I Can See Health

Zhang Wulong recognized the doctor who spoke in the group.

His name is Yu Songbei, and he is the deputy chief physician of the Department of Cardiology at Pingshui County Hospital of Traditional Chinese Medicine.

My ability to read electrocardiograms is pretty good. I am usually very active in the group and am always eager to help others answer electrocardiograms.

"Thank you, Teacher Yu, for your guidance."

Yu Songbei replied with a smiling emoticon: "You're welcome."

Zhang Wulong's anxious mood calmed down a little.

It will be easier to deal with if you can have a preliminary impression and diagnosis.

Since myocardial ischemia is considered to be caused by coronary heart disease, it is enough to wait for the cardiology department to come for consultation and then send the patient to the cardiology department for hospitalization.

…

"Dr. Zhang, the doctor from the cardiac consultation is here!"

The nurse called from the corridor.

Zhang Wulong immediately walked out of the ward and welcomed the cardiologist in.

"Lao Fan, why did you come here? It's been almost ten minutes. This patient is a relative of the county leader. The director has already spoken, so we can't neglect him."

"Hey, Corey is busy, so I took some time out." Fan Zhiqingping, the chief physician in the Department of Cardiology, shook his head slightly and said, "Let me see what kind of patient it is."

Zhang Wulong handed the electrocardiogram in his hand to Fan Zhiping.

"The patient's general fatigue has been worsening for the past day. He has no special medical history, but he has high blood pressure. His blood pressure has not been well controlled."

Fan Zhiping glanced at the electrocardiogram and then conducted a simple physical examination on the patient.

"The patient's myocardial ischemia is severe."

"Well, we just considered it to be coronary heart disease." Zhang Wulong nodded, "However, the patient did not have obvious symptoms of chest tightness or chest pain. The symptoms of coronary heart disease do not seem to be consistent."

"It may be fatigue and anorexia caused by coronary heart disease and heart failure." Fan Zhiping said, "Some heart failure patients have less typical symptoms. They may be serious gastrointestinal symptoms, such as poor appetite and poor long-term nutritional status. , it may lead to fatigue and anorexia.”

At present, the diagnoses of Fan Zhiping and Zhang Songbei in the group are similar, and they both mainly consider myocardial ischemia caused by coronary heart disease.

"Then I will issue a hospitalization certificate from the Department of Cardiology and let him go into your heart." Zhang Wulong said.

"Okay." Fan Zhiping nodded, "Then I'll go back to the department."

"Thanks."

Zhang Wulong smiled. He was about to issue a hospitalization certificate to the patient, but unexpectedly his cell phone vibrated.

He glanced slightly and found that it was a message from the electrophysiology communication group, as if someone was following him.

Zhang Wulong frowned and opened the WeChat group in confusion.

After seeing the message in the group, he was stunned.

Then he immediately shouted to Fan Zhiping, who was preparing to go to the emergency department: "Lao Fan, please wait before you leave!"

Fan Zhiping stopped and turned around in confusion: "What's wrong?"

"Take a look at this electrocardiogram again!"

Fan Zhiping's eyes were stunned, and he quickly walked back to Zhang Wulong at any time and picked up the electrocardiogram on the table.

"Is it possible that it's hypokalemia?" Zhang Wulong asked softly.

Fan Zhiping's eyes flashed, "Hypokalemia?"

He concentrated his attention and carefully analyzed every waveform in the electrocardiogram.

This is...U wave?

Fan Zhiping discovered that after the T wave of this electrocardiogram, there was a very small waveform, the U wave!

The small U wave is a specific waveform of hypokalemia.

Fan Zhiping's frown suddenly relaxed.

"Yes, this is hypokalemia!"

"The patient has symptoms of general weakness, which is caused by hypokalemia!

"In addition, the patient's heart rate is relatively slow, which is also due to hypokalemia!"

In this way, all the patient’s symptoms and signs can be explained!

"Is it really hypokalemia?" Zhang Wulong said in surprise.

"Well, it seems that it is probably hypokalemia!" Fan Zhiping nodded, "The blood test report may be a little late. Take a blood gas analysis now to see the potassium in the blood gas analysis. ion level.”

"Okay!" Zhang Wulong immediately ordered the nurse to collect arterial blood gas.

Emergency departments are equipped with rapid blood gas analyzers, with results usually available in minutes.

A blood gas analysis draws blood from the patient's arteries.

It can initially evaluate the patient's pulmonary ventilation function and acid-base balance status. At the same time, the value of potassium ions is also included in the blood gas analysis.

The nurse begins taking arterial blood gases.

Fan Zhiping did not leave, but stayed in the emergency department, waiting for the results of the blood gas analysis to come out.

Arterial blood gas collection was completed three minutes later.

"Doctor Zhang, the results of the blood gas analysis are out!"

The nurse handed the small note for blood gas analysis to Zhang Wulong.

Fan Zhiping immediately put his head over.

"Serum potassium: 1.9mmol/L..."

The normal blood potassium range is 3.5-5.5mmol/L.

1.9mmol/L is already a standard for severe hypokalemia.

Patients are at risk of cardiac arrest or even sudden death at any time!

"Severe hypokalemia!" Zhang Wulong said.

"Replenish potassium quickly!" Fan Zhiping nodded, "Although generally speaking, the potassium ion level in arterial blood is lower than that in venous blood, this patient's serum ion value should be higher than 1.9mmol/L , but not much higher.”

Zhang Wulong immediately gave the doctor's order to start potassium supplementation through oral and intravenous methods at the same time.

"Lao Fan, based on this patient's past history of hypertension, is it possible that he has original aldehyde?"

Fan Zhiping glanced at Zhang Wulong in surprise, "You're not a simple boy. Have you diagnosed all this?"

Everyone has been colleagues for many years, and Zhang Wulong's level is very clear to him.

Normally I can't even detect myocardial ischemia in the electrocardiogram, so why did I directly detect hypokalemia today?

And he mentioned primary aldosteronism in one breath?

"Hey, I don't have the ability to read an electrocardiogram."

Zhang Wulong took out his mobile phone and opened the WeChat group.

"No, I posted this picture in the electrophysiology communication group. At first, some doctors said it was coronary heart disease or myocardial ischemia."

"However, a teacher just said that it may be hypokalemia. Based on the medical history, raw aldehyde is considered, so I called you back."

Fan Zhiping took the phone and looked through the chat history in the group.

The last message in the group was sent by a person with the nickname "Jinghua Electrophysiology Association".

" @Zhang Wulong from the emergency department of Feng M County People's Hospital may have hypokalemia. Based on the medical history, raw aldehyde is considered."

Fan Zhiping asked in confusion: "Old Zhang, what do you guys do as a group?"

"Oh, this group is a group established by the Jinghua Electrophysiology Association at UU Kanshu www.uukanshu.net in order to facilitate academic exchanges in grassroots hospitals. The members are all doctors from nearby county-level hospitals. They usually communicate about electrocardiogram matters. "There are several members of the Jinghua Electrophysiology Association in each group. They are basically doctors from Jinghua Hospital, and some are even professors." Zhang Wulong smiled, "But this teacher is called Lu Chen." "It seems that I saw him speak for the first time today, and I had no impression of him before."

"You still have this kind of group?" Fan Zhiping became interested.

"Yes, this has only emerged in recent times." Zhang Wulong said, "I also joined the group through a good friend."

"Old Zhang, then quickly bring me into the group!" Fan Zhiping patted Zhang Wulong on the shoulder.

"Hey, do you still want to find someone else to look at the pictures?" Zhang Wulong said with a smile.

"Oh, it's not like you don't know that there is nothing specializing in electrophysiology in the cardiology department of our grassroots hospital." Fan Zhiping shook his head slightly, "There are many difficult electrocardiograms that even our director can't understand, so we have to send patients to them. It’s a big hospital. But some patients’ family conditions don’t allow it, so they still stay in our department, which is difficult for us to do.”

"Okay, then I'll bring you into the group."

"Thank you, Lao Zhang. I'll treat you to a massage in a few days."

"It's easy to talk about."

…

Jinghua Second Hospital, Guipei Building dormitory.

Lu Chen was lying on the bed.

"Congratulations, I received a +1 thank you from Zhang Wulong!"

Lu Chen looked happy. It seemed that this picture really showed hypokalemia!

as expected.

After a while, Zhang Wulong sent a message in the WeChat group.

" @Jinghua Electrophysiology Association Lu Chen, thank you Professor Lu! It's really hypokalemia!"