible? The speed is too fast! Faster than me!"

There was even a thought in his mind, that is, has this intern encountered this disease before?

Um!

It must be so!

Otherwise, it is impossible to recognize this special disease at a glance!

Even he himself had only met him once in the capital hospital, and this kid was lucky.

Qin Feng ignored his surprise and paid attention to physical examination every minute to adjust the speed and ratio of fluid replacement to prevent shock rebound.

And this process also surprised Zhang Chen!

Ten minutes later, the shock symptoms have basically disappeared.

Isn't this kid an intern?

How can you even adjust the fluid replacement through a physical examination?

Kind of awesome!

Unconsciously, his gaze towards Qin Feng changed, with a confident appreciation.

good!

It seems that I may have wrongly blamed him before, this intern is a good seedling!

"Good job, what's your name?"

Thinking of this, he took the initiative to walk over and asked Qin Feng with a smile.

"Qin Feng."

Qin Feng said flatly.

"Okay, I know."

After speaking, he turned and left the emergency room.

Only he and Wei Dajing were left, as well as two nurses who were equally confused.

Is this guy stupid?

Should he have such a reaction when he heard the name Qin Feng?

Could it be that there are still people in Jiangcheng who don't know who Qin Feng is?

At this time, except for Qin Feng, these two words popped into their minds at the same time.

Fool!