I Can See Health

  Chapter 681 Prominent pericardium

   "Sister Jiao, I think your idea is very likely." The young attending doctor said.

  Pericardiocentesis is a risky clinical skill operation.

  If the puncture needle accidentally penetrates a few centimeters more, it is likely to hit the heart and puncture the heart. Even a small rupture will cause pericardial effusion.

   However, Lu Chen shook his head slightly.

   "I don't think this is very likely. Because the echocardiography before the puncture showed a large amount of pericardial effusion, the puncture needle can be drawn without going too deep into the needle."

   A large amount of pericardial effusion, as long as the puncture needle breaks into the pericardium, the fluid can be drained.

   There is no need to go deep into the pericardium at all.

   This kind of operation can be done even by a doctor in a county-level hospital.

   In addition, most of the current pericardiocentesis is done under the guidance of cardiac ultrasound, and you can see whether it touches the heart or not.

   "Lu Chen, what you say is quite reasonable." Jiao Jingqiu nodded slightly, "If the puncture needle touches the heart, the heart rupture caused by it may not be small. Will the patient still be like this?"

   There was a lot of discussion.

   There is still no conclusion about the etiology of pericardial effusion in patients.

   "Lu Chen, what do you think?"

   Jiao Jingqiu asked when she saw that Lu Chen had not made any comments.

  Lu Chen didn't come to Modu Hospital for a long time, but his clinical thinking was particularly meticulous, which is widely recognized.

   However, Lu Chen said helplessly: "Everyone has actually talked about the cause of pericardial effusion, and I really can't say anything else."

  There are only so many causes of effusion, and everyone can say one.

   basically sums it all up.

   "Alas." Seeing this, Jiao Jingqiu sighed slightly.

   Gathered everyone's opinions, but in the end I couldn't discuss the reason.

  This is very melancholy!

   What should I do if the pericardial effusion swells up again after the patient's drainage tube is removed?

   At this time, Lu Chen thought about it, and then said softly, "Senior Sister Jiao, this patient has not had a cardiac ultrasound after being admitted to the hospital. Well, let me go and have a cardiac ultrasound for the patient."

   "You know how to do an ultrasound?" Jiao Jingqiu was stunned.

   In fact, she originally wanted to review the patient's heart ultrasound.

   However, the patient is currently inconvenient to move, and it is certainly inconvenient to go to the ultrasound room, so he can only do bedside cardiac ultrasound.

   "It will be a million points." Lu Chen nodded slightly.

   His current cardiac ultrasound technology has reached an advanced level.

   "Okay, let's try it out."

   Corey always has a small ultrasound machine, but not many people use it.

   After all, ultrasound requires systematic learning and training.

  …

  Lu Chen quickly got a portable ultrasound machine.

   The group followed Lu Chen to the hospital bed.

   "Actually, ultrasound is very simple, and practice makes perfect." Lu Chen sat on the right side of the patient with the ultrasound instrument, and explained to everyone, "Practice on the patient a few times, and you will be able to do it."

   Echocardiography is a non-invasive test.

   is different from invasive procedures such as coronary intervention and electrophysiology. It is simple and harmless, and it is easy to accumulate a lot of experience.

   "It's easy to say, but difficult to do!" Jiao Jingqiu shook her head. She had tried to learn cardiac ultrasound, but because it was too difficult, she had no time to practice, so she gave up.

  Lu Chen took the cardiac ultrasound probe, smeared the couplant, and placed it on the surface of the heart skin.

   "This is a short-axis view of the heart, here is the left ventricular outflow tract, the aortic arch..."

  Lu Chen also explained to everyone while examining the patients.

   There are not many such opportunities.

  General ultrasound doctors do not have the leisure time to explain ultrasound to everyone.

   "The fluid dark area here is pericardial effusion."

   "Easy to distinguish, fluid from normal heart tissue."

  Lu Chen placed the probe at the apex of the patient's heart again.

   "This is a slice of the apical four-chambered heart..."

   Everyone heard Lu Chen's voice, and when they looked back, they saw him staring at the ultrasound machine screen.

   "Lu Chen, what's wrong?" Jiao Jingqiu said quickly.

   "Senior sister, look here." Lu Chen pointed to the screen, "This is the apex of the patient's heart."

   Jiao Jingqiu blushed pretty, "Even if you point it out to me, I can't understand it..."

   "Senior sister, you don't need to understand."

"what?"

   "That's not what I meant." Lu Chen hurriedly said, "I mean that there is obviously a protrusion here. Even if you can't read the specific picture, you can still see the strong echo streak of the protrusion."

   "Oh, there seems to be a strong echo shadow." Jiao Jingqiu came over and took a closer look, "What is this? Normal people don't have this?"

   "Definitely not!" Lu Chen said sternly, "I think it is most likely the pericardium."

   "Pericardium?" Jiao Jingqiu was startled.

   "Yes!" Lu Chen had already paused the picture of the cardiac ultrasound and circulated it to everyone.

   "Protruding pericardium... Could this be..."

  Suddenly, Jiao Jingqiu was stunned and looked at Lu Chen beside him in amazement, "Pericardium...heart rupture?"

  Lu Chen also nodded slightly, "Yes, it should be a complication after myocardial infarction - rupture of the free wall."

  Heart rupture is divided into free wall rupture and ventricular septal perforation, but the mortality rate of free wall rupture is close to 100%.

   Lu Chen was the first time he saw a person who survived a ruptured heart.

   "The patient has a rupture in the apex of the heart, which is considered to be caused by myocardial infarction, and the rupture is gradually sealed by the local visceral pericardium."

  Lu Chen couldn't help but sigh. Fortunately, with the help of the pericardium, he saved his life.

   This man has such a big life!

   aside, Jiao Jingqiu swallowed, and his right eyelid twitched.

   She immediately said to the graduate student behind her: "Xiao Zhang, please call for emergency consultation from the Department of Thoracic Surgery, Ultrasound, and CCU!"

"receive!"

  The graduate student ran out in a flash.

   Everyone in the ward, all of them could not help breaking out in a cold sweat.

   Heart rupture with a mortality rate close to 100% is actually in this ward!

   "Patients should stay in bed absolutely, avoid emotional agitation, and can't get out of bed for bowel movements!" Jiao Jingqiu instructed, "If the bowel movements can't be resolved, we will open the medicine!"

  …

five minutes.

   Doctors from thoracic surgery, CCU, and ultrasonography all came.

   The director of the ultrasound department came with a regular cardiac ultrasound machine.

   Portable ultrasound instruments are too small and many are not fully functional.

  Jiao Jingqiu asked the ultrasound department to perform bedside ultrasound for further diagnosis.

"That's right, the apex of the heart is the protruding pericardium!" The director of the ultrasound department had the same diagnosis as Lu Chen. "After myocardial infarction, the myocardium is damaged and the myocardium is weakened, which may lead to rupture of the free wall or perforation of the interventricular septum. !"

   Diagnosed with heart rupture with a mortality rate of nearly 100%!

  Why do you say the death rate is 100%?

   Once ruptured and bleeding, it will cause cardiac tamponade in a very short time, restricting the beating of the heart.

   Surgery is usually too late!

   However, in this case, the patient is not suitable for hospitalization in the general ward, and was transferred to the Cardiology Intensive Care Unit as soon as possible.

  …

   in the doctor's office.

   Jiao Jingqiu looked at Lu Chen next to him, feeling like the rest of his life.

   Fortunately, Lu Chen did an ultrasound and found the protruding pericardium in time.

   In case, the pericardium is ruptured and the heart ruptures and hemorrhages.

   That man, that is beyond the reach of gods!

   But that's the case, I got a little life back.

  The prognosis of this patient will also be poor, and the risk of severe heart failure and heart rupture is still high.

   "Congratulations, received +5 thanks from Jiao Jingqiu!"

   "Congratulations, received from..."

   The system popped up a few more prompts, brushed a wave of thanks, and the system upgrade completion rate also increased.

   Ask for a monthly pass

   (end of this chapter)