This Doctor is Great

pulmonary embolism,

How should it be diagnosed?

Pulmonary angiography, the gold standard for diagnosis!

But it takes time, as the patient may suffer cardiac arrest at any time.

The bedside ultrasound is much simpler, although it is not very accurate.

"There is one in the emergency room..."

Although the emergency brother was surprised, he quickly took out a B-ultrasound from under a storage box.

Zhou Mo quickly turned on the machine, adjusted the parameters, and then began to check the pulmonary artery.

result:

Pulmonary hypertension (moderate to high)!

Right atrium, right ventricle enlarged!

In other words, the heart can't pump blood into the pulmonary artery, because the blood from the pulmonary artery can't get out.

This is actually evidence of a pulmonary embolism.

In addition, including the patient's low blood oxygen, it was only 63...62%.

It must be a pulmonary embolism. Blood in the pulmonary artery (a large amount of carbon dioxide) cannot enter the pulmonary capillaries and alveoli, and cannot exchange air (oxygen).

Although the patient continues to inhale oxygen, the oxygen only stays in the alveoli and cannot be exchanged with the blood. No matter how much oxygen is inhaled, it is useless, so the patient's finger pulse oxygen saturation is so low.

Zhou Mo told Mr. Huang Li the result of his examination.

"I think it's a pulmonary embolism..."

"I suggest sending it directly to the interventional diagnosis and treatment center of our Department of Cardiology, while doing angiography, if a pulmonary embolism is found, the thrombus should be removed immediately... (about 30,000)"

"If the family thinks it's expensive, I suggest immediate pulmonary angiography (2,000 yuan) and then thrombolysis..."

Teacher Huang Li nodded after listening.

"Just do it!"

Embolism, there are two ways to solve - intervention, thrombolysis.

Intervention is expensive, has a higher rate of vascular patency, wider indications, and fewer bleeding complications.

Thrombolysis is cheap, and the risk will be higher, because once the thrombolysis is overdone, the consequences will be very serious, and it is easy to cause bleeding everywhere, especially cerebral hemorrhage, which may directly kill you.

By the way, Zhou Mo has also read a lot of papers, and the thrombolysis of pulmonary embolism is still quite controversial.

Many doctors (papers) believe that the long-term prognosis of thrombolytic therapy for pulmonary embolism is no different from that of non-thrombolytic therapy, so they are not very supportive of thrombolytic therapy.

Of course, there are more doctors who support thrombolytic therapy for pulmonary embolism.

At this moment,

The results of the patient's arterial blood gas analysis also came out:

Oxygen partial pressure 66.2, carbon dioxide partial pressure 27.9, lactic acid 4.6...

hypoxemia, hypocapnia...

Obviously, they are all consistent with the performance of pulmonary embolism.

Teacher Huang Li said to the emergency brother: "You ask the family members to see the choice of the patient's family members."

Emergency brother: "I will tell my family now."

He ran out quickly.

Not long after, the emergency brother took the patient's son into the emergency room.

"Mr. Huang, the family members are hesitant to choose, and would like to ask for your opinion..."

"Doctor, I don't understand. I want to ask, what is the best way?" The patient's son looked at his mother on the bed with a worried, nervous, and apprehensive expression.

Naturally, it was impossible for Mr. Huang Li to make suggestions. He said to Huang Yiming, who had never had the chance to impress everyone, "Yiming, tell your family the difference between intervention and thrombolysis..."

Huang Yiming was overjoyed, finally I had a chance to perform.

"Intervene in this method, specifically..."

Huang Yiming introduced the differences, advantages and disadvantages of intervention and thrombolysis in detail. For this, he is still very clear.

The son thought for a while, and finally gritted his teeth!

"Get involved!"

Although the family conditions are so-so, he doesn't want his mother to have a good or bad situation. Although the cost of intervention is 10 times more expensive, the complications will be much lighter.

"Okay! Let's go to the cardiology department!"

"Yiming, contact the intervention center and intervene to remove the thrombus as soon as possible!"

"Okay, I'll call right away."

soon,

The elderly patient was relieved of endotracheal intubation, replaced with non-invasive breathing, and went into battle lightly.

Huang Li, Zhou Mo, and their family members pushed the patient to the cardiology department.

Just as Zhou Mo and others pushed the patient through the green passage, not long after leaving the emergency room,

"Beep beep beep~~~~~"

brake----

An ambulance stopped at the emergency room.

A patient is lifted down.

"Mr. Liu, Mr. Liu, hold on!!"

A beautiful secretary shouted anxiously to the middle-aged man in a suit and leather shoes on the flat car.

...

Cardiology,

Zhou Mo and others pushed the patient all the way into the Department of Cardiology and directly to the Interventional Diagnosis and Treatment Center.

Professor Lu came out.

"This is the patient with pulmonary embolism just mentioned?"

"Yes, please trouble Professor Lu..."

"Fortunately, the previous patient has already finished the treatment, don't wait... just push it in, do it now..."

The patient is pushed into the operating room.

The patient's son took Professor Lu's hand and begged for a while: "Doctor, you must save my mother."

The corner of Professor Lu's mouth twitched, he pulled out his hand, and comforted: "We will do our best..."

Just when Zhou Mo wanted to go in and interfere with the interventional operation,

A nurse's shout came from the nurse's station.

"Doctor Huang, there is a consultation in the emergency department. A patient with myocardial infarction..."

"Okay, come right away...Zhou Mo, do you want to go or not?"

"go!"

"I'll go too!" Huang Yiming quickly raised his hand, for fear of being missed.

So, the three of them hurried to the emergency room again.

...

emergency room,

emergency room.

When Zhou Mo walked in, he immediately saw a familiar person.

The beautiful and capable female secretary was beside the bed with an anxious expression on her face: "Mr. Liu! Mr. Liu, wake up!"

Mr. Liu, who was originally arrogant and arrogant, suddenly had a cardiac arrest, and the ECG monitor displayed the compression waveform.

And the brother in the emergency department was at the bedside, constantly doing cardiopulmonary resuscitation for Mr. Liu.

Zhou Mo: "..."

"Teacher, I know this patient... the one who went to the cardiology department this morning and refused to be hospitalized..." Zhou Mo introduced.

"It's him..." Teacher Huang Li had an impression of this patient who didn't believe in medicine.

Zhou Mo: "This morning, his diagnosis was myocardial infarction. He was in a coma for about an hour, and after waking up later, he was able to move and think without any problems... Now that he has suffered a cardiac arrest, he may have had another myocardial infarction."

The nurse next to him introduced to the three of Zhou Mo: "When the patient was brought in, he had severe chest pains and sweating profusely. Then he had a cardiac arrest just after calling the cardiology department."

Next,

Teacher Huang Li looked at the electrocardiogram taken by the 120 ambulance on the road and determined that it was a myocardial infarction.

Obviously, the size of the myocardial infarction was further enlarged.

1 minute……

10 minutes……

20 minutes……

The cardiopulmonary resuscitation continued, and 6 doctors were changed, and Zhou Mo also went up.

After using up 5 epinephrines, the patient still showed no signs of relapse.

(Adrenal gland: Above the left and right kidneys, there is a gland named "adrenal gland". It is a very important endocrine organ in the human body, and adrenaline is secreted by it. Adrenaline is necessary and certain for cardiac arrest. drugs used.)

(Adrenal gland, boss, give me a picture?)

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