bookpower Chapter 542
Chapter 542
so
Why does "right heart failure" cause edema in both lower limbs?
The main cause is the increased pressure of the systemic system, that is, the pressure of the venous system, resulting in water not fully circulating through the heart throughout the body, resulting in blood stagnating on the legs, resulting in edema of both lower limbs.
soon
The patient's elderly home was pushed into the emergency room.
The patient's son, blocked from the door.
"Quick, connect..."
In fact, without Lin Feng's orders, nurses will quickly use ECG monitors, ventilators...
Connect quickly.
Lin Feng ordered: "Hurry up and push the electrocardiometer over... And bedside ultrasound is also pushed over..."
At this point,
ECG monitor data began to come out.
The physical data of the patient's elderly family are as follows:
Blood pressure: 198/130, very high (if it falls down at this time, pay attention to cardiac arrest)
Blood oxygen: 94%, it should be heart failure that causes blood to return to the lungs, resulting in pulmonary edema, and the itchy function of the lungs to exchange air decreases...
Heart rate: 140... (If the heart rate drops at this time, cardiac arrest is likely to occur)
Breathing: 48... The heart rate, breathing are very high, obviously the heart is still working wildly...
At this point,
The drug has come.
Prothetics, sacubitril-valsartan, β receptor blockers... Wait, lower your blood pressure...
While the nurse was taking medicine, Lin Feng listened to the heart and lung sounds.
• Lungs, with strong crackles, apparently already pulmonary edema (blood backflow to the lungs)
soon
The electrocardiogram pushed over.
Take the electrode and attach it to the old man.
After 1 minute,
The results are out!
Ventricular hypertrophy ...
No myocardial ischemia, etc...
Needless to say, this is definitely "heart failure".
"Doctor Lin..."
At this time, another nurse also pushed the B-ultrasound machine over.
Lin Feng turned on, adjusted the data, took the probe, and applied the couplant.
He did not aim at the patient's heart for the first time, but at the aorta of the old man's neck down the clavicle fossa.
Test "ejection function"!
When the heart pumps blood, blood is ejected from the aorta, called ejection.
Then there's a concept called "ejection fraction."
Ejection fraction is a volume ratio measure that reflects the ejection function of the ventricles from a volumetric perspective. Reduced ejection function indicates heart failure.
Lin Feng took the probe and measured it,
Really!
Ejection fraction: 38%!!
In general, the left ventricular ejection fraction is ≥50%; Right ventricular ejection fraction is ≥40%. Less than this value is cardiac insufficiency.
Then the B-ultrasound probe was aimed at the heart, and sure enough, it was found that the ventricles were hypertrophied and thickened, and there was a large amount of fluid diffused in the lungs...
All checks are complete.
The current situation of the elderly is relatively serious.
Heart failure + pulmonary edema + insufficient itching + hypertension + coronary artery sclerosis...
They are all more troublesome diseases.
......
It took more than 2 hours to rescue,
The patient's condition in the elderly family finally stabilized a little.
Cough, nausea, ascites halfway through... And so on and so forth...
The only lucky thing was that the patient did not have the heart arrest that he feared.
......
"Phew~~~~"
Lin Feng sat on the chair, exhaled a long breath, and finally rested.
"This night shift, really tired !!"
Lin Feng felt that the God of Night Shift was no longer so cute.
(God of the Night Shift: ??? Little brother, do you want to get tired a little ?? ）
At last
The God of the Night Shift felt that Lin Feng was too handsome to make him so tired, so this night shift was spent so 'safely'...
......
Take a day off during the day...
And then the next day,
Lin Feng continued to go to work.
The first 8 patients were all abdominal pain and fever...
The 9th patient is more special.
Ophthalmology.
Lin Feng has not touched the disease of ophthalmology for a long time.
......
"Doctor Lin, look into my eyes... There's something here..."
The patient, probably about 30 years old, was wearing clothes from the construction site, but washed cleanly and behaved a little restrained.
He stretched his head over and glared at Lin Feng.
Point to the rubbed red right eye.
"In my eyes, there seems to be something, probably iron filings..."
Lin Feng's eyes were very good, and he immediately saw that the cornea next to the patient's dark pupil had a brown dot, about 1mm in size.
"Corneal foreign body"!
"Tell me about the situation..."
"That's right, I'm a soldering iron worker at the construction site, and half an hour ago, I didn't wear goggles when I soldered iron, and then I felt a pain in my eyes, maybe I was splashed with iron filings... At that time, I was so painful that I couldn't open my eyes, and when I opened my eyes, my co-worker told me that there was a black spot, and I looked in the mirror and sure there were black spots, and I rubbed my hands for a long time without getting the iron filings out..."
Lin Feng nodded.
According to the patient's description, it should be iron filings.
When soldering iron, high-temperature sparks, that is, iron filings, will burst out, and then sputter into the eyes.
The disease of the patient in front of him is obviously a "corneal foreign body".
This disease is a common ophthalmic disease, and the general patient has a corneal foreign body, and then can't rub it down, will be seen by the ophthalmology department of the hospital.
This disease is easy to treat.
As long as "corneal foreign body removal" is combined with "antibiotic eye spotting", the recovery effect is usually better.
However, Lin Feng did not have the corresponding tools in his hands.
"You go to the ophthalmology..."
"No, no, no... Dr. Lin, I want you to help me treat, you are a good doctor..."
“.................."
In the face of such a, Lin Feng had no choice but to agree.
"You wait outside first, I'll ask the girl (nurse) to go to the ophthalmology department to borrow some tools..."
"Thank you Dr. Lin..."
......
After 20 minutes,
Nurse Xiao Ai returned with eye tools.
Lin Feng skillfully gave anesthetic to the patient's right eye, removed the corneal foreign body, and then ordered the patient with anti-infective eye drops...
Lin Feng was satisfied: "Okay, it's okay..."
The patient thanks: "Thank you Dr. Lin! "
After thanking you, I left the consultation room happily...
Lin Feng thought that this was the end of the matter,
outcome
Half an hour later, the patient returned!
Lin Feng: "???? "
The patient rubbed his right eye: "Dr. Lin, no, I still have a lot of pain..."
Lin Feng was stunned.
"It still hurts? Impossible, right? "
.