bookpower Chapter 299
Chapter 299
Lin Feng told the doctors in the ICU about the possibility of "pulmonary embolism".
"It's like... It's really possible..."
"It's a bit far away, but it's a possibility..."
"This question cannot be ruled out ..."
Lin Feng pulled open Wang Lao's trouser leg.
"Is there a pulmonary embolism, you can look at his leg."
As soon as you open the trouser leg,
"Huh!"
"A lot of varicose veins!"
"This... Pulmonary embolism? "
Many doctors were shocked at once.
In their gaze, Wang Lao's legs had a lot of varicose veins and bulges.
If you have varicose veins, it means that thrombosis will be easier.
And, there is another piece of evidence:
Edema of the lower extremities!
One of Wang Lao's legs, around the site of varicose veins, has symptoms of edema.
"Edema": Once a blood clot is formed, the blood flow is not smooth, and excess blood will leak out into the soft tissues under the skin, which is manifested as edema.
There is edema - there is a high probability of thrombosis - there is a high probability of considering pulmonary embolism!
logic
Very reasonable!!
"The probability of pulmonary embolism has increased!"
"Yes."
Lin Feng looked at the director of the ICU: "Director Chen, the ICU should have a color ultrasound, right?" "
Director Chen: "Yes!" "
Lin Feng: "I will color ultrasound, I want to do a lower limb vascular color ultrasound for the patient to see if there is a blood closto, as long as there is a blood clos, the possibility of pulmonary embolism is very large!" "
Director Chen's mind moved: "Doctor Lin, will you be B-ultrasound?" "
Lin Feng: "B ultrasound is still quite simple, when doing intervention, some interventions need to use B ultrasound..."
Doctors: ".................."
B Super simple?
It's a simple ghost, I won't do it!
Dr. Lin is such a demon!
Soon, the ICU nurse pushed the color ultrasound instrument to the hospital bed.
Turn on the ultrasound machine, apply lubricant, and aim the probe at the leg to start looking.
Examination results: 14 blood clots!
It's just shocking!
Even if a blood clot falls at random, it will flow all the way down the vein.
After the following cycle:
Lower extremity (whole) blood flow will first enter the (upper and lower) vena cava - right atrium (blood storage) - (tricuspid valve) right ventricle (pumping blood) - (high-pressure blood pumping) pulmonary artery - pulmonary capillaries (alveoli, oxygen, carbon dioxide exchange) - pulmonary vein (oxygenated blood) - left atrium (blood storage) - (mitral valve) left ventricle (pumping blood) - (high-pressure blood pumping) aorta - arteries of organs throughout the body... (PS: full of dry goods)
The thrombus goes all the way down the above blood pathways, all the way to the tributary position of the pulmonary artery, that is, when it has not yet reached the "pulmonary capillaries",
And then block the tributaries,
Formation of "pulmonary embolism"!
Seeing so many blood clots,
The scales began to tilt towards the 'pulmonary embolism' side.
"It should be a pulmonary embolism!"
"Thrombolysis."
A doctor suggested.
However, there are also doctors who object.
"Can't dissolve thrombosis, the side effects are too big, easy to lead to internal bleeding, if the brain hemorrhage is troublesome..."
"I recommend thrombolysis, now the onset is less than 3 hours, there is still a chance of thrombolysis, and it is meaningless when the time has passed."
"Don't worry, look at the color ultrasound first, is there a pulmonary embolism!"
"Yes, there may not be a pulmonary embolism."
"With so many blood clots, how can there be no pulmonary embolism ..."
A bunch of doctors, quarrelling.
Lin Feng was unmoved.
Because there is no need to be noisy,
The patient can be given a "cardiopulmonary ultrasound" examination immediately.
Lin Feng quickly applied the lubricating oil to the patient's chest.
The doctors quieted down and waited for the ultrasound results.
soon
The probe shone into the lungs of patient Wang Lao...
Find the pulmonary arteries, look at the tributaries of the arteries one by one...
10 minutes later...
· Ultrasound results: normal blood flow, no embolism...
Doctors: "..........................."
Vozh!
So many thrombs in the lower extremities, there is no pulmonary embolism!
It's so bizarre!!
Next, the doctors began to scratch their heads.
Look at the heart blood flow, that is, the heart ultrasound...
Check result: Still normal!
Doctors: "%¥#¥#%......
There is no more fuck to speak of!!
There is no problem with the lungs, that is, there is a problem with the head?
But
The intensity of B ultrasound cannot penetrate the braincase of adults, and color ultrasound has no effect.
Only if the baby's head is soft, can B ultrasound be used.
thereupon
The condition is deadlocked!
In the absence of cerebral hemorrhage or bruise, why does the patient have edema?
Is it because of cerebral infarction?
Now by means, there is no way to confirm cerebral infarction, because the time is not long enough (after 24 hours)!
CT (contrast agent) can be enhanced, but now the patient is staying alive in the ICU and cannot go to the CT room.
There is no way to use MRI ...
All doctors: ".............................."
Muggle up!
If you can't find the cause, there is no way to treat the symptoms!
Stalled!!
Lin Feng scratched his hair, considering various possibilities in his heart.
"Could it be... Cerebral embolism? "
"Cerebral embolism": that is, the blood clot enters the brain, blocking the blood vessels...
But
There is a problem, the blood clot can't even pass through the pulmonary capillary, how can it run to the brain?
"Huh... Wait..."
suddenly
Lin Feng thought of a possibility:
"Patent foramen ovale"!
"Patent foramen ovale": Explanation of the meaning: the left atrium and right atrium are close to each other (located in the upper part of the heart), which are normally not connected, but there is a foramen ovale communication between the left and right atria in the fetal period, and it gradually closes after birth.
If the "foramen ovale" is not closed, it is "patent foramen ovale".
This is a congenital heart disease that is relatively common, and 1 in 4 adults has this disease.
It's a bit like "room shortage", there is no danger of room shortage.
"If the patient really has "patent foramen ovale", then the thrombus can be pumped from the right atrium - foramen ovale - left atrium - left ventricle - high-pressure pumping into the aorta of the heart - reaching the cerebral artery - resulting in cerebral embolism, further ischemia and hypoxic cerebral infarction!!"
Come to think of it!
Lin Feng was excited.
Quickly put the B-ultrasound probe into the "left and right atrium" position of the patient's heart.
Look closely,
really
I was really found by Lin Feng a 'round hole', about 1cm in size!!
Didn't run!
This cliff is a murderer!
A doctor noticed Lin Feng's expression: "Doctor Lin, have you found it?" "
Lin Feng nodded and pointed to the B-ultrasound display: "Here... There is a "patent foramen ovale"..."
"What?" Patent foramen ovale"? "
"Congenital heart disease?"
"I'll see..."
"Oh, really!"
"Patent foramen ovale"? Could it be... Cerebral thrombosis? A doctor, shouted excitedly!
Other doctors woke up.
"There are so many blood clots in the patient's lower limbs, plus a "patent foramen ovale", it is really possible that there will be cerebral thrombosis!"
"Feeling, this should be the real cause!"
"Doctor Lin, awesome!"
Lin Feng shook his head: "There is no way to really confirm the cerebral thrombosis now... It is best to wait for the patient's condition to ease and go for contrast-enhanced CT angiography..."
Lin Feng sighed secretly,
Why did I not go for CT enhanced imaging in time when I checked CT before sending it to ICU?
However, at that time, I didn't think about cerebral embolism, because the probability is too low, and the probability of pulmonary embolism is higher than it.
I just didn't expect to add such a rare thing as "patent foramen ovale".
Lin Feng did not see it, and secretly sighed at the impermanence of fate.
"Wait..."
"When the condition is stable, send brain CT angiography..."
Lin Feng said.
The ICU doctors nodded in agreement.
But
Things suddenly took a sharp turn.
"It's not good, my blood pressure has dropped again!!"
"The heart rate jumped to 170!"
"Blood oxygen has dropped to 89%!"
The nurse reported in a panic.
All the doctors were taken aback.
A shock life lasted, and that's it!
It means that the condition is worsening!
"Quick, replace it with a high-frequency ventilator (higher frequency than ordinary ventilators, smaller gas injection and higher efficiency)!"
"Vasopressors, more!"
Lin Feng gave a series of instructions, and the nurses took action.
Soon, the medicine was used.
Although the condition is stable, it is a little lower than just now.
Lin Feng and many ICU patients were worried.
At this time,
Lin Feng decided: "Inform the family and see the opinions of the family... Now this situation can not be delayed, if it is really a cerebral thrombosis, the cerebral infarction will continue to expand over time... So, my recommendation is thrombolysis! "
The risk of thrombolytic therapy is very large, and thrombolytic drugs may cause cerebral hemorrhage if they are not careful? Isn't that the end of the game?
But......
The current etiology analysis, the only probability is cerebral thrombosis!
You can only bet!
Bet on the patient is a cerebral thrombosis!
If you gamble, the patient will be rescued!
If you don't gamble, the patient's condition may worsen!
All this,
It's up to the family to decide!
Doctors can't make this decision!
......
ICU outdoor,
On the stool,
Wang Lao's wife, son, daughter-in-law, and 5-year-old grandson are anxiously waiting.
The son walked around, anxious.
I was also a little aggrieved in my heart!
Airplanes~~~~
At this time, the electronic lock door of the ICU is panned open.
Director Chen of the ICU walked out with the nurse.
"Is Wang Dongsheng's family there?"
"I'm in!"
They all came to Director Chen.
The son was nervous: "Director Chen, what's wrong with my dad?" "
Director Chen: "The patient's condition is not optimistic, because now in the ICU, there is no way to do CT, there is no way to do MRI, and there is no way to really determine the cause... Moreover, the patient's condition is currently deteriorating..."
The son wanted to lose his temper and yelled: How did your hospital do it...
But as soon as he saw Director Chen's majestic gaze, he couldn't spit out this sentence.
Son: "So what now?" "
Director Chen: "At present, we consider the patient to have cerebral thrombosis... Balabala (explained the analysis of the condition, the diagnosis process) ... Finally, there are two options, one is thrombolytic treatment, the other is not thrombolytic, continue to wait for the condition to improve, go for CT angiography..."
For a while, the son felt a dilemma.
Thrombolysis, which can lead to death from cerebral hemorrhage.
Not thrombolysis, and afraid of deterioration.
And Wang's wife, a 60-year-old lady, has already fallen on the chair at this moment, crying, and her daughter-in-law and grandson are comforted...
10 minutes...
20 minutes...
Director Chen did not rush because he could not influence the judgment of the family.
After thinking about it for a long time, my son gritted his teeth for the last time!
"Thrombolysis... Please Director Chen! "
"Good!"
The son signs the agreement.
The moment he signed the word, he suddenly felt as if his whole body had been drained of strength, and he fell to the ground.
......
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ps: There are more dry goods, I am afraid that book lovers will be bored, and the author has tried to write the content in a simple and understandable way.
The chapter puts a picture: Cardiac circulation ·jpg
Distressed to send yourself ~~~