Nine years ago, we admitted one of our employees, and the imaging showed a circular irregular shadow in the lingual lobe of the left lung, because it was an employee of our hospital, I took the film to the provincial capital for consultation with several experts, some said tuberculosis, some said tumor, one of the professors said “tumor is rare in the middle lobe of the right lung, mostly tuberculosis or inflammation, but the lingual lobe of the left lung should be One of the professors said, “Tumors are rare in the middle lobe of the right lung, and most of them are tuberculosis or inflammation. I saw that nearly 80% of the lingual lesions in the left lung were tumors, but the patient did not adopt it and took conservative anti-tuberculosis treatment, which resulted in pericardial metastasis on chest X-ray six months later. Last year, I again admitted a patient, 50 years old, with diabetes mellitus, and the imaging showed a patchy irregular shadow in the left lung lingual lobe near the chest wall, no change in anti-inflammatory treatment, I gave her a percutaneous lung biopsy, suggesting inflammation, with the last lesson, I did not die, and asked a professor from a tertiary hospital to do a second percutaneous lung biopsy, still suggesting inflammation and tending to tuberculosis, the professor gave her a prescription for anti-tuberculosis treatment in January. I still did not give up and convinced the patient’s family to transfer the patient to a hospital in Shanghai, where two more percutaneous lung biopsies were done, and finally the diagnosis of lung adenocarcinoma was confirmed. The family came back and told me, just remember your words, “The lingual lobe lesion of the left lung should be highly considered as a tumor,” so the first percutaneous lung biopsy in Shanghai was inconclusive, and the doctor said to change the method. We didn’t hesitate at all when the doctor said to do it again. A patient diagnosed with cirrhosis/primary hepatocellular carcinoma in a local hospital presented with “vomiting blood” and was considered to be bleeding from esophagogastric varices or acute gastric mucosal lesions. After admission to the department, the patient was found to have fresh blood and a small amount of continuous “vomiting” during the duty check. He reported to the chief, who instructed him to “examine the oral cavity carefully”, and found that the patient’s right tonsil was II degree enlarged, with a large area of blood oozing from surface erosion. The initial diagnosis was “tonsillar hemorrhage – tonsillar cancer?” The patient was treated surgically and the bleeding stopped after the operation. Pathology: tonsillar carcinoma. An elderly man with a mass in the upper lobe of the right lung was diagnosed with pulmonary tuberculosis on open lung biopsy, but anti-tuberculosis treatment was ineffective for two months, and the lesion increased in size. Tuberculosis and cancer can co-exist. The patient had a history of tumor surgery 10 years ago (I can’t remember what tumor) and was admitted to the hospital for 2 weeks, but his symptoms were basically relieved, except for his blood WBC, which hovered between 11,000-13,000/uL. After reporting the medical history and examining the patient, the professor spoke: the patient’s situation is very good, long-term hormone patients, the blood picture can rise. One sentence made me feel ashamed, how could I not think of such a simple truth? (The patient had been taking hormone 5mg/d for a long time since the surgery.) The memory was too deep. Several other possibilities for postoperative hemoptysis I was on duty in the thoracic surgery department during my graduate studies. A patient who was 2 days postoperative for esophageal cancer and had been stable postoperatively had dark red blood drawn from gastrointestinal decompression (through the right nostril). The volume was not too much. There was a cough, but no cough with blood in the sputum and no hemoptysis. There was sudden hemoptysis at night, which was bright red with foamy blood sputum. The volume of gastrointestinal decompression increased by more than 200 ml in 2 hours. The hemorrhagic fluid was relatively fresh in color. Bleeding from the left nostril, also bright red blood. I was inexperienced in this area as well, and quietly ordered hemostatic drugs, and was confused whether the patient was vomiting blood, or hemoptysis, and the patient was still bleeding. The family repeatedly came to see me, and I immediately called the professor of the treatment team, who did not say that the nostril was also bleeding. So a gastroscopy was performed in an emergency. It turned out that there was no active bleeding from the anastomosis or the residual stomach. There was no positive result and I was baffled. An older nurse on duty told me, “Could the patient have a nosebleed? It was a lot of effort to lower the gastric tube.” I immediately woke up and urgently asked for an ENT consult, which revealed a posterior nasal tract bleed. A tamponade was given to stop the bleeding. The bleeding soon stopped. The next morning at the end of my shift, the chief praised me for my careful observation. I have to thank that nurse. Another patient with lung cancer was admitted to the hospital and given a lung puncture to characterize the lung; the patient recovered well after surgery and had no discomfort. The patient was given paclitaxel-based chemotherapy, along with dimethoate, meclizine, and granisetron to reduce the toxic side effects of the drugs. Two days after the administration of the drug, the patient developed coughing blood, but the remaining signs were not abnormal; he was considering giving adjuvant pulmonary examinations to exclude the possibility of bleeding from the surgical site or the tumor; the family said that the old man’s face was also red in the past two days, and it immediately came to mind that the patient was taking oral demi 7.5 mg Bid, and the coughing blood disappeared after giving discontinuation of the drug; when another patient later developed the same condition, he added Yunnan Baiyao without hesitation. Bone pain and tumor Shortly after graduation, working in the emergency department of internal medicine, there was a 70-year-old male patient who reported joint pain and low-grade fever. On physical examination, he saw bilateral wrist joint redness and swelling, and scattered subcutaneous nodules in the upper extremities, and was diagnosed with rheumatoid arthritis. On the following day, I saw the chief of the respiratory department visiting an acquaintance during a room visit, so I asked him to stop by and see the patient. The director asked me, after asking about the medical history and the disease under consideration, if I had ever seen rheumatoid arthritis that occurred only at the age of 70. I was awakened and dared to check the chest X-ray immediately, and it was central lung cancer. It was pulmonary osteoarthropathy. A man, 65 years old. He had shoulder pain for several months, especially in the middle of the night. He was treated as frozen shoulder in the health center, but the effect was not good. He came to our hospital and had a chest X-ray: lung cancer. I have a 35-year-old male patient who felt severe pain in the right shoulder. CT chest scan showed no abnormality. The patient was considered to have a family history of hepatitis B. Ultrasound and biopsy of the liver confirmed “hepatocellular carcinoma”. He died three months later. This is my own summary, although it is very simple, but in the process of transferring the department really feel that this point is easy to be ignored. Respiratory doctors focus on blood gas, other departments pay less attention. And in the case of shock, the serious impact of the generation of acid can not be overstated, timely correction, there will be a great turnaround. Once a patient’s blood pressure continued to fall, dopamine, m-hydroxylamine and other antihypertensive drugs simply directly into the pour, or not, the physician’s family are planning to give up, blood gas back, severe substitution of acid, sodium bicarbonate 100, 100 into a few times can not, and then brave, sodium bicarbonate a lot of use, and then, a miracle, blood pressure slowly back up … …, the substitution of acid corrected, in order to be sensitive to blood pressure drugs. The tip of “two watery eyes” When I first joined the workforce, every time I saw patients with respiratory failure, I always felt that their faces were very special, swollen, difficult to breathe, shortness of breath, and two gleaming eyes …… One day, an old professor checked the room and said to himself: “watery eyes, respiratory failure, CO2 retention”, and one sentence made my eyes light up. Are the lab indicators credible? An elderly patient with a lung infection, I don’t know the exact signs, but it was very serious. Six hours later, the WBC was 12.0*10e9/L, the doctor was anxious and called to say that it was not allowed, a colleague next to him took over the phone and said: Is your patient’s infection very serious? A colleague slapped the table, that’s right, infected shock patients, complement-mediated leukocyte adhesion in the endothelium, when the blood can not be drawn, the use of hormones after the leukocytes are stimulated down, of course, high. If you don’t believe me, wait a few hours and check again, it’s higher. A few hours later, the WBC was 22.0*10e9/L. Great. The test also has strong people. A patient with low potassium was given continuous intravenous pumping for potassium and was rechecked for potassium monitoring. The patient had a history of cardiac arrhythmia and was immediately given calcium gluconate to lower the potassium level, which later went down again: 3.4 mmol/l. I didn’t understand it at the time. The result was that the next day the director checked the visit: from which side was the blood drawn yesterday? Khan …… It turns out that when the nurse drew blood, the new nurse drew it from the proximal end of the vein that pumps potassium ……