I Can See Health

   Chapter 744 Lu Chen who can't rest

  Lu Chen walked back to the single talent apartment, which took about 20 minutes.

   He is now the deputy chief physician and does not need to stay in the department all the time.

   The timing of commuting to and from get off work is also relatively free.

   If this was the time he was studying for his Ph.D., and it took twenty minutes to get home at noon, then he didn’t need to go back at all.

   After coming and going, it may take less than ten minutes to rest before I have to come to the hospital again.

   Now Lu Chen can go back to the apartment boldly, and even enjoy the scenery on the way.

   Back to the community, it was peaceful, most people didn't come back, they all took a lunch break in the unit.

   The apartment that Lu Chen returned to alone seemed very leisurely.

   The opposite and upstairs are quiet, and they should not come back

  Lu Chen made a cup of tea, found the latest papers and literature, and began to read.

   Maintaining a certain amount of reading every day is a habit that Lu Chen has cultivated over time.

   And, whether it is a cardiologist or not, he will take a look.

   Until he was tired, he lay back in the bedroom, prepared to take a lunch break for half an hour, and then went to work.

  Lu Chen smiled slightly, is he living the life of a retired director ahead of schedule?

  …

afternoon.

  Lu Chen stepped on the spot and came to the second district in his heart.

   This surprised Jin Miao, because the senior doctors from the other groups didn't come at this time.

   The superior doctors in other groups will not be so punctual. They may stay in the department for a while and then leave.

  Lu Chen was the one who came earlier.

   Back in the lounge and put on his white coat, he sat firmly in front of the computer and continued to familiarize himself with the hospital's medical records and doctor's order system.

   He will be out of the outpatient clinic tomorrow, so Lu Chen has to get acquainted as soon as possible.

  Jin Miao didn't pay much attention to the early morning here, so he had a lot to do!

   Not only have to admit new patients, but also adjust the treatment plan of old patients, which is not an ordinary job.

   However, Jin Miao has a lot of students, including regular trainees, graduate students, and interns. With these free labor, he can also handle it.

   In addition, Jin Miao also ordered a cardiac MRI examination for the patient with elevated "cardiac enzymes".

   Waiting for the results to report, we can determine whether the patient has myocarditis.

  Lu Chen can also guide Jin Miao occasionally, earning a small amount of thanks.

   However, in the system mall now, the gratitude value required to exchange skill cards is often tens of thousands or hundreds of thousands.

   The gratitude value obtained from the students is already negligible.

   On the other hand, Lu Chen is now the deputy chief physician. When most medical students encounter problems they do not understand, the first thing they consider is to ask the attending physicians.

   Therefore, apart from Jin Miao occasionally asking Lu Chen to discuss a few questions, there were very few students who came to ask Lu Chen questions.

   This channel for getting thank you points has been blocked!

   This made Lu Chen quite melancholy!

  …

   However, Lu Chen couldn't rest after all.

   At three o'clock in the afternoon, Lu Chen was familiar with the medical record system, and when he was about to rest, Jin Miao walked into the doctor's office.

   He came to Lu Chen: "Director Lu, a patient who came this morning has a heart attack!"

   He held an electrocardiogram in his hand and handed it to Lu Chen.

  Lu Chen looked down.

   This electrocardiogram is also really problematic.

   ST-segment elevation in the anterior septal leads, suggesting myocardial infarction.

   For ordinary patients, Jin Miao would not take the initiative to find Lu Chen.

   Unless the illness is serious or complicated, he will take the initiative to find a superior doctor.

   And the patient in front of him belongs to the category of serious illness.

   Even if he can treat the patient, he still has to fulfill his duty to inform.

   "What are the symptoms of the patient?" Lu Chen asked.

   "Mainly chest tightness, no obvious chest pain." Jin Miao thought about it and briefly described the patient's condition.

   The patient is a 60-year-old aunt. She has had chest tightness for 4 days. She feels uncomfortable when she walks. Just sit down and rest for a few minutes.

   The children at home are busy, so I didn’t take it seriously at first, but I didn’t expect it to become more and more powerful.

   Now when I lie down, I feel bored and suffocated, cough and don’t like to eat.

  She was willing to let her husband and wife bring her to the hospital to have a look.

   "The patient said that he used to have gastritis, bile reflux, and old cold legs. He usually takes some painkillers, but he has never had a heart attack."

  Lu Chen nodded slightly, "What about other risk factors for coronary heart disease?"

  Jin Miao replied eloquently: "Apart from age, high blood pressure, diabetes, dyslipidemia, obesity, smoking, drinking, family history, etc. are not related to her. The heart examination is generally normal, and there is a small amount of rales on auscultation of the lungs."

  Lu Chen read the patient's examination and test results while listening to the story.

   Blood routine: white blood cells 11.13×109/L, neutrophil percentage 86.5%, neutrophil absolute value 9.63×109/L, hemoglobin 131g/L.

  Myocardial injury marker: Troponin T (cTNT) 42.2ng/L (0-14ng/L).

  Brain Natriuretic Peptide (BNP): 12723pg/mL (<100pg/mL).

There were no obvious abnormalities in the three items of   biochemistry, coagulation function and thyroid function.

  Jin Miao continued: "The increase in troponin T was not as high as expected, but the increase in BNP was particularly significant."

After thinking for a while, Lu Chen said: "Severe heart failure can also cause a slight increase in troponin, which may be ischemic cardiomyopathy. First, basic treatment of coronary heart disease is performed to improve heart function, and then cardiac ultrasound is arranged. Elective coronary angiography."

  Even considering acute myocardial infarction, the patient missed the best time for surgery-within 12 hours of onset, the patient's heart is now extremely fragile, like a lump of bean curd.

   If you do coronary intervention now, it is easy to puncture the heart.

   Therefore, we can only wait for the patient's heart function to recover, make the heart stronger, and then perform coronary intervention.

  Jin Miao agreed with Lu Chen, "I will communicate with the patient's family."

  …

   Just when Lu Chen felt that everything was in order, the patient's condition suddenly took a turn for the worse.

  The patient suddenly developed nausea and vomiting at around 4:00 p.m. The vomit was coffee ground-like, and the vomit occult blood test was positive.

  Lu Chen immediately ordered Jin Miao to review the blood routine.

   The patient's hemoglobin decreased from 125g/L to 100g/L.

   Could it be upper gastrointestinal bleeding?

   "This is a big trouble!" Jin Miao walked in front of Lu Chen.

  Lu Chen frowned deeply.

   To avoid rats, it is necessary not only to fast and rehydrate, but also to take into account the heart function, and to stop antiplatelet drugs.

   Coronary heart disease is a thrombus, which is contradictory to the treatment of gastrointestinal bleeding!

   Coronary angiography has also become a distant prospect!

  Lu Chen recalled that he had seen cases of gastrointestinal bleeding after taking aspirin before, but most of them were based on gastrointestinal tumors and gastrointestinal ulcers.

   "He used to have gastritis, bile reflux, and old cold legs..."

  In Lu Chen's mind, he suddenly remembered what Jin Miao said when he just explained his medical history.

   The foundation of the digestive system is indeed not good, and then there is "old cold legs", which is another "folk diagnosis".

   However, the smallest details cannot be missed.

  Lu Chen looked at Jin Miao, "I'll go see the patient with you."

   (end of this chapter)