Original title: husband repeatedly threatened to notify his wife is still smiling, two female doctors found terrible clues
Hu Ying, the chief physician of the Department of Nephrology of the second hospital of Zhejiang medicine and the deputy director of Wang Jianqing, had an experience that he had never had in this life. And successfully assisted the police to arrest the suspects.
This incident brought great shock to two doctors who had been doctors for nearly 20 years, and felt five mixed feelings in their hearts. Reporters understand the ins and outs, but also greatly regrets.
Things should be told in June of this year.
After three days of Chinese medicine, we got uremia?
In June 7th, it was a Thursday. The clinic of Dr. Xiao Huaying of the Department of Nephrology, Zhejiang medical second hospital, three people poured into the clinic. Among them, a tall, thin, 50 year old man is a patient, the surname Cheng (the pseudonym), the appearance still can, the mind is sober, just because of the throat swollen pain, can not speak. He pressed his stomach and said painfully: he has a stomachache and a marked decrease in his urine.
He was accompanied by his wife and son, his son, twenty years old, a round face, his wife's medium height, fat teeth, and his teeth.
According to family description, Cheng master a few days ago because of foot pain, in a local county clinic with a Chinese medicine to eat, did not want to eat two days to vomit diarrhea, third days to the local hospital to see, check out the kidney function is very bad, has been to the place of uremia, the local hospital felt serious, the Master Cheng to Zhejiang two to visit. Treatment.
Three days after hospitalization, the illness turned straight
Dr. Shaw made an emergency test. Cheng's blood creatinine was as high as more than 800 (blood creatinine was one of the indicators of the renal function, and the normal male was not more than 104umol/L). She felt that Cheng's situation really needed to be hospitalized.
On the same day, there was no hospital bed in the Department of nephrology. Dr. Xiao immediately transferred the patient to the emergency room. On the second day, Master Cheng gave priority to the hospital in the nephrology ward through emergency. The medical team composed of Hu Ying and deputy chief physician Wang Jianqing, director of Nephrology, is responsible for Cheng's treatment.
After admission, rehydration, acid correction, anti-inflammatory, hemodialysis, all the treatment in accordance with the uremia orderly conduct, Cheng master's condition seems to have gradually stabilized. However, not waiting for the doctors to relax, Cheng master's condition turned straight down: in less than three days, Cheng master's gluten transaminase, jaundice index progressively rose, which prompted the patient to appear liver failure; after that, Cheng began to feel anxious in chest, and the chest seemed to have been strangled by the rope as the same pain and big mouth. There is no breath in the ground. Blood oxygen saturation is only about 70% (more than 95% of normal people). Oxygen must be inhaled at all times.
How did it get so bad and changed so fast? The doctors can't think about it.
"When he was in the hospital, he was also given chest radiography, when his lungs were only slightly infected. We can't explain his breathing difficulties. Uremia does not deteriorate so quickly, and the condition is not so progressive. And our treatment for all kinds of uremia, including hemodialysis, continues to deteriorate. " Director Hu Ying said.
Intoxication of traditional Chinese medicine? There are only ordinary medicinal herbs in the prescription of traditional Chinese Medicine
Cheng master's condition is aggravated day by day, blood oxygen saturation has been declining (can be understood as the respiratory function is becoming weaker and weaker), Rao is experienced Hu director and Doctor Wang also can not solve it, they asked the Department of respiration, ICU, digestive department and other disciplines to consult, no results.
"A few days ago, several of our doctors were talking about the patient's condition almost every moment. How could it be so strange? We asked Cheng's wife again and again, and she said that Cheng was healthy before, liver and kidney are all right, that is, eating Chinese medicine for three days. That Chinese medicine is to eat three meals a day, the Master Cheng on the first day to eat no reaction, the second day began to vomit and diarrhoea, third days to eat a meal to do not. So he stopped eating and went to the local hospital to see that he had already had uremia.
According to the description of Cheng's wife, at that time everyone focused on the three days of traditional Chinese medicine, and wondered if Cheng was poisoned by traditional Chinese medicine.
Wang Jianqing, deputy chief physician, asked his wife to bring the Chinese medicine and prescription that had not been eaten to the Department of traditional Chinese medicine.
But after seeing the Department of traditional Chinese medicine, I think the prescription is all commonly used traditional Chinese medicine. It is unlikely that there will be such a serious reaction.
This idea doesn't work.
The brothers and sisters wanted to know what illness he had. His wife never asked a husband about his illness.
Because Cheng's illness is becoming more serious, doctors in the nephrology need to talk to their families every day to tell the disease, and the doctors have found that their families are too different.
When visiting patients, Cheng's brothers and sisters always ask the doctor what the disease is and why the more serious the treatment is. The hospital should be responsible! Sometimes the residents can't make sense to them. Director Hu had to go from home to the hospital to explain and communicate with them. Once he was called to the hospital at 11 p.m.
Master Cheng's wife is accompanying him every day in the hospital, facing her husband's situation, she is calm. Unless the doctor talked to her, he never asked a husband's condition, and said that if the rescue was not returned in the ordinary ward, she would not send him to the intensive care unit.
"But he is only in his fifties. How can he pull home? Acute onset, there is hope! If the oxygen saturation goes down again, only the ventilator in the intensive care unit can get the chance to come back. " Director Hu and Dr. Wang repeatedly persuaded the patient's wife.
"Can the guardianship guarantee that he must be good? We don't have any money in our house! "
How to do it? The cause is not clear. The family members are not active in treatment. Why should they give up so early?
Every day in the hospital, there are various kinds of human tragedies, and the doctors of all kinds of people have seen more. They just thought the wife was a little cold and didn't think much about it.
Would it be paraquat poisoning? Master Cheng and his family deny the history of pesticide contact
In June 13th, Cheng's breathing function was further exhaustion, oxygen flow under the oxygen storage mask had reached the maximum. He still had a hard breath, like the fish on the shore, full of red face, yellow dyed skin with jaundice, and a decrease of oxygen concentration to only forty percent.
A few times, his wife was still polite and smiling, but the director of Hu Ying and the deputy director of Wang Jianqing were very anxious, and he had been in the office to discuss Cheng's illness.
"Such a strange disease, do you say that someone will be poisoned?" Dr. Wang, for a moment, said a word.
This sentence quickly lit up the two doctors' brain holes. They looked at the performance of the Master Cheng again. The performance of this progressive respiratory failure was like the symptoms of paraquat poisoning, kidney failure, liver failure, progressive respiratory failure, and the more it looked like paraquat poisoning!
Paraquat is a highly toxic pesticide. So far, no special antidote has been found. The mortality rate of oral poisoning is 90%. Paraquat is composed of two chlorides and two kinds of dimethyl bisulfate salt, which can be absorbed through complete skin, respiratory and digestive tract. After absorption, it is distributed to all organs and organs of the whole body after absorption. It can lead to multiple organ failure, such as liver and kidney, pulmonary fibrosis (irreversible) and respiratory failure.
"Other departments may not think of this, but we are nephrology, there is a blood purification center, as long as the hospital received paraquat poisoning patients, we have to be sent to the blood perfusion, a activated carbon like material, the blood of the patient all filtered, the poison adsorbed into the perfusion apparatus, To play the role of blood purification. "
In these years, two doctors have seen hundreds of cases of paraquat poisoning and hundreds of cases, so it is very clear that the symptoms and progress of the patients are very clear.
Of course, the symptoms are similar and do not show that the Master Cheng must be paraquat poisoning, two women doctors are also surprised by their own bold hypothesis, after all, Master Cheng and his family have never told them to have contact with paraquat.
The two doctors went to ask Cheng master and his family to deny that there was a history of pesticide exposure.
After discussion, they decided to give Cheng a check-up to rule out the possibility, but do not tell their families.
Is the link between paraquat concentration gone missing?
Director Hu issued a doctor's order, June 14 early in the morning to Cheng Shifu a little blood, and then leave a little urine for hematuria paraquat concentration determination.
"Sample sent in the morning, the test report will be out at one or two o'clock in the afternoon, we are waiting for this period of time is also very nervous, want to know the results early."
Kidney internal medicine because often contact with paraquat poisoning patients, sometimes the patient sent in the middle of the night, the laboratory can not do a test immediately, they have a descending earthwork to screen: with the patient's urine mixed two reagents, if turned blue green, may be paraquat poisoning, the deeper the color of the body The higher the concentration of the blight.
Two directors, and the first doctor Shaw doctor and other doctors, and other doctors and nurses, such as the results of laboratory tests, and so on, they can not stay up, the first use of the soil square, the Master Cheng's urine and the two reagents mixed, the result, the color really changed!
"The color is changed, but not very deep. Because he's been in our hospital for a week and he's been doing dialysis all the time, it's possible that the paraquat concentration in his blood has been washed down.
To be on the safe side, the two directors also took their own urine samples for reagent mixing and comparison, and it turned out that their urine samples did not change color at all.
"We are more suspicious in the heart, but because this is only the earth law, can not be a 100 percent definite basis, so we immediately call the laboratory to ask the results of the test. However, the laboratory said that the blood paraquat concentration was negative, that is, it can not be detected. But the laboratory urine specimen, laboratory did not receive.
Where did the urine specimen go?
Director Hu was a little surprised at that time, the blood was drawn by nurses, urine samples are usually left for workers to take away by family members, is it his wife forgot to give her husband urine samples?
Hu asked the nurse of the day, and found that Cheng's test report of "routine urine" had been sent back. That is to say, Cheng master to use urine to do two checks that day, do "urine routine" test tube is sent, but do "urine paraquat concentration measurement" of the test tube is not.
Which part is probably wrong? Director Hu didn't think much about it either. At two o'clock that afternoon, she asked the nurse to take another tube of Cheng's urine. Dr. Wang Jianqing sent it to the laboratory in person.
"In fact, we only do two times a week in our laboratory. All the samples have been done on that day. For our uncertain imagination, doctors in the laboratory are also very good, reopen the machine to test us, and have been doing six o'clock in the evening."
In the evening, the report came out, and the concentration of paraquat in the urine of Cheng was 0.9ug/ml.
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