I Can See Health: Chapter 30 cardioversion
Chapter 30 Cardioversion
"Old Dong, so this ECG is really not a supraventricular tachycardia, but a left posterior fascicular tachycardia?"
After , Lu Wenguo looked up at Lu Chen.
Over the phone, Lao Dong smiled and sighed.
"Yes, it is indeed the left posterior fascicular tachycardia."
"This special type of ventricular tachycardia is easily confused with supraventricular tachycardia with right bundle branch block. This type of electrocardiogram is rarely seen in a primary hospital like ours, and I really didn't notice it at first glance. But I took a closer look. Look, there is atrioventricular dissociation, it should be left posterior fascicular tachycardia."
"You can quickly stop Dalon, push a verapamil, and you should be able to stop the left posterior fascicular ventricular tachycardia."
"Okay, but we don't have verapamil in our department. I'll ask the nurse to borrow two from your department."
Lu Wenguo sighed in his heart, this is exactly the same treatment method as Lu Chen said.
"Hey, Lao Lu, hang up the phone later! You haven't said that who saw this electrocardiogram room?"
Lu Wenguo smiled, "Let's talk next time we meet. The patient's condition is urgent now, so I'll ask the nurse to take medicine first."
Hearing the busy tone on the phone, Lao Dong shook his head helplessly.
He has a good understanding of the level of Binh Duong hospitals.
As the deputy chief physician in the heart, if he didn't even judge that this ECG was left posterior fascicular tachycardia at the first time, let alone other people.
Not to mention that the other party is also a surgeon.
This is definitely not the level that Lao Lu can have!
Is there someone behind him?
Old Dong thought to himself, he guessed that there was someone behind Lu Wenguo, but he couldn't guess it was his son.
…
General Surgery.
After making this call, Lu Wenguo could basically make a clear diagnosis. This electrocardiogram should be "left posterior fascicular ventricular tachycardia".
Wu Yun also heard the conversation between the two. After confirming that it was the left posterior branch ventricular tachycardia, he gave Lu Chen a thumbs up.
"Zhang Xin, stop the patient's Dalong just now."
Lu Wenguo walked to the nurse's desk.
"Then call the nurse and go to the cardiology department to borrow two verapamil."
Sometimes, the medicines from the night shift emergency pharmacy of the hospital are slow to arrive. It is better to borrow one directly from the relevant department, and then return the medicine after the pharmacy arrives.
Zhang Xin said in surprise: "Director Lu, this patient's Dalong pump still has more than half of the liquid, so stop it?"
Lu Wen nodded.
"After borrowing Verapamil, push one first."
"Okay." Zhang Xin immediately called the Cardiology Department.
In less than five minutes, the nurse brought verapamil from the cardiology department.
Verapamil, a derivative of papaverine, is a class IV antiarrhythmic drug, an inhibitor of calcium ion influx.
Lu Wenguo and Wu Yun stood beside the patient's bed, watching Zhang Xin slowly and quietly push a verapamil into the patient's vein.
"Director Lu, your medicine is..."
The fat man with big head and big ears carefully looked at the doctor's order on the treatment list.
"Vehicle pulls rice."
Lu Wenguo glanced at the fat man: "Verapamy."
"Director Lu, why did you take the medicine just now?" the fat man wondered, "I think there are more than half a bottle in it, isn't it all wasted?"
Lu Wenguo kept staring at the ECG monitor, and replied without raising his head: "Your father is not sensitive to the drug just now, and the type of his arrhythmia is more complicated, we need to try another drug."
"Oh." The fat man nodded, and then sat down beside the bed with peace of mind.
Many times, based on the hospital's medical level and awareness of the disease, diagnostic errors or treatment errors often occur, but it is inevitable.
For example, the identification of left posterior fascicular ventricular tachycardia and supraventricular tachycardia with right bundle branch may be mistaken by the top three hospitals, let alone a primary hospital like Pingyang!
So when this happens, proper communication can avoid the occurrence of medical disputes.
If Lu Wenguo tells the truth now, saying that the diagnosis is wrong and that the wrong medicine is used, then the family of the patient will not be allowed to make a scene again.
…
Time passes by every minute and every second.
It has been five minutes since the intravenous bolus of verapamil.
Lu Wenguo and Wu Yun were still standing beside the patient's bed, their eyes fixed on the ECG monitor.
Heart rate is still 150 bpm!
Wu Yun whispered: "Director Lu, I just heard Xiaochen say that if the first verapamil does not work well, you can wait ten minutes and then push another one."
"Yeah." Lu Wenguo replied softly, "Then observe for a few minutes, if it doesn't work, push it again."
Another three minutes passed.
Patient's heart rate is still 150-160/min.
"Zhang Xin, prepare to push another verapamil." Lu Wenguo ordered.
"Okay, I'll go to the dispensing room." Zhang Xin nodded, turned and left the ward and walked towards the dispensing room.
Zhang Xin just walked out of the ward.
The heart rate value on the ECG monitor suddenly jumped!
Lu Wenguo and Wu Yun saw that the original value of 150 suddenly dropped to 130…
Then another jump, down to 110…
"Zhang Xin, wait a minute, you don't have to go now." Lu Wenguo immediately looked at the patient on the bed, "Master, how do you feel now?"
The old man on the bed slowly opened his eyes.
"I don't feel much, just feel a little better, and feel that my heart is not beating as fast as before."
Lu Wenguo turned his head and instructed, "Xiao Wu, contact the ECG room and give the patient a review of an ECG."
"Good Director."
Wu Yun immediately took out his mobile phone and called the ECG room.
Surgical departments in basic-level hospitals like them do not have a standing electrocardiograph.
Once you encounter a patient with such arrhythmia, you need to ask the night shift doctor in the ECG room to come and do an ECG.
"Director Lu, my dad's heart rate has dropped!" The fat man was delighted. He also saw the phone on the ECG monitor, "Is he okay?"
Lu Wenguo's serious expression softened slightly.
"It's hard to tell right now, we're going to give your father a review of an electrocardiogram."
Clinicians are never full of words, and everything must be said with the evidence of auxiliary examinations.
"Okay, I will listen to you, Director Lu."
The fat man nodded like a chicken pecking rice, and with his bloated figure, he felt a little bit of joy.
The night shift doctor in the ECG room arrived soon.
"Buzz...buzz..."
Twelve lead ECG is done.
Heart rate 106 beats/min!
Although the heartbeat is still faster than normal people, it has dropped significantly.
…
doctor's office.
Lu Chen suddenly received a system prompt.
"System completion increased!"
System completion has risen again, from 40% to 50%.
Lu Chen smiled slightly, it seems that the patient should have been cardioverted!
But this time, the gratitude value did not increase.
Lu Chen guessed that although this case was diagnosed by him, the patient and his family did not know of his existence.
So this time, only the system completion degree has increased, and the gratitude value has not increased.
on the system light curtain.
Thanks for a total of 5 points.
System completion is 50%.
One step closer to 100% completion of the system!
All cases, diagnoses, treatments mentioned in this book are real.
Some I have encountered, some I have heard of, and some are derived from case reports and papers.
Including eating barbecue, leading to rat poisoning, this is a patient who has personally experienced it.
(end of this chapter)