bookpower Chapter 560
Chapter 560
Lin Feng quickly ran from the consultation room to the bed of patient Chen Meijuan.
At this point,
The patient shouted anxiously, but Chen Meijuan did not respond.
The ECG monitor at the bedside shows:
Blood pressure: 88/50mmHg.
Oxygen saturation is only 92%.
"Husband..."
At this time, Chen Meijuan woke up slowly.
She was breathing a little shortly.
Heart rate display 110 beats per minute...
"I'm here, I'm here..." Chen Meijuan's husband excitedly grabbed his wife Chen Meijuan's hand, just now he was really afraid.
"Dr. Lin, help me see my wife... She's like this, it's too scary..."
When my husband saw Lin Feng, he was surprised...
"I'll see..."
Lin Feng first instructed the nurse to insert an oxygen tube into the patient.
Lift the 92 itch up.
Then I began to call up the historical blood pressure data recorded by the patient's ECG monitor, and there was no problem with the blood pressure in front, which fluctuated around 88/50mmHg.
This blood pressure generally does not cause the patient to faint.
This surprised Lin Feng.
Could it be something else?
Lin Feng carefully checked the data of the first 1 hour of the ECG monitor, and did not find the record of arrhythmia, which was normal.
so
Try to analyze it from the perspective of itching 92%.
Even coronary heart disease generally does not cause 92% of this level of hypoxia, and directly myocardial infarction.
Could it be that there is a problem with the lungs?
Lin Feng asked the couple in detail.
"Do you have any other medical history other than coronary heart disease and hyperlipidemia?"
"It's like... It's gone..."
"It's gone..."
"Did you eat any special food or medicine for a long time?"
The husband and wife looked at each other.
Lin Feng was very serious: "This is very important, every detail that is missed may keep the real cause away... So, what to say, then I judge for myself. "
Wife: "I like to eat stinky tofu, does it count... Eat often..."
Lin Feng mused: "Stinky tofu, it should be a problem of the digestive tract... Are there others? "
The husband thought for a while: "It seems that there is nothing else, everything I eat is normal, except for stinky tofu..."
Lin Feng: "What kind of medicine do you take for high blood pressure and high blood lipids?" "
The wife said a few medicines, Lin Feng thought about it, there is no problem.
At this moment,
The husband suddenly said:
"Birth control pills, count?"
Lin Feng didn't care at first, but after a moment of silence, he suddenly felt wrong!
Contraceptive....
Taking birth control pills for a long time can cause the blood to thicken ...
Thick blood can completely lead to thrombosis...
In case this thrombus breaks off and flows into the pulmonary artery ...
Pulmonary embolism!!!
However, when admitted, it is normal to check for D dimers.
Also, pulmonary embolism should have coughing symptoms.
Patient Chen Meijuan did not!
It doesn't feel like a pulmonary embolism!
However, Lin Feng does not dare to guarantee that it is absolutely not, because some patients will be special, such as the child with "angina" in the last time, others will have fever, sore throat, and do not eat, and as a result, the child is stunned and has no stupid reaction.
"Push the B ultrasound machine to me... Be quick..."
Lin Feng said to a nurse.
"Yes!"
The nurse ran out, and in less than 2 minutes, the B ultrasound pushed over.
Lin Feng needs to do a heart color ultrasound.
Patients with pulmonary embolism, although there is no way to see the embolization point, but can rely on the response of the heart to determine whether there is pulmonary embolism.
Probe......
Couplant ...
Aim at the patient's precordial area.
At a glance,
Lin Feng found the problem.
Patient Chen Meijuan's right ventricle and right atrium are clearly enlarged!!
It must be "pulmonary embolism"!
The blood circulation in the human body is as follows:
Right heart (venous blood from the whole body) - > pumped into the pulmonary artery - > pulmonary artery - > capillaries - itching at the > alveoli - > pulmonary vein————> left heart (arterial blood) - > whole body...
Right now
The patient, Chen Meijuan, had an enlarged right heart.
The only possibility is that the lower level, that is, the pulmonary artery is blocked, the blood is not easy to flow out, and it will naturally be trapped in the right heart, so it will support the right heart.
So
Inference holds - pulmonary embolism!
And it's still an arterial embolism!
Next
It's simple.
CT angiography.
Either go to the CT room or go to the interventional department.
At last
Lin Feng chose the interventional operating room.
Do CT angiography... Determine the amount of thrombosis, and determine what method to use for thrombectomy and thrombolysis.
The advantage of interventional operating room over CT room is that interventional surgery can be performed directly without thrombolysis.
Because of the high risk of thrombolysis, once the drug is overdosed, direct systemic bleeding is possible.
If the drug is not enough, it will not dissolve the suppository.
So
Intervention is the best way to do it.
However, intervention is more expensive, equivalent to nuclear weapons.
One hundred, one more than ten thousand, the difference is very large.
Lin Feng informed her husband in a low voice about his inference, and told him the difference between intervention and CT room.
The husband was stunned on the spot.
"Do it now, do it as soon as possible!!"
The husband said decisively, without any hesitation.
Push to the CT room, husband signed...
And in this process, Chen Meijuan's condition began to worsen, breathing became more difficult, her heart rate jumped to more than 120, the itch was falling, Lin Feng could only increase the oxygen supply content, pumping itch hard...
......
Half an hour later...
Interventional Section,
The imaging was successful.
The answer is revealed!
Pulmonary artery, embolism!!
There are several pulmonary arteries, the contrast agent does not pass, is blocked.
Lin Feng started directly,
Interventional thrombectomy, radial artery implantation catheter guidewire, all the way into the pulmonary artery, successful removal of thrombus...
The operation was successful,
Half an hour after the thrombectomy,
The patient's heart rate dropped to 80 beats per minute, and blood oxygen returned to the safe range of 97%.
At this time, looking back, why is the D dimer in front normal?
It is very likely that the blood clots were not severe at that time.
As for the cause of the formation of blood clots, in the end, Lin Feng boiled it down to -
Contraceptive!!
"Don't take birth control pills in the future... If you give birth to a child, go to the ring ... If you don't have children, bring safety measures..."
Lin Feng instructed.
The couple could only blush and nod their thanks.
......
。