I Can See Health

   Chapter 262 Pulmonary Embolism? (Fourth more cold Xiaohe Wan reward plus more)

   At this moment, the patient's eyes suddenly widened and he passed out.

   Everyone present was very nervous.

  If you don’t put the endotracheal tube into the patient’s trachea and connect the ventilator within a minute, the patient may soon stop the heart due to lack of oxygen.

   However, Lu Chen did not disappoint everyone. With a few clicks, he put the tracheal intubation tube into the patient's trachea.

   The two nurses immediately came over to connect the ventilator.

  Lu Chen also quickly adjusted the parameters of the ventilator.

  Puchi puchi, the ventilator began to pump up the patient.

   "Give pure oxygen first." Lu Chen said after wiping the sweat off his face.

   Before he knew it, his back was soaked through.

   "What about the patient's family?"

   Yin Xinhua asked the nurse on duty beside him in a deep voice.

   "I've already contacted my family and I'm on my way," said a nurse on duty.

   "Report to the medical department immediately." Yin Xinhua said sternly, "At the same time, ask the ICU and respiratory department for consultation."

   "Okay, I'll call."

   Fan Zhiping nodded and immediately walked towards the nurse station.

   On the line of life and death, it is very easy to have disputes without family accompany.

   Such patients are extremely special, and the medical department must be notified to let them assist in this matter.

  …

   on a ventilator.

   The patient is still in a coma, and his breathing is still very fast, but it is slightly better than before.

  Oxygen saturation went from the lowest 70% to 92%. No matter how you adjust the parameters, the blood oxygen saturation will not rise.

   "The blood oxygen saturation is not going up, there must be a problem!" Yin Xinhua said solemnly.

   The blood oxygen saturation of normal people is 100%, and the blood oxygen saturation of very severe pneumonia patients will definitely drop.

   But if you are connected to a ventilator and give pure oxygen, you can get better quickly, like this patient has been maintained at 92% oxygen saturation...

  Lu Chen thought of a possibility, that is pulmonary embolism!

   He re-examined the patient with an electrocardiogram.

   This time the electrocardiogram had an unexpected harvest.

The    ECG showed a relatively typical high pressure load on the right heart, deepening in lead I, Q/q waves in lead III, and inversion of the T wave.

   Professional respiratory and cardiologists will know that this may be a pulmonary embolism as soon as they see this electrocardiogram.

  When the pulmonary artery is blocked by an embolus, the pressure of the entire pulmonary artery will increase, which will cause the right heart pressure to increase transitively, and the electrocardiogram will show it.

Yin Xinhua gave a wry smile and said: "Junior brother, this should be a pulmonary embolism, we won the first prize. But now I definitely dare not launch a pulmonary artery CTA to confirm the diagnosis, we can only wait, let's take the respiratory department and ICU doctors first. Let’s talk about it later, let’s discuss it. We are responsible for stabilizing the vital signs first.”

   The most important thing is that the family members of the patients have not come yet.

   Any subsequent operations require the consent of the patient's family.

   Less than five minutes.

  The respiratory doctor is here.

  Re-analyzed the patient's medical history, but the patient was in a coma, and it is difficult to ask about the situation now.

After seeing the patient, the consulting doctor in the respiratory department returned to the doctor's office and said to Yin Xinhua: "Judging from the patient's speed of onset, manifestations and electrocardiogram, it is indeed consistent with the manifestations of pulmonary embolism, short-term shortness of breath, hypoxia, and respiratory failure, and no pneumothorax was found. , Atelectasis, if possible, do a pulmonary artery CTA to see at a glance, it is really not good, you can also see some manifestations by doing a cardiac ultrasound or electrocardiogram, especially the cardiac ultrasound."

   The consulting doctor of the respiratory department also agreed with Lu Chen and Yin Xinhua.

   However, Lu Chen frowned, "Senior sister, I have a question."

  Yin Xinhua glanced at Lu Chen, "You said."

   "If the patient is considered to have pulmonary embolism, but he does not have any high-risk factors for pulmonary embolism!"

  According to the patient's previous medical history, he has no history of lower extremity surgical injury, no long-term bed rest, and no congenital factors, such as protein S/protein C deficiency or anticardiolipin syndrome, etc.

  How can I get pulmonary embolism all the time?

   This question surprised Yin Xinhua and the respiratory doctor.

   Seems to be the case!

   If you just pass the symptoms, it does look a lot like a pulmonary embolism.

   But there are very few cases of pulmonary embolism without risk factors!

   "There may be other unknown factors." The respiratory doctor frowned, "Anyway, pulmonary embolism should be considered first."

  The reason is put aside for now, and the cure is the main thing.

  Lu Chen nodded, now the first problem is to solve the patient's cause.

  The ICU doctor came soon.

   After seeing the patient's condition, he basically agreed with Yin Xinhua and the respiratory doctor's judgment.

   But it is impossible for the patient to do CT in this situation, unless he pushes the ventilator to follow, but the patient's vital signs are still fluctuating.

   "May have thrombolysis!"

   The results of everyone's discussion were consistent, but further examinations of color Doppler ultrasound or CT were required to confirm the use of thrombolytic drugs.

  If I make a mistake, I'm afraid I won't be able to eat and walk around.

   Although the thrombolytic drug can dissolve the thrombus, it may cause cerebral hemorrhage in minutes, which is troublesome.

"Why don't you go to the ICU first to see what's going on? Then we'll use our own heart ultrasound to see if we can see signs of pulmonary embolism. If it's a pulmonary embolism, we'll consider thrombolysis. If you find anything else, you will analyze it later. Save your life first and then talk about it.”

  The ICU doctor told Yin Xinhua.

   What patients need most right now is a ventilator, but if the patient really has a large area of ​​pulmonary embolism, the ventilator is not too useful. The reason is very simple.

  The working principle of the ventilator is to put oxygen into the patient's lungs, and force it.

   But if the patient's pulmonary artery is blocked by an embolus and there is no blood flow, there is no way to carry out effective blood oxygen exchange!

  Oxygen alone will not work. Without blood flow, it will not be able to bring oxygen into it, and it will not be able to expel carbon dioxide. The patient will still die due to hypoxia and carbon dioxide retention.

  Yin Xinhua nodded and agreed with the ICU doctor, "If a pulmonary embolism is diagnosed, the timing is right, and then thrombolysis can dissolve the embolus and restore pulmonary artery patency. There should still be a chance, after all, the patient is so young."

  …

   About half an hour later.

  The family is finally here!

   The medical department also came forward to communicate and explained.

   However, the patient’s family refused to be transferred to the ICU.

   The family members are the patient's sister. The patient is not married yet, and she rents an apartment in Jinghua. Her sister works here, and her income is not expected to be high. The ICU is simply bad news for them.

   But the existence of ICU has indeed turned the bad news of many people into good luck, which is also what many people expect from it.

   The patient was quickly assigned to a separate room, and various monitoring equipment was installed.

  The blood pressure is low, with active drugs, the blood pressure can barely be maintained at 90/60mmHg.

   (end of this chapter)