bookpower Chapter 642
Chapter 642
Patients with myocardial infarction,
The ECG will respond quickly,
Troponin, cardiac enzymes: 2-3 hours to rise.
Myoglobin: 30 minutes to 1 hour to rise.
And now,
The chest pain of the patient is less than 2-3 hours, so troponin is not elevated, which is normal.
Lin Feng explained to Xiaoru.
Xiao Ru nodded and made a note in her heart.
It is difficult to train doctors, and every superb doctor must be trained for more than ten years to become a talent.
It's an industry that relies on experience.
"Teacher, what should we do next?"
"First judge the condition ... The electrocardiogram of the patient in front of him has a decrease in ST waves, there is a manifestation of myocardial ischemia, and there may be myocardial infarction... In addition, according to experience, if it is angina, it can be relieved by taking nitroglycerin, and if it cannot be relieved, most of them are myocardial infarction..."
"So, the teacher's judgment is myocardial infarction?"
"That's right!"
Xiao Ru asked, "Then what to do next... After routine anticoagulation and antiplatelets, go to the interventional department for interventional surgery? "
If it is really myocardial infarction, then immediately send the interventional department to do coronary intervention to open the coronary artery blocked by the thrombus, in order to save more ischemic and hypoxic myocardium.
But Lin Feng shook his head.
"Not yet... Before that, we need to rule out "aortic dissection" and "acute pulmonary embolism", these two diseases are often confused with acute myocardial infarction, easy to misdiagnose, and even some patients may have aortic dissection and myocardial infarction at the same time, these three critical diseases will cause obvious chest pain..."
"If the patient has "aortic dissection", once you go down with anticoagulant and antiplatelet drugs, it will be bad, maybe it will cause bleeding, and the patient will be gone."
So
To exclude "aortic dissection" and "acute pulmonary embolism".
Patients are required to:
· CTA！
With CTA (row 64), aortic dissection and acute pulmonary embolism were thoroughly excluded.
As long as these two items are excluded, it can be determined that it is "myocardial infarction".
Then push to the interventional department to do coronary interventional treatment.
"Xiaoru, give you a task, go to the family to sign!"
"Good teacher!"
Xiaoru has strong mobility, and rushed out of the rescue room with the "Disease Notice", "Interventional Surgery Consent Form" and "CTA Consent Form".
Ask a family member to sign it.
"Xiao Chen, go to the anesthesiology department, ask for a little morphine!"
Morphine is a special medicine and must be applied for.
It takes time.
So Lin Feng needs to prepare in advance.
Whether the patient has a myocardial infarction or aortic dissection, excessive pain is not conducive to recovery from the disease and may aggravate the heart's oxygen consumption.
So morphine is necessary.
At the same time, Lin Feng called the interventional department and asked if there was an empty operating room.
The intervention section said there were vacancies.
Lin Feng breathed a sigh of relief, and then called the CT room.
"Colleagues in the CT room? Hello, I am an emergency Colin Feng Lin Feng, there is a patient on my side, more urgent, want to do CTA as soon as possible, trouble to help prepare, I will push people over now..."
The colleagues in the CT room were enthusiastic: "Dr. Lin... Okay, come on, I'll get people ready. "
Lin Feng thanked: "Thank you." "
CT colleague: "You're welcome, Dr. Lin can give us more CTA lessons..."
Lin Feng has taught several classes to the imaging department, and the results are good and widely praised.
However, Lin Feng's time is not so easy to please.
Lin Feng smiled and said, "Well, I must give a lecture when I have time!" "
The CT teacher happily hung up the phone.
At this point,
Nurse Xiao Chen quickly ran in.
"Dr. Lin, morphine is back."
"Okay, push quietly..."
"Yes..."
At this time, Xiaoru returned to the rescue room with his signature.
"Go, go to the CT room..."
Time is life.
If it is really a myocardial infarction, the longer it takes, the more difficult it is for the patient to recover.
So hurry up and go to last night's CTA.
Silently push morphine,
Everyone worked together to quickly push the patient out of the rescue room.
Although the family was mentally prepared, they followed the car with great trepidation and ran all the way to the CT room.
soon
The CTA is finished.
Computer reconstruction.
Lin Feng took a general glance, there was no obvious dissection of the thoracic and abdominal aorta, and there was no obvious embolism of the pulmonary artery.
So
Exclude:
"Aortic dissection" and "acute pulmonary embolism"!
Next
Needless to say!
Go to the interventional department and get rid of "myocardial infarction"!
en route
Injecting anticoagulants, antiplatelet drugs...
As for thrombolysis?
Lin Feng is obviously more familiar with intervention, and the risk of thrombolysis is prone to excessive thrombolysis, resulting in heavy bleeding of the patient, which is troublesome.
"The operation process is probably to insert a lead and put a stent into the coronary artery..."
"Now braces aren't that expensive, but surgery isn't cheap either... You can choose thrombolysis, but thrombolysis is riskier... I'm better at intervening..."
The patient's family heard Lin Feng say this.
Then you can disagree.
They believe in Lin Feng's character and will not deliberately choose interventional surgery for a little surgical fee.
Sign!
Advance the interventional operating room!
But!
The unexpected happened!
10 minutes later...
The contrast agent is injected into the patient's body, and the black contrast agent travels along the aorta and enters the heart...
“？？？？"
"No narrow part?"
"No myocardial infarction?"
Lin Feng was stunned.
That's not right!
"Aortic dissection" and "acute pulmonary embolism" were ruled out, and now it is not "myocardial infarction?"
What the hell is that?
Lin Feng fell into deep thought.
The patient was reintroduced to the interventional operating room.
A confused look.
The family members were also confused.
Lin Feng told the truth about things.
"What? Neither? "
"Doctor Lin, what is that?"
The family looked panicked, and so did the patient.
The cause cannot be found, like a large rock hanging in the air.
Lin Feng thought for a while:
"So be it, make a heart color ultrasound!"
Electrocardiogram (circuit), no specific problem is seen.
Imaging (water pipe), no problem was seen.
That leaves the heart ultrasound.
Heart color ultrasound (walls, doors) to see what is wrong.
Originally, because the time was too urgent, I didn't do the heart ultrasound. Now that nothing else can find the reason, then it is necessary to do cardiac ultrasound.
Push back to the emergency department.
Then Lin Feng did bedside color ultrasound.
This look,
Sure enough, I saw that something was wrong!
The left ventricle is hypertrophied and asymmetrical!
。