I Can See Health: Chapter 204 Embolism, and bleeding again!
Chapter 204 Embolism and bleeding again!
"If the patient is pretending to go down with a furosemide, he will definitely have to go to the toilet later." Fan Zhiping said.
"Well, that's a good idea." Cheng Peng nodded.
Lu Chen frowned, "I think there may be something wrong."
"What could be wrong with this?" Fan Zhiping asked in confusion.
"Push furosemide, there are indications." Lu Chen said, "We currently consider the patient to be in a pseudo-coma, but we can't be 100% sure, so we can't just use it. Because once the patient uses furosemide, there will be a Any problem, such as malignant arrhythmia, etc., that is our responsibility, and the consequences can be serious."
"Then what should we do?" Cheng Peng glanced at Lu Chen helplessly, "Just wait for the patient to become impatient and wake up by himself?"
Lu Chen smiled, "No, don't you forget that patients in a coma have some operations that must be done according to the principles of treatment."
Fan Zhiping frowned at first, then suddenly realized.
"You mean intubation and upper stomach tube?"
"Yes!" Lu Chen laughed.
Cheng Peng and Fan Zhiping glanced at each other.
It turns out that Lu Chen is the most "bad" one...
…
"What are your expressions..." Lu Chen glanced at the two of them angrily, "I'm just going to give it a try. If I'm in a coma, according to the principles of treatment, the urinary catheter must be inserted. If you have to insert a catheter, you will wake up 100%..."
"Then give it a try." Cheng Peng said.
A person who pretends to be in a coma, if you pinch him, he can also grit his teeth and endure it.
Because of the pain of pinching, most people have psychological expectations, know what is going on, and can prepare psychologically.
But when the stomach and urinary tubes were inserted, he couldn't bear it.
Because the feeling of inserting a stomach tube and a urinary tube is something that most people have never experienced before, and they cannot make psychological expectations to endure it.
…
came to the bedside.
Lu Chen was fully armed, wearing gloves, hats and masks.
Cheng Peng stood beside him on the platform, holding a catheter kit in his hand.
On the hospital bed, a middle-aged woman was lying on the bed, her face was very calm.
Lu Chen clearly saw her HP—74.
It seems that as Fatty Cheng said, the patient is pretending to be in a coma.
"Doctor, you are..." The patient's accompanying family member is a young woman, who should be the patient's daughter.
Cheng Peng said quickly: "We all need a urinary catheter for comatose patients."
The patient's daughter's face changed.
"This... shouldn't be necessary."
Cheng Peng shook his head, "Urinary catheters must be intubated. For all comatose patients, this is the basic principle of treatment. We cannot violate them, and after catheterization, you will take better care of the patients."
The young woman still waved her hand to refuse, stood up, and stood in front of Lu Chen.
"Doctor, why don't you wait a little longer, my mother might wake up soon."
Lu Chen pretended to be puzzled: "We can't guarantee when we will wake up. If our condition changes and we don't have time to respond, it will be bad."
"No, it won't." The young woman looked very resistant to the operation of the catheter.
The family members did not agree to insert the catheter, so Lu Chen and Cheng Peng naturally would not force the operation.
"Then let's observe for another 20 minutes. If the patient does not wake up, a urinary catheter must be inserted, otherwise this does not meet the treatment principles."
Lu Chen's voice was so loud that he believed that the middle-aged woman lying on the bed could also "hear" it.
"This, this... that's fine."
The young woman looked back at the woman on the bed and could only nod silently.
…
The catheter bag was not opened, and Lu Chen and Cheng Peng returned the same way.
Back to the doctor's office.
Cheng Peng said hesitantly, "Lu Chen, does this really work? If you try Dr. Fan's method, I think it should work!"
"Don't worry," Lu Chen said with a smile, "I will give her twenty minutes, and she will definitely wake up later. Pushing furosemide seems to be a good solution, but it does not conform to the principles of treatment. If you trouble us, it won't be easy."
"Well." Cheng Peng nodded.
Now we can only wait.
Waiting for the patient to wake up on his own.
…
Eight district wards in the heart.
"Mom, if you don't wake up again, the doctor will insert a urinary catheter for you!" The young woman looked around and whispered to the woman on the hospital bed, "I heard that the urinary catheter is very painful, and there are many complication…"
The middle-aged woman on the hospital bed, with her eyes closed and her eyelashes fluttering slightly, seemed to be waking up at any time.
"Mom, it's almost done... I've already scared others. The neighbors won't dare to quarrel with you in the future. They have already paid for the medical bills."
After the young woman finished speaking, the middle-aged woman on the hospital bed slowly opened her eyes, her voice sounded extremely weak, "Then I will have to buy a few more expensive bottles of qi and blood!"
"Okay, then I'll go talk to the doctor." The young woman breathed a sigh of relief, she was really afraid that her mother had overplayed.
…
While Lu Chen and Cheng Peng were chatting, Nurse Liu walked into the doctor's office.
"Doctor Cheng, your comatose patient is awake!"
Cheng Peng looked happy and stood up quickly: "That's great! I'll go see her."
Lu Chen smiled and joked: "Come on, or you'll be unconscious again later."
Cheng Peng came back within five minutes of going to the ward.
"Hey, what kind of injection does the patient need to replenish qi and blood? We don't have any proprietary Chinese medicine here, so we can't take it!" Cheng Peng said helplessly.
Chinese people, especially the older generation, are very superstitious about Chinese patent medicine preparations.
It cannot be said that Chinese-made preparations are useless, but the ones that really play a clinical role are also Western medicine preparations.
Many proprietary Chinese medicines are only placebos.
"Fatty, just call her a bottle of amino acids and a bottle of vitamins." Lu Chen suggested.
"That's the only way." Cheng Peng nodded.
Amino acids, albumin and other drugs have special magic power for the older generation.
Many patients, no matter what disease or department they are in, will come up and ask if they can take amino acid or albumin.
For the treatment of diseases, amino acids are useless, even as a nutritional medicine.
If the albumin is not low, the infusion of albumin will not only have no benefit, but also increase the burden on the heart, leading to the occurrence of heart failure.
After negotiating with the patient, Cheng Peng solved most of the problems.
Everyone opened one eye and closed one eye, and did not reveal the fact that she was pretending to be asleep.
The middle-aged woman asked to be discharged from the hospital after finishing the drip.
Compared with Fan Zhiping's "push furosemide", Lu Chen's "intubation catheter" is more in line with the clinical thinking of diagnosis and treatment.
Otherwise, in the process of pushing furosemide, if there is a real change in the condition, it will not be worth the loss.
After the incident, Lu Chen also received thanks from Cheng Peng.
"Congratulations, +1 for the thank you from Cheng Peng!"
…
After resolved this episode, Lu Chen continued to prepare his case report.
He flipped through the medical records he had encountered before.
The more interesting cases are oleander poisoning and the recent heart transplant case.
Other cases are either too simple and common, or too out of touch with the clinic.
Lu Chen temporarily listed two cases of oleander and heart transplantation as candidate cases.
…
After get off work, Lu Chen finished his dinner in the cafeteria and went back to the bedroom very early.
As soon as he opened the bedroom door, he received a call from his uncle Lu Wenjun.
On the phone, Lu Wenjun thanked Lu Chen again.
His father-in-law is already in good condition, and he is going to undergo surgery. This time, he came to ask Lu Chen's opinion.
Lu Chen patiently explained it to Lu Wenjun.
hung up the phone, Wang Zihao and others also returned to the bedroom.
"Zihao, can you do PPT?" Lu Chen looked at Wang Zihao.
Wang Zihao shook his head and walked to Lu Chen's side.
"You can do simple things, but you can't do things that are too complicated. What's the matter, do you want to give a PPT lecture? Or do you do it for the boss?"
"I use it myself. I'm not familiar with some functions in the PPT." Lu Chen said, "The time is tight, and learning slowly may be too slow. I want to find someone to show me."
"Well, I remember Lao Gu seems to know, he is an old driver." Wang Zihao thought for a while, "When he was an undergraduate, he gave speeches on stage several times, and the PPT is very beautiful."
"Gu Xinyue?" Lu Chen wondered.
"Yeah." Wang Zihao nodded, "He and I are both undergraduates from Jinghua Medical University, so we know him well."
"it is good."
Lu Chen found Gu Xinyue on WeChat.
…
"You want to do PPT?"
"Well, after I finish the first edition, can you help me review and proofread it?"
Lu Chen's words appeared in the dialog box, and a smile appeared on Gu Xinyue's face.
He was finally in a field where he could overtake Lu Chen.
Lu Chen thought that Gu Xinyue was unwilling, and was about to say it, but Gu Xinyue sent an "OK" gesture.
Lu Chen was overjoyed.
"Thank you so much, I'll send you the first version in two days, you can help me review it, and I'll invite you to dinner next time."
"Okay, then I can remember."
Gu Xinyue said many words, but she readily agreed.
After solving the problem of ppt production, Lu Chen re-invested in the screening of cases.
…
and on the other side of the bedroom in the Guipei Building.
Gu Xinyue received an email from Jinghua Electrophysiology Association after accepting Lu Chen's request.
He is now an ordinary member of the Electrophysiology Association, and occasionally receives emails from the association.
"Dear members, next Sunday, the Jinghua Electrophysiology Association will hold an academic exchange meeting. All members are welcome to participate actively at that time. The fare is at your own expense, and there is room and board."
"Electrophysiology exchange meeting?" Gu Xinyue touched her chin, "I must go see it."
This kind of academic exchange meeting is generally the exchange of academic frontier knowledge.
For Gu Xinyue, this is definitely a good opportunity to gain knowledge.
He had to go.
…
…
was speechless all night.
The next day.
Today Lu Chen is on the night shift.
So after he checked the room in the morning, he could go back to the bedroom to rest.
Recharge your batteries and prepare for the night shift at night.
Came to the department, Sun Guoguo led everyone to check the room.
As soon as he returned to the doctor's office, Lu Chen saw that the hospital charity meeting was coming.
The purpose of their trip was to investigate the patient with aortic dissection.
If the patient’s condition is true, then they will waive part of the patient’s fee.
The entire review process was relatively smooth.
The information of patients with aortic dissection is very detailed, and the survey by the Charity Association has passed!
In the end, you can reduce the fee by about 30%.
This should be considered a large proportion of the cost of surgery that can cost hundreds of thousands of dollars.
However, it also depends on the patient's family members and whether they can make up the remaining surgical expenses.
As long as the family members can collect the remaining expenses, the patient can be transferred to surgery immediately!
…
After resolving the matter of the Charity Association, Lu Chen was ready to leave the department.
Suddenly, Li Yao returned to the department.
She has been in the department more recently than before.
She walked into the doctor's office and glanced at everyone at work.
"The three districts in my heart have invited a general hospital consultation. Lu Chen, please accompany me to attend."
After , Li Yao walked away.
Lu Chen was about to leave. Hearing this, he could only stay temporarily.
It seems that we will have to wait until after attending the general consultation before going back to the dormitory.
"Junior brother, let's go, this is a good opportunity to learn." Sun Guoguo whispered, "The whole hospital has a large consultation, there are eight districts in the heart, each district will visit, and there will be people in other related departments of the hospital. join."
Lu Chen nodded, while thinking in his heart, "What kind of intractable patient is this, and he is so inspiring?"
He was in the Jinghua No. 2 Hospital, and it was the first time he met a patient in a general consultation of the whole hospital.
While thinking, Lu Chen followed Teacher Li Yao downstairs.
…
The place where the general consultation of the whole hospital is located is the showroom on the fourth floor.
This classroom can accommodate more than 200 people, and it is a classroom specially prepared for various meetings of the Cardiology Department.
The whole floor on the fourth floor is very large and is mainly divided into two areas, the CCU ward of the Cardiology Department on the right, and the catheterization room on the left.
Between the CCU and the catheterization laboratory, there is also a large classroom, which is the large classroom of the Department of Cardiology.
Lu Chen put on his shoe covers and hat, and followed Li Yao into the classroom.
indicates that there are already many people in the classroom, and everyone’s conversations are endless.
Lu Chen also met Gu Xinyue, who was sitting in the second row with a very good location.
Li Yao greeted the teachers in other districts in his heart.
Ten minutes later, the number of participants was almost there.
Director Yang of the third district in the heart, who presided over the general consultation of the whole hospital, slowly stepped onto the stage and began to speak.
"Thank you all for taking time out of your busy schedule to attend this general consultation of the whole hospital. This case is very difficult. The patient has been admitted to the hospital many times, and the condition has repeated. The current diagnosis is not clear, and it involves many disciplines. I think Again, I only invited the general meeting of the whole hospital this time."
"I hope everyone can brainstorm and propose a feasible diagnosis and treatment idea for this patient in our department!"
"Below is the patient's doctor Wang Peng, who will introduce the patient's medical history."
A young doctor came to the stage.
He is thin, about 1.7 meters tall, and has a light beard at the corner of his mouth.
On the screen in front of the stage, the patient's medical history information is displayed.
Wang Peng's voice also sounded.
Patient, female, 54 years old.
was admitted to hospital due to "sudden chest tightness for 4 hours".
Three months before admission, he received thrombolytic therapy in a local hospital for “inferior myocardial infarction” (the specific diagnosis and treatment process is unknown), and then underwent emergency coronary angiography to show proximal occlusion of the anterior descending artery.
On the third day after the operation, the patient developed tarry black stools of about 200g, **** occult blood (+++) and hemoglobin 97g/L after abdominal pain during hospitalization. The symptoms improved and he was discharged from the hospital.
After 2 months, the patient was admitted to the gastroenterology department of our hospital again due to "two times of black stool". On the 9th day after admission, the patient developed headache, vomiting, and blurred vision. Magnetic resonance imaging examination showed hemorrhagic cerebral infarction in the right occipital lobe and hippocampus.
…
"From a monistic perspective, what are the possible causes of multiple arterial embolisms and gastrointestinal bleeding in this patient?"
After listening to Wang Peng's description, Lu Chen felt that this patient was not simple.
Embolism for a while, and bleeding for a while.
It seems that these are two completely contradictory things.
No wonder we have to invite the whole hospital for a general consultation!
Lu Chen did not come up with any possible diagnosis or treatment for a half hour.
(end of this chapter)