Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Chapter 269 The old lady whose heartbeat stopped!
Wu Jiang comforted:
"Don't worry, let's do a colonoscopy to see where the problem is."

The family members didn't understand either, so they could only nod and listen to the doctor.

Soon this unlucky boy was sent to the colonoscopy room again.

This colonoscopy is more careful and longer than last time.

Wu Jiang stared at the screen for a moment, for fear of missing something.

Suddenly, a very strange protruding abnormal blood vessel was found at the position of the sigmoid colon?
And there is a small bleeding point on this malformed blood vessel? ?

"Huh?! There was nothing here last time? Why did a vascular malformation suddenly appear?? Could it be that we didn't see it clearly last time?"

Wu Jiang asked the doctor who was doing the colonoscopy next to him to observe the colonoscopy back and forth again and again.

Wu Jiang remembered that there was no deformity in this position before.

what happened?

Wu Jiang couldn't help but bewildered.

After the colonoscopy, Wu Jiang sent the checklist to the anorectal surgery doctor.

It happened that Zhou Chao was also in the office at this time, so Wu Jiang told Zhou Chao about it.

Zhou Chao also looked puzzled after listening:
"A hemorrhoid operation bleeds twice? And there was no malformation in the colonoscopy last time, but vascular malformation appeared this time?
You mean that the last bleeding may be caused by the patient's own stool too hard.

Is the bleeding caused by that vascular malformation? "

Wu Jiang nodded:

"That's right, this vascular malformation still has a bleeding point. I guess this time it must be the problem of this vascular malformation."

Zhou Chao nodded and said:
"Then this young man has to get rid of the vascular malformation quickly, or he will have to bleed again later."

It just so happened that news came from the anorectal surgery side, saying that the vascular malformation had to be removed immediately, otherwise there might be a risk of increased bleeding.

When the patients and their families heard this, they were confused and frightened.

"Why did I come to the hospital to cut a hemorrhoid? Why did so many things happen? Let alone the bleeding, this time it was found out that I have a vascular malformation??"

The patient felt aggrieved and wanted to cry.

What is this called!

Moreover, according to the surgical plan told by the doctor, a small section of intestine must be cut.

Because the vascular malformation attached to the intestinal wall cannot be removed alone, it can only be removed together with that section of intestine to stop bleeding and prevent bleeding.

If that part of the deformity is cut only, it is easy to cause massive bleeding.

This guy, a small operation on hemorrhoids turned into a major operation requiring an open abdomen and intestines in the blink of an eye.

The patient finally couldn't help but exploded.

Enduring the pain from his butthole, he stood at the door of the emergency room and scolded Wu Jiang for more than half an hour before he relieved his anger.

As a result, as soon as I returned to the ward, I started to have bloody stools again.

Visually, the amount of bleeding this time was about [-] milliliters.

Seeing that something was wrong, the family members rushed to call the doctor again.

Wu Jiang and Zhou Chao hurriedly came to the ward to check the situation.

Looking at the blood in the urinal, Zhou Chao also knew that the operation could not be delayed.

At this rate of bleeding, the patient will get anemia sooner or later, and in severe cases, he will go into shock.

Zhou Chao immediately turned around and called the anorectal surgery department, saying that the patient was bleeding again.They performed emergency surgery directly in the emergency room.

Zhou Chao personally took the lead.

Once the patient heard that Zhou Chao wanted to perform the operation himself, he had nothing to worry about.

After all, he is the emergency department director.

How can you be a director in no time?
Preoperative infusion, anticoagulant volume expansion, blood test by the way to check hemoglobin.

116g/L.

Fortunately, although about [-] milliliters of blood came out, so far, the patient has not developed anemia.

The family members also signed to agree to the operation, and the patient was sent to the operating room soon.

The surgery is performed laparoscopically.

Make a hole around the umbilicus, insert the lens into the abdominal cavity, and then cooperate with the colonoscope to accurately find the location of the vascular malformation.

To ensure accuracy, Zhou Chao stretched out his index finger and touched it.

There is indeed a tactile sensation of a lump in the place of the vascular malformation.

After confirming the location, Zhou Chao cut off the intestines about three centimeters around the vascular malformation.

After cutting, the intestinal tube is re-anastomized.

The operation was performed by the director of the emergency department. Not only did the other doctors feel at ease, but the family members also felt more comforted.

The operation was very successful.

After the vascular malformation was cut off, it was shown to the family member.

There is indeed a protruding blue blood vessel, which looks scary.

"Thank you, doctor."

The family members were very polite and thanked Zhou Chao.

Zhou Chao waved his hand and said:

"Many patients have complex conditions, and sometimes the disease is dangerous. Our doctors only have one pair of eyes, and it is impossible to cover everything."

………………

The Department of Cardiac Surgery received a patient, a 73-year-old female with a heart attack.

Sudden shortness of breath for an hour, and a cardiac arrest was rushed to the hospital.

When shortness of breath can not lie down, can only sit up breathing, and cough up pink foamy sputum.

When admitted to the hospital, it was found that the heartbeat, breathing, and pulse all stopped.

Immediately give cardiopulmonary resuscitation, intravenous injection of epinephrine, and give a series of rescue measures such as electric shock defibrillation and ventilator-assisted breathing.

After about 15 minutes, the patient resumed spontaneous heartbeat.

But consciousness is still in a fuzzy state.

抢救后查体，T36.7℃、P114次/分、R15次/分、BP88/58mmhg。

The pupils are equal in size and round, but the light reflex is weakened, the breath sounds of both lungs are rough, and wet rales are heard.

The heart rhythm was regular, and a systolic ejection murmur could be heard at the apex of the heart.

There was no edema in the lower extremities.

His past medical history included diabetes and hypertension.

血常规白细胞：17.31x 10/L（4-10x 10/L）

Neutrophil percentage: 44.2% (50-70)

Blood sugar: 25.4mmol/L.

High-sensitive troponin T: >5000pg/ml.

(One of the markers of myocardial damage.)
Creatine kinase: 213U/L (0-25)

The rest of the liver function, kidney function, thyroid function and blood lipid were not abnormal.

Electrocardiogram: QRS wave high voltage.

Coronary angiography showed that no stenosis was found in the left main artery, anterior descending artery, and right coronary artery.

Color Doppler echocardiography: the interventricular septum was thickened on the left ventricular wall, with a thickness of 38mm (20-35mm), and reduced compliance.

After all the examination results came out, Wang Zhongliang immediately gave a diagnosis:
1. Fulminant myocarditis 2. Acute pulmonary edema 3. Acute left heart failure 4. Coronary obstructive myocardial infarction?
Explosive myocarditis can indeed cause ventricular wall thickening, so Wang Zhongliang, deputy director of cardiac surgery, considered this as the primary diagnosis.

As for coronary obstructive myocardial infarction, there is a question mark behind it, which means that further observation is needed to confirm.

However, the patient's high-sensitivity troponin and creatine kinase were both very high, so the possibility of myocardial infarction cannot be ruled out.

After the diagnosis was made, Wang Zhongliang also told his family members.

The etiology of the patient was ventricular wall hypertrophy caused by myocarditis.

Wall hypertrophy reduces the systolic function of the heart.

If the systolic function is reduced, the blood outflow of the left ventricle will decrease, and all the blood will be piled up in the ventricle and cannot be discharged.

It can cause both heart failure and increased pulmonary venous pressure.

So left heart failure and pulmonary edema appear together.

After the rescue, Wang Zhongliang also issued a long-term doctor's order for infusion.

First, blood vessels dilate, increasing cardiac output.

A drug that increases cardiac contractility, dopamine.

(The dosage of dopamine should be strictly controlled, as different dosages have different effects.)
Sodium nitroprusside reduces arterial pressure and reduces left ventricular outflow tract afterload.

As a result, two days after the medication.

The old lady showed no signs of getting better.

And it got worse!
The family will definitely not want it.

"You have such a big hospital, can't you cure the disease?!"

"A heart failure and pulmonary edema, I see other people with the same disease can be discharged from the hospital!"

"Our family is getting more and more serious? Is this the level of your medical care?! Or are you deliberately discriminating?!"

"Could it be that we are bullying us because we are from other places?!"

The family member said that his face was blushing and his neck was thick.

Today is the third day of hospitalization.

The patient's condition did not decrease but increased. Wang Zhongliang also overturned the previous diagnosis after the rounds in the morning.

Generally speaking, after taking medicine, the situation will be relieved a lot.

But the old lady got worse.

So this medicine can no longer be used.

Stop taking the medicine first.

In the morning, the patient did not take any medication and did not give the latest diagnosis.

The emotions of the family members naturally reached a breaking point.

She roared as she walked toward the doctor's office.

Wang Zhongliang also walked out immediately when he heard the noise.

"Family, please stay calm. We are currently discussing the real cause of your mother. We will inform you when we have the results."

The family members obviously didn't buy it either.

"Notification?! When will you be notified?! Will you be notified after everyone dies?"

"Don't get excited, we didn't deliberately bully you, don't worry, we will stabilize your mother's current situation, and there will be no life-threatening for the time being."

"I want a concrete result!" the family members roared.

"We will let you know as soon as our consultation is over."

Wang Zhongliang said patiently.

In the hospital, it is common for the patient's family members to be emotionally agitated because of the patient's condition.

Some doctors have a good temper and will try to explain.

If you encounter someone with a bad temper, you will directly quarrel.

Fortunately, Wang Zhongliang's temper is not bad.

In fact, there are many diseases for which the cause cannot be found, and doctors can only continue to learn and advance through exploration.

Suddenly, as soon as I finished speaking here, several other family members in the intensive care unit rushed out and said:
"Doctor! Come and take a look, why did the blood pressure drop suddenly?!"

In the doctor's office and the nurse's office, when they heard that the blood pressure had dropped, they came to the intensive care unit consciously.

I was originally a patient with heart failure, but now the effect of medication is not good, and if I am not careful, I may die.

Only vital signs can be detected at any time.

"Director Wang, stop fighting!"

"Hurry up for cardiopulmonary resuscitation, one milligram of epinephrine intravenously!"

"Get on the ventilator!"

"A static push by Lobelin!"

"Lidocaine [-] mg static push!"

The intensive care unit instantly became an emergency room.

Patients with heart failure whose cause cannot be found are at risk.

Family members can only pray silently at the door:
"Must be rescued successfully... Please!"

Finally, 13 minutes later, the patient recovered his own heartbeat.

The rescue doctors and nurses breathed a sigh of relief, as did the family members outside the door.

But this can't solve the urgent need at all.

This patient with heart failure now has a problem with ventricular hypertrophy leading to weakness of the heart muscle.

But after taking drugs to increase myocardial contractility, the situation not only did not improve but worsened!
"What should I do? Director Wang!"

A doctor next to him frowned and asked Wang Zhongliang.

"I think of someone..."

Wang Zhongliang stared at the front and said.

"Who?"

"Lin Yi, an independent clinic in the emergency department!"

After speaking, he took out his mobile phone and called Lin Yi.

"Hello? Dr. Lin, that's it. Our department has admitted a patient with left ventricular wall thickening with acute left heart failure and pulmonary edema.

But after I finished using the medicine, there was still no improvement, and the patient's condition worsened.

So here I also want you to help take a look, do you think you have time? "

Lin Yi thought for a while and asked:
"How is the patient's current condition?"

"It's not very good. I did another cardiopulmonary resuscitation just now to rescue the person. I'm really in a hurry, so I'm bothering you."

"What kind of drugs were used in the previous treatment?"

Wang Zhongliang's [-] answer:

"Dopamine, the dose and drip rate is 2-5ug/kgmin, which is pumped. There are also sodium nitroprusside, 25μg/min, nitroglycerin, 10μg/min, and some basic nutrients."

Hearing Wang Zhongliang's answer, Lin Yi also frowned.

These drugs are not wrong. They are indeed drugs that need to be used in heart failure. They can dilate blood vessels, increase myocardial contractility, and reduce outflow tract load.

No problem.

But Wang Zhongliang also said that the patient not only did not improve but also deteriorated, and he also performed cardiopulmonary resuscitation?
Lin Yi didn't make a conclusion hastily, he just said:

"Just listening to you, I can't give you an accurate answer. How about it, I'll come and help you look at the specific situation of this patient."

Hearing Lin Yi's answer, Wang Zhongliang instantly had a smile on his face.

"That's great! Thank you, Dr. Lin!"

After hanging up the phone, Wang Zhongliang's tightly knit brows finally relaxed.

After Wang Zhongliang returned the phone to him, he hurried to the family and said:
"I've already contacted a very capable and insightful doctor to come over for your consultation, and he will come right away."

The family member who yelled just now waved his hands and glared at Wang Zhongliang and said:

"I don't care what doctor or expert you are, if you can't cure my mother, I will complain to you immediately!"

The other family members on the side hurriedly comforted her:
"Huahua, don't say that, mom is old, there is nothing to do if she gets this disease."

"Hmph? What can't be done? I see that other beds can get better and be discharged from the hospital. Why can't my mother?"

The emotions of the family members have not calmed down, so Wang Zhongliang didn't say anything more to her.

You'll know when Lin Yi comes over and takes a look.

"Doctor Lin, you are here!"

Behind Wang Zhongliang, there were several other cardiologists, staring at Lin Yi closely.

"It's not hard, it's important to save people, take me to see that patient first?"

"Okay, you come with me."

After saying that, Wang Zhongliang quickly brought Lin Yi into the intensive care unit of the cardiac surgery department.

Five more serious patients were lying in the intensive care unit.

It's all heart problems.

Wang Zhongliang brought Lin Yi to the old lady.

Afterwards, he gave Lin Yi a detailed introduction to the condition, and gave Lin Yi the patient's checklist.

But at this moment, Lin Yi was staring at the patient's heart.

After a while, Lin Yi's expression gradually became serious!

(End of this chapter)