I Can See Health

These days, Lu Chen has also devoted some of his energy to follow the "Jinghua Electrophysiology Exchange WeChat Group".

In this group, doctors send electrocardiograms every day and exchange some interpretation experiences with each other.

Before, Lu Chen was reviewing for the skills test and did not have much time to pay attention.

Now, he will open WeChat from time to time to see if there are some difficult electrocardiograms that need to be interpreted.

Perhaps, he can earn some gratitude points from it.

…

Feng M County People's Hospital.

Department of Cardiology.

Fan Zhiping is in the doctor's office, exchanging stock market experiences with colleagues.

"Oh, the current market is not very good. I was liquidated some time ago and suffered heavy losses!" Fan Zhiping beat his chest and sighed.

"Director Fan, you are still lucky. You made a lot some time ago, but I lost a lot this time." A resident doctor in the department shook his head, "My wife is almost angry with me, alas."

Just as the two sighed.

The head nurse walked into the doctor's office in a hurry and knocked on the door of the office.

"Director Fan, a patient with acute heart failure has been pushed into the emergency department! I think the patient's condition is quite serious, please go and take a look!"

Fan Zhiping was startled, immediately put away his smile, and grabbed the stethoscope.

"Which bed? I'll go now!"

"The patient is in the emergency room!"

"Okay."

Fan Zhiping immediately walked out of the ward, and the resident doctor who had just chatted with him followed closely.

Soon they arrived at the emergency room.

On the bed was an old lady in her seventies or eighties, sitting on the bed, breathing heavily, with a little cyanosis on her lips.

There was also a young doctor wearing glasses standing next to the bed.

"Director Fan, you are here, this should be a patient with heart failure."

When the emergency doctor saw Fan Zhiping coming, he felt relieved and immediately began to report the medical history.

"The patient, a 78-year-old female, complained of palpitations for more than 10 days."

"The patient felt that her heartbeat was accelerated, which was continuous and sometimes aggravated. She had no other discomfort such as chest tightness, chest pain, dyspnea, cough, sputum, dizziness, syncope, abdominal pain, abdominal distension, etc."

"The old lady reported that she was usually healthy, denied any other medical history or any history of taking medicine, and rarely went to the hospital for treatment."

"Physical examination upon admission: blood pressure 125/75mmHg, heart rate 125 beats/min, absolutely irregular rhythm, heart sounds of varying strengths, no murmurs, clear breath sounds in both lungs, no dry or wet rales, and no edema in both lower limbs."

"After admission, an electrocardiogram was checked: it was rapid atrial fibrillation with frequent premature ventricular contractions. A chest CT scan has been done, but the results are not yet available."

Fan Zhiping nodded and began the physical examination.

At the same time, he instructed the nurse to perform electrocardiogram monitoring and oxygen inhalation on the patient.

The emergency doctor handed the electrocardiogram and emergency medical records to the resident doctor next to him.

"Director Fan, I'll leave the patient to you. I'll leave first."

"Okay." Fan Zhiping nodded.

The emergency doctor pushed the flatbed and left.

"Director, this is acute left heart failure caused by rapid atrial fibrillation, right?" The young resident doctor next to him picked up the electrocardiogram and took a closer look. "It is also accompanied by secondary ST segment changes."

"Yes." Fan Zhiping nodded with relief and said to the nurse, "First, check the blood, renal function, ions, myocardial enzymes, and BNP urgently, then push a bottle of furosemide and half a bottle of digoxin intravenously!"

"Okay, Director."

The nurse quickly returned to the treatment room to prepare the medicine.

Fan Zhiping said to the resident doctor beside him: "Xiao Fang, when we encounter heart failure, the first choice is furosemide. If the effect is not good, we can use digoxin to strengthen the heart. But this patient is different. I chose a cardiotonic at the beginning. Do you know why?" Xiao Fang paused, pondered for a moment, and said slowly: "I remember that the internal medicine book said that the best indication for digoxin is rapid atrial fibrillation with heart failure. This patient...just meets the requirements!" "Yes." Fan Zhiping nodded slightly, "Yes, digoxin can control the ventricular rate of atrial fibrillation and can quickly relieve the symptoms of heart failure." At this time, the nurse just took furosemide and digoxin. "Director, I will check the oral doctor's order for you again. One bottle of furosemide is injected intravenously, and half a bottle of digoxin is injected intravenously." "That's right." The nurse received Fan Zhiping's affirmative reply and began to execute the doctor's order. Furosemide is injected intravenously! Slowly inject digoxin! ... Fan Zhiping has returned to the doctor's office, leaving only Fang Yong in the ward to observe the patient's condition changes. At this time, the nurse had just finished pushing the digoxin.

"Grandma, do you feel better from the chest tightness?" Fang Yong approached the bed and asked softly.

On the bed, the old lady was still breathing hard and waved her arms weakly.

Fang Yong frowned.

Looking at the patient's condition, not only did it not get better, but it seemed to be getting worse!

This is not right!

"I, I have some chest pain and chest tightness..." The old lady said a few words with difficulty.

The patient's family members beside him heard this and suddenly became anxious.

"Doctor, what's going on? I feel that my mother's symptoms have become worse after taking these medicines just now!"

"Don't worry, observe it again!" Fang Yong calmed down and turned back to the nurse, "Go and call Director Fan over."

At the same time, he picked up the stethoscope to auscultate the patient's lungs.

As soon as he placed the stethoscope on the auscultation area of ​​the patient's lungs, Fang Yong felt something was wrong.

When the patient first came to the department, her lungs were clean on auscultation and no wet or dry rales were detected.

But now.

The old lady's bilateral lungs newly developed wheezing sounds mainly in the expiratory phase, and a little wet rales could be heard in both lower lungs.

Why is it happening like that?

"Xiao Fang, what's wrong?"

At this time, Fan Zhiping arrived.

"Director, the nurse just finished pushing Cidilan, and the patient feels that the chest tightness has worsened!" Fang Yong said immediately, "I just auscultated the patient's lungs, and there are changes compared to before!"

Fan Zhiping frowned and quickly auscultated his lungs again.

"There are indeed changes. You can hear wheezing, and there are even some crackles at the bottom of the lungs, which were not heard before."

This is a sign that the condition is getting worse!

"Push one furosemide, and then give the patient a set of nebulization! Then give the patient another shot of Protent!"

Fan Zhiping immediately began to issue verbal medical orders.

Now is not the time to think about why a patient is getting sicker.

Stabilize the condition first, that is the most important thing!

About ten minutes later.

The patient's symptoms began to ease, and the chest tightness and chest pain gradually disappeared.

Everyone breathed a sigh of relief.

…

At the same time, UU Reading www.uukanshu.net Fan Zhiping began to speculate on various possible reasons.

"This patient developed symptoms after taking Cidilan. Is it a drug reaction to Cidilan?"

Back to the doctor's office.

Fan Zhiping looked through all the patient's laboratory indicators, still at a loss for a long time.

"Director Fan, I just checked another electrocardiogram."

Fang Yong was very diligent. After the patient's symptoms improved, he reviewed an electrocardiogram.

Fan Zhiping got the review electrocardiogram and took a closer look.

The electrocardiogram reexamined still showed atrial fibrillation and frequent ventricular premature ejaculation, and the heart rate returned to normal.

However, compared with the electrocardiogram at admission, ST segment depression and T wave inversion were common, indicating changes in myocardial ischemia.

"Director Fan, why did the patient's condition suddenly worsen?" Fang Yong asked in a low voice.

"I don't know." Fan Zhiping shook his head. He had not found the source of the worsening condition.

But according to the usage specifications of Cidilan, under the current situation, it is definitely right to promote Cidilan silently!

The only thing that has changed now is the two electrocardiograms before and after!

But after pondering for a long time, he couldn't find any thoughts in the electrocardiogram.

Suddenly, Fan Zhiping thought of the "Jinghua Electrophysiology Exchange Group" he had just joined.

Maybe professors from higher-level hospitals can see the difference!

Think of this.

He quickly took pictures of the two electrocardiograms with his mobile phone and sent them to the Jinghua electrophysiology exchange group.

Fan Zhiping also briefly described the patient's medical history, and at the end, he specially addressed Lu Chen.

" @Professor Lu, please help me take a look at these two electrocardiograms when you have time, thank you."