I Can See Health

   Chapter 276 Take a Look

  Gestational hypertension refers to the symptoms of high blood pressure, edema, proteinuria and other symptoms after 20 weeks of pregnancy in women, which are transient and disappear after delivery.

   This is a pregnancy-specific disease and is currently one of the main causes of maternal and perinatal illness and death.

   "Hypertension during pregnancy?" Dr. Xiaolin shook his head quickly, "What Dr. Lu means is that the patient is pregnant? This is impossible...it is absolutely impossible..."

   Dr. Kobayashi's face was full of disbelief.

  Lu Chen frowned and said, "The patient said that he hasn't had a period for two or three months..."

   Before he could finish speaking, he was interrupted by Dr. Liu Lin.

"I know this. I asked her on the day she was admitted to the hospital. The patient had this condition before, and her menstruation was irregular. After she drank the traditional Chinese medicine, her menstruation became regular. Besides, if she is pregnant, can she not know it? "

Director Yin Chao on the side of    was a little silent.

   He recalled the patient's entire medical history, and vaguely felt that Lu Chen's words seemed to make sense.

   The patient has not had a period for two to three months.

   In this situation, the first thing to consider is not menstrual disorders, but whether there is a possibility of pregnancy!

   The most critical point is that in the patient's urine routine, occult blood and urine protein are positive, and the blood pressure has never been lowered!

   This is more in line with the characteristics of gestational hypertension!

  Clinical diagnosis requires bold guessing, questioning, and finally speaking with the test results.

  Lu Chen pondered for a moment, then said slowly: "I don't deny that this may be caused by menstrual disorders, but I still recommend improving some gynecological ultrasounds, and it is best to rule out gestational hypertension."

   In case, the patient really has gestational hypertension, then she can't use many drugs.

   involves this multidisciplinary disease, which is often complex.

  Because once the wrong drug is used, or an overdose causes problems with the fetus, that's bad.

   Dr. Xiaolin also turned his head to look at Li Yao beside him.

  Li Yao said softly, "Dr. Lu's opinion is my opinion. I suggest improving gynecological ultrasound."

Dr. Xiao Lin wanted to say something, but Yin Chao waved his hand and interrupted: "Xiao Lin, it is absolutely necessary for this patient to improve the gynecological ultrasound. Just listen to Dr. Lu's advice and arrange a gynecological ultrasound for her immediately. If there is any problem , and then ask for a gynecological consultation."

   Seeing that the director had said so, Dr. Kobayashi could only nod his head.

   He immediately left the doctor's office and went to communicate with the patient's family about the condition.

  The only thing I can be thankful for now is that the patient and family members have a milder attitude and have no idea of ​​having children.

   The little girl beside her bed was adopted by her.

   "Professor Li, this case, we are still negligent."

  After Dr. Xiaolin left, Yin Chao said to Li Yao, "The patient himself said that he had irregular menstruation, he had taken traditional Chinese medicine, and he had no birth history. We didn't think about gestational hypertension at all."

   Common secondary hypertension, mainly coarctation of the aorta, renal artery stenosis, epinephrine tumors, etc., few people think about hypertension during pregnancy.

  Clinically, a doctor's judgment is easily affected by various factors.

  For example, many patients with breathing difficulties said that they had emphysema before when they came to the hospital. They treated the lungs for a long time, and they did not improve at all, but they were finally found to be heart failure!

   Therefore, how to correctly extract useful information from the medical history is very important.

  …

   The first patient is a small episode.

   However, after some analysis by Lu Chen, the case that has not been diagnosed for three days already has a clue.

  The doctors in the Cardiology Department of Feng M County began to pay attention to this young doctor.

  At the beginning, everyone thought that Lu Chen was just here to make up the numbers.

   After all, no one pays attention to a fresh graduate student.

   But now, even Yin Chao has some admiration.

   Sure enough, Professor Li Yao is not aimless!

  This master student of hers really has two brushes.

   As for Li Yao, she thought Lu Chen would have some stage fright.

   But so far, she is quite satisfied with Lu Chen's performance.

  …

  Li Yao came to the Department of Cardiology on this trip to prepare for teaching ward rounds.

   However, the patient in the teaching rounds is not this hypertensive patient, but someone else.

   "Professor Li, shall we start teaching ward rounds?"

   It was getting late, Yin Chao asked Li Yao.

   "Okay." Li Yao nodded.

  Teaching ward rounds, as the name suggests, are carried out by the superior physician with all doctors to conduct ward rounds on patients.

   Generally speaking, the form of this kind of teaching ward rounds is very standardized, and the patients in the ward rounds are also difficult cases.

   "Professor Li, this is the medical record of this teaching round."

  Wang Zhihe, another attending physician in the Cardiology Department, has prepared all the medical records.

  Li Yao took the medical record with a smile, she read it carefully, and then handed it to Lu Chen.

  Lu Chen also took the medical record curiously.

   He also encountered this form of teaching rounds once, and he looked quite curious.

   This is a 41-year-old male patient.

   was admitted to hospital mainly due to "sudden cardiac arrest".

   No family history of sudden cardiac death, no smoking or drinking history.

   The patient's wife found that the patient was unresponsive in bed at night. After calling the emergency number, the doctor gave electrical defibrillation and cardiopulmonary resuscitation.

   After about 33 minutes of cardiopulmonary resuscitation, the patient returned to spontaneous circulation.

Wang Zhi explained: "Professor Li, this patient is living in our 25th bed, and his condition is basically stable, but we have not yet found out the cause of his cardiac arrest. We mobilized the patient to go to a higher-level hospital for examination, but at home Because of economic conditions, he refused to be transferred to a higher-level hospital."

  Li Yao nodded: "Go see the patient first."

   The group followed Li Yao to bed number 25.

  Li Yao conducted a comprehensive medical history inquiry and physical examination of the patient.

   "Is the patient's myocardial enzymes and ions normal after admission?" Li Yao asked.

   "Normal." Wang Zhidao, "In addition, echocardiography showed no abnormality in the size of the atrium and ventricular cavity, LVEF was 65%, the valve motor function was normal, and there was no ventricular wall movement disorder. There was no obvious abnormality in the chest CTA."

  Lu Chen frowned.

   The health value on the patient's head is 68, indicating that he is out of danger.

   However, the results of cardiac ultrasound, laboratory tests, and CT are all normal, which can basically rule out the common causes of cardiac arrest such as myocardial infarction and cardiomyopathy.

   Immediately afterwards, Li Yao asked a few more questions.

   For example, the common causes of cardiac arrest, the possible diagnosis of the patient and the treatment measures are currently considered.

  The doctors in the Cardiology Department of Feng M County answered one by one, but obviously they did not meet Li Yao's wishes.

   Back to the doctor's office.

   "What about the electrocardiogram done after admission?" Li Yao said.

   "Here it is." Wang Zhi took out all the ECGs the patient had done before and after, a total of five copies.

  Li Yao raised her brows, "You have done so many electrocardiograms, but you haven't figured out any problems?"

   "This..." Wang Zhi paused. Then he scratched his head embarrassedly, "No."

   Corey's only deputy director, Fan Zhiping, who can read ECGs well, has already gone to study.

  Li Yao sighed slightly in her heart, and she handed the electrocardiogram to Lu Chen.

  Lu Chen took the five electrocardiograms.

   After careful comparison, he found something abnormal, "There should be broken QRS waves and early repolarized J waves."

  Yin Chao looked at Lu Chen with a surprised expression.

   Good guy, just take a look and see the problem?

   In the following real case from a county-level hospital, the patient finally had an abortion and his blood pressure returned to normal.

   (end of this chapter)