NovelTags Chapter 721
Chapter 721
Come out of the operating room.
Lin Feng asked people to push patients into the ICU.
During the operation, the patient bleed about 300ml, and the blood oxygen saturation after coming out was only 92%, which looked okay.
However, for the safety of patients, it is better to send them to the ICU for comprehensive monitoring and insurance.
After arranging the patient, Lin Feng went to the patient's family and briefly described some of the situations that occurred during the operation.
Knowing that there were some minor accidents in their hands, the patient's family was still a little unacceptable.
It is not to blame Lin Feng, but to feel that the patient's life is suffering.
Lin Feng then continued to explain: "We can't know whether the patient has pulmonary embolism, but the probability will be, or it may be other problems, so for the safety of the patient, the patient will be sent to the ICU for further monitoring and treatment after the operation." "
Hearing that the patient was going to enter the ICU, the patient's family members were actually worried, especially the patient's husband, and almost collapsed on the chair.
In their cognition, the patients who enter the ICU are nine deaths.
Hearing Lin Feng's explanation, they themselves would not block the matter of sending patients to the ICU.
As soon as the patient entered the ICU, a full set of monitoring was immediately undertaken.
Arterial qi and blood were checked, and in the case of being on a ventilator, the partial pressure of oxygen was only 60mmHg, which was obviously abnormal.
With such a high oxygen concentration, the patient's partial pressure of oxygen must be at least 200mmHg or more to be normal.
However, this also shows that the patient does have undetected problems.
As for whether it is pulmonary embolism, if you want to find out, you need to send a chest CTA, but the patient's current condition is obviously not suitable for heavy transportation.
Immediately, Lin Feng decided to give the patient another cardiac ultrasound.
You can do it directly in the ICU.
If it is really pulmonary embolism, some signs can also be found on the color ultrasound.
For example, you see an embolism in the pulmonary artery, or you measure an increase in pulmonary artery pressure.
Soon.
The heart color ultrasound was done well, and sure enough, the problem was found.
It does not matter that the patient's biatria are enlarged, as is the case before surgery, due to long-term atrial fibrillation.
The point is that something about 3cm can be seen in the patient's right atrium!
What is it?
It is not seen in the preoperative color ultrasound, and it is likely to be a blood clots.
Next, looking at the pulmonary artery, there was no obvious thrombus inside, but the pulmonary artery pressure was measured to be surprisingly high, and the systolic blood pressure reached 50mmHg, and the normal value should be less than 25, which has more than doubled.
Normal blood flow is: venous blood→ right atrium→right ventricle→ pulmonary artery→ capillaries (alveoli), →pulmonary veins→ left atrium→left ventricle→ systemic arteries→ capillary network→venous blood....
Cycle.
However, now a foreign body is seen in the right atrium, which may be a blood closis.
Increased pressure in the pulmonary artery indicates that a blood clot may form behind the pulmonary artery and blood flow is not smooth, so the pressure will be so high.
Now the patient can clearly diagnose pulmonary embolism.
Pulmonary embolism!
A nightmare for all.
After hearing Lin Feng's diagnosis of pulmonary embolism, the patient's family almost lost their minds.
Lin Feng immediately comforted: "Although pulmonary embolism is dangerous, not all pulmonary embolism will be fatal. Like the patient's situation, although the lack of oxygen but the blood pressure is still stable, not necessarily fatal, you can treat the situation first! "
"Doctor, please! Please save her! The patient's husband almost knelt in front of Lin Feng, a man in his sixties, his eyes were red, and tears came out.
In the face of death, few people are really strong, and even if they are strong, they are strong.
Lin Feng understood the patient's husband's mood very well, and immediately said: "Don't worry, we will definitely do our best to treat it!" "
Of course, in order to avoid troubles in the later stage.
Lin Feng still has to communicate with the patient's family about all the risks that will occur during treatment.
People may die, but not necessarily and need to be observed while treating.
After communicating with the families.
Lin Feng returned to the office and began to think about the patient's treatment plan.
Thrombolysis!
This is the most conventional means of treatment, and it is effective.
But with great risk.
If the solution is just right, the patient is rescued.
If thrombolysis is slightly overdone and the dose is too large, it will cause bleeding, and if it is a cerebral hemorrhage, it is over.
Moreover, the patient is also in the advanced age range, and the treatment plan needs to be cautious.
Especially for patients who have just finished surgery, just after surgery, the wound has not completely healed, if thrombolysis at this time, it may cause the wound to continue bleeding until the blood runs out and the blood is lost and dies.
However, although the patient was diagnosed with pulmonary embolism, it was not the most severe, because the blood pressure was still standing.
There is no such landslide and cracking state, and thrombolysis is necessary to save life.
Come to think of it.
Lin Feng believes that gentle treatment is still needed, and it is safer to choose anticoagulant therapy.
First make sure that the patient does not form a new thrombus, do not let the thrombus continue to expand, and let the patient's body dissolve the thrombus by itself.
After making a decision.
Lin Feng no longer hesitated.
Start thinking about the next question, where did the patient's blood clots come from.
Two possibilities.
One is the deep vein of the lower extremity, and the other is the broken end of the bone.
First of all, the deep veins of the lower extremities can be ruled out with a high probability, because the preoperative ultrasound did not see thrombosis, of course, it does not mean that there is none.
Most likely, the bone is broken, the bone is broken, the surrounding tissues are all messy, and the blood vessels are exposed, which is very easy to form blood clots.
Lin Feng immediately thought of the vena cava filter.
All the blood in the lower body of the human body will flow through the inferior vena cava and into the right ventricle of the right atrium, in other words, whether it is a deep vein thrombosis in the lower extremities or a thrombus at the broken end of the femoral neck, it belongs to the upstream.
Va cava filters are placed downstream of them, like umbrella-like filters, if there is a large thrombus shed, the filter can net it halfway, prevent it from entering the heart and pulmonary arteries, and will not aggravate pulmonary embolism.
It's a brilliant treatment option.
While anticoagulating, the filter of the inferior vena cava is placed, double insurance.
Choosing anticoagulation is not only for pulmonary embolism, but also for atrial fibrillation.
Patients have a history of atrial fibrillation, and if they are not anticoagulated, atrial emboli may form and lead to cerebral embolism.
But the patient is doing well.
Cardiac ultrasound did not find a thrombus in the left atrium, and the risk of cerebral embolism was relatively low.
Later, Lin Feng told the patient's family about his treatment plan.
At this moment, the patient's family has no more to think about.
Completely agree with Lin Feng's arrangement.
Lin Feng began to arrange, and needed to wait for the patient's condition to stabilize a little.
After evaluation, the chest CTA is refined to determine whether it is pulmonary embolism and whether it is blocked by the main pulmonary artery or by branches.
After figuring it out, send it directly to the interventional department and prepare to place the inferior vena cava filter.
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