I Can See Health

   Chapter 442 Trap (Second)

  Lu Chen took the electrocardiogram.

  There are five electrocardiograms, which were completed before and after the patient's onset.

   At this moment, Sun Guoguo's voice came from his ear.

   "Junior Brother, this is the patient who came yesterday."

   "Young female, 22 years old, was admitted to hospital with repeated palpitations for 1 month, which worsened for 2 days."

   "She gave birth to a boy 1 month ago and denied family history of hereditary disease."

  …

   The patient's medical history is simple, with only a few simple sentences.

  Lu Chen stared at this electrocardiogram intently.

   "At present, the patient has recurrent ventricular tachycardia and ventricular fibrillation, and he has been given amiodarone, lidocaine, and electrical cardioversion and other rescue treatments, but his condition has not improved significantly."

   said, Sun Guoguo sighed and said, "She just gave birth, I don't know if she can survive, it's too pitiful."

  Lu Chen sighed slightly in his heart, but didn't say anything, and continued to study the electrocardiogram in front of him.

   The electrocardiogram of the patient before the onset was normal sinus rhythm with occasional a few premature ventricular contractions.

   But the electrocardiogram at the time of onset is all ventricular fibrillation or ventricular tachycardia.

   "Senior sister, what did you think about this electrocardiogram?" Lu Chen put down the electrocardiogram and looked up at Sun Guoguo.

"Well, the electrolyte of the patient's admission showed a low potassium level of 3.02umol/L, and it may be caused by ventricular tachycardia and ventricular fibrillation caused by low potassium." Sun Guoguo said, "But the strange thing is that we actively supplemented potassium, and after the potassium ion returned to normal, , the patient's symptoms did not improve significantly, and ventricular fibrillation and ventricular tachycardia still occurred frequently."

  VF is an extremely malignant arrhythmia, and sustained attacks are likely to lead to human hemodynamics and even sudden death.

   "Senior sister, what medicine did you use?" Lu Chen paused.

   "Amiodarone, lidocaine, these antiarrhythmic drugs have been used." Sun Guoguo said, "Besides, electrical defibrillation has been used many times."

  Amiodarone, an extremely common broad-spectrum antiarrhythmic drug in cardiology.

   In other words, more than 95% of clinical arrhythmias, whether ventricular or atrial arrhythmias, can be treated with amiodarone.

   The drug has a wide range of indications and the effect is not bad, so amiodarone is a panacea drug clinically.

   So that in the medical examination questions, there is the option of amiodarone, which can basically be selected, and the correct rate is also very high.

   However, Lu Chen pondered for a moment, frowned and said, "Senior sister, your medicine may be wrong!"

   "Ah?" Sun Guoguo was slightly startled, "What medicine is wrong?"

   "Amiodarone!" Lu Chen's words surprised Sun Guoguo for a moment.

  Amiodarone is wrong?

  Patients with ventricular fibrillation and ventricular tachycardia, is it wrong to use amiodarone?

  Sun Guoguo picked up the electrocardiogram and carefully compared the front and back, but still found nothing abnormal.

   At this time, Lu Chen's voice came again: "Senior sister, look at this electrocardiogram, is the patient's QT interval abnormal?"

   "QT interval..." Sun Guoguo recited a sentence, and shifted his gaze to the QT interval of the electrocardiogram, "This QT interval seems to be a bit long?"

   Seeing this, Sun Guoguo was suddenly stunned.

   Could it be caused by prolongation of the QT interval and ventricular tachycardia?

   is TDP (torsade de pointes)!

  Lu Chen saw Sun Guoguo's expression and knew that she had thought of this.

   "Sister, this electrocardiogram, I think it is probably TDP caused by a long QT interval!"

   There are many types of VT.

   Most ventricular tachycardia and ventricular fibrillation can be treated with amiodarone.

   And only the ventricular tachycardia caused by the long QT interval is a contraindication to the use of amiodarone!

   Amiodarone cannot be used in this case.

  Amiodarone can further prolong the QT interval and aggravate the patient's condition.

  Thinking of this, a cold sweat broke out on Sun Guoguo's forehead.

   She didn't think about this first, but after Lu Chen mentioned it, she figured it out immediately.

   They all defaulted to conventional ventricular tachycardia and ventricular fibrillation, but ignored the situation of long QT interval causing ventricular tachycardia!

   I used the medicine for a day, but it was the wrong one!

   not only has no therapeutic effect, but may worsen the condition.

   "Xiaofang, go and ask the nurse to stop the amiodarone pumped in the 31 beds! Then use the magnesium sulfate!" Sun Guoguo quickly said to the intern beside him, "Forget it, I'll go in person!"

  TDP requires not only potassium supplementation, but also a polarized solution of magnesium sulfate to combat arrhythmia!

After   , Sun Guoguo left the office in a hurry.

  Lu Chen put down the electrocardiogram in his hand and followed closely.

  …

   in the ward.

  Sun Guoguo is instructing the nurses in the ward to stop amiodarone and use magnesium sulfate while supplementing potassium.

   "Doctor, why did you stop this drug?" the patient's husband asked nervously.

   "Because of my illness, I'll explain to you later." Sun Guoguo said.

   At the same time, Lu Chen also came to the ward.

   In his eyes, the health value on the patient's head is 38 (---)!

   has been continuously treated with drugs, but the trend of changes in the patient's health is still three minus signs.

   This means that the currently used drugs may not have any effect.

After the nurse changed the medicine for the patient, the patient's husband left the ward with Sun Guoguo.

  …

   in the corridor of the ward.

  Sun Guoguo patiently explained the condition to the patient's husband.

   "Doctor, are you saying that my wife's arrhythmia is relatively rare?" the man said.

  Sun Guoguo nodded and said, "Well, amiodarone can be used for routine ventricular tachycardia and ventricular fibrillation, but your wife's arrhythmia is relatively rare, so amiodarone cannot be used, and the risk of sudden death is extremely high!"

   As soon as he finished speaking, the patient's husband "thumped" and knelt down.

His eyes were already red, and he tightly pulled on the cuffs of Sun Guoguo's white coat, his hoarse voice had a hint of crying: "Doctor, please, save my wife! I will repay you as a cow and a horse. "

  Sun Guoguo hurried forward and grabbed the patient, "Don't do this, we will do our best!"

  Lu Chen also turned his face away, feeling a little uncomfortable in his heart.

  Rao is because he was used to seeing life and death in the hospital, but seeing this scene made him feel a little uncomfortable.

"It's my fault!" The patient's husband was still unable to kneel, holding his hair tightly with one hand, "It's my fault! She is usually not in good health, and I have to let her have children, yes I'm not good!"

  The man's emotions seemed to explode like a flood, and a feeling of regret and grief spread in his heart.

  Sun Guoguo was at a loss for a while.

Seeing this, Lu Chen stepped forward, grabbed the man's arms, forcibly pulled him up, and said sternly: "Now is not the time for you to be sad! You need to be by the patient's side 24 hours a day, if there is any illness Changes, you must inform the medical staff at any time."

  Although nurses will often make rounds, it is impossible to accompany them at the bedside 24 hours a day.

  The man silently wiped away a tear, and finally stopped kneeling.

   He nodded fiercely, looked at Lu Chen and Sun Guoguo, "Thank you doctor!"

   Then with heavy steps, he turned and walked towards the ward.

  …

   Back to the doctor's office.

  Sun Guoguo breathed a sigh of relief and looked at Lu Chen with grateful eyes, "Junior Brother, thank you."

   At the same time, her eyes were a little sad.

  Lu Chen said: "Senior sister, don't think too much. This patient is young, I think there should be hope."

   "I hope." Sun Guoguo said softly.

   The QT interval of this electrocardiogram is prolonged, which is very hidden.

   Many doctors in the department have seen it, but no one has found it.

  According to conventional treatment methods, there is nothing wrong.

   But no one could have imagined that behind the ventricular tachycardia, there was a bigger trap hidden.

   (end of this chapter)