bookpower Chapter 715
Chapter 715
Afternoon.
Before leaving work.
Another patient was brought in by ambulance.
Lin Feng took Xiaoru to the rescue ward.
On the way, I learned about the patient's condition from the mouth of the doctor accompanying the car, suspected of myocardial infarction.
At this moment, the patient on the hospital bed has a painful face and moans from time to time.
Xiaoru hurriedly connected him to ECG monitoring.
Heart rate 120 beats / min
Blood pressure 98/50mmHg
The patient in the bed looked like he was in his thirties, a man in the prime of life.
This value can be said to be low.
If the blood pressure is so low, the organs of the whole body will not get enough blood oxygen, the metabolism of cell function will be hindered, and after a long time, the organs will collapse.
Then people will die!
Since myocardial infarction is suspected, it is necessary to confirm whether it is or not.
"Do an electrocardiogram!" Lin Feng immediately said to Xiaoru.
Hearsay.
Xiao Ru immediately began to prepare and gave Lin Feng a hand.
Soon, the electrocardiogram came out.
Suggest that the ST segment of leads II., III., and aVF is elevated.
A general ECG has a total of 12 leads, and each lead has a corresponding meaning.
Leads II., III., and aVF correspond to the lower wall of the heart, and if these leads are abnormal, it often indicates that the lower wall of the heart may be ischemic necrosis.
Lin Feng looked at the electrocardiogram, and there were indeed changes similar to myocardial infarction.
However, now the patient's onset time is shorter, and there should be more obvious changes later, because the ECG changes of myocardial infarction are dynamically evolving.
Normally, our heart is continuously discharged, but this electricity is different from our usual household electricity, and the discharge of the heart can only control the beating of the heart muscle, of course, there is no way to support its tungsten lamp.
When we put the electrodes of the electrocardiogram on the chest wall, we can feel the electrical conduction, and then record it on the ECG drawing, if there is an ischemic necrotic myocardium, their discharge must be poor, and it can be faithfully reflected on the ECG drawing, thereby capturing useful information.
Then Xiaoru asked the patient to draw blood for examination.
It is mainly to check the patient's troponin and other indices.
Small as the action is still relatively fast, plus the urgency of the emergency department.
Not for a while.
I came back with the results of the test.
As expected, the patient's troponin was significantly elevated, and the diagnosis of myocardial infarction was basically a certainty.
Troponin is a protein that is almost exclusively present in cardiac muscle cells, and once troponin is elevated, we can infer that it is the cardiomyocyte necrosis that ruptures and releases troponin into the blood, so we can detect troponin elevation.
At this time, Xiaoru opened his mouth and said: "Teacher, the electrocardiogram results are available, and troponin is also clearly elevated, and now you can basically diagnose myocardial infarction, right?" Do you want to notify the cath lab so they are ready? "
Basically, myocardial infarction is because the coronary arteries are blocked by thrombus, blocking the blood flow, naturally will be ischemia, in order to save the myocardium, the only way is to open the blood vessels and restore blood flow.
If myocardial infarction is confirmed, either drug thrombolysis, or intervention to do a stent to open the narrowed coronary artery and restore blood flow.
Interventional therapy is generally preferred.
It is understood that the patient had sudden chest pain in the morning, mainly dull pain, and never appeared.
Lin Feng then decided to do another ECG for the patient, while continuing to let Xiaoru draw blood for the patient to detect troponin.
After the two results come out, a comparison of the two time points can indeed diagnose myocardial infarction.
It is also a myocardial infarction of the lower and posterior walls of the heart.
When the results come out, then there is no need to wait.
Immediate initiation of interventional therapy.
Immediately Lin Feng said to the patient: "When will your family arrive?" "
Although the patient looked at the situation quite serious and frowned, his consciousness was still clear, and he said softly: "I have no family members, so I came by taxi alone." "
Hearing this, Lin Feng was a little surprised.
For a patient with such a serious condition, it is quite troublesome to have no family members present.
However, the situation cannot be left unresolved now.
No one signed, so I had to contact the medical department first and let them figure it out.
After contacting the Medical Section.
Lin Feng pushed the patient to the cath lab to prepare for interventional surgery.
On the way, Lin Feng asked the patient: "Are you married?" If you are married, then call your wife over, after all, your situation is so serious, you still need to have family members present. "
Hearing the question, the patient tested his face, looked at Lin Feng and said: "I was divorced a few days ago, you don't need to look for her!" "
Hearing this news, Lin Feng was even more surprised in his heart, and then asked, "What about your parents?" "
"Both parents are home! I'm the only one here, no relatives! If I want to sign it, I'll just sign it myself! The patient said.
In the simple two sentences of dialogue, Lin Feng instantly felt a little sad.
Fortunately, I have reported it to the medical department before, such a special situation, in case the patient has a little accident on the operating table, then it will be troublesome.
Not to mention who is responsible for things, even the claim of the body is a problem.
Everything is in place on the cath lab side.
The patient is pushed away.
It is indeed very rare to remember myocardial infarction at such a young age.
The patient has no history of hypertension and hyperglycemia, only a history of hyperlipidemia, and does not smoke.
To be honest, there are not many high-risk factors at all, and the result is such a myocardial infarction.
It really made Lin Feng a little afraid in his heart, worried about whether he would have a heart attack at any time.
After entering.
Lin Feng instantly put aside all kinds of thoughts in his mind and began to treat the patient.
Soon, he was stunned.
Coronary angiography: the patient's coronary arteries are very unobstructed, there is no obvious stenosis, no thrombosis, and it is not myocardial infarction at all.
If the coronary arteries are severely narrowed or blocked by a blood clot, then it is a myocardial infarction.
The patient is not a myocardial infarction and is misdiagnosed!
Lin Feng immediately fell into deep thought.
What is the problem?
。