This Doctor is Great

Chapter 41 The printer is broken again...

28 beds,

The consultation took about 20 minutes...

Zhou Mo asked very detailed questions and wrote down a lot of things on paper.

Huang Yiming next to him was sweating from his forehead because he realized that he couldn't keep up with Zhou Mo's thoughts. There are many things that he didn't consider, but must consider.

"How do you feel, Zhou Mo has opened up a big gap for me?"

"Ke's education is higher than his..."

Huang Yiming was a little skeptical about life.

If at the beginning, I was inexperienced, and Zhou Mo opened up the gap until I was fine, why now that I am on the right track, I still can't see the taillights of the car because of Zhou Mo's rejection?

at this time,

Zhou Mo put away the splint and said to the patient:

"I'm basically done with the questioning. Next, I need to give you a physical examination..."

"Okay, okay, please Dr. Zhou..."

The patient Zhang Yan was not impatient, but felt that the doctor was very responsible.

It made him very happy.

Zhou Mo took out the 3M stethoscope given by Huang Yiming.

After using it last time, he fell in love with this damn high-end sound deeply, and he couldn't stand the more than 600 stethoscopes he bought.

Of course, this thing is a loan, and after Zhou Mo hooks up with a rich woman, he will pay back the money to Huang Yiming.

Put on the distinguished 3M stethoscope,

Start auscultation.

first,

Listen to the overall heart sound.

heart sound.

Let me talk about the concept of heart sound first.

"Heart sound": refers to the sound produced by the mechanical wave phenomenon caused by myocardial contraction, heart valve closing and blood hitting the wall of the ventricle and the wall of the aorta.

In one cardiac cycle, four heart sounds can be produced.

That is, the first heart sound (S1), the second heart sound (s2), the third heart sound (s3), and the fourth heart sound (s4).

Under normal circumstances, the first and second heart sounds can be heard normally, the third heart sound (S3 is usually only heard in children and adolescents), and the fourth heart sound (seldom heard under normal conditions).

Zhou Mo put the stethoscope over.

listen,

One heartbeat...another heartbeat...another heartbeat...

very clear:

: The first and second heart sounds are normal,

: Zhou Mo heard the obvious fourth heart sound, and it was the fourth heart sound produced by the strong contraction of the hypertrophic left atrium.

It is clear,

This heart sound is problematic.

This fourth heart sound confirms "aortic stenosis", because "aortic stenosis" will cause the left atrium to be overloaded for a long time, causing the myocardium of the left atrium to grow and become hypertrophic involuntarily.

The elements are assembled.

Next step,

Zhou Mo placed it between 1 and 2 intercostals on the right edge of the sternum.

This is where the characteristic heart sound of aortic stenosis is most prominent.

Listen to this!

Immediately, Zhou Mo heard a rough and loud jet noise, and it was very loud. According to Zhou Mo's evaluation, it was at least level 3/6 and above, and it was in an increasing-decreasing pattern, and it was transmitted to the neck...

This is a typical heart sound of aortic stenosis.

And judging from Zhou Mo's experience, there should be calcification.

A calcified aortic valve is different from a non-calcified aortic valve in terms of softness and hardness, and the sound will be different.

This point has been written on P308 of "Internal Medicine".

Zhou Mo looked at Huang Yiming: "A question for you..."

Huang Yiming was startled: "Test me?"

Immediately, there was a nervous feeling of being selected by the teacher for the exam.

But soon realized: I'm so nervous, Zhou Mo is not my teacher, I'm afraid of a ghost!

Huang Yiming relaxed: "Ask..."

Zhou Mo smiled: "Are you familiar with the textbook?"

Huang Yiming: "It's okay!"

Heads up!

I'm a top student!

What are textbooks?

Moreover, in the past two weeks, he dug up the textbook again, and brushed everything about cardiology.

Questions related to teaching materials, self-confidence will not trouble him!

Zhou Mo smiled: "I can tell that the patient in front of me is calcified aortic stenosis..."

"In "Internal Medicine" P308 heart sounds of aortic stenosis: If the valve leaflets are in normal motion, the aortic valve jet sound can be heard at the right and left borders of the sternum and the apex area. If the valve leaflet is calcified and stiff, the jet sound will disappear. Mentioned in heart murmurs: rough and loud jet murmurs, most clearly auscultated in the 1-2 intercostal spaces at the right border of the sternum. The louder the murmurs and the longer the duration, the more severe the stenosis."

Zhou Mo summed up the relevant content of "Internal Medicine" p308 at once.

Huang Yiming nodded: "I remember that's what the book said..."

Zhou Mo smiled: "Then here comes the problem, since the more severe the stenosis, the louder the murmur. Then the stenosis should become heavier when the leaflets are calcified and stiff. Why do you say that the jet sound will disappear? Why does it feel like a contradiction? ?”

Huang Yiming thought for a while and replied, "Is it possible that the description in the book is wrong, or not accurate enough?"

Zhou Mo: "Tell me..."

Huang Yiming pondered for a while and said: "Because the murmur is caused by turbulent flow, not valve closure, calcification only makes the valve activity less or stiff and the closing range is small, causing the heart sound to weaken. Calcification aggravates stenosis, increases turbulence formation, and enhances the murmur. ..."

Zhou Mo nodded: "Not bad, not bad!"

Involuntarily patted Huang Yiming on the shoulder.

praise!

Huang Yiming was immediately flattered.

There was a burst of excitement in my heart!

I am praised!

Wow, is this how it feels to be praised?

I want to do it again~~

etc!

Huang Yiming looked at Zhou Mo and blinked.

No, I was not praised by the teacher.

It's just that Zhou Mo praised me, I'm so excited!

囧rn—3...

...

It took 3 minutes to give the patient Zhang Yan a complete physical examination.

Zhou Mo picked up the pen and wrote it down on the paper.

Huang Yiming followed suit and auscultated patients with a stethoscope.

Zhou Mo wrote and drew on the paper. According to the current diagnosis, the patient Zhang Yan's disease is undoubtedly "calcified aortic stenosis"!

Next, do a more detailed inspection.

Electrocardiogram: There will be severe left ventricular hypertrophy with strain and left atrial enlargement.

X-ray: lateral fluoroscopy, aortic valve calcification;

Color Doppler ultrasound: the opening of the aortic valve is greater than 18mm, the valve area is greater than 1.8 cm2, and the transvalvular pressure is greater than 20mmHg...

In particular, color Doppler ultrasound is an important method to clearly diagnose and determine the degree of aortic valve stenosis. It is very sensitive to detect abnormalities of the aortic valve and helps to display the number, size, thickening, calcification, size and shape of the valve leaflets, The structure of the valve, such as the size of the valve ring, helps to determine the etiology of the stenosis, and the measurement of the maximum blood flow velocity through the aortic valve by continuous Doppler can calculate the mean transmembrane pressure gradient, peak transmembrane pressure gradient and valve area . In addition, various information such as cardiac chamber size, left ventricular hypertrophy and function can be provided.

"Okay, the basic examination is over, I will prescribe some examinations for you later, electrocardiogram, X-ray, cardiac color Doppler ultrasound... and blood tests such as blood routine and myocardial enzyme spectrum..."

Zhou Mo said a series of inspections.

The patient Zhang Yan was a little confused, because he didn't understand, he could only nod his head.

"Okay, thank you doctor."

"Both cardiac ultrasound and X-ray need an appointment. The X-ray should be done sooner. I can do it tomorrow. The cardiac ultrasound depends on the schedule. I will try my best to arrange it..."

"Okay, thank you doctor..."

After ordering some more things, Zhou Mo finished his ward rounds.

I checked the time, it has been 40 minutes.

Go back and write a doctor's order, let the nurse come over to draw blood, do an electrocardiogram...

In addition, medical records, admission reports, etc. have to be written...

By the way, the opening report of the thesis also needs to be written...

"Why are there so many things?"

Zhou Mo scratched his head in distress.

His hair was messed up a bit, but he was still handsome and handsome.

And Huang Yiming next to him had a happy face.

learned!

Following Zhou Mo's rounds, I learned a lot.