I Can See Health

   Chapter 633 No Electric Shock

   The second area of ​​the heart.

  In the ward.

   "Doctor Lu, you...are you sure you are using amiodarone?" the nurse asked.

  Lu Chen frowned, the nurse in this magic capital is too long-winded!

   A question that has been asked many times!

   "I'm sure!" Lu Chen said solemnly.

   "Oh, that's good." The nurse pouted and put amiodarone in the infusion pump, ready to infuse the patient.

   The nurse has the responsibility to help the doctor check the correctness of the doctor's order, but if Lu Chen insisted, she would not continue to ask.

   At this time, Yu Bin and Yan Shuming walked quickly into the ward together.

   "Lu Chen, what's the condition of the patient?" Yu Bin opened his mouth and asked.

   The nurse who was dispensing the medicine immediately stopped what she was doing when she saw this situation.

  Lu Chen explained: "Senior brother, the patient has a heart attack. This is her electrocardiogram. I am going to use amiodarone for cardioversion."

  Yu Bin was slightly startled, but instead of uttering a sound, he stretched out his hand to take the electrocardiogram.

   "Isn't this VT? Why amiodarone? Is there any special purpose?"

   Yu Bin's words were very subtle and did not directly refute Lu Chen.

  Beyond his words, why not use electrical cardioversion?

  The first measure of ventricular tachycardia is electrical cardioversion.

   aside, the corners of Nurse Yan Shuming's mouth twitched.

   She would like to see how this new young doctor handles this matter.

   "This Lu Chen didn't listen to my advice. Fortunately, Yu Bin was found here. If the doctor's order is wrong, wouldn't the patient be harmed?"

   In clinical practice, many nurses are even more experienced than young doctors.

  Yan Shuming secretly thought that he would have to give advice to the director in the future. These new doctors have too poor clinical experience, so they still have to study in the department for a period of time before they can become independent.

  Otherwise, the risk is too high!

  Lu Chen's expression didn't change. He glanced at Yu Bin and said slowly, "Because... this is not room speed!"

The voice of    just fell.

   The entire ward, whether it was the doctor or the nurse, stared wide-eyed and looked at Lu Chen in disbelief.

   Yu Bin was a little unhappy in his heart.

   How could he believe what Lu Chen said!

   He looked down at the electrocardiogram in his hand, wide QRS complex tachycardia, this is ventricular tachycardia!

   And the patient has done it many times in the past, and every time the diagnosis is ventricular tachycardia, he uses electrical cardioversion.

   Lu Chen's three students also opened their mouths wide.

   Especially the female graduate student Ji Yingying, she had always emphasized to Lu Chen that this patient had supraventricular tachycardia.

   At this time, Lu Chen smiled and said slowly: "Senior Brother Yu, I ask you a question, why hasn't the blood pressure dropped in patients with such frequent VT?"

   Blood pressure, this is also one of the "suspicious points" that Lu Chen noticed!

   Normally, malignant arrhythmias such as ventricular tachycardia and ventricular fibrillation will basically cause a drop in blood pressure.

  Yu Bin was also stunned. In his subconscious, the patient was a patient with ventricular tachycardia and needed electrical cardioversion. He didn't pay attention to the blood pressure issue at all.

   "The patient's blood pressure is very low?"

   "Yes." Lu Chenwei nodded.

   He turned over the patient's past medical records.

   The patient's echocardiography and coronary angiography showed no structural heart disease.

   There is no long QT, Brugada syndrome and other manifestations on the electrocardiogram.

   The ECG of the patient at the time of the attack does not match the ECG characteristics of the left posterior or left anterior branch VT (ventricular tachycardia).

   The most important thing is that the patient's HP is 72 (-)!

   If it is really a ventricular tachycardia attack, such a serious arrhythmia, the change in life value must be more than a minus sign.

   The diagnosis of ventricular tachycardia does not seem to be very scientific!

"this…"

   Yu Bin frowned, and he was a little unsure for a while.

  Lu Chen seems to have some truth in what he said!

  If the patient is really suffering from VT, why is the hemodynamics so stable?

  Why is it just a little flustered and uncomfortable, but no other symptoms at all?

   Yu Bin picked up the patient's electrocardiogram and read it carefully again.

   He didn't want to let go of any clues.

   "Is the patient really not having ventricular tachycardia?"

  …

  Lu Chen saw Yu Bin in a daze, and hurriedly urged the nurse: "Hurry up and use amiodarone."

  Yan Shuming glanced at Yu Bin, saw that he had no response, gritted his teeth, and put amiodarone on the patient.

   "Okay, pay attention to the rate of amiodarone pumping and monitor heart rate changes."

  Lu Chen breathed a sigh of relief when he saw that the nurse took the medicine.

   Yu Bin swallowed his saliva, glanced at Lu Chen secretly, and asked in a low voice, "Lu Chen, if the patient is not ventricular tachycardia, what is it?"

  Lu Chen smiled slightly, "Room speed?"

   "Huh?" Yu Bin looked at the electrocardiogram repeatedly, his brows furrowed, and he muttered, "I really didn't see where the SVT was..."

The differential diagnosis of    wide QRS complex tachycardia is a timeless topic in cardiology.

   VT and SVT are often difficult to distinguish.

  VT is a malignant cardiac arrhythmia that often implies a more dangerous condition and requires more aggressive management strategies.

   Supraventricular tachycardia is a relatively good prognosis arrhythmia.

  Especially in some emergency situations, if you can quickly distinguish between ventricular tachycardia and supraventricular tachycardia, you can gain a lot of rescue time for rescue.

  …

   "Lu... Doctor Lu, are you sure you really don't need electric shocks?"

  The man stood at the door of the ward and looked inside.

   He was quite excited after seeing the nurse giving his wife medicine instead of using "electric shock".

   At this time, his attitude towards Lu Chen was no longer the arrogant and domineering he had before.

  Before, every time his wife had a heart attack, she came to the hospital for electric shock cardioversion.

   caused the two of them to have a deep fear of this "electric shock".

   "No electric shock." Lu Chen said slowly, "We temporarily used an anti-arrhythmic drug for the patient, and now it's enough to monitor the heart rate changes at any time."

   "But..." The man frowned, "When will my wife's heart rate drop?"

   "It depends on the specific condition and the sensitivity of the patient to the drug." Lu Chen said, "Some people take half an hour, some people three hours, and some people may need a day or two."

   "Will this medicine... be useless!" The man said with some concern.

  Electric shock is scary, but it is real and effective!

   After each shock, his wife's heart rate returned to normal.

  This drug treatment, if it doesn't work, doesn't that delay the treatment time?

  Lu Chen saw the man's worry at a glance.

   "Uncle, you can rest assured that we will evaluate the patient's condition at any time. No electrical cardioversion is required for the time being, and no electrical cardioversion is required!"

   The man wanted to say something, and the patient on the hospital bed immediately said, "I listened to Dr. Lu. I don't need electric shocks for the time being. I want to try drugs. Even if it takes a day or two, I'm willing to try it!"

  The man seems to underestimate his wife's determination not to use "electric shock".

   Having experienced the torture of "electric shock", the patient suddenly heard that there is no need for electric shock, and the whole person was very excited.

   "Okay, Dr. Lu, we will follow your arrangement." The man said.

  Lu Chen nodded slightly, and after instructing the nurse to pay attention to the patient's heart rate changes, he left the ward.

   (end of this chapter)