I Can See Health

  Chapter 132 Strange Cidilan (please ask for votes)

   These days, Lu Chen also devotes some of his energy to paying attention to the "Jinghua Electrophysiology Exchange WeChat group".

   In this group, doctors send electrocardiograms every day to exchange some interpretation experiences with each other.

Before   , Lu Chen had been reviewing the skill test and didn't have much time to pay attention.

  Now, he will open WeChat from time to time to see if there are some difficult electrocardiograms that need to be interpreted.

  Perhaps, you can earn some thanks from it.

  …

   Feng M County People's Hospital.

Cardiology.

  Fan Zhiping is in the doctor's office, sharing his stock market experience with his colleagues.

   "Oh, the current market is not very good, the position was liquidated some time ago, and the losses were heavy!" Fan Zhiping sighed, beating his chest.

"Director Fan, you're pretty good. You made a lot of money some time ago, but I've lost a lot this time." A resident doctor in Corey shook his head, "My mother-in-law is almost anxious for me. Hey."

   Just when the two sighed.

   The head nurse hurriedly walked into the doctor's office and knocked on the door of the office.

   "Director Fan, a patient with acute heart failure has been brought in by the emergency department! I think the patient is in a serious condition, go and see!"

  Fan Zhiping was shocked, and immediately put away his smile and grabbed the stethoscope.

   "How many beds? I'll go now!"

   "The patient is in the rescue room!"

"it is good."

  Fan Zhiping walked out of the ward immediately, followed by the resident doctor who had just chatted with him.

   Soon to the emergency ward.

   On the hospital bed, was an old lady in her seventies or eighties, sitting beside the bed, panting heavily, her lips slightly cyanotic.

   A young doctor with glasses was standing beside the hospital bed.

   "Director Fan, you are here, this should be a patient with heart failure."

  The emergency doctor was relieved when he saw Fan Zhiping coming, and immediately started reporting his medical history.

   "The patient, a 78-year-old female, complained of palpitations for more than 10 days".

   "The patient's conscious heart rate is rapid, which is continuous and sometimes aggravated. There is no chest tightness, chest pain, dyspnea, cough, expectoration, dizziness, syncope, abdominal pain, abdominal distension and other discomforts."

   "The old lady complained that she was in good health, denied any other medical history and any history of taking medicine, and seldom went to the hospital to see a doctor."

   "Physical examination on admission: blood pressure 125/75mmHg, heart rate 125 beats/min, absolutely irregular rhythm, varying heart sounds, no murmurs, clear breath sounds in both lungs, no dry or wet rales, and no edema in both lower extremities."

   "Check ECG after admission: it is rapid atrial fibrillation with frequent ventricular premature beats. Chest CT has been done, but the results have not yet come out."

  Fan Zhiping nodded and started the physical examination.

   At the same time, he instructed the nurse to perform ECG monitoring and oxygen inhalation for the patient.

  The emergency doctor handed the electrocardiogram and emergency medical records to the resident doctor beside him.

   "Director Fan, the patient will be handed over to you, I'll go first."

   "Okay." Fan Zhiping nodded.

  The emergency doctor pushed the flat cart and left.

   "Director, is this acute left heart failure caused by rapid atrial fibrillation?" The young resident doctor on the side picked up the electrocardiogram and took a closer look, "It is also accompanied by secondary ST segment changes."

   "Yeah." Fan Zhiping nodded gratified and said to the nurse at the same time, "First urgently check blood, renal function, ions, myocardial enzymes, BNP, then intravenously push a furosemide, and then push half a cedilan!"

   "Okay, Director."

The    nurse soon returned to the treatment room to dispense the medicine.

Fan Zhiping said to the resident next to him: "Xiao Fang, the first choice for heart failure we usually encounter is to use furosemide. If the effect is not good, we can use cedilan to strengthen the heart. But this patient is different. , I chose cardiotonic from the beginning, do you know why?"

  Xiaofang paused, pondered for a moment, and said slowly: "I remember that the internal medicine book said that the best indication for cedilan is rapid atrial fibrillation accompanied by heart failure. This patient... just fits!"

   "Yes." Fan Zhiping nodded slightly, "Yes, cedilan can control the ventricular rate of atrial fibrillation, and can quickly relieve the symptoms of heart failure."

   At this time, the nurse just brought furosemide and cedilan.

   "Director, I'll give you another oral doctor's order, one intravenous injection of furosemide and half of cedilan."

   "That's right."

   The nurse received Fan Zhiping's affirmative reply and began to execute the doctor's order.

  Furosemide static push!

  Cydilan pushes slowly and quietly!

  …

   Fan Zhiping has returned to the doctor's office, and only Fang Yong is left in the ward to observe the patient's condition.

   At this time, the nurse had just finished pushing the cedilan.

   "Mother-in-law, do you feel any more tightness in your chest?" Fang Yong asked softly as he approached the hospital bed.

   On the hospital bed, the old lady was still breathing hard and waved her arms weakly.

  Fang Yong frowned.

   Looking at the patient's condition, not only has it not improved, but it seems to be getting worse!

   This is not quite right!

   "I, I have some chest pains and chest tightness..." A few words popped out of the old lady's mouth with difficulty.

The patient's family members on the side of    were a little anxious when they heard this.

   "Doctor, what's the matter, I feel that my mother's symptoms have gotten worse after taking these medicines!"

   "Don't worry, take a look again!" Fang Yong calmed down and turned back to the nurse, "Go and call Director Fan over."

   At the same time, he picked up the stethoscope to auscultate the patient's lungs.

   As soon as he placed the stethoscope in the auscultation area of ​​the patient's lungs, Fang Yong felt something was wrong.

   When the patient first came to the department, her lungs were clean by auscultation, and she did not smell any wet or dry rales.

   But now.

  The old lady’s lungs were newly developed with expiratory wheezing, and a little moist rales could be heard in both lower lungs.

Why is it happening like that?

   "Xiao Fang, what's wrong?"

   At this time, Fan Zhiping arrived.

   "Director, the nurse has just finished pushing Cedilan, and the patient feels more chest tightness!" Fang Yong immediately said, "I just auscultated the patient's lungs, and compared to before, there has been a change!"

  Fan Zhiping frowned, and quickly auscultated his lungs again.

   "There is indeed a change. You can hear wheezing, and there are even some wet rales at the bottom of the lungs, which I hadn't heard before."

   This is a sign of a worsening condition!

   "Push a piece of furosemide, and then give the patient a set of nebulization! Push another piece of panting!"

  Fan Zhiping immediately started giving oral medical orders.

   Now is not the time to consider the cause of a patient’s exacerbation.

   Stabilize the condition first, this is the most important!

   After about ten minutes.

   The patient's symptoms began to ease, and the symptoms of chest tightness and chest pain gradually disappeared.

   Everyone breathed a sigh of relief.

  …

   At the same time, Fan Zhiping began to speculate on various possible reasons.

   "This patient has symptoms after pushing cedilan. Could it be a drug reaction of cedilan?"

   Back to the doctor's office.

   Fan Zhiping looked through all the test indicators of the patient, still puzzled for a long time.

   "Director Fan, I just checked another electrocardiogram."

  Fang Yong was very diligent. After the patient's symptoms were relieved, he reviewed an electrocardiogram.

  Fan Zhiping got the re-examination ECG and took a closer look.

   The electrocardiogram of the re-examination was still atrial fibrillation, frequent ventricular premature beats, and the heart rate returned to normal.

   However, compared with the general lead ST segment depression and T wave inversion on the electrocardiogram at admission, there were changes in myocardial ischemia.

   "Director Fan, why did the patient's condition suddenly worsen?" Fang Yong asked in a low voice.

   "I don't know." Fan Zhiping shook his head. He didn't find the source of the aggravation.

   But according to the specification for the use of cedilan, it is definitely right to push cedilan in this situation!

  The only thing that has changed now is the two electrocardiograms before and after!

   But he pondered for a long time, and on the electrocardiogram, he could not find the slightest thought.

   Suddenly, Fan Zhiping thought of the "Jinghua Electrophysiology Exchange Group" he had just joined.

   Maybe the professor of the higher-level hospital can see the difference!

   thought of this.

   He quickly took pictures of the two types of electrocardiograms with his mobile phone, and then sent them to the Jinghua Electrophysiology Exchange Group.

  Fan Zhiping also briefly described the patient's medical history, and at the end, specially called Lu Chen.

   "@Professor Lu, if you have time to look at these two electrocardiograms for me, thank you."

   Still owes three more shifts.

   Thank you all for your donations!

   (end of this chapter)