NovelTags Chapter 287
Chapter 287
harmonious
Cardiac surgery.
Early in the morning, Professor Yang Hanmei, the director of cardiac surgery, entered the department and heard the doctors around him rapidly discussing the news of last night.
"Dr. Lin is so powerful that he actually came up with a treatment operation for mitral regurgitation!"
"At this time, more than 8 million patients in our country have been saved!"
"Those people abroad have always blocked these advanced technologies, and this time they were broken through by Dr. Lin."
Professor Yang Hanmei wondered.
Mitral regurgitation?
Lin Feng has a new technology? Treat this thing?
He returned to the office, called the students, and asked for details.
When he understood the whole situation, Professor Yang Hanmei was surprised!
"Lin Feng, would actually do this operation?"
......
Interventional Section,
The interventional doctors were equally surprised at this time.
Lin Feng actually broke through mitral valve regurgitation surgery!
Astound!
The heart shouted 666~~~
thereinto
Lin Feng's senior brother Zhu Zhi'an even knelt on the ground, and his heart was so impressed that he fell to the ground!
......
The news spread throughout Harmony Hospital,
Countless medical staff are talking excitedly, shouting 666...
And the dean's side also learned the news from the secretary's mouth, and in addition to being stunned, he thought in his heart:
"Lin Feng is our harmonious talent!"
"We must let Lin Feng build a project team for mitral valve regurgitation surgery in our Harmony Hospital!!"
So, I called Zhang Guofeng, director of the emergency department.
Borrow someone!
Director Zhang Guofeng listened.
Hard!
of the Malgobi,
Lin Feng has just returned to the imperial capital, and he hasn't gone to work yet, so you guys are going to borrow someone?
Pit is not pit, hey!
......
......
At this point,
Lin Feng, returned to the emergency department to work.
Morning
Sitting in the clinic.
Turn on the call machine.
"Please Huang *han, go to the No. 3 consultation room..."
soon
A 58-year-old man, with a face full of pain, was supported by his son and slowly walked into the consultation room step by step.
"Sit down and tell me what's going on..."
After some inquiry,
The summary is as follows:
Huang Wenhan, male, 58 years old, previous history of hypertension for 10 years, up to 180/100mmHg, untreated regularly. 30 years of smoking.
Pain in the precordial area (the area of myocardial infarction mentioned in the previous medical record, meaning: projection of the heart on the body surface) after waking up 3 hours before admission, ranging from about 1 palm size, can radiate to the back and left neck, with chest tightness and breath holding.
After Lin Feng listened,
The first reaction is: "angina", "myocardial infarction"!!
Lin Feng: "Is there any relief from rest?" "
Patient Huang Wenhan's face was painful: "No, it hurts all the time..."
Lin Feng: "Have you taken any medicine?" On the way here? "
Son: "Yes, I went to the pharmacy and asked the clerk to buy nitroglycerin, originally I wanted to buy a quick-acting heart-saving pill, but the clerk said that nitroglycerin works faster and better..."
Lin Feng nodded,
Both drugs are used to treat angina.
Lin Feng: "Is there any effect?" "
Son: "A little, but soon gone..."
Nitroglycerin is the best and most effective targeted drug for the treatment of angina.
If nitroglycerin does not work, then the patient can rule out angina.
Then consider "myocardial infarction" and "aortic dissection".
"Acute aortic dissection" and "acute myocardial infarction" are common causes of acute chest pain in clinical practice.
There are similarities between the two in terms of clinical manifestations, symptoms and signs, pathogenesis, and fatality rate.
However, there is a contradiction in the treatment principles of the two, so in clinical treatment, if the two are misdiagnosed, it will greatly increase the mortality of patients.
Aortic dissection usually needs to be identified by aortic CTA (CT with contrast, angiography). But not every patient with chest pain can do this, especially if the condition is critical, it is necessary to be cautious, often unable to perform aortic CTA examination.
An electrocardiogram, on the other hand, can be misdiagnosed.
To continue checking.
"Take a blood draw and do a coagulation test."
In the coagulation function test, there is an indicator of "D-dimer".
"D-dimer": a special degradation product of cross-linked fibrin in the human body.
It is an important way to check for aortic dissection.
Very high sensitivity.
When aortic dissection occurs, the lining of the artery is torn and damaged, a large number of tissue factors are released into the blood, the coagulation system is activated, and a pseudoluminal thrombus is formed, which triggers the coagulation cascade waterfall reaction, activates the fibrinolytic system, and rapidly increases the level of D-dimer in plasma.
When the critical value of D-dimer level is 500ng/mL, its detection sensitivity is 98%; When the level cut-off is defined as 100 ng/mL, its detection sensitivity is as high as 100%.
......
An hour later,
The patient returns with the results of the examination.
· D-dimer indicator, up 4 times!
At this level, the likelihood of arterial dissection is much higher than that of myocardial infarction.
Subsequently, Lin Feng gave the patient Huang Wenhan an electrocardiogram, and its dynamic evolution was also inconsistent with the dynamic evolution after myocardial infarction, but consistent with aortic dissection.
ultimately
Lin Feng made a diagnosis:
"Your father, it's time for an aortic dissection!"
"Doctor Lin, what next?"
"I will send you to the interventional department for interventional treatment, minimally invasive and painless, 1 hour to get it!"
It's a very simple disease.
interventional guidewire catheter,
Then stuff in a gelatin sponge and plug the mezzanine.
Lin Feng brushed the bill and made a call to the intervention department.
Half an hour later,
The interventional department reported that after aortic CTA examination, it is indeed aortic dissection and is preparing for surgery.
......
The 8th patient...
A patient in a suit in his 40s, supported by a beautiful woman.
Push the door to enter.
The suit patient shouted loudly: "They all said don't come to the hospital, I'm fine, isn't it chest pain?" "
In the voice, there is a kind of domineering and arrogant attitude that rebukes Fang Xuan.
"President Chen, all diseases with chest pain cannot be underestimated, let's talk about it after seeing a doctor..."
Through these short words, Lin Feng probably understood some of the 'intelligence. ’
The man in the suit should be a leader, what a general, and in a high position, he speaks domineeringly. And also very disdainful of the doctor.
And the beautiful woman should be the secretary.
The secretary pulled this Mr. Chen and walked into the consultation room.
"Doctor Lin..."
When the female secretary saw that the doctor was Lin Feng, her eyes immediately lit up, and she secretly shouted in her heart: So handsome!!
"Sit down and talk about the situation... Name, ID card..."
Lin Feng said expressionlessly.
When Mr. Chen heard this, he was not happy: "You don't know me? "
Lin Feng: "??? "
Who are you?
Why should I know about you?
The female secretary hurriedly smiled next to her and said, "Doctor Lin, this President Chen is the vice president of our takeaway group..."
Lin Feng was abrupt.
Takeaway groups, that's a big group, tens of billions of market capitalization. This Mr. Chen is estimated to be accustomed to ordering five drinks and six in the company and subordinate companies, thinking that the hospital is also a place where he can order five drinks and six drinks.
Lin Feng: "Tell me the name, ID card..."
The female secretary hurriedly said again.
Lin Feng found the registration information and then began to consult the doctor.
"What problem?"
"It's a little stuffy, painful, nauseous, uncomfortable here (pointing to the precordial area)..."
“.................."
Lin Feng's brain passed for a while, it seems that today's first aortic dissection patient is also painful here, right?
Is this patient myocardial infarction or aortic dissection?
Lin Feng's face was strange.
Lin Feng: "Was there any illness before?" "
Mr. Chen was impatient: "No, I have always been healthy..."
Lin Feng: "Really?" No medical history? "
Mr. Chen was a little angry: "Hey, I said you doctor, curse me?" "
Lin Feng is neither salty nor light: "I am a doctor, naturally I have to ask clearly..."
Lin Feng wrote on the medical record: Chief complaint, no medical history.
Lin Feng continued to ask: "When you come, what medicine to take?"
The secretary shook his head: "I didn't eat..."
Lin Feng: "Is there any relief halfway?" "
Secretary: "No..."
Well, exclude angina.
Do another ECG...
The electrocardiogram came out, waveform, dynamic evolution, Lin Feng considered "myocardial infarction"...
Lin Feng glanced at this President Chen.
Originally, the general patient Lin Feng tried to check as little as possible, but this President Chen is so arrogant and has money, so let's do a few more examinations.
I, Lin Feng, think about the patient!
thereupon
Lin Feng began to open the bill.
"Let's do a "cardiac marker", "cardiac enzyme spectroscopy", "coronary angiography", "echocardiogram"..."
Three in a row...
Mr. Chen looked at it and was angry!
"I know that your hospital is black, okay, I just have one chest pain, just three checklists, how much does it cost?"
Lin Feng's face was expressionless: "About more than 1,000..."
Mr. Chen said coldly: "It's really dark!" "
The secretary covered his forehead, and he really dared to say anything.
Who is opposite?
Dr. Lin Fenglin, his medical ethics, everyone who knows will thumb up!
The female secretary quickly pulled Mr. Chen: "Mr. Chen, let's go for an inspection, anyway, it's not much money, isn't it?" Buy peace of mind..."
Mr. Chen listened: "That's right, Laozi has money, more than 1,000, cut..."
......
An hour later,
The secretary pulled Mr. Chen back to the consultation room,
With various examination results.
Mr. Chen scolded and cursed: "This broken hospital wasted me for 1 hour, I handled hundreds of thousands of dollars per second, and I lost hundreds of millions in this hour... Next time, don't come to this harmony hospital, go directly to the United Family Hospital, it's expensive there, but don't wait, I have money...! "
The patients and family members behind him looked at him like a neuropathy.
The secretary already felt faceless.
Lin Feng chuckled,
Take a few test results.
Myocardial enzyme profile: myocardial tissue necrosis...
Ultrasound: 2 of the coronary artery branches have blocked blood flow...
Others: Insufficient blood supply to the heart...
Lin Feng took a look,
Didn't run!
Myocardial infarction!
Because a tributary of the coronary artery is blocked, resulting in insufficient blood supply, which in turn causes myocardial ischemia and necrosis...
"Doctor Lin, Mr. Chen..."
"The results of the examination are clear: myocardial infarction ... Need to be admitted to the hospital, have an operation..."
Lin Feng said.
The purpose of admission is not only surgery, but also to detect the rehabilitation or exacerbation of cardiac necrotic myocardium, and continue treatment.
"Huh? Admission? "
As soon as I hear this,
That President Chen had a temper on the spot!
Letting him wait an hour for the results of the examination has worn out all his patience, and now he wants to be admitted to the hospital?
Lin Feng: "In your case, myocardial infarction, there is a piece of thrombus that falls, blocking two of the arterial tributaries, resulting in cardiac ischemia and myocardial necrosis... So, you need to be admitted to the hospital, have surgery, and then continue the treatment for a few more days..."
After hearing this, Mr. Chen not only did not panic, but looked contemptuous and sneered:
"Flicker, continue to flicker... Aren't you doctors just trying to cheat out some money?! "
Female secretary: ".................."
She knew that this President Chen had always been afraid of medical treatment, but she didn't expect it to be so serious.
Dr. Lim wants to scam you out of your money?
Joke!
Your net worth is not as much as Dr. Lin!
The heart is constantly complaining.
At this time, Lin Feng's heart did not fluctuate, and he even wanted to laugh.
This Mr. Chen is really a strange flower!
However, he still followed the doctor's guidelines to explain his condition in detail to the patient Mr. Chen.
"Hospitalization is impossible... Let's go! "
Mr. Chen was very impatient, called the female secretary, got up and left.
That's right
He also had a little chest pain, but anger and pride made him forget about chest pain.
Lin Feng stopped: "Wait, if you really don't want to be hospitalized, please sign a letter saying that you refuse to be admitted to the hospital, if something happens in the future, our hospital does not need to bear any responsibility..."
。