Background: This miniseries is adapted from the American TV series "The Night Doctor" s3e1, an example of diagnosis and treatment of pheochromocytoma, prepared as an annual meeting program (one night of coding and one night of revision).

Characters: Two emergency department night shift doctors (female doctor Alexander and male doctor Scott), two interns (female intern Shannon and male intern Paul), one patient Lucia, and a family member Kelly, an emergency room nurse, an ambulance crew member

Other characters: a narrator and announcer and sound effects artist, and one responsible for transition props

:

The siren of an ambulance is playing in the background. At the door of the night shift emergency channel of the hospital, the ambulance arrives and the ambulanceman lifts the patient out of the ambulance.

The narration imitates the broadcast sound: Alexander. Doctor, please go to the ambulance entrance.

Dr. Alexander and a group of doctors and nurses arrived.

Dr. Alexander asked the ambulance: What is happening now? >

The ambulanceman replied: The patient was a 30-year-old woman. Her wrist and abdomen were injured in a car accident. Her vital signs were unstable.

Dr. Alexander asked: OK, tell me what her blood pressure is. Low?

The ambulanceman replied: It is not low, on the contrary, her systolic blood pressure is 190.

Dr. Alexander asked: 190?

The patient was lying on the gurney and began to moan: It hurts.

The patient’s family member, whose arm was injured, said to the doctor: Please, please save her.

< p>Dr. Alexander took out the stethoscope and simply listened to the patient's heartbeat, and said: Her heartbeat is very fast now, push her in quickly.

The patient Lucia was very worried and said to her family: Kelly. , I'm so scared.

The emergency bed was pushed to the emergency room, and the nurse coordinated to bring in various monitoring instruments.

The patient's family member, Kelly, followed and comforted: "It's okay." Yes, Lucia.

Dr. Alexander said to the nurse: Open a debridement pack and cross-match four units.

< p>Act 2:

Narrator: At the entrance of the emergency room, the female intern Shannon took the patient's family aside.

The female intern Shannon said: Madam, I guarantee our Alexander. The doctor will take good care of your friend.

The patient’s family member Kelly said: She is not my friend, she is my wife.

Female intern doctor Shannon lifted up Kelly. Arm, said: Oh, okay, let me take a look at your wound, by the way, what happened?

Patient family member Kelly said: We were getting ready to go to dinner, and then a truck The car passed by us. The speed must have been 160, and then we lost speed.

Shannon, the female intern, said: Okay, I need a suture bag and 4-0 Prilim. Stitch up your wound and I promise to keep you informed of her condition.

Kelly, the patient’s family member, said: OK

Shannon, the female intern, said: OK, let’s go.

Act 3:

Narrator: The scene changes to the emergency room.

Play background blood pressure and heart rate monitor sounds.

Dr. Alexander pressed the patient's abdomen and Dr. Scott entered the emergency room.

Dr. Alexander said: Full abdominal muscle guard, the patient needs surgery.

Dr. Scott said: So here I am, lift her up. After saying that, he planned to lift the patient from the bed.

Dr. Alexander said: Wait, there is a problem. The patient's blood pressure is very high.

Dr. Alexander glanced at the blood pressure monitor and said: The blood pressure is now as high as 230, and her heart rate is 140.

Dr. Scott took the pupillary mirror and asked: Does the patient have a history of hypertension?

Dr. Alexander replied: There is no record. Even after taking sodium nitroprusside, the blood pressure is still rising.

While examining the patient's pupils, Dr. Scott asked: What do you think is going on?

Dr. Alexander replied: I don’t know, we are waiting for the toxicology results.

Dr. Scott answered: She will definitely not survive the surgery like this.

After speaking, he picked up the stethoscope handed over by the nurse and planned to listen to the patient's heartbeat.

A nurse next to him put down the phone and replied: The laboratory said they are short of staff and the toxicology test results have not been released yet.

Paul, a male intern doctor, walked into the emergency room and said: I just asked the police. Witnesses said that she drove in a weird way before and ran rampant on the road.

Dr. Scott said: Possibly methamphetamine or cocaine.

Paul, a male intern doctor, said: She doesn’t look like a drug addict, at least his lover doesn’t look like it.

Dr. Scott asked: Come on Paul, how long have you been in the emergency room?

Paul, a male intern doctor, said: Yes, that makes sense.

Dr. Alexander said: It may also be drugs to treat attention deficit or other diseases, which can cause increased blood pressure, increased heart rate and crazy driving. The test results haven't come out yet, so let's go talk to her wife. See what she knows.

Paul, a male intern doctor, said: Shannon has just sewn up her arm and is doing an X-ray on her. I will bring her over.

Paul leaves the emergency room.

Act 4:

Narrator: Kelly, the patient’s family member, tied a bandage and was brought into the emergency room by Paul and Shannon.

Kelly walked into the ER and asked: I don't understand, if she needs surgery, why is she still in the ER?

Dr. Alexander replied: Because we couldn't lower her heart rate and blood pressure.

Kelly, a family member of the patient, answered: We just had a physical examination a few weeks ago. Her blood pressure was normal at that time. Why is it so high now?

Dr. Scott asked: We thought you could tell us why.

Kelly, the patient’s family member, was very surprised.

Dr. Alexander asked: Is she taking any medication to treat ADHD or narcolepsy?

Kelly, a patient’s family member, answered: No.

Dr. Scott asked: Does she have a history of drug abuse? Meth and cocaine and stuff like that.

Kelly, a family member of the patient, looked shocked: Of course not, she is very healthy. Lucia doesn’t even take aspirin and is an absolute vegetarian.

Dr. Scott asked again: Are you sure? Witnesses said she was driving erratically.

Kelly, a patient’s family member, answered: I’m absolutely sure, she didn’t take any medicine. I know my wife.

Dr. Alexander said: We didn’t say you didn’t understand, but if you knew other things, maybe you could save her faster.

Dr. Alexander turned to the female intern doctor Shannon and said: Shannon, ultrasound machine.

Shannon, the female intern doctor, pulled the ultrasound machine over, and the male and female doctors were ready to start taking ultrasound pictures. Dr. Scott applied glue to the patient's abdomen, and Dr. Alexander picked up the ultrasound probe and prepared to scan the patient's abdomen.

Kelly, a patient’s family member, asked: What are you doing?

Dr. Alexander answered: We now need to monitor the patient for renal bleeding.

Dr. Alexander looked at the ultrasound machine while scanning the patient's abdomen.

Everyone looked at the ultrasound image. Dr. Scott asked Paul, the male intern doctor: What do you think?

Paul said: The bleeding has stopped and the condition is good.

Then Paul asked the patient’s family: Has the patient been sick recently? Flu or something?

Kelly, a family member of the patient, replied: It seems not, she just complained about headaches, hot flashes, and dizziness, but the doctor just said welcome to perimenopause.

Shannon, a female intern doctor, looked disdainful: Is that doctor a man?

Kelly, a patient’s family member, answered: Yes.

Dr. Alexander heard the alarm sound of the heart rate monitor and quickly said: She is in ventricular fibrillation, Shannon! Get the defibrillator.

The nurse on the side also quickly picked up the breathing mask.

Kelly, the patient’s family member, was very frightened and said: Oh my god, what happened?

Dr. Scott said: Nurse, hurry.

Kelly, a patient’s family member, said: What’s wrong, are you here? Oh my god, save her, what do you guys do quickly? What's going on?

The nurse came over and took the patient's family away from the bed and said: It's okay, ma'am. But you need to wait outside.

Kelly, a family member of the patient, said as she left the emergency room: No! Please!

The doctor here has attached the wires of the defibrillator, connected the oxygen mask to deliver oxygen, and picked up the panel of the defibrillator to start it.

Dr. Alexander picked up the defibrillator and said: Okay, clear

Dr. Scott left the bed and said: clear!

Dr. Alexander said: Still in ventricular fibrillation, recharge! continue!

Shannon, the intern female doctor, continued to operate the defibrillator, and Dr. Alexander said: clear!

Everyone left the bed and said: clear.

Shannon, a female intern, then performed cardiopulmonary resuscitation on the patient. Dr. Alexander said: Stop pressing.

Dr. Alexander glanced at the heartbeat monitor and said: There is a pulse!

Shannon, a female intern, said to Dr. Alexander: Sinus rhythm has been restored, and blood pressure and heart rate have dropped. What do you think caused ventricular fibrillation?

After saying that, Dr. Scott and male intern doctor Paul also looked at Dr. Alexander.

Dr. Alexander replied: Ultrasound scan is focused on trauma.

Dr. Scott said: That’s right.

Shannon, a female intern, asked: What does this mean?

Dr. Scott replied: When Dr. Alexander performed an ultrasound on the patient's kidneys, her heart rate and blood pressure spiked.

Dr. Alexander shined the ultrasound scanner on the patient's abdomen again, looked at the image on the scanner and said: Just like this.

Dr. Alexander then pointed to the screen and said: Now look up there, above the kidneys, what do you see?

Paul, a male intern doctor, said: Pheochromocytoma, also known as adrenal medulla tumor.

Dr. Alexander said: Paul, I know you know, I'm asking Shannon.

Shannon, a female intern doctor, said: I know it too!

Paul, the male intern doctor, snorted mockingly.

Shannon, a female intern doctor, said: What’s wrong with you?

Dr. Scott added: What else do I want to ask you about?

Shannon, a female intern doctor, said: You just want to be in the limelight.

Paul, the male intern doctor said: I have been trying to be friendly to you all day today. But you always are. . .

Shannon, a female intern doctor, said: Is it just because I am a girl?

Dr. Scott said: What are you doing? There are patients too!

Dr. Scott said: The adrenal glands must have been squeezed in the car accident, so adrenaline flowed into the bloodstream.

Dr. Alexander said: Every time we squeeze, it will have the same effect.

Paul, a male intern doctor, said: It needs to be taken out. I will notify the operating room.

Dr. Alexander said: Not so fast.

Dr. Scott said: Surgery now could trigger a lethal dose of hormones to flow into his body.

Dr. Alexander says: So, Shannon, what do we do?

Shannon, a female intern doctor, said: The patient will be injected with alpha and beta blockers over the next few days until it is safe to operate.

Dr. Alexander said: Exactly.

Shannon, the female intern doctor, proudly winked at Paul, the male intern doctor.

Dr. Scott said: I hope the patient will not bleed again.

Act 5:

Scene change:

Narrator: Hospital corridor, Dr. Scott pushing the patient's bed, the patient's family members Kelly and Dr. Alexander Follow along.

Dr. Scott said as he walked: The new blood picture shows that the patient's blood cell count has dropped, indicating that her tumor may be bleeding again.

Kelly, a patient’s family member, said: Can’t it be repaired directly?

Dr. Scott’s answer: It’s not that simple.

Dr. Alexander answered: Normally we would give the patient anti-adrenergic drugs for a few weeks before surgery, but because she started bleeding again, surgery was needed now.

Dr. Scott said to the patient’s family member Kelly: You have to know that there are great risks if you perform surgery now, but the risks are even greater if you don’t do it.

Kelly, a patient’s family member, said: Are you saying you will die?

Dr. Scott said: I'm just saying that the situation is complicated.

Kelly, a patient’s family member, said: Then find a way to make it less complicated. .

Dr. Alexander said: I hope so too, but we have no choice. Although there are risks, this is the best choice.

The patient’s family members covered their faces and said: We shouldn’t have come out tonight. I forced her to come out. I think if we had stayed at home, none of this would have happened and we wouldn’t have been arrested. Hit.

Dr. Alexander dissuaded and said: OK Kelly, this is not your fault, okay? Sometimes bad things happen to good people.

Kelly, a patient’s family member, said: It’s my fault. We had all kinds of quarrels recently. I was very angry when we were just in the car. I asked to separate from her, which made her very sad.

Dr. Alexander said: Okay, okay, let’s go have a cup of coffee.

Act 6:

Scene change:

Narrator: At the coffee break, Dr. Alexander and Kelly are drinking coffee.

Dr. Alexander said: She underwent surgery not because of the car accident, but because of an adrenal tumor. It's like there's a time bomb inside her that could explode at any time, so it's not your fault at all.

Patient family member Kelly said: I'm just tired of us arguing all the time.

Dr. Alexander said: You know, although we don’t understand each other, please allow me to ask, did you just quarrel in the past few months? Is it because she has become very irritable and often gets angry?

Kelly, a patient’s family member, said: Yes, she has a bad temper towards me.

Dr. Alexander said: That’s right, these are symptoms of tumors causing adrenaline to rise.

Kelly, a family member of the patient, was very surprised and said: oh my god!

Dr. Alexander said: I’m not saying that’s the whole reason for your quarrel, but. . .

Kelly, a family member of the patient, said: That makes sense for a lot of things. Yes, we have experienced so much in the past few months. Sometimes it is not easy to get through all the hardships, you know?

Dr. Alexander said: I understand, but I have experienced it too. But you know a lot of things because even if you don't succeed, at least you know you tried your best.

Kelly, a patient’s family member, nodded and said: I just hope we can go back to the beginning.

Act 7:

Scene change:

Narrator: The scene changes to the operating room. Dr. Scott is performing laparotomy and Dr. Alexander is in the operating room. Watching from the sidelines, a nurse assisted during the operation.

Dr. Scott said: OK, cut it.

Dr. Scott took out a piece of tissue and handed it to the nurse and said: Send it for pathological analysis.

The nurse said: OK right now, doctor.

Suddenly the blood pressure monitor started alarming and playing background sound.

The nurse said: The blood pressure has dropped, and the systolic blood pressure is 170.

Dr. Scott said: What happened?

Dr. Alexander said: Have you ligated all the blood vessels?

Dr. Scott Answer: Yes.

The nurse said: The heart rate is 160.

Play cardiac arrest alarm.

Dr. Scott said: The patient is dying.

Dr. Alexander hauled in the defibrillator.

Dr. Scott said: Oh oh oh, don’t die, take this surgical cloth away.

Said and picked up the defibrillator, ready to charge and defibrillate. After two operations, the patient's heartbeat returned.

Dr. Scott then examined the patient’s abdomen and said: This is unreasonable. The entire tumor was removed?

Dr. Alexander asked: Scott, what if you didn’t take it all out?

Dr. Scott said: I took them all, look! There is nothing here anymore.

Dr. Alexander said: Okay, but what if there is another one? 10% of patients with pheochromocytoma have secondary tumors outside of the adrenal gland.

Dr. Scott said: That explains it all, but where?

He continued to examine the patient's abdomen.

Dr. Alexander said: Scott, the patient’s blood pressure has been rising.

Dr. Scott said: Come out, where are you? You bastard. Nurse, release the retractor.

The nurse removed the retractor, Dr. Scott continued the examination, and then said: It is here, at the end of the aortic bifurcation, nurse, come on, forceps!

After speaking, he picked up the pliers and removed them. Dr. Alexander looked at the blood pressure monitor and said: Okay, it’s okay. The blood pressure dropped to 180/100.

Dr. Scott said: Nice, okay, very good, now let’s eliminate this thing completely.

Dr. Scott suddenly stopped and said: oh oh.

Dr. Alexander asked: What’s the matter?

The narration said: Dr. Scott gave Dr. Alexander a meaningful look.

Act 8:

Scene change:

Narrator: Outside the operating room, two doctors and Kelly were talking.

Kelly, a patient’s family member, asked: I thought you removed all the tumors?

Dr. Alexander says: Yes, Dr. Scott removed all the tumors from Lucia's adrenal glands, but the cancer spread through her lymph nodes.

Dr. Scott said: I'm afraid it's the fourth period.

Kelly, a patient’s family member, asked: What about the treatment?

Dr. Alexander said: I'm sorry Kelly, it can't be cured at this stage, and I probably only have a few weeks, maybe a few months, left to live. For now we need to try to make Lucia's life as painless as possible.

Dr. Scott nodded.

Kelly, a family member of the patient, looked shocked: I just learned that her anger was caused by her illness. Lucia was going to change back to her original self, but now do you think I will lose her forever?

Dr. Scott said: We regret that this disease is difficult to detect before surgery.

Kelly, a family member of the patient, shook her head sadly and said: We had a big fight when we last talked!

Dr. Alexander said: But that was before the accident, and now you can tell her how much she actually means to you.

End of narration: Pheochromocytoma is one of the common causes of secondary hypertension, which can be diagnosed and treated. Through surgery and targeted treatment, the patient's blood pressure can be cured or the blood pressure can be effectively controlled. , thereby preventing target organ damage caused by increased blood pressure levels.

However, because the incidence of secondary hypertension is low and the cause is hidden, it is very easy to be missed or misdiagnosed, resulting in untimely screening, inappropriate treatment, and uncontrollable blood pressure. Therefore, identifying the cause of secondary hypertension through accurate detection is the key to treating secondary hypertension. Our current adrenal hypertension package can simultaneously screen and diagnose secondary hypertension such as pheochromocytoma, primary aldosteronism, and Cushing's syndrome, enabling early detection and diagnosis of secondary hypertension. Early diagnosis and early treatment can prevent the tragedy of Lucia and Kelly from happening again.

Thank you all!

The End.