I Can See Health

   Chapter 263 I'm a Beginner

  Since the patient's family did not agree to be transferred to the ICU, Yin Xinhua decided to give the patient a cardiac ultrasound before making the next step.

  If the patient really has a pulmonary embolism, a heart ultrasound can also be found.

  Color Doppler ultrasound can find that the pressure of the right heart of the patient has increased, and it may also be seen that the pressure of the pulmonary artery has increased. If you are lucky or skilled, you can even see the emboli blocked in the pulmonary artery.

   If this is the case, the diagnosis is a certainty.

   However, the emergency echocardiography at night cannot come immediately, and it takes about 20 minutes to wait.

  Like the last night shift, Yin Xinhua called the inpatient department of cardiology and asked the inpatient department to do an ultrasound. After a preliminary diagnosis, he waited for a professional doctor in the department of ultrasonography.

  However, by coincidence, the Cardiology Department was in the second area of ​​the heart to help rescue the patient, so he couldn't come over immediately.

   "Senior sister, do you want me to try this first?"

   When Lu Chen appeared in the ward with a portable echocardiograph, Yin Xinhua was extremely surprised.

   "You know this?"

   Recalling the last night shift, Lu Chen couldn't even read the most basic heart section.

   Today, pulmonary embolism is diagnosed, but it is more difficult to look at the image of the pulmonary artery than to look at the structure of the heart.

   "Senior sister, I just learned, so I'll give it a try." Lu Chen smiled.

   Fan Zhiping stood beside Lu Chen, but in his heart he "despised" Lu Chen's words.

  You just learned?

   cheating ghosts!

  Fan Zhiping remembered that Lu Chen used this portable ultrasound a while ago to diagnose cardiac hypertrophy for others.

  Yin Xinhua nodded in agreement when Lu Chen really wanted to try it.

   Waiting is also waiting, it is better to let Lu Chen practice his hands.

  …

   came to the bedside.

  Lu Chen placed the ultrasound probe close to the patient's chest wall.

   swiped twice and it was frozen.

   He frowned: "Senior sister, look, the patient's right ventricle is really dilated, and the pressure is high!"

  Yin Xinhua was stunned for a while, then took a closer look.

   The patient's right ventricle seems to have really grown!

   At this time, the probe is turned to the section of the pulmonary artery.

  Lu Chen didn't see the emboli in the pulmonary artery, but what he could see was that the pulmonary artery had thickened!

   This ultrasound manipulation technique is so skillful!

  Yin Xinhua looked at Lu Chen in surprise.

   This kid, did you play stupid last night shift?

Lu Chen didn't notice Yin Xinhua's expression, he said slowly: "Senior sister, although I didn't see a pulmonary embolism, but the right heart pressure and pulmonary artery pressure load have increased, can we indirectly think that the patient still has a pulmonary embolism? ?"

   Hearing Lu Chen's words, Yin Xinhua came back to his senses.

   "If the ultrasound can really see these signs, then it can indeed confirm the diagnosis of pulmonary embolism."

   After saying these words, Yin Xinhua still looked at Lu Chen in disbelief.

   This Junior Brother is too almighty.

   Skill operation, electrocardiogram, cardiac ultrasound... all will be done!

   The only thing that doesn't happen is that he hasn't published a paper yet.

  …

   At this moment, the inpatient of the Cardiology Department came to the eight districts in the heart.

   "Mr. Li Qinghua again?" Lu Chen was quite surprised when he saw the person coming.

   He felt that Li Qinghua had always been hospitalized in the Cardiology Department.

   Almost every night shift can meet him.

   Then doesn't he stay in the hospital every day?

   Li Qinghua also noticed Lu Chen.

   "Lu Chen, why is it your kid again?" Li Qinghua looked at Lu Chen in surprise, then smiled.

   This student made a deep impression on him.

   It's three to five, and you can meet it on the night shift.

   "Mr. Li, this is fate..." Lu Chen smiled.

   face black, that does not exist.

  Li Qinghua held the cardiac ultrasound machine and said with a smile, "Then our fate is really not shallow!"

   After chatting for a while, Li Qinghua immediately started using the ultrasound.

   He noticed couplant residue in the patient's heart.

   "Have you seen it?"

  Lu Chen nodded, "I took a look."

   "What did you see?" Li Qinghua looked up at Lu Chen, who was beside him. He thought it was Yin Xinhua who tried to have an ultrasound. "What did you see?"

  Lu Chen immediately said, "The right ventricle is enlarged and the pulmonary artery is enlarged."

  Li Qinghua smiled and didn't answer, and focused on checking the patient's heart and pulmonary arteries.

  Although he is not as good as a doctor who specializes in ultrasound, he can probably handle it.

   About five minutes passed.

  Li Qinghua said slowly, his eyes did not leave the ultrasound screen for a moment, "The right ventricle is obviously enlarged, and the pulmonary artery can also be seen thickening, but the emboli in the pulmonary artery cannot be seen."

   Li Qinghua's ultrasound results are basically consistent with Lu Chen's!

   "Thrombolysis should be arranged." Li Qinghua looked up at Lu Chen, this kid's skills are pretty good!

  Thrombolysis in pulmonary embolism is different from thrombolysis in myocardial infarction.

  Although both of them are thrombus blocking the blood vessel, the thrombolytic drug for myocardial infarction is much more urgent, and it will be completed within 1-2 hours, otherwise the myocardial cells will all be necrotic, and it may be meaningless to have thrombolysis again.

   But pulmonary embolism is different. The lungs have many blood supply channels. The pulmonary artery is blocked and the bronchial artery is still supplying blood, so it will not be necrotic so quickly. Therefore, thrombolysis in pulmonary embolism can be considered within 14 days.

   But the patient in front of me is so serious, it cannot be delayed.

  If the embolus does not melt away for a moment, it blocks the pulmonary artery all the time, and the patient is still extremely hypoxic, which is not enough.

  It is barely maintained now because the ventilator has given full horsepower, and it is easy to have an accident with a little trouble.

   "Then let's dissolve it." Yin Xinhua said. "I'm going to communicate with the family to sign."

   This communication is extremely important, Yin Xinhua did not let Lu Chen go.

  Because the complications of thrombolysis are very serious, especially cerebral hemorrhage, etc., don't melt the embolus by then, but have a cerebral hemorrhage, then you will lose a lot of money.

   "However, in order to be more precise, let the teachers of echocardiography come over and let them guide and confirm whether there is pulmonary hypertension and whether there is a possibility of thrombosis, so we can be relieved." Li Qinghua said.

   "Okay." Yin Xinhua nodded, "I'll go to the ultrasound room, and then communicate with the patient's family."

  …

  Yin Xinhua left the ward, leaving only Lu Chen, Fan Zhiping and Li Qinghua.

   At this time, Lu Chen looked at the patient on the bed and asked his doubts again.

   "Mr. Li, the patient has no high-risk factors for pulmonary embolism, nor does he have a tumor, only this pneumonia. Could it be pulmonary embolism caused by pneumonia?"

  Li Qinghua didn't answer immediately. He pondered for a moment before saying: "Pneumonia is not a high-risk factor for pulmonary embolism, but it's hard to say, it has to be carefully considered."

   At this moment, the nurse on the side suddenly said, "Dr. Li, Dr. Lu, look, what's wrong with the patient's arm?"

   Her tone was incredible, apparently finding something unusual.

  Lu Chen and Li Qinghua followed the direction she pointed, which was the patient's arm, near the elbow joint.

  Lu Chen and Li Qinghua were shocked when they saw it.

   Why is this hand so dense that it is a rash?

   This is the fifth update today.

   (end of this chapter)