I Can See Health

Chapter 104: Professor Lu, it's really hypokalemia!

Chapter 104 Professor Lu, it's really hypokalemia!

Zhang Wulong recognized the doctor who spoke in the group.

His name is Yu Songbei, and he is the deputy chief physician of the Cardiology Department of Pingshui County Hospital of Traditional Chinese Medicine.

The level of reading the ECG is not bad. He is very active in the group and has always been very enthusiastic to help others to answer the ECG.

"Thank you, Teacher Yu, for your guidance."

Yu Songbei replied with a smiley expression: "You're welcome."

Zhang Wulong's urgent mood calmed down a little.

If you can have a preliminary impression diagnosis, it will be easy to handle.

Since it is considered to be myocardial ischemia caused by coronary heart disease, it is enough to wait for the cardiologist to come for consultation and then be admitted to the cardiologist for hospitalization.

…

"Doctor Zhang, the doctor who consults in the heart is here!"

The nurse shouted in the corridor.

Zhang Wulong immediately walked out of the ward and welcomed the cardiologist in.

"Lao Fan, why did you come here? It's been almost ten minutes. This patient is a relative of the county leader. The director has already spoken, so I can't ignore it."

"Hey, Corey is busy, so I have time to spare." Fan Zhiqing, the chief physician of the Cardiology Department, shook his head slightly, "Let me see what kind of patient it is."

Zhang Wulong handed the electrocardiogram in his hand to Fan Zhiping.

"The patient has been fatigued in the last day and has been progressively worsening. He has no special medical history, but he has high blood pressure, and his blood pressure has not been well controlled."

Fan Zhiping looked at the electrocardiogram, and then performed a simple physical examination on the patient.

"The patient's myocardial ischemia is very serious."

"Well, we also considered coronary heart disease just now." Zhang Wulong nodded, "But the patient has no obvious symptoms of chest tightness and chest pain. The symptoms of coronary heart disease do not seem to match."

"That may be fatigue and anorexia caused by coronary heart disease and heart failure." Fan Zhiping said, "Some heart failure patients have less typical symptoms, and may have serious gastrointestinal symptoms, such as poor appetite and poor long-term nutritional status. , it may lead to fatigue and poor appetite.”

At present, the diagnosis of Fan Zhiping and Zhang Songbei in Qunli are similar, and they mainly consider myocardial ischemia caused by coronary heart disease.

"Then I will issue a hospitalization certificate for the Cardiology Department and let him go to your heart." Zhang Wulong said.

"Okay." Fan Zhiping nodded, "Then I'll go back to the department."

"Thanks."

Zhang Wulong smiled. He was about to issue a hospitalization certificate to the patient, but the phone beside him vibrated.

He glanced slightly, and found that it was the news of the electrophysiological exchange group, as if someone was at him.

Zhang Wulong frowned and opened the WeChat group suspiciously.

Seeing the news in the group, his expression was taken aback.

Immediately after that, he shouted to Fan Zhiping who was preparing for the emergency department: "Old Fan, wait and leave!"

Fan Zhiping stopped and looked back in doubt: "What's wrong?"

"Look at this electrocardiogram again!"

Fan Zhiping was stunned for a moment, then walked back to Zhang Wulong's side quickly and picked up the electrocardiogram on the table.

"Is it possible hypokalemia?" Zhang Wulong said softly.

Fan Zhiping's eyes narrowed, "Hypokalemia?"

He focused his attention, carefully analyzing every waveform in the electrocardiogram.

This is… U wave?

Fan Zhiping found that behind the T wave of this electrocardiogram, there is a very small waveform, the U wave!

Small U waves are specific waveforms of hypokalemia.

Fan Zhiping's frowning brows suddenly stretched out.

"Yes, this is hypokalemia!"

"The patient has symptoms of general malaise, which is caused by hypokalemia!

"In addition, the patient's heart rate is relatively slow, also because of hypokalemia!"

In this way, all the symptoms and signs of the patient can be explained!

"Is it really hypokalemia?" Zhang Wulong asked in surprise.

"Well, it seems that it is very likely to be hypokalemia!" Fan Zhiping nodded, "The report of the blood test may be out a little late, so take a blood gas analysis immediately to see the potassium in the blood gas analysis. ionic level."

"Okay!" Zhang Wulong immediately ordered the nurse to collect arterial blood gas.

Emergency departments are equipped with rapid blood gas analyzers, which usually provide results in minutes.

Blood gas analysis, which draws blood from the patient's arteries.

It can preliminarily evaluate the lung ventilation function and the acid-base balance of the patient, and the blood gas analysis also has the value of potassium ions.

The nurse started taking arterial blood gas.

Fan Zhiping did not leave, but stayed in the emergency department, waiting for the results of the blood gas analysis.

Arterial blood gas collection is completed, three minutes later.

"Doctor Zhang, the results of the blood gas analysis are out!"

The nurse handed Zhang Wulong a small note for blood gas analysis.

Fan Zhiping immediately put his head over.

"Blood potassium: 1.9mmol/L..."

The normal serum potassium range is 3.5-5.5mmol/L.

1.9mmol/L is already a standard for severe hypokalemia.

Patients are at risk of cardiac arrest or even sudden death at any time!

"Severely low potassium!" Zhang Wulong said.

"Quickly replenish potassium!" Fan Zhiping nodded, "Although in general, the potassium ion level in arterial blood is lower than that in venous blood, this patient's serum ion level should be higher than 1.9mmol/L. , but not by much."

Zhang Wulong immediately issued a doctor's order to start potassium supplementation at the same time, both oral and intravenous.

"Old Fan, based on the patient's history of hypertension, is there a possibility of protoaldehyde?"

Fan Zhiping glanced at Zhang Wulong quite unexpectedly, "You are not simple, you are all diagnosed?"

Everyone has been colleagues for many years, and Zhang Wulong's level is very clear to him.

I can’t even see an ECG of myocardial ischemia at ordinary times. How can I directly judge hypokalemia today?

also said primary aldosteronism?

"Hey, I don't have the ability to read an electrocardiogram."

Zhang Wulong took out his mobile phone and clicked on the WeChat group.

"No, I posted this picture in the electrophysiology exchange group. At the beginning, some doctors said it was coronary heart disease and myocardial ischemia."

"However, a teacher just said that it may be hypokalemia, combined with the medical history, consider the original aldehyde, so I called you back."

Fan Zhiping took over the phone and looked at the chat records in the group.

The last message in the group was sent by a person with the nickname "Jinghua Electrophysiology Association".

"@FengM County People's Hospital Zhang Wulong, there may be hypokalemia, combined with medical history, consider the original aldehyde."

Fan Zhiping wondered: "Old Zhang, what are you guys doing?"

"Oh, this group is a group established by Jinghua Electrophysiology Association in order to facilitate academic exchanges in primary hospitals. The members are doctors from some nearby county-level hospitals, and they usually communicate about electrocardiograms. Each group has Several are members of the Jinghua Electrophysiology Association, and they are basically doctors from Jinghua University Hospital, and some are even at the professor level." Zhang Wulong smiled, "But this teacher named Lu Chen, I seem to be the first time today. When I saw him speak, I had no impression of him before."

"Do you still have such a group?" Fan Zhiping became interested.

"Yeah, this has only emerged recently." Zhang Wulong said, "I also joined the group through a good friend."

"Old Zhang, then quickly pull me into the group!" Fan Zhiping patted Zhang Wulong on the shoulder.

"Hey, you still have to find someone else to see the picture in your heart?" Zhang Wulong teased.

"Oh, it's not like you don't know that the cardiology department of our grassroots hospital doesn't specialize in electrophysiology." Fan Zhiping shook his head slightly, "There are many difficult electrocardiograms that even our director can't understand, so we have to ask patients to go to the top. A large hospital. But some patients' family conditions do not allow it, so they still stay in our department, and it is difficult for us to do it."

"Okay, then I'll pull you into the group."

"Old Zhang, thank you, please give me a meal in a few days."

"It's easy to talk."

…

Jinghua Second Hospital, the dormitory of Jipei Building.

Lu Chen was lying on the bed.

"Congratulations, +1 thanks to Zhang Wulong!"

Lu Chen's face was overjoyed, it seems that this picture is really hypokalemia!

as predicted.

After a while, Zhang Wulong sent a message in the WeChat group.

"@Jinghua Electrophysiology Association Lu Chen, thank you Professor Lu! It's really hypokalemia!"

Thanks for the reward I want a girlfriend, Daluzi, Yuntianxing, Kunlinyuanshan, Floating Life Bencun, 20190623.