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

Zhou Chao stared at the monitor, his heart fluttering, hoping that the patient's blood pressure would drop as soon as possible.

Only by lowering the blood pressure of this patient to the normal range.

Then the risk of his aneurysm rupture would be reduced. Only in this way would Zhou Chao dare to take him for CT and cardiac color Doppler examinations.

However, ten minutes later, the patient's blood pressure was still 200/120mmHg.

On Zhou Chao's forehead, a layer of sweat could not help but appear.

Sodium nitroprusside is the most powerful drug used to lower blood pressure.

For most patients, blood pressure will drop after taking medicine for three to five minutes, not to mention taking medicine for 10 minutes.

However, this patient has used it for more than ten minutes, but his blood pressure has remained stable.

Due to the application of pethidine analgesic drug to him, the pain was relatively relieved a lot.

But because the blood pressure didn't drop, Zhou Chao didn't dare to touch him at all.

Not to mention taking him to check.

The blood pressure is so high, so take him for a checkup. If the aneurysm ruptures on the way to the checkup, the patient will undoubtedly die.

Then Zhou Chao himself will have an unshirkable responsibility.

"Adjust the sodium nitroprusside to 8 mg per hour and pump it intravenously."

Zhou Chao asked the nurse to increase the dose of medicine.

Even if the patient's blood pressure drops to the normal range,
Zhou Chao had already taken a great risk by taking him for an examination.

If the blood pressure cannot drop to the normal range, Zhou Chao would never dare to take the risk and take the patient to check.

However, after more than ten minutes, after increasing the dose, the patient's blood pressure still did not drop, and even rose slightly.

At this moment, Zhou Chao began to feel anxious.

This patient urgently needs to be checked, but the blood pressure has not come down, what should I do?

Zhou Chao frowned slightly, and said to the nurse, "Add another 100mg dose of uradil and pump it in to lower the blood pressure as soon as possible."

The nurse on the side hurriedly prepared the spare urapidil injection and pumped it into the patient's body with an infusion pump.

After more than ten minutes, seeing that the blood pressure on the monitor had become 160/100mmHg, Zhou Chao gradually calmed down with his heart hanging.

As long as the patient's blood pressure can be lowered to a normal level, the risk of aneurysm rupture will be much lower, and she will have the opportunity to have an examination, and the patient will have a greater hope of surviving.

After waiting for about ten minutes, the patient's blood pressure has dropped to a lower level than normal. Now that this is the case, the patient can be taken for an examination, although there is still a certain risk.

But when the blood pressure was higher than before, the risk has been reduced a lot.

At this time, Zhou Chao could no longer take care of too many thoughts, and hurriedly pushed the gurney with the nurse to examine the patient.

Lin Yi knew what was going on, and he didn't follow.

After more than 20 minutes, Zhou Chao pushed the patient back to the emergency room.

He took the patient's ct film and color Doppler ultrasound results for Lin Yi to see.

"This patient really has an aortic dissection aneurysm. Let him be transferred to the vascular surgery department for surgery as soon as possible."

Lin Yi nodded and didn't say much.

Lin Yi is naturally not a problem with such interventional surgery.

A disease like this that can cause death at any time must be explained clearly to the family members.

Otherwise, if the patient dies, he will be very passive if he can't tell.

The patient's wife trembled and agreed to the operation.

But this operation consent form does not need to be signed in their emergency department.

Instead, after the person who needs vascular surgery comes, he will be transferred to their department to sign there.

Zhou Chao first called the on-duty doctor of the vascular surgery department and asked them to come over to have a look first.

Soon a young doctor came to the emergency department.

He is about the same age as Wu Jiang, and he is also an attending physician named Chen Jiaqiang.

Chen Jiaqiang first listened carefully to Zhou Chao's medical report.

Then look at the patient, and look at all the patient's test results.

He pondered for a moment, frowned and said: "The diagnosis of this patient is very clear, and he definitely needs immediate surgery.

But the problem is that our director has a meeting in another place and will come back in three days. Can this patient wait until then? "

The director of vascular surgery is Gao Lin. The stent implantation for aortic dissection aneurysm is a level 4 operation.

Only he can do it, other people under his command can't do it.

When Zhou Chao heard that Gao Lin was having a meeting outside, he suddenly became nervous again.

He has to be nervous!
If the patient cannot be transferred to the vascular surgery department today, she will still be in charge of the bed.

Director Wang of the vascular surgery department is not at home, so the doctors under him will definitely not take him in.

Because this patient is a ticking time bomb, death may occur at any time.

Who wants to put such an unstable patient in their own hands when the operation cannot be performed immediately?

If the patient is to wait for Gao Lin to come back for surgery, then the vascular surgery staff must keep the patient in the emergency department.

Just keep it stable, and when the director comes back, he will be transferred to their department immediately.

Zhou Chao knew very well in his heart that there was a lot going on here.

The patient's condition is particularly critical, and no one wants to take this risk.

Gao Lin won't come back until three days later, which means that the surgery can't be performed until three days later.

But the patient's condition, can it last for three days?

The patient's dangerous hemangioma could rupture at any moment and kill him.

Even if the doctor can wait, the patient can wait, but can the illness wait?
If the patient is to be transferred to another hospital, the question is where can the patient be transferred?
In the entire Jiangnan Province, only the Provincial People's Hospital has the conditions to perform this operation.

If the patient is transferred to another hospital, he can only be transferred to Beijing, but is the patient's physical condition allowed?

With such a long distance, if something happens on the way, the patient will die.

But no matter what, Zhou Chao didn't want this patient to remain in her hands, she said tentatively:

"Dr. Chen, this patient is no longer suitable in our department. Let's transfer to your department now!"

This is also human nature. No doctor wants to keep a patient who will die at any time.

Chen Jiaqiang shook his head.

"Director Zhou, our director is not here, if you transfer the patient to us, it's the same as if you were here.
It's better to maintain good blood pressure and vital signs at your place, so as not to have to move him. When our director comes back, he can be transferred to our department! "

Chen Jiaqiang is not a fool either.

If such a dangerous patient is transferred to their department and waits for three days, who knows what accidents will happen?

Might as well keep him in the emergency department.

Zhou Chao felt a little irritable.

Chen Jiaqiang is obviously pushing the patient here!
The role of the emergency department is to screen the patients first, and then transport the patients to the corresponding departments for further treatment after their condition is stabilized.

Now the patient with aortic dissection has stabilized blood pressure and has been diagnosed clearly.

Obviously need to be sent to major vessel surgery.

Regardless of whether their director is in or not, they should not continue to stay in the emergency department.

This is a matter of principle.

After all, this patient is really dangerous.

For three days, Zhou Chao felt that the patient might not be able to wait.

If this patient is left in the emergency department, in case of an accident.

The family members will only find their own troubles, not the great vessel surgery.

Zhou Chao was suddenly a little unhappy, and his tone of voice became a little blunt.

"Doctor Chen, it doesn't matter whether your director is here or not, but this patient belongs to the scope of your department's treatment.

Now it is a matter of principle to transfer to your department for further treatment, right?If you don't accept it now, aren't you trying to prevaricate the patient? "

Immediately, Chen Jiaqiang's expression turned a little ugly.

After all, Zhao Yun Zhouchao's tone bluntly said that he was shirking the patient.

If the patient's family members complain, then he is responsible.

But Chen Jiaqiang put on a posture that a dead pig is not afraid of boiling water.

"Director Zhou, what you said is serious. Our director is not here, and the operation will not work. Isn't it the same to transfer to our department and your department? What's the difference?
Aren't you afraid of the moving process, his ruptured aneurysm, isn't that also a risk?Anyway, if our director doesn't come back, I won't accept this patient. As for which department you want him to transfer to, it's up to you. "

After Chen Jiaqiang finished speaking, he turned his head and left without waiting for Zhou Chao's rebuttal.

He doesn't want to get too entangled here.

Seeing Chen Jiaqiang leaving without looking back, Zhou Chao immediately said:
"Lin Yi, why do the people in their vascular surgery department behave like this? They are so defiant!"

What can Lin Yi do, he can't control the people in the Department of Great Vascular Surgery.

He had no choice but to comfort him: "Director Zhou, don't be as knowledgeable as them."

At this moment, the nurse rushed into the office and shouted, "Director Zhou, that patient's blood pressure has risen again, come and have a look!"

Zhou Chao's heart immediately rose again.

He hurried out of the office, and Lin Yi followed.

Sure enough, the blood pressure on the patient monitor now shows 160/90mmHg.

This is still a patient, and his blood pressure started to rise again while taking sodium nitroprusside and urapidil.

Like his condition, once blood pressure rises, the risk of hemangioma rupture also rises linearly.

Zhou Chao frowned, stared at the monitor carefully for a while, and then looked at Lin Yi.

"Lin Yi, I can't control my blood pressure!"

In just a short while, the patient's blood pressure has risen to 170/95mmHg.

Moreover, the dosage of antihypertensive drugs has been prescribed to the maximum, but the patient's blood pressure still seems to be on the rise.

The patient began to have dull pain again, and his condition was not optimistic.

"Director Zhou, it seems that this patient can no longer maintain his blood pressure with drugs alone, and needs surgery as soon as possible!"

But now Lin Yi suggested that the patient should undergo an operation as soon as possible, which made Zhou Chao extremely embarrassed.

If you could have surgery, wouldn't you have done it sooner?
Who would wait until now?

Zhou Chao frowned, thought for a while, and had to say: "Gao Lin is not here, or let him transfer to another hospital. It is really difficult for us!"

Lin Yi knew very well the condition of this patient.

If you are transferred from their hospital to a large hospital in the province, you cannot take a plane and need to be sent there by ambulance.

It will take at least several hours for an ambulance to send it there.

The bumps along the way are likely to worsen the patient's condition and cause his death.

In general, the risk of transferring him is higher than the risk of waiting here for three days.

In this way, the patient's condition is close to death, and his life is hanging by a thread.

When this happens, Lin Yi can't sit idly by.

He is a doctor after all.

If you refuse to save him, you will feel bad for your conscience.

If he does not know how to perform this operation, he will not feel guilty if the patient dies.

But in this situation, if the patient died, Lin Yi would not forgive himself in his heart.

It's such a time, and he doesn't care about "one thing more than one thing less", saving people is the most important thing.

Seeing Zhou Chao's painful choice, Lin Yi said, "Director Zhou, why don't I perform this operation!"

"you………"

Zhou Chao couldn't help frowning, looking at Lin Yi.

"Will you do this intervention?"

Stent implantation in aortic dissection aneurysm is a fourth-level operation, and the difficulty is not ordinary.

Only Gao Lin can manage the entire central hospital.

I haven't heard of other doctors who can do this operation.

But now Lin Yi actually said that he can perform this operation.

Zhou Chao also knew in his heart that it was almost impossible for Lin Yi to be joking.

Lin Yi has been here for so long.

Although it can't be said that Lin Yi can't be understood thoroughly, but he already has a certain understanding of Lin Yi.

Lin Yi is a very stable person, and he will not make jokes casually when it comes to curing diseases and saving lives.

Looking at Zhou Chao's expression, Lin Yi knew that he didn't believe what he said.

Let alone the Zhou Dynasty, if it was someone else, he himself would not believe it.

After all, age and experience are here, Lin Yi is too young.

Lin Yi said solemnly: "Director Zhou, of course I won't make jokes about this kind of thing, what I said is true, I can do this operation.

But if you really don't believe me, just pretend I didn't say it.This patient, whether to transfer him to the province or let him wait for three days to wait for Director Gao, you decide for yourself! "

You have to speak out, and you can't let yourself go against your will.

As for how Zhou Chao made up his mind, that was his business, and Lin Yi would not interfere.

Zhou Chao thought for a while, leaned closer to Lin Yi, looked him straight in the eyes, and asked again: "Lin Yi, can you really perform this operation?"

Lin Yi nodded and said: "I can assure you that I can perform this operation 100%, and I will not make fun of the patient's life."

Seeing Lin Yi's affirmation, Zhou Chao seemed relieved.

He looked at Lin Yi fixedly, and said, "Okay, this patient will be handed over to you, and you will perform this operation."

Song Borui was also surprised when he was notified to have the surgery together.

Although he knew that Lin Yi was very skilled in hand surgery and general surgery.

But he really didn't expect that Lin Yi would still perform interventional surgery.

In particular, this kind of fourth-level surgery in cardiovascular intervention was far beyond his expectations.

But Song Borui knew in his heart that Lin Yi would not joke about it.

And after seeing the patient, I also know the patient's condition. It is estimated that I can't wait for three days, and there is almost no possibility of transferring to another hospital.

All they can do now is unconditionally believe that Lin Yi can do the operation well.

Zhou Chao told the family members in detail again, and then asked the family members to sign the consent form for the operation.