When doctors have a simulated operating room

The patient was diagnosed with heart failure.

"The patient was relatively old, in his sixties or seventies. When he was first diagnosed, he had no other special problems except ventricular hypertrophy.

The results of various examinations showed no obvious cardiovascular problems.

But he was hypoxic and coughed up phlegm, and it was pink foamy phlegm.

Is this child also hypoxic, and does he also like to cough as soon as he wakes up?"

Zhang Yi continued to ask in the shocked eyes of everyone.

Mai Xiaofeng and his family members nodded in unison, it was true.

Not only coughing, but also the color of the sputum coughed up was pink!

Mai Xiaofeng knew that this was caused by acute pulmonary edema.

Acute pulmonary edema is caused by increased left ventricular return pressure and left heart failure.

"Also, I took a look at the child's medical records. The heart border is not obviously enlarged, and a systolic jet murmur can be heard at the apex.

The white blood cell and lymphocyte ratios are both elevated.

The rest of the liver, kidney, and thyroid function are normal.

The results of the coronary angiography are very similar to those of the patient except for the tetralogy.

And after the patient was injected with dopamine, sodium nitroprusside, and even adrenaline, the symptoms became more severe!

Does this child also have this situation?"

Mai Xiaofeng's pupils shrank at the time! !

I knock!

This is exactly what Mai Xiaofeng finds strange!

The child's deformity is very serious, so serious that these drugs not only did not improve, but made the situation worse!

How did Zhang Yi know all this? ?

Mai Xiaofeng nodded in shock: "Yes, that's right! So after we found something wrong with the medication this morning, we stopped using it temporarily. The child's deformity is too serious..."

Zhang Yi narrowed his eyes and shook his head slowly:

"No, the serious deformity is not necessarily the reason for the worse situation.

In short, I still suggest that you do a hemodynamic test as soon as possible, focusing on cardiac output, stroke volume and cardiac index."

Mai Xiaofeng frowned, as if he was wondering what the main reason Zhang Yi said was?

It actually takes a hemodynamic test to see it? ?

And it's more serious than tetralogy of Fallot?

Everyone looked at each other.

What problem would be more serious than tetralogy of Fallot? ?

Mai Xiaofeng asked:

"What disease did your patient have last time?"

Zhang Yi kept it a secret and said:

"I just suspect it now. We can only check as soon as possible to see how the compliance of the two blood vessels is and whether there is a pressure difference."

Mai Xiaofeng glanced at the family members next to him and nodded:

"Okay, I'll arrange someone to do it now."

After that, Mai Xiaofeng arranged two doctors to take the child for examination.

The only people left in the ward were the family members, He Biao, and the doctors and nurses who came to the door after hearing the news.

He Biao quietly pulled Zhang Yi and asked:

"Doctor Zhang... do you think this can be done? If it's an operation, how confident are you?"

Unconsciously, whether Zhang Yi can cure the child even involved a big business of He Biao.

That's why he was so concerned about this matter.

After thinking for a while, Zhang Yi said:

"Well... I'm not sure, but it shouldn't be low."

He Biao was immediately delighted when he heard it! !

Since he said so, there must be hope!

This guy can complete the operation with a success rate of 99%!

The "not low" he mentioned should be at least 70% or 80%, right? ?

He Biao immediately continued:

"Don't worry, Dr. Zhang, if this operation can be done, I will... I will donate another 500,000 to your fund!"

Zhang Yi was slightly surprised. Is He Biao so generous? ?

The family members haven't said anything yet, but he is eager to donate? ?

Zhang Yi could only thank you:

"Then I will thank you on behalf of the patients who have received help from Mr. He!"

He Biao smiled heartily: "You're welcome!"

After the chat, Zhang Yi also turned around and went to the doctor's office of the cardiac surgery department.

In the ward, Mr. Wang and his family asked nervously:

"Mr. He, is this doctor really capable? I don't understand what he said?"

He Biao gave Mr. Wang a reassuring look and said:

"I have asked for you just now, and he said that the success rate of this operation will not be low. Don't worry, Dr. Zhang succeeded in my mother's difficult operation, and there is no problem with postoperative recovery!"

Seeing that He Biao believed in Zhang Yi so much, the family members hesitated and did not speak again.

At the same time.

Zhang Yi's consultation at the provincial hospital was almost the same.

Spread throughout the hospital.

When Wu Xiumin heard that Zhang Yi came to Baoshan, she hurried to the hospital after work.

Even Shen Weigang, director of the Gastrointestinal Surgery Department, rushed to the Cardiac Surgery Department after hearing the news just after the operation.

In the office.

Obviously the directors of these provincial hospitals are the bosses.

But at this moment, they all took the initiative to greet Zhang Yi very politely.

The family members watching gradually began to suspect a problem.

It’s just that Zhang Yi looks young, but why does he feel so awesome? ?

Just because it has been in the news a few times?

Mr. Wang thought for a while, obviously not.

The medical skills of these directors of the provincial hospital are among the best in the entire province.

How could one respect an ordinary doctor who is so much younger than oneself so much just because of a few news articles?

Then there is only one reason.

It’s just that Zhang Yi is not just in the news.

It should be because of his excellent medical skills or operations that the directors of these provincial hospitals are so polite and respectful to him.

After Zhang Yi greeted Director Wu and Director Shen, the child also returned from the examination.

Looking at the results of the hemodynamic test, Zhang Yi said to the doctors:

"Okay, now that the results are out, I think I can make a diagnosis."

Everyone looked up at Zhang Yi, waiting for his answer.

“First of all, this child does have tetralogy of Fallot, and repair surgery is necessary.

But why do symptoms worsen after taking cardiotonic drugs? ? "

All the doctors in the cardiac surgery department shook their heads.

If we knew where it was, would we still need you to come to the Provincial Hospital to steal the limelight, brother? !

"Because... this child's current condition is a dynamic obstructive heart disease caused by ventricular thickening!"

"What??"

"What obstruction?"

"Dynamic obstructive heart disease??"

“The test report shows that there is a significant pressure difference between the blood outflow and inflow channels, and the compliance is also reduced.

Normal stroke volume (SV) is 60-90ml/beat.

Even a child should reach 30-40ml/beat, but this child is only 18.

There is also cardiac index (CI) (cardiac output per square meter of body surface area per minute). The normal value is 2.8-4.2L/(min·m2).

If it's lower than 2.5, it's considered heart failure, but this kid's is only 2.2.

There is also cardiac output (CO), which is also reduced.

Director Mai, if you look at the ratio of the three values, does it mean that the compliance has decreased? What does this indicate? "

Mai Xiaofeng looked at the checklist and thought for a while, then raised his head and said:

"It means the speed of the outflow channel and the inflow channel are different!"

"That's right!"