Start as an Emergency Physician

The reason why I don't say 100% is because nothing guarantees success.

What if the scalpel suddenly broke?

What's wrong with the assistant?

What about the power outage?

It can only be said that under the condition that everything is normal, it is impossible for Zhou Yuan's operation to fail.

He Jianyi thought for a while: "It's okay to do reperfusion therapy first. However, on the side of heart bypass surgery, we don't have bypass tools in the emergency department, so we have to go to the cardiovascular department. "

How can a patient with a heart bypass be given to an emergency physician to do it... The emergency department is also normal without the appropriate equipment.

Zhou Yuan smiled.

If you go to the cardiovascular department to borrow tools, you will definitely be complained about robbing them of their jobs, and they will suffer from white eyes.

This kind of work, Zhou Yuan, the culprit, can't go.

He glanced at He Jianyi and smiled knowingly: "Teacher, I'm busy doing perfusion therapy for Qian Wei here, or... Are you going?"

He Jian's face darkened.

Really...... This little bunny pushes himself out!

"I'll go, I'll go!" He Jianyi sighed.

's own disciples, no matter how pit the teacher, they have to endure it.

"Trouble the teacher. "

He Jianyi went to the cardiovascular department, and Zhou Yuan was preparing for perfusion therapy.

In the previous ECG, Qian Wei's ST segment was obviously elevated, and it can be judged that Qian Wei's myocardial infarction was due to this reason.

Perfusion therapy is the most important treatment for acute ST-elevation myocardial infarction.

Opening the occluded coronary artery within 12 hours of the onset of the disease and restoring blood flow can reduce the size of myocardial infarction and reduce death. The sooner the coronary arteries are recanalized, the greater the benefit.

Therefore, all patients with acute ST-elevation myocardial infarction must be diagnosed as soon as possible after presentation, and a strategy for reperfusion therapy must be made as soon as possible.

The so-called reperfusion therapy is a method of reopening the completely occluded blood vessels and reperfusing the ischemic tissue through thrombolytic drugs, interventional therapy or surgical treatment.

Since interventional therapy is not suitable for left main lesions, and patients are very concerned about the cost, Zhou Yuan chose to use thrombolytic drugs for reperfusion therapy.

This method is versatile, easy to implement, and inexpensive.

The method of thrombolytic therapy is very simple, through intravenous injection, systemic or selective thrombolytic drugs such as urokinase and streptokinase.

However, there are many contraindications to thrombolytic therapy, such as intracranial hemorrhage, cerebrovascular injury, aortic dissection, and so on.

You have to wait for Qian Wei's past medical history and examination results to come out before you can start doing it.

"Another brain angiogram. "This is to prevent the occurrence of diseases.

Soon, the results came down, and Qian Wei had no other symptoms except acute myocardial infarction, so after simple preparation and treatment, intravenous thrombolytic drugs were started.

After the administration, Zhou Yuanzheng, Qian Wei, who had been silent, suddenly spoke.

"Doctor Zhou, can I ask you a few questions..."

Zhou Yuan paused, "What's the problem." "

"Can you explain my disease, I've never had a heart problem, why do I have to have surgery on my heart all of a sudden?"

Qian Wei didn't believe in the doctor, but simply didn't understand.

Zhou Yuan nodded and explained, "Your acute myocardial infarction is caused by a lesion of the left main. The so-called left main lesion refers to the stenosis of the left main in coronary angiography greater than or equal to 50%, and your blood vessel stenosis has reached 80%, and surgery must be performed..."

"It's like a traffic jam, if the road is blocked, you can take an overpass, if the blood vessels in the heart are blocked, you can also build a bridge to let the blood flow bypass, this is heart bypass surgery. "

"To put it more precisely, it is to create a channel at the proximal and distal ends of the coronary artery stenosis, so that blood bypasses the narrowing site and reaches the distal end, thereby restoring the blood supply to the coronary arteries. "

Qian Wei thought carefully for a while, nodded after understanding, and said a little embarrassedly: "You said before that the cost of heart bypass surgery is 40,000 to 100,000... Can you make it as cheap as possible, I don't want to drag down the whole family because I am alone!"

Qian Wei said: "Why is there such a big difference, can you choose the cheapest one as much as possible and help me do the surgery for only 40,000 yuan!"

Qian Wei has worked hard for so many years to bring his family to the city, and he just finished buying a house at this juncture, where can he get so much money...

Zhou Yuan hesitated for a moment and explained: "There are three main reasons why there is such a big difference in costs. The first is the number of bypasses, for example, if you build a bridge with three blood vessels, it will definitely cost more than building one blood vessel. "

"The second is the way to perform heart bypass surgery. The cost of a bypass is higher than that of a non-stop bypass because it requires the establishment of cardiopulmonary bypass and the need for transfer. Of course, whether or not you need to stop beating heart bypass depends on the degree of blockage of your blood vessels, and no one can decide. "

"In addition, if you need to take the saphenous vein as a bridge to bypass the bridging, the cost of how to take the graft is different, and if it is minimally invasive under endoscopy, it is much more expensive than that of the open area. "

"Is there any difference?" Qian Wei finally heard a step that seemed to be cheaper for himself.

"The difference is that minimally invasive wounds are small wounds, which heal faster and less painfully after surgery, and are definitely better than open areas. "

Will the blood vessels taken out of the open area be worse than those taken out by the endoscopic minimally invasive?"

Zhou Yuan frowned: "Theoretically, it won't." If the technology is good, it's actually about the same. "

"Doctor, help me get it from the open area! it's nothing painful!" Qian Wei gritted his teeth.

Zhou Yuan was a little unbearable and said, "I'll try my best." "

"You say there are three influencing factors, and one more that affects the price?"

Zhou Yuan smiled helplessly: "The third one you shouldn't have much to change, that is, regional differences and hospital differences." Different regions and different levels of hospitals charge different fees for bypass surgery, and the reimbursement ratio of medical insurance for bypass surgery in different regions is also different. "

"Although the risk of this kind of surgery is not high, it can also be very dangerous, and if the small hospital does not accept it, it is better to stay with us with peace of mind. Zhou Yuan dispelled Qian Wei's idea of going to other hospitals to save money.

After a while, He Jianyi came back, with a black-faced director of the Department of Cardiovascular Medicine.

Obviously, the Department of Cardiovascular Medicine came because of the job grabbing.

As soon as he saw Zhou Yuan, the director of the Department of Cardiovascular Medicine asked, "What kind of surgery are you going to take?"

There are a number of specific methods for heart bypass surgery.

For example: median Hungarian bypass surgery under cardiopulmonary bypass;

Coronary artery bypass grafting;

Hungarian laparoscopic minimally invasive coronary artery bypass grafting;

hybrid surgery for coronary artery bypass grafting;

Total arterial grafting for bypass;

Left internal mammary artery bypass graft under the left anterior Hungarian small incision, etc.

As for which one to choose, it all depends on the patient's physical condition.

Zhou Yuan smiled when he heard the words of the director of the Department of Cardiovascular Medicine.

This is to test yourself!_

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