bookmarkrole Chapter 301
Chapter 301
Chapter 301
Lin Feng talked about the possibility of “pulmonary embolism” to the doctors at icu.
“It seems… it’s really possible…”
“Although it is a bit far away, there is indeed a possibility…”
“Can’t rule out this problem…”
Lin Feng opened Wang’s trouser legs.
“If you have a pulmonary embolism, you can look at his leg.”
As soon as I opened my trouser legs,
“what!”
“A lot of varicose veins!”
“This… pulmonary embolism?”
Many doctors were shocked at once.
In their eyes, Wang Lao’s legs had a lot of varicose veins and bulges.
There are varicose veins, which means that thrombosis will be easier.
Moreover, there is another proof:
Edema of lower extremities!
Wang Lao’s legs, around the varicose veins, have symptoms of edema.
“Edema”: Once a thrombus is formed, the blood flow is not smooth, and the excess blood will leak to the subcutaneous soft tissues, which manifests as edema.
There is edema-a high probability of thrombosis-a high probability of considering a pulmonary embolism!
logic,
Very reasonable! !
“The probability of pulmonary embolism has increased!”
“right.”
Lin Feng looked at the director of icu: “Director Chen, ICU should have a color Doppler ultrasound?”
Director Chen: “Yes!”
Lin Feng: “I can do color Doppler ultrasound. I want to do a lower limb vascular color Doppler ultrasound for the patient to see if there is a thrombus. As long as there is a thrombus, the possibility of pulmonary embolism is very high!”
Director Chen thought: “Dr. Lin, do you know how to do ultrasound?”
Lin Feng: “B-ultrasound is still quite simple. When doing interventions, some interventions require b-ultrasound…”
All the doctors: “………………”
B super easy?
Simple ghost, I don’t know how to do it!
Doctor Lin is such a villain!
Soon, the icu nurse pushed the color Doppler ultrasound instrument to the bed.
Turn on the B-ultrasound machine, apply lubricant, aim the probe at the leg and start checking.
·Check result: 14 thrombus!
It’s shocking!
Even if a bleeding clot drops at random, it will flow all the way forward along the veins of 997.
After the following cycle:
The blood flow of the lower limbs (whole body) first enters the (upper and lower) vena cava—right atrium (blood storage)—(tricuspid valve) right ventricle (pumping blood)—(high pressure blood pumping) pulmonary artery—pulmonary capillary Blood vessels (alveoli, oxygen and carbon dioxide exchange)-pulmonary vein (oxygenated blood)-left atrium (storage)-(mitral valve) left ventricle (pumping blood)-(high-pressure blood pumping) aorta- —The arteries of various organs throughout the body… (ps: full of dry goods)
The thrombus follows the blood pathways above, all the way to the tributary position of the pulmonary artery, that is, before it reaches the “pulmonary capillaries”,
Then block the tributary,
Form a “pulmonary embolism”!
Seeing so many blood clots,
The balance began to tilt to the side of the ‘pulmonary embolism’.
“It should be a pulmonary embolism!”
“Thrombolysis.”
A doctor suggested.
But some doctors objected.
“It can’t dissolve thrombolysis. The side effects are too great, and it is easy to cause internal hemorrhage. If there is cerebral hemorrhage, it will be troublesome…”
“I suggest thrombolysis. It is less than 3 hours after the onset of the disease. There is still a chance for thrombolysis. It will be meaningless after the time has passed.”
“Don’t worry, watch the color Doppler ultrasound first, for pulmonary embolism!”
“Yes, there may not be a pulmonary embolism.”
“With so many blood clots, how can there be no pulmonary embolism…”
A bunch of doctors quarreled endlessly.
Lin Feng was unmoved.
Because there is no noise,
Immediately, the patient can undergo a “cardiopulmonary B-ultrasound” examination.
Lin Feng quickly applied lubricant to the patient’s chest.
The doctors calmed down and waited for the B-ultrasound results.
soon,
The probe shot into the patient’s lungs…
Find the pulmonary artery, look at the tributaries one by one…
10 minutes later……
·B-ultrasound results: normal blood flow, no embolism…
All the doctors: “……………………”
Woj!
With so many blood clots in the lower (aicc) limb, there is no pulmonary embolism!
It’s weird! !
Next, the doctors began to catch blindness.
Look at the blood flow of the heart, that is, the heart color Doppler ultrasound…
·Check result: still normal!
Doctors: “%￥#￥#%………………………………”
There is no fucking to say! !
There is no problem with the lungs, that is, there is a problem with the head?
but,
The intensity of B-ultrasound cannot penetrate the brains of adults, and color Doppler ultrasound has no effect.
B-ultrasound can only be used if the baby’s head is relatively soft.
then,
The condition is deadlocked!
·Why does the patient get edema without cerebral hemorrhage or bruise?
·Is it because of cerebral infarction?
·With current methods, there is no way to confirm cerebral infarction, because the time is not long enough (after 24 hours)!
· CT (contrast medium) can be enhanced, but now the patient stays alive in ICU, and there is no way to go to the CT room.
·There is no way to use mri NMR…
All doctors: “……………………”
Muggle!
If you can’t find the reason, there is no way to treat the symptoms!
Deadlock! !
Lin Feng scratched his hair, considering various possibilities in his mind.
“Could it be… cerebral embolism?”
“Cerebral embolism”: It means that the blood clot enters the brain and blocks the blood vessels…
but,
There is a question. How can a blood clot not pass through the pulmonary capillary tube to the brain?
“Huh…wait…”
Sudden,
Lin Feng thought of a possibility:
“The foramen ovale is not closed”!
“Patient foramen ovale”: Explanation of the meaning: The left atrium and right atrium are close to each other (located in the upper part of the heart). Normally they are not connected, but there is a foramen ovale between the left and right atriums during the fetal period. Communicative, gradually closed after birth.
If the “foramen ovale” is not closed, it means “foramen ovale is not closed”.
This is a kind of congenital heart disease, which is relatively common. For every 4 adults, 1 person will have this disease.
It is a bit like “house shortage”, there is no danger of room shortage.
“If the patient really has “patent foramen ovale”, the thrombus can be pumped from the right atrium-foramen ovale-left atrium-left ventricle-high pressure into the heart aorta-reaching the cerebral artery-causing Cerebral embolism, further ischemia and hypoxic cerebral infarction! ! ”
Thought of this!
Lin Feng was excited.
Quickly place the B-ultrasound probe in the “left and right atrium” of the patient’s heart.
Observe carefully,
really,
Lin Feng really discovered a ‘round hole’, about 1cm in size! !
Did not run away!
This cliff is the murderer!
A doctor noticed Lin Feng’s look: “Dr. Lin, have you found it?”
Lin Feng nodded, pointed to the B-ultrasound display and said: “Here…there is “foramen ovale not closed”…”
“What? “The foramen ovale is not closed”? ”
“Congenital heart disease?”
“Let me see……”
“Hey, it really is!”
“”The foramen ovale is not closed”? Could it be… cerebral thrombosis? “A doctor shouted excitedly!
Other doctors awakened one after another.
“The patient has so many thrombosis in both lower limbs, plus a “patent foramen ovale”, it is really very likely to have a cerebral thrombosis! ”
“It feels like this should be the real cause!”
“Doctor Lin, awesome!”
Lin Feng shook his head: “There is still no way to really confirm the cerebral thrombosis… It is best to wait for the patient’s condition to ease before going for enhanced CT imaging…”
Lin Feng sighed secretly.
Why did I fail to do CT-enhanced imaging in time when I checked the CT before I was sent to ICU.
However, at that time, I didn’t think about cerebral embolism at all, because the probability was too low, and the probability of pulmonary embolism was higher than it.
I just didn’t expect to add a rare thing like “patent foramen ovale”.
Lin Feng did not sigh secretly about the impermanence of fate.
“wait……”
“When the condition is stable, send brain CT imaging…”
Lin Feng said.
The icu doctors nodded in agreement.
but,
Things took a sudden turn.
“It’s not good, blood pressure has dropped again!!”
“Heart rate has jumped to 170!”
“The blood oxygen drops to 89%!”
The nurse reported in a panic.
The doctors were taken aback.
Surprised, life is maintained, still like this!
It shows that the condition is getting worse!
“Quickly, put on a high-frequency ventilator (compared to ordinary ventilator, higher frequency, smaller air volume per injection, higher efficiency)!”
“Boost medicine, add more!”
Lin Feng issued a series of instructions, and the nurses acted one after another.
Soon, the medicine went on.
Although the condition has stabilized, it is a little lower than before.
Lin Feng and many icu patients are worried.
At this moment,
Lin Feng decided: “Notify the family and look at their opinions… Now this situation cannot be delayed. If it is really a cerebral thrombosis, the cerebral infarction will continue to expand over time… Therefore, my suggestion is to proceed. Thrombolysis treatment!”
Thrombolytic therapy is very risky. Can thrombolytic drugs cause cerebral hemorrhage if they are not careful? Isn’t that over?
but……
According to the current cause analysis, the only possibility is cerebral thrombosis!
I can only bet!
Gambling patients is cerebral thrombosis!
If the bet is successful, the patient can be rescued back!
If you don’t bet, the patient’s condition may get worse!
all of these,
Let the family decide!
The doctor cannot make this decision!
…
icu outdoor,
On the stool,
Wang’s wife, son, daughter-in-law, and 5-year-old grandson are waiting anxiously.
The son walked around, anxious.
My heart is also a little aggrieved!
Hum~~~~
At this time, the electronic lock door of the icu opens in translation.
Director Chen Icu walked out with the nurse.
“Are Wang Dongsheng’s family members there?”
“I am here!”
One after another came to Director Chen.
The son was nervous: “Director Chen, what happened to my dad?”
Director Chen: “The patient’s condition is not optimistic, because at ICU now, there is no way to do CT, and no way to do MRI. There is no way to really determine the cause of the disease… and the patient’s current condition is getting worse…”
The son wanted to lose his temper, and shouted: What happened in your hospital…
But as soon as I saw Director Chen’s majestic gaze, I couldn’t spit out these words.
Son: “Then what should I do now?”
Director Chen: “At present, we consider that the patient is a cerebral thrombosis…Balabara (I repeat the analysis of the condition and the diagnosis process)… Finally, there are two options, one is thrombolytic therapy and the other is not thrombolytic. Continue to wait for the condition Get better, go for CT imaging…”
For a while, the son felt dilemma.
· Thrombolysis may cause death from cerebral hemorrhage.
·Does not dissolve thrombolysis and fear that the condition will worsen.
And the old wife of Wang, a 60-year-old old lady, was already lying down on her chair, crying, and her daughter-in-law and grandson comforted…
10 minutes……
20 minutes……
Director Chen did not urge, because he could not influence the judgment of his family.
After thinking about it for a long time, my son gritted his teeth for the last time!
“Thrombolysis… Please Director Chen!”
“good!”
The son signs the agreement.
The moment he signed the word, he suddenly felt his whole body slumped to the ground as if he had been drawn out of strength.
…
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ps: There are a lot of dry goods, and I am afraid that the book friends will be boring. The author has tried to write the content in a simple and understandable way.
A picture is placed in the chapter: Heart Cycle·jpg
Distressed to send myself~~~.