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

Chapter 271 Successful hemostasis!

The person named Huahua raised her head and looked at Wang Zhongliang.

Then she looked at Lin Yi again:

"Doctor, just give me an accurate word, can my mother's disease be cured?"

Lin Yi nodded happily:

"Yes, why not, look at the degree of hypertrophy of the ventricle wall, if the pressure difference between the ventricle and the outflow tract is too large, the ventricle wall is too thick.

Then the only option is surgical resection of the hypertrophic ventricular wall.

Of course, it is best not to have surgery if you can.

Because the heart is different from other organs, the entire wall of the ventricle is muscle.

There are many nerve conduction techniques in it. These nerves and muscles are connected together, so that the heart beats again and again.

If the hypertrophic ventricular wall is removed, it will definitely have an impact on the entire heart function.

There can be arrhythmia, where a muscle is suddenly cut away, and the conduction of the heart is cut off.

It must be unstable heart rate ah.

Another example is acute heart failure. Part of the ventricle is cut off, and the recovery after suturing is very poor. The heart muscle is damaged and the heart cannot beat.

That could lead to heart failure of the entire heart.

But don't worry too much, treatment can definitely cure it, but any operation is risky.

I hope your family members can also understand. "

It is best if the pressure difference between the outflow tract and the ventricular inflow tract does not exceed 50-60 mmHg.

Drugs are stable.

Once the pressure difference is too large, or even above 100 or 150, it will be very serious.

Despite the dangerous complications, this resection had to be done.

The family members took another look at Lin Yi before leaving the doctor's office worried.

An hour later, the results came out.

Differential pressure 110! !
Looking at the result, Lin Yi also had a sad face.

"Director Wang, I saw that the pressure difference displayed in the examination before your admission was more than 70.

This time it reached 110. I guess it must be related to the use of drugs such as dopamine and sodium nitroprusside.

Well, I suggest first using verapamil and metoprolol to control the patient's myocardial contractility.

After reducing the speed, do a check and take a look. "

Hearing Lin Yi's suggestion, Wang Zhongliang nodded again.

Today, Lin Yi is the boss here!

listen to him!
In the ward.

Wang Zhongliang is instructing nurses to administer medicine to patients.

Behind him, several younger attendants who followed him couldn't help asking:
"Director Wang, do you really trust that doctor? What if... what he said is wrong?"

Wang Zhongliang glanced at him and cursed:
"I can see that you rarely read books and rarely take the initiative to study!

Go check out the various symptoms of obstructive hypertrophic cardiomyopathy after get off work!
Write me an article about the main symptoms, simulated diagnosis and treatment plan of obstructive hypertrophic cardiomyopathy within two days! "

"what?!"

The eyes of the people behind them widened.

isn't it...

We are just asking... nothing else!

two hours later.

After using the correct drug treatment, the old lady's symptoms improved a lot.

The shortness of breath was significantly relieved, and the oxygen saturation index also increased.

At this time, I will arrange for a hemodynamic test.

Look at the result again, 73 mm Hg.

"Isn't that right? This one isn't that bad." Lin Yi looked at the checklist and said.

Wang Zhongliang finally showed a slack expression and said:
"Yeah, it means that the medicine is right. Hey... Today is really thanks to you!"

After Lin Yi returned to the consulting room, Wu Jiang was seeing a pale male patient.

Lin Yi hurried over to understand the situation.

The patient is male, 46 years old.

The main complaint is that he has been feeling full and pantothenic acid in the upper abdomen in recent years.Especially when eating raw or cold food, it will obviously feel aggravated.

Four days ago, not long after he ate two apples, he suddenly found himself having black loose stools.

Because he had a six-year history of hemorrhoids, he treated it with medicine at home as if hemorrhoids had recurred. He didn't pay much attention to it, and this situation lasted for four days.

As a result, after breakfast this morning, the patient suddenly developed symptoms such as dizziness, nausea, and hematemesis.Moreover, the blood was dark red with blood clots inside.

The amount of vomiting blood is about 500ml, but there is no abdominal pain or diarrhea.

On the way the patient took a taxi to the hospital, the patient vomited blood twice again, the color was dark red, the blood volume was about 500ml, and there were still blood clots.

Lin Yi was taken aback after measuring the patient's blood pressure.

If the patient's blood pressure drops further, shock will occur.

Subsequently, Lin Yi immediately gave the patient 500ml of colloid, 400ml of whole blood, 80mg of pantoprazole, and 1000ml of normal saline.

After infusing the patient, Lin Yi checked the patient's body and measured the blood pressure again.

Fortunately, 10 minutes after the infusion, the patient's blood pressure gradually rose to 100/60mmHg.

After the physical examination, Lin Yi wrote in the medical record.

The patient was conscious, clear in speech, pale with symptoms of anemia, pale yellow skin all over the body, no palpable swelling of superficial lymph nodes, pale conjunctiva, and clear breath sounds in both lungs.

The heart rate was 82 beats per minute, the rhythm was regular and there was no murmur, the abdomen was soft, the pressure in the middle and upper abdomen was uncomfortable, the liver, spleen and ribs were not touched, and there was no edema in both lower limbs.

Then, a full set of biochemical examinations and color Doppler ultrasound routine examinations were arranged for the patient.

血常规检查结果很快就反馈回来了，WBC8．1＊109／／L，HGB80g／L，PLT230×109／／L。

Liver function, kidney function, and electrolytes were all normal, five items of hepatitis B were negative, hepatitis C antibody was negative, and AIDS was negative.

Abdominal B-ultrasound liver, gallbladder, and spleen were generally normal.

After seeing the patient's examination results, Wu Jiang asked:

"Brother Yi, what disease does the patient have based on the test results?"

Lin Yi had received treatment for such symptoms before, he said to Wu Jiang.

"Based on the current situation, my preliminary diagnosis is that the patient suffers from upper gastrointestinal bleeding or peptic ulcer, or rupture of the constant-diameter artery under the gastric mucosa.

Antiacid, hemostasis, and symptomatic fluid supplementation were given first.

After the patient's signs are stable, do a gastroscopy for the patient. "

Wu Jiang nodded and said.

"Okay, let's do as you say!"

Then, he notified nurse Zhang Shiqi to transfer the patient to the observation room.

Half an hour later, Zhang Shiqi hurried over and said:
"Brother Yi, Wu Jiang, the blood pressure of the patient you sent over just now was very unstable during the infusion process, and kept changing."

Lin Yi couldn't help asking:

“Blood pressure change? Did it go up or down?”

"The patient's condition is very strange. The blood pressure has been fluctuating between 80-110/50-70mmHg."

Zhang Shiqi replied,

"Although there was no more nausea or vomiting during the subsequent infusion, the patient had a black stool just now."

After Lin Yi finished listening, he immediately said to Wu Jiang:

"The patient may not be a peptic ulcer! Let's go and see!"

After finishing speaking, Lin Yi and the two hurried to the observation room.

After a simple examination of the patient, Lin Yi discovered another situation, that is, the patient had mild pitting edema of both lower limbs...

Under such circumstances, Lin Yi didn't dare to be careless, so he immediately said:
"Wu Jiang, hurry up and arrange a gastroscopy for the patient. I suspect that the patient has varices in the esophagus and gastric fundus and is bleeding!"

Soon, Wu Jiang pushed the gastroscope equipment over.

Immediately, the three of them hurriedly performed a gastroscopy for the patient.

The inspection results showed that Lin Yi's judgment was not wrong.

The patient had esophageal and gastric varices and bleeding, and chronic superficial gastritis with erosion.

After seeing the inspection results, Lin Yi said:

"Consider the patient with portal hypertension, esophageal and gastric variceal bleeding and multiple polyps in the stomach.

We will first cut the pathology of multiple polyps and send them for inspection.

Then, deal with the rupture and bleeding of esophageal and gastric varices.

Immediately afterwards, Lin Yi cut all the polyps in the patient's stomach for pathology, and then sent to Wu Jiang for examination.

The next step is how to deal with the rupture and bleeding of esophageal and gastric varices.

Bleeding from esophageal and gastric varices is one of the serious and fatal complications of liver cirrhosis and a common cause of upper gastrointestinal bleeding.

There are many liver disease patients in Jiangcheng, and the successful prevention and treatment of liver disease complications is also one of the key links to reduce patient mortality and prolong patient survival.

When a general hospital emergency department encounters a patient with upper gastrointestinal bleeding, it is first necessary to correct the hypovolemia to prevent infection and other complications.

Then, when bleeding from esophageal and gastric varices is diagnosed, drug therapy should be the first-line option.

For example, the early application of drugs to reduce portal pressure, the selection of vasopressin and other treatment methods for the treatment of patients.

After drug therapy fails, salvage treatments are still available.

For example, endoscopic treatment, transjugular intrahepatic portosystemic shunt, three-chamber two-capsule compression hemostasis and other methods.

For this situation, Lin Yi did his part, picked up the equipment and started preparing to stop the patient's bleeding.

Again, the same problem as before was encountered.

There is active bleeding in the gastric fundus, and there is no operative field.

However, such a difficult question can't help Lin Yi.

He solved the problem of no surgical field only by changing the body position and the suction tube at the front end of the stomach tube.

This small change surprised Song Borui on the side.

"Simply moving like this, will the surgical field be exposed?"

Song Borui asked in surprise.

Lin Yi smiled slightly and said:
"That's right, as long as you are familiar with it, it's that simple."

"This………"

Song Borui was speechless for a moment.

As long as you are familiar with it, this sentence is easier said than done!

Without thousands of operations, how can you be familiar with it...

Subsequently, Lin Yi chose to use the balloon compression method to stop bleeding for the patient.

Because the varices are located in the esophagus and gastric fundus mucosa, compression of the esophagus or stomach has a hemostatic effect.

Therefore, what Lin Yi uses is the most common three-chamber two-balloon tube.

He first coated the front end of the three-lumen tube and the outside of the balloon with liquid paraffin, and then slowly inserted it into the gastric cavity through the patient's nostril.

Immediately after that, 200ml of gas was injected into the gastric balloon, and the pressure was maintained at 45mmHg, and then the end was fixed.

After finishing, Lin Yi asked Song Borui to observe whether the patient still had bleeding.

Song Borui replied after observing.

"Brother Yi, there is still a small amount of bleeding in the patient's stomach cavity."

Lin Yi nodded.

"okay, I get it."

He gently injected another 150ml of air into the esophageal balloon, and looked at the pressure gauge. The current pressure is maintained at 40mmHg.

This pressure is okay, enough to compress the esophageal vein.

When he was done, he asked back.

"What about this time? Is the patient still bleeding in the gastric cavity?"

Song Borui looked at the monitor again and said:
"It seems to be all right this time, no bleeding was found."

After waiting for another 3 minutes, Song Borui still found no signs of bleeding, so he quickly told Lin Yi.

"Brother Yi, there is indeed no problem this time. The patient no longer bleeds!"

Lin Yi nodded again.

"That's okay, the bleeding finally stopped."

After speaking, he relaxed the traction and released the gas in the bag.

Then, he turned his head and said to Zhang Shiqi.

"Nurse Zhang, keep the tube and continue to observe for 24 hours. If there is still no bleeding after 24 hours, please notify me or Director Jiang, and we will extubate the patient.

During this time, the airbags were deflated for 12 minutes every 30 hours while the traction was released.

A small amount of the three-lumen tube was sent into the stomach to relieve the pressure on the cardia of the gastric fundus, and then inflated for traction to avoid erosion and necrosis of the local mucosa due to prolonged pressure. "

"Yes!"

After confessing, Lin Yi returned to the consulting room.

"Dr. Lin, the radiology department said that a patient I just diagnosed was feeling unwell during the examination, please help me to go and have a look."

An attending doctor in the emergency department suddenly opened the door and said.

Lin Yi knew the attending doctor, and his name was Xu Chao.

"Okay, don't worry."

After speaking, Lin Yi hurriedly followed Xu Chao to the Radiology Department.

As soon as I entered the door, I saw the girl from before covering her chest with her hands, panting heavily, and shouting in her mouth.

"Ah, ah, it hurts! My chest hurts!"

Several people carried the female patient onto the stretcher and quickly returned to the emergency room in the emergency room.

"Doctor Xu, connect the ECG monitor."

"The heart rate monitor has been connected."

"What is the patient's blood pressure?"

Xu Chao glanced at the ECG monitor and replied:

"The patient's blood pressure is now 95/65mmHg, and the heart rate is 60 beats/min."

"Push a dobutamine."

Dobutamine, clinically used for heart failure patients with low cardiac output and slow heart rate, has a better effect on improving left ventricular function than dopamine.

"What is the patient's current blood pressure?"

"Blood pressure went up a little bit."

"How many?"

"The patient's blood pressure is now 100/75mmHg, and the heart rate is 65 beats/min."

Under the action of dobutamine, the female patient's signs gradually recovered, and she no longer complained of chest pain.

"call……"

Lin Yi wiped the sweat from his forehead, took a long breath, and said to Lin Yi.

"After the injection of dobutamine, the patient has stabilized. Let's go to the observation room for observation for 2 hours. If the blood pressure does not continue to rise, add an ampoule of norepinephrine diluted with normal saline."

"Okay, Dr. Lin."

Xu Chao agreed.

"How are you feeling now?"

After giving the doctor's order, Lin Yi leaned over and asked the female patient lying on the stretcher.

"Thank you, doctor. I feel better now. I don't know why my stomach has been hurting since the operation. During the examination just now, my stomach suddenly hurt. Can you give me some painkillers? "

The female patient rubbed her stomach with her hands and said with a frown.

(End of this chapter)