I Can See Health

Since the patient's family did not agree to be transferred to the ICU, Yin Xinhua decided to perform a cardiac ultrasound on the patient first before making next steps.

If the patient really has pulmonary embolism, it can also be discovered by performing a cardiac color ultrasound.

Color Doppler ultrasound can reveal increased pressure on the patient's right heart, and may also reveal increased pressure on the pulmonary arteries. If you are lucky or have good skills, you can even see the emboli blocking the pulmonary arteries.

If so, the diagnosis was certain.

However, the emergency cardiac ultrasound at night cannot come immediately, and you have to wait for about twenty minutes.

Just like the previous night shift, Yin Xinhua called the chief resident of the cardiology department and asked him to do an ultrasound first. After making a preliminary diagnosis, he would wait for a professional doctor from the ultrasound department.

However, as luck would have it, the resident general of the cardiology department happened to be helping to rescue patients in the second cardiology area, so he couldn't come over right away.

"Senior sister, why don't you let me try this first?"

When Lu Chen appeared in the ward with a portable cardiac ultrasound machine, Yin Xinhua was extremely surprised.

"You know this?"

Recalling the last night shift, Lu Chen couldn't even perform the most basic cardiac cross-section.

Currently, diagnosing pulmonary embolism requires looking at images of the pulmonary arteries, which is more difficult than looking at the structure of the heart.

"Senior sister, I just learned it, so I'll give it a try." Lu Chen smiled.

But Fan Zhiping stood next to Lu Chen, but he "despised" Lu Chen's words in his heart.

Have you just learned?

What a liar!

Fan Zhiping remembered that Lu Chen used this portable ultrasound to diagnose cardiac hypertrophy for others some time ago.

Yin Xinhua only thought that Lu Chen really wanted to give it a try, and nodded in agreement.

Waiting is just waiting, it's better to let Lu Chen practice his skills.

…

Come to the bedside.

Lu Chen placed the ultrasound probe close to the patient's chest wall.

After scanning it twice, it was fixed.

He frowned: "Sister, look, the patient's right ventricle is really dilated, and the pressure is high!"

Yin Xinhua was stunned for a moment, then took a closer look.

The patient's right ventricle seems to have really enlarged!

At this time, the probe is turned to the section of the pulmonary artery.

Lu Chen did not see the pulmonary artery emboli, but what he could see was that the pulmonary artery was thickened!

This ultrasound operation technique is so skillful!

Yin Xinhua looked at Lu Chen in surprise.

Is this kid pretending to be stupid when he works the night shift?

Lu Chen didn't notice Yin Xinhua's expression. He said slowly: "Sister, although no pulmonary embolism was seen, the increase in right heart pressure and pulmonary artery pressure load can indirectly suggest that the patient still has pulmonary embolism. ?”

After hearing Lu Chen's words, Yin Xinhua came back to his senses.

"If ultrasound can really see these signs, then it can indeed confirm the diagnosis of pulmonary embolism."

After saying these words, Yin Xinhua still looked at Lu Chen in disbelief.

This junior brother is too versatile.

Skill operations, electrocardiogram, cardiac ultrasound...all are available!

The only thing he doesn't know is that he hasn't published a paper yet.

…

At this moment, the chief resident of the cardiology department came to the eighth district of the heart.

"Teacher Li Qinghua again?" Lu Chen was quite surprised after seeing the person clearly.

He felt that Li Qinghua had always been the resident in the cardiology department.

You can meet him almost every night shift.

Then doesn't he stay in the hospital every day?

Li Qinghua also noticed Lu Chen.

"Lu Chen, why is it you again?" Li Qinghua looked at Lu Chen in surprise, then smiled.

This student made a very deep impression on him.

You can meet him on the night shift at least three times.

"Teacher Li, this is fate..." Lu Chen chuckled.

Dark face, that doesn’t exist.

Li Qinghua held the cardiac ultrasound machine and said with a smile: "Then our fate is really deep!"

After chatting for a while, Li Qinghua immediately started using the ultrasound machine.

He noticed coupling agent residue in the patient's heart.

"Have you seen it?"

Lu Chen nodded, "I took a quick look."

"What did you see?" Li Qinghua looked up at Lu Chen who was standing aside. He thought it was Yin Xinhua who was trying to do an ultrasound. "What results did you see?"

Lu Chen immediately said: "The right ventricle is enlarged and the pulmonary artery is thickened."

Li Qinghua smiled and did not reply. He concentrated on checking the condition of the patient's heart and pulmonary artery.

Although he is not as good as a professional ultrasound doctor, he can probably handle it.

About five minutes passed.

Li Qinghua said slowly, his eyes never leaving the ultrasound screen, "The right ventricle is obviously enlarged, and the pulmonary artery can also be seen to be thickened, but the pulmonary artery emboli cannot be seen."

Li Qinghua's ultrasound results were basically consistent with Lu Chen's!

"Thrombolysis should be arranged." Li Qinghua raised his head and glanced at Lu Chen. This guy's skills are pretty good!

Thrombolysis for pulmonary embolism is different from thrombolysis for myocardial infarction.

Although both are caused by blood clots blocking blood vessels, thrombolytic drugs for myocardial infarction are much more urgent and need to be completed in 1-2 hours. Otherwise, the myocardial cells will be necrotic, and it may be meaningless to use thrombolytic drugs again.

But pulmonary embolism is different. The lungs have many blood supply channels. If the pulmonary artery is blocked, there are still bronchial arteries supplying blood, which will not cause necrosis so quickly. Therefore, thrombolysis of pulmonary embolism can be considered within 14 days.

But for a patient like this, who is so serious, it cannot be delayed.

If the embolus is not melted away for a moment, it will block the pulmonary artery all the time. The patient will still be extremely hypoxic, which is quite embarrassing.

The reason we can barely maintain it now is because the ventilator has enough power, and accidents can easily happen if there is any slight disturbance.

"Then dissolve it." Yin Xinhua said. "I'll go communicate with the family members and sign."

This communication was extremely important, and Yin Xinhua did not let Lu Chen go.

Because the complications of thrombolysis are very serious, especially cerebral hemorrhage, it would be a big loss if you fail to melt the embolus and develop a cerebral hemorrhage.

"But in order to be more accurate, we should ask the teachers of the cardiac color ultrasound to come over and let them provide guidance and confirm whether there is pulmonary hypertension and whether there is a blood clot, so that we can feel more at ease." Li Qinghua said.

"Okay." Yin Xinhua nodded, "I'll go to the ultrasound room and then communicate with the patient's family."

…

Yin Xinhua left the ward, leaving only Lu Chen, Fan Zhiping and Li Qinghua.

At this time, UU Reading www.uukanshu.net Lu Chen looked at the patient on the bed and asked his doubts.

"Teacher Li, the patient has no high-risk factors for pulmonary embolism, nor does he have tumors. He only has pneumonia. Could it be pulmonary embolism caused by pneumonia?"

Li Qinghua did not answer immediately. He pondered for a moment and then said: "Pneumonia is not a high-risk factor for pulmonary embolism, but this is difficult to say and needs to be carefully considered."

But at this moment, the nurse on the side suddenly said: "Dr. Li, Dr. Lu, look, what's wrong with the patient's arm?"

Her tone was incredulous, obviously she had discovered something unusual.

Lu Chen and Li Qinghua followed the direction she pointed, which was the patient's arm, near the elbow joint.

Lu Chen and Li Qinghua were shocked when they saw it.

Why are these hands so densely covered in rashes?

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