I can see health

Chapter 51: Cardiac Stent Price Reduction
Click the Receive button.

A red box popped up on the central interface of the computer.

Laboratory critical value reminder!
Department: The Eighth Ward of Cardiovascular Medicine

Name: Zhang Guangming
Bed size: 20 beds

Age: 31 years old

Critical value: cardiac troponin I (fluorescence method) 5.4ng/ml (normal value 0-1 ng/ml).

Seeing the critical value of the test, Lu Chen's heart sank. Troponin increased five times. Did this young man have a heart attack?
The current international diagnostic criteria for acute myocardial infarction follow the "1+1 model".

The first 1 is the dynamic change of typical markers, that is, there must be an increase in troponin.

The second 1 is any one of the four criteria. The four criteria refer to: [-]. Symptoms of chest pain and tightness, [-]. Pathological Q wave in ECG, [-]. Elevation or depression of ST segment in ECG [-]. Imaging examination shows abnormal myocardial movement.

And this 20-bed patient just met the 1+1 diagnostic criteria!

"Senior Sister Guoguo, the troponin has risen in the 20 beds just received!"

Lu Chen shouted to Sun Guoguo who was beside him.

Sun Guoguo was reviewing the discharge medical records. When she heard Lu Chen's words, she was shocked. She quickly put down the medical records in her hand and sat down in front of the computer.

Open the test sheet of the system, cardiac troponin I (fluorescence method) 5.4ng/ml!

Just now she was saying that it might be coronary artery spasm caused by smoking
What a slap in the face now!
"Heart attack!" Sun Guoguo immediately picked up the stethoscope and stood up, "Brother, go push the electrocardiogram machine and recheck the patient's electrocardiogram. I'll go and communicate with the patient's family about the condition!"

"Okay." Lu Chen nodded and began to split up.

……

Patients with suspected myocardial infarction must frequently review the ECG, preferably every half an hour to an hour.

Electrocardiogram is a simple, non-invasive and cheap examination, and can understand the changes of myocardial ischemia in patients at the first time.

Pushing the electrocardiogram machine to bed 20.

As soon as Lu Chen entered the ward, he saw a middle-aged uncle about 50 years old standing beside the bed. He should be the patient's family member.

The middle-aged uncle is thin and dark-skinned. He may be a person who has been working under the sun for a long time.

Lu Chen looked at the young male patient lying on the bed.

The color on his head has changed from yellow to red!

Lu Chen pushed the electrocardiogram forward and immediately reviewed the electrocardiogram for the patient.

The electrocardiogram showed that the ST segment in the V1~V3 leads of the chest was about 0.2mv higher than before.

After Sun Guoguo auscultated the patient again, he looked at the re-examination of the electrocardiogram and frowned: "Basically, acute myocardial infarction has been confirmed."

"Doctor Sun, you said my son had an acute myocardial infarction?"

The middle-aged uncle had a sullen face, with his hands behind his back, and his eyes were erratic.

"Well, judging from the current laboratory tests, electrocardiogram and symptoms, the high probability is acute myocardial infarction."

"We need to contact you to perform coronary angiography and interventional surgery immediately to evaluate the condition of the heart vessels and possibly implant a coronary stent if necessary!"

Sun Guoguo's face was serious, and there was a hint of indisputability in his tone.

"Interventional surgery? Dr. Sun, I understand this disease fairly well, because a relative in my family had a heart attack and also had a stent placed." The middle-aged uncle said solemnly, "But at that time, my relative had a severe chest pain. My son doesn't feel any discomfort now, how could it be a heart attack? Could it be a mistake?"

The male patient lying on the bed also said loudly: "That's right, I don't have any symptoms now, and I don't feel any pain at all. I'm no different from a normal person. You just took a blood test. Could it be inaccurate!"

Sun Guoguo patiently said slowly, "Every patient's condition is different, and it will change at any time. Moreover, the patient has already had chest pain symptoms when he was active in the morning, which indicates that the probability of myocardial infarction is high."

The middle-aged uncle was silent for a while before he spoke.

"Doctor Sun, to tell you the truth, my relative died the next year after the stent was placed. Now I don't know whether it is due to his own disease or the stent."

Sun Guoguo frowned

Patients or their family members who can say such things are generally difficult to deal with.

If you don't trust the hospital at the beginning, it may cause more disputes when it comes to various treatments in the future.

"Whether to do coronary angiography, whether to put a stent, it's up to you to decide, our doctor is just giving our suggestion." Sun Guoguo said, "If you are in the Cardiology Department of our hospital, it means that you need to do coronary angiography immediately." Pulse imaging!"

"Can't it be treated conservatively?"

The middle-aged uncle was puzzled.

Sun Guoguo shook his head, "Currently, within the time window for interventional surgery, emergency coronary angiography is the best treatment at present!"

As soon as the words fell, the young patient on the bed immediately said: "Dad, I won't have an operation. I don't have any problems now. I don't want to put a stent! If I put a stent, won't I be useless for the rest of my life?"

"I'm not married yet, if other women know that I have a stent, can I still find a wife?!"

The middle-aged uncle frowned, "Doctor Sun, how about it, I have a friend who is in the medical field, I'll call him first and ask him, and then I'll give you an answer."

Sun Guoguo nodded: "Yes, whether you want to have surgery or not, make a decision as soon as possible. We will give you 10 minutes at most. If you do it, we will arrange it immediately. If you don't do it, sign and bear the risk, that's all."

The middle-aged uncle responded softly, and then walked out of the ward with his mobile phone in his pocket.

"Junior brother, change the nursing level of this patient to first-level nursing, ask the nurse to use the ECG monitor, then report critical illness, and issue a critical illness notice to the patient's family."

Walking out of the ward, Sun Guoguo instructed.

"Okay." Lu Chen nodded.

He looked around and found that the middle-aged uncle was standing in the corner of the corridor, talking with someone on his mobile phone.

For this kind of patient, Lu Chen couldn't say much.

Sometimes, the advice of the doctor in charge may not be as useful as the words of a stranger.

……

Go back to the doctor's office.

Lu Chen began to revise the doctor's order for 20 beds.

"Brother, this patient's vital signs are all stable, why do we need to change the level of secondary care to primary care?" Yao Jie suddenly stepped forward and looked at Lu Chen suspiciously, "And the 19-bed old man is The 69-year-old also had an acute myocardial infarction, and a stent was placed in our hospital, why is he in secondary care?"

First-level nursing care is mainly applicable to those who are seriously ill, critically ill, and those with extreme heart, liver, and kidney failure who require strict bed rest and cannot take care of themselves.

Secondary care is mainly applicable to patients who are in severe illness, whose acute symptoms disappear, and who are in stable condition after major surgery.

To put it simply, patients in primary care are generally more critically ill!

Secondary care is next, and tertiary care is the lightest.

At present, the vital signs of the 20-bed patients are all normal, such as heart rate, blood pressure, respiration, and pulse.

Lu Chen smiled, and explained while revising the doctor's order.

"Junior sister, don't think that the 20-bed patient is young and his condition is stable, so you don't think there is any major problem with him."

"As long as it is a patient with myocardial infarction, as long as it is in the acute stage, his heart is in a very fragile state, and his heart is at risk of rupture or even sudden death at any time."

"So you have to remember that any patient with acute myocardial infarction needs to issue a critical illness notice during the acute phase."

"As for the 19-bed patient, although he also had acute myocardial infarction and had two stents placed, he has already passed the acute danger period, so the level of care has been lowered from primary care to secondary care!"

Yao Jie nodded, her eyes half understanding.

……

After about 10 minutes.

The middle-aged uncle walked into the doctor's office.

"Doctor Sun, I've thought about it."

Sun Guoguo put down the medical records in his hands and looked at the middle-aged uncle in front of him.

"I heard from a friend that in a few months, the price of heart stents will be reduced! Now the price of six or seven thousand, or even tens of thousands of stents, may be reduced to four or five hundred or even lower in the future. My thoughts Well, let’s take conservative treatment now, and when the price of the stent drops, I’ll bring him over for interventional angiography.”

"Because if you have an operation now, if you need to put a stent, it will be a loss!"

Sun Guoguo frowned, and asked in confusion, "It was your doctor friend who suggested you to do interventional surgery in the future?"

The middle-aged uncle waved his hand, "No, I just asked about the price of the stent, and he told me that the price of the stent will be reduced, but he didn't tell me when to have the surgery."

Sun Guoguo's expression softened a little. She thought that some doctors violated the principles of treatment in order to save money.

"Uncle, things should be prioritized. It is true that the price of heart stents will be reduced, but your son's condition is relatively urgent, and immediate interventional surgery can achieve the best results." Sun Guoguo said, "If you wait until the price of heart stents is reduced, you may have to wait. Several months, in case your son gets sick again during this period, what should we do?"

The young uncle smiled, and said, "Oh, the price reduction of this heart stent will be a matter of next month, and we can't wait for too long."

"Doctor Sun, don't worry, the price of cardiac stents will be reduced by then, I will definitely come back and ask you to do it!"

Sun Guoguo frowned. Since the persuasion was ineffective, he had no choice but to give up, and turned to Lu Chen.

"Junior brother, print out a copy of the communication record of the refusal to perform the interventional operation."

"it is good."

When Lu Chen heard the decision made by the middle-aged uncle, he had already printed out the communication record of "refuse to intervene in the operation".

"Uncle, just sign your name on this last line." Lu Chen pointed to the blank space at the end of the communication record, "After you sign your name, write it again. If you refuse the operation, you will bear the consequences."

The middle-aged uncle was straightforward, and signed his name without hesitation, and then wrote the eight characters "Reject the operation, at your own risk".

"Then I'll ask Dr. Sun to take care of it for the next few days." The middle-aged uncle said, "We will be discharged from the hospital when the condition is stable. After a while, the price of heart stents will be reduced, and we will come for surgery."

Seeing the back of the middle-aged uncle leaving, Sun Guoguo was also very helpless.

It can be seen that this middle-aged uncle did not want to have surgery, but chose to postpone it because of economic reasons.

(End of this chapter)