I Can See Health

   Chapter 680 Acupuncture into the pericardium? (seek wave double monthly pass)

   One hospital in the magic capital, one area in the heart.

  The doctors in the department are already sitting together.

   "Senior Sister Jiao, what kind of patient? Do we need so many people to discuss?"

  Lu Chen stepped forward quickly.

   "The patient who was admitted yesterday, take a look."

   Jiao Jingqiu handed the medical record forward, Lu Chen took it, and sat down to check it.

  The attitude of everyone in the department towards Lu Chen has obviously improved a lot.

   Originally, everyone was a little unhappy about the application for the fund project last time.

   But because there are some pre-determined candidates, Lu Chen was able to break through the blockade of the pre-determined personnel, which made everyone admire him.

   In addition, Lu Chen can understand the feelings of the attending doctors. Seeing a doctor and treating a patient cannot determine the future and destiny.

   However, this fund project has affected everyone's promotion.

  Lu Chen and the young attending doctors reconciled.

  …

   At this time, Jiao Jingqiu introduced:

   "One week before admission, the patient experienced sudden symptoms of chest pain, accompanied by profuse sweating, chest pain, and inability to lie down. The symptoms persisted and did not relieve, and he went to the local hospital for treatment."

   "Acute extensive anterior myocardial infarction and heart failure were considered, and conservative medical treatment was given. The echocardiography showed a large amount of pericardial effusion."

   "Pericardiocentesis and drainage were given, and the daily drainage volume exceeded 500 mL, which was **** pericardial effusion. Afterwards, the patient's symptoms improved, but the pericardial effusion continued to flow out, so he went to our hospital for treatment."

  Lu Chen quickly read through the medical records and had a simple understanding of the patient.

  Simple sentence summary.

   means that there is a large amount of pericardial effusion after myocardial infarction, 500ml of pericardial effusion is continuously drained every day, and there is still continuous pericardial effusion.

   The local hospital cannot handle it.

  The patient was transferred from the hospital below to the First Hospital of Magic City.

   "We are wondering why the patient's pericardial effusion keeps increasing?" Jiao Jingqiu said while frowning.

  Lu Chen didn't reply immediately, he pondered for a moment, then said, "Go and see the patient first."

   "Okay." Jiao Jingqiu nodded slightly.

   Other doctors who wanted to check the patient's condition also followed Jiao Jingqiu and Lu Chen to the bedside.

  …

   Beside the hospital bed.

   The patient is a forty-year-old male. Lie on the bed in a semi-recumbent position.

   There was also a middle-aged woman sitting beside the hospital bed, who seemed to be his wife.

   At this point, the health value on the patient's head is only 38(——).

   Jiao Jingqiu said to the family members of the patient beside him: "The doctors in our department will come to see the patient together."

   "Okay, thank you doctors."

   The middle-aged woman had a grateful look on her face, and hurriedly stood aside, giving up her seat beside the bed.

  Lu Chen took the stethoscope and walked to the bedside.

  No nonsense, let’s go straight to the physical examination.

   The patient is in a semi-recumbent position, with a clear and clear voice.

Blood pressure 100/60 mmHg, a drainage tube can be seen in the 5th intercostal space of the midclavicular line, thick breath sounds in both lungs, a few moist rales can be heard at the base of both lungs, low and dull heart sounds, regular heart rate, heart rate 80 beats/min, no murmurs are heard , Abdominal soft, no tenderness, no edema in both lower extremities.

   "What's uncomfortable right now?"

   "It hurts here...and stuffy." The patient pointed to his chest weakly, "I can't breathe out when I lie down, I feel like I'm suffocating to death."

  Lu Chen nodded.

   The patient currently has a significant sign of pericardial effusion.

   Review the patient's current exam.

  ECG: sinus rhythm, rS pattern in leads V1-V6, T wave inversion, heart rate 80 beats/min.

Echocardiography: Left ventricular ejection fraction (LVEF) 38%, segmental motion abnormalities of the left ventricular wall (thinning of the left ventricular anterior wall and apex myocardium, decreased motion, bulging of the apex, paradoxical movements seen in class), Pericardial effusion (massive) with echogenic drains visible in the pericardium.

   After seeing the patient, Lu Chen was about to leave the ward.

  Unexpectedly, the patient's wife followed behind everyone.

   "Is something wrong?" Jiao Jingqiu asked suspiciously.

   "Doctor Jiao, can I listen to you discussing the condition?" The patient's wife gritted her teeth, looking anxious.

   "No!" Jiao Jingqiu shook her head resolutely, "It is impossible for family members to participate in the discussion, but we will tell you the results of the discussion."

   "This... that's fine." The patient's wife pursed her lips. "Doctor Jiao, you must save my lover. He is the backbone of the family. Without him, I really don't know what to do."

   As he spoke, the patient's wife's eyes were already red.

   "We will try our best." Jiao Jingqiu said indifferently, "But the patient is in critical condition and there is a risk of sudden death at any time."

   "I, I know." The patient's wife lowered her head.

  Lu Chen could already hear her faint sobbing.

   Everyone just comforted a little, didn't have much time to pay attention, and then left silently.

   This kind of thing, everyone has seen too much.

  Many doctors are already numb when they see this scene.

  …

   Back to the doctor's office.

   Everyone temporarily formed a team to discuss the condition.

  Jiao Jingqiu was the first to say: "After admission, the patient was considered to have persistent **** pericardial effusion and mild anemia, so single antiplatelet therapy was temporarily given."

   "After admission, all immune items, tumor markers and tuberculosis antibodies were all negative, and pericardial effusion due to other causes was not considered for the time being."

   "So we finally focused on the heart itself. Given that the patient's blood pressure is not high, fluids should be added every day as appropriate, and the drainage tube will be clamped after the daily drainage volume is about 500mL."

   "The most needed question at present is what is the cause of the patient's pericardial effusion? Tumor? Tuberculosis? Rheumatism? Inflammatory stimulation after myocardial infarction? Or something else."

  Jiao Jingqiu's questions came up one after another.

  Lu Chen frowned slightly.

   In his opinion, this patient may not be so simple, and there are still many doubts.

   At this time, an older doctor in Corey said: "Blood pericardial effusion is more common in tumors and infections, and infections are more common in tuberculosis patients in developing countries."

   "There was no obvious tuberculosis on the chest CT of the patient outside the hospital, the tuberculosis-related test was negative, and the patient had no relevant medical history, so the probability of directly suffering from tuberculous pericarditis was relatively small."

  Jiao Jingqiu nodded slightly, "Troubleshooting tuberculosis and rheumatic diseases temporarily."

   "What I want to ask is, does he have a history of pericardial effusion before this myocardial infarction?" the veteran attending doctor said again.

   At this time, Jiao Jingqiu continued to say: "The patient should have no pericardial effusion before. If there was pericardial effusion before, it will not be the only symptom of heart failure this time, and the patient has no previous symptoms of wheezing."

   "Well, that makes sense." The attending doctor nodded.

   This possibility has also been ruled out.

   "Sister Jiao, what about the pericardial effusion caused by inflammatory stimulation after myocardial infarction? Is this possible?"

   Corey, a very young attending physician, came up with his own idea.

   "It's unlikely." Jiao Jingqiu immediately rejected it, "Pericarditis and pericardial effusion are post-myocardial infarction syndromes, but most of them are small amounts of fluid leakage, the color should be mainly pale yellow, and a large amount of **** pericardial effusion is extremely rare."

  The discussion was at an impasse for a while.

  Pericardial effusion is caused by various reasons?

   At this time, Jiao Jingqiu frowned and said, "Actually, I've been thinking about a possibility. Could it be that the puncture needle pierced the ventricle during pericardiocentesis?"

   As soon as the voice fell, everyone was shocked and agreed.

   During the double monthly pass period, ask for a monthly pass.

   Starting tomorrow, a five-day holiday.

   I am the donkey of the production team, and I will die if I vote.

   (end of this chapter)