Krafft's Notes on Anomalies

This is not a symptom that I expected before coming here.

The fever type of tuberculosis patients mostly presents as a low-grade fever, and some patients even do not show fever symptoms or feel insignificant. And this kind of fever, this kind of fever that made Professor Brimmer hesitate to speak during the discussion, arises from the body without obvious inducement, and appears unknowingly when Kraft is concentrating on the physical examination.

"Your Excellency, can you hear me?" Kraft stretched out two fingers and moved them left and right in front of the Duke's eyes. He found that his eyeballs followed the fingers at a narrow angle, and at the same time there was uncontrollable tremor and dissociation. It seemed that there was something wrong. What variable sensory stimulation is acting on the vestibular receptors, inputting information that makes it impossible for the eyeballs to adjust to the corresponding position no matter what.

"." There are unformed words behind the lips, which collapse into meaningless syllables before exiting the mouth, and are mixed into an unsettling mute sequence like a mantra in irreducible disorder.

Without a thermometer, Kraft put his hand to the patient's forehead to gauge. Although the fever is coming fiercely, it is still in the medium-heat range in terms of body sensation, and has not yet risen to a level that can cause such a sharp disturbance of consciousness and function, and such synchronization should not occur.

This overturned the previous first reaction. The disorder of consciousness was not the result of fever, but two concurrent symptoms.

Facing the change, Wilbert and Fernand did not show any panic or surprise. Obviously, this was not the first time such an attack had occurred, and it was self-limiting. Kraft held the artery in his wrist, and the sudden beating was fast and weak, just like the declining respiratory system trying to maintain compensation by increasing the frequency of contraction and contraction.

This is a stupid strategy, as soon as all the margin is used up, it will go from compensation to decompensation, and then the organ will kill itself without intervention.

The fever gradually increased, and the twitching of the trunk and limbs seemed to have acquired independent will, and they were performing high-frequency contractions that did not form effective movements. It was similar to being shivering in the ice and snow in winter, and this was exactly the case. This means that the body temperature set point moves upward, the body treats the current body temperature as hypothermia, and the skeletal muscles produce a large amount of heat through trembling, which behaves similarly.

In this case, there must be something affecting the thermoregulatory center. There are many factors, including infectious factors and non-infectious factors, but generally speaking, acute fever is more common in the former.

Kraft also thinks so, although it is a bit far-fetched, lacking rigorous and various laboratory test evidence that he relies on, and it is consistent with the focus theory of Professor Linden, whom he just despised.

But this is what made him feel a sense of déjà vu. There were one or more infection foci, repeatedly releasing exogenous pyrogens such as endotoxin or the pathogen itself, and then through a series of "It's boring to talk about it in detail." It’s fatal, but anyway, it’s the mechanism in which white blood cells release endogenous pyrogens, cross the blood-brain barrier, and act somewhere in the hypothalamus through a series of reactions that cause fever.

This is very reasonable. It is not just tuberculosis. The immunity has been weakened by long-term consumption. A concurrent infection has occurred in this body.

What is it?

In the absence of etiology, no one can answer this question for him, and it is followed by another question, what is the disorder of consciousness? It does not seem to be caused by fever, but the cause. Another manifestation of this body.

Kraft tried to change the title, "Your Majesty, can you hear me?

The call was answered, and Duke Westminster raised his eyelids slightly, indicating that he could still respond to the outside world instead of completely losing consciousness. He even tried to fight against his disordered body and control his mouth and tongue to produce sounds to prove that he was normal, but what he produced was still unintelligible and incoherent content.

This made the old Duke feel a little indignant. He raised his trembling hands and tried to write something down. The accuracy was as if he was fighting an invisible enemy. However, these actions failed to achieve his goal after all, as if those Words are cursed to be erased and cannot be conveyed.

"We have tried recording these contents, and Brimer thinks we can analyze disease-related information from them." Fernand couldn't help but remind him. Seeing the hesitation on the face of the internal affairs officer, he stopped him from continuing to guide the Duke, "But his research has made little progress so far. It may really be that the disease has blinded his mind, and it is meaningless."

"No, I just don't think so." Kraft temporarily ended the examination, rearranged the patient's coat, adjusted his position, and finished the servant work he was about to do.

"What should be noted is not only the content of the words, but also that the patient can still speak at this time, but the words cannot express what he means."

【Wernicke's aphasia】

It's the most annoying time to look at the dysfunction and guess the damaged part. It turns out that the Duke's brain dysfunction at this time is not widespread and indiscriminate. On the contrary, he retained part of the single-language functional area, showing that he could hear, could not understand, and expressed confusion.

"We have encountered situations where patients who have injured 'here' in the skull, unlike other people who have suffered mute injuries to the skull, still retain the ability to speak, but they can no longer speak a correct sentence. "Pointing to the posterior pole of the upper edge of the temporal bone, Kraft explained.

Very good, now there is no restrained dissatisfaction on Wilbert's face. As the castle's internal affairs officer, he does not lack the brain to associate the source of this knowledge. Now this brain feels a little uncomfortable to continue to stay with Kraft. And the face inevitably showed a slight expression of rejection and fright.

Fernand just nodded noncommittally. He was past the age of confinement between disciplines, and he also understood anatomy, and he was willing to accept the idea that a certain lesion caused a certain corresponding symptom.

"This shows that during the attack, this area of ​​the patient's skull was damaged, and it was temporary and reversible." But this made him unable to explain anymore, why there could be an intermittent specific area. Functional dysfunction concurrent with fever symptoms? And it seems that the motor functional areas of the limbs are also affected at the same time.

"Then what should we do?" Internal Affairs Officer Wilbert didn't understand much. He looked at his master worriedly. The Duke of Westminster's symptoms were severe, but the duration of neurological dysfunction was not as long as that of a simple febrile convulsion. After a while, he was able to better control his fine movements. He reached for the steaming chamomile tea, and Wilbert hurriedly He stepped closer and helped him steady the cup.

"The situation is very complicated. This is not a simple wasting disease." Kraft solidified the atmosphere in the room with one sentence, but he did not want these people to think that he could do anything good. "I think that in the original lung On the basis of wasting disease, another disease infection was combined, and there were multiple lesions in the brain."

"I need to know how often these attacks occur and how long they last."

"Well, roughly once a week. The time and length of the attack are basically the same as this one." Fernand answered without any hindrance. His observation and recording awareness is far superior to other people of his generation. "I guess this attack is about to take you." Bring just the right amount.”

"What about the severity? Has there been any change?" Kraft touched the Duke's forehead again. The heat was still there, out of sync with the neurological symptoms. "In addition, have you monitored the duration of this fever?"

"It's very difficult. This is often mixed with the heat of wasting disease itself. It lasts for at least half a day, and the cause is unknown."

Indeed, pyrogens released into the bloodstream are not cleared that quickly. Kraft was lost in thought. He had ideas, but they were all speculations. And it is foreseeable that if he continues to think like this, there will be no answer.

The scene was a little tense, with consultation experts discussing endlessly, family members looking worried, and the patient struggling to wake up from the chaos and taking a sip of chamomile and licorice tea with honey into his throat that had been parched by the dry hot air.

"Knight Kraft, it seems you haven't learned much from your fathers." The dry voice came from the Duke who had regained control of his vocal cords and mouth. The two professors, who were obsessed with thinking, quickly apologized personally.

"I understand. You are saying that I have two diseases, one is consumption disease that will kill me, and the other, it seems, will not happen yet."

"Yes, but the other one may actually be more deadly. I'm not sure if it is related to the wasting disease or if it is a separate disease. It may form lesions in your body that periodically release toxins." Although he didn't quite understand what the Duke meant, Kraft recounted his findings in a good manner.

However, the patient interrupted him nonchalantly, "I want to treat the wasting disease first."

"But it's not clear whether the other one will affect the treatment." Kraft felt that it should be reconsidered. It is too risky to start treatment hastily.

"Treat the wasting disease first."

"It may even lead to more serious consequences." This must be explained.

"I get to decide about my own body."

Well, the Duke understood what he meant, but he still persisted.

"Young knight, I even thought you were older than Fernando." The Duke stood up by pressing the shoulder of the internal affairs officer. Only then did Kraft notice that he was much taller than he thought. "Easy, I just want to A cure, a chance to make a bet on the possibility of surviving until the winter after tomorrow.”

"Your Excellency, I must point out that it is unlikely that you will win given the complications." Kraft seemed to understand the logic of this idea. It was not that he had not seen this kind of behavior in Old Wood, and he The relationship with physical obstacles is regarded as a duel, and the victory criterion is to overcome obstacles and complete the purpose, including but not limited to lame bear hunting.

No matter what the risk-benefit ratio is, as long as there is a possibility, they will definitely do it.

To put it nicely, it's called bravery, but to put it another way, it's reckless. But it’s easy to understand why they chose that way. Those who have lived to this position are senior members of the Survivor Bias Association. They have won gambling all their lives, and their bodies have never let them down.

“And potentially losing life expectancy under current palliative care.”

"Your job is only to make feasible suggestions for me, not to recommend options, Knight Kraft. I will bear the consequences of my decision myself."

With a speech that is stronger than armor, you know that if you don't hand over the treatment plan today, you will definitely not be able to escape.

"Okay." Kraft took a deep breath, like he was holding his breath before opening an old attic and taking out the dusty antiques. "Allow me to introduce to you the artificial pneumothorax."

【Artificial Pneumothorax】

This is really an old piece of antiques.

"This treatment is based on current surgical findings in humans. Our lungs are actually surrounded by membranes on both sides, and normally the space between them is sealed, like a shriveled water bladder with a cork."

"The risk is to inject air into the space between these two membranes to expand it and compress the lungs." In the narrative, Kraft moved his hands from both sides to the center to indicate the process, "until the lungs The head collapses, the range of motion is compressed and rested, the body fluid circulation is sluggish to limit the spread of the disease, and the eroded lung cavity is squeezed and healed."

"There is no doubt that this is a risky, traumatic, and incurable treatment. If you must persist, then I will continue to complete the examination and plan the treatment for you." This is the first time he hopes that the risk Informing can scare away patients.

"why not?"

It seems the first time is always difficult.

At the Duke's insistence, the inspection continued.

With the mentality of "this is what happened" and "there's nothing I can do anyway", Kraft started the rest of the physical examination. He had to carefully evaluate the condition of the riddled lungs on one side and indirectly understand the cardiopulmonary function. If the results are not good, then inevitably you have to consider using your mental senses.

Due to the lack of tools, he had to place the auricle against the patient's chest to listen. This inconvenience triggered his desire to work overtime to make an original stethoscope within three intercostal spaces.

[This will be included in their tuberculosis project funding later]

In order not to use his mental senses, Kraft carefully compared the results of auscultation and percussion, striving to be as close to the greatest degree of accuracy and reliability. However, the objective results still prove that the radiology ancestors’ pursuit of new machines for many years is indeed due to the insurmountable gap between machines and people.

Kraft still wanted to hold on for a while. Note down another auscultation result, move to the other side, and lean under the right scapula, roughly at the seventh and eighth intercostal spaces. In the percussion just now, there was a sound between a skin drum and an empty urn, indicating that There may be a cavity near the chest wall, and its size requires caution.

Listening closely, a musical rale breaks into the ear canal. He didn't quite recognize the sound.

To be honest, it is too difficult for a person who has rarely seen such a degree of tuberculosis to accurately judge. Kraft hesitated for two breathing cycles, still puzzled.

To be on the safe side, he decided to percuss again. As usual, stick the second section of the left middle finger on it, tap it with the right middle finger, and wait for the sound feedback that echoes in the space.

There was a low, muffled sound, muddy and thick, but it was not the drumming feeling that echoed in an empty jar in my memory.

"What's going on?" Kraft knocked again in disbelief, but the sound was still solid. "How could it be solid?"