I Can See Health

   Chapter 287 Lu Chen's Rapid Progress

   In the third round of the competition in the province, Cheng Guowen, the chairman of the Jinghua Electrophysiology Society, attaches great importance to this.

   A total of two people from Jinghua Second Academy entered the third round.

   One is Lu Chen, and the other is Lei Cui, the attending doctor in the first ward of the Cardiology Department of the Second Jinghua Hospital.

   Cheng Guowen provided two free classrooms in the teaching building for the two of them as exam venues.

   At two thirty in the afternoon, Lu Chen came to room 303 of the teaching building.

  Lei Cui sat in room 304 next to Lu Chen for the exam.

  …

  The classrooms in the teaching building are very empty, and there is a computer in the middle of the venue.

  Two cameras were placed around the classroom in accordance with the requirements of the exam rules.

   At this point, there is still half an hour before the exam starts.

  Lu Chen sat in front of the computer, recalling all the knowledge of electrocardiogram and electrophysiology in his mind.

   After studying all day yesterday and this morning, he relied on the super-high comprehension ability given by the ECG advanced skill card to integrate the deeper electrophysiological knowledge.

   Especially the real questions over the years in the email that Cheng Guowen sent him, including the test scope, format, difficulty, etc., Lu Chen conducted a careful analysis.

   Originally, Lu Chen couldn't understand many real exam questions.

   For example, in terms of electrophysiological pacing, Lu Chen can only know a little.

   He has never done electrophysiological surgery, and just watched one with Li Yao, and it is difficult to understand the electrophysiological principle.

   However, with the ECG Advanced Skill Card, Lu Chen's comprehension became stronger.

   For some deeper electrophysiological knowledge, he can understand very thoroughly.

  …

  The conference room on the 3rd floor of the teaching building of Jinghua Second Hospital.

   Cheng Guowen and Li Yao, as well as some electrophysiology members of the Cardiology Department, were all together.

   There is a huge screen before the meeting, through which everyone can monitor the progress and ranking of the exam in real time.

   "Director Shi, Lei Cui should be sure to be in the top three, right?" Cheng Guowen looked at Shi Qinghua beside him.

  Shi Qinghua is the deputy director of the first district in the heart, and knows Lei Cui's learning state best.

  Shi Qinghua smiled and nodded, "Lei Cui's main focus has long been electrophysiology. Her master's and doctoral studies are very thorough in this area. It should be no problem for her to enter the national competition."

"That's good." Cheng Guowen said, "If we can enter the national competition this time, we will be able to take the initiative in the general election. If we can enter the top ten in the country, then this chairman has a 99% chance. , will still stay in our Jinghua Second Hospital."

   Although Li Yao is the deputy chairman, she has been silent.

  Lu Chen was his student and also entered the third round of the exam, but few people paid attention.

   Everyone seems to have decided that Lu Chen can't be in the top three.

   Cheng Guowen glanced at Li Yao, wanted to say something, and swallowed it back.

  …

   At three o'clock in the afternoon, the exam officially begins!

  Lu Chen entered the exam platform.

   In the third round of the test, there are a total of 20 questions and answers, each of which is worth five points. The test time is two hours. After each question is completed, a professional staff will immediately interpret it.

   Twenty questions, giving two hours of test time.

   From this, you can also see the difficulty of this competition!

  Lu Chen opened the first question.

  A 92-year-old male patient, 20 years after single-chamber pacemaker implantation (VVI), underwent pacemaker (VVI) replacement 8 years ago, and suffered from repeated dizziness, which was obvious when changing position, and improved after rest. The dynamic ECG segment is as follows. The patient's dynamic ECG performance may be caused by the following reasons?

   Sure enough, the difficulty of the third round was more than one grade higher than that of the first two rounds!

   Moreover, the content of this exam is not the diagnosis of ECG, but the reason for the occurrence of this dynamic ECG!

   This is not only a test of diagnosis, but also a deep-seated principle.

   Fortunately, Lu Chen had seen the real exam questions over the years before, otherwise he would have been really confused.

  …

   Conference room in the teaching building.

   "The exam questions this time are more difficult than the previous two years. A lot of cutting-edge electrophysiology knowledge, if there is no training in this area, it is actually difficult to answer."

   Cheng Guowen said solemnly.

   "Yeah, if you haven't undergone electrophysiological surgery or done a pacemaker implant yourself, it's difficult to analyze this kind of problem." Shi Qinghua nodded, "Just by imagination, the difficulty is increased several times."

  Li Yao frowned.

   The meaning of what everyone said is very clear.

   As a senior doctor in charge, Lei Cui has done a lot of electrophysiological operations, but Lu Chen is different. A student who doesn't even have a medical license, can he ask such a question?

   The answer is obviously impossible!

  …

  Room 303.

  Lu Chen began to analyze the clips of the Holter.

   This electrocardiogram is characterized by variable pacing intervals with an unstable baseline.

   But the shortest pacing interval is 1000ms (60 beats/min), which is in line with the default lower limit pacing frequency setting of the pacemaker under normal circumstances, considering that the lower limit of the pacemaker frequency is 60 beats/min.

   "The electrocardiogram showed chaotic EMG signals in the long pacing interval, with no pacing pulses."

   After analyzing for about eight minutes, Lu Chen had the answer in his heart.

   "First of all, it should be considered that the pacemaker inhibits the ventricular pulse emission after sensing the EMG signal. The EMG interference signal causes the pacing rhythm to reset, resulting in a long ventricular interval of up to 2813ms."

  Lu Chen wrote down the answer, and after clicking Confirm, he entered the next question.

  …

   Conference room in the teaching building.

   "Well, Dr. Lei Cui answered the question very quickly, and the first question was completed, and the analysis was correct. This dynamic electrocardiogram was caused by the misperception of the pacemaker." Cheng Guowen was very satisfied with Lei Cui's performance.

   At present, Lei Cui's answering speed and accuracy rate are among the best among all ten doctors.

  Shi Qinghua smiled and could not close his mouth.

  If Lei Cui can maintain this state of doing the questions, then there is absolutely no problem in getting the top three!

   Except for Li Yao, few people noticed Lu Chen's answering status.

  Lei Cui's first question took five minutes, and Lu Chen's first question took eight minutes.

  Li Yao was surprised to find that although Lu Chen took a lot more time than Lei Cui, the content of his answer was very detailed.

   Is this really a student new to electrophysiology?

  Li Yao looked a little dazed because she knew Lu Chen's level too well.

   When Lu Chen first arrived in the eight areas of his heart, he was at most a student with a solid basic knowledge, and he knew nothing about electrophysiology.

   But now, Lu Chen's knowledge reserve is even more than the average attending doctor!

   It all happened in these three months…

  …

  Lu Chen didn't know what was going on outside the court. He was now concentrating on reading the second question.

   Question 2, female, 84 years old.

   Abdominal discomfort with nausea and vomiting for 4 days, electrocardiogram showed: sinus rhythm, third-degree atrioventricular block, junctional escape rhythm, acute inferior wall myocardial infarction.

   Emergency coronary angiography showed complete occlusion of the proximal segment of the right coronary. A stent was implanted in the right coronary, and a temporary pacemaker was implanted (parameter setting: voltage: 5.0V, sensing sensitivity: 3.0mV).

  The ECG monitoring 3 days after the operation is as follows, what is the diagnosis of the ECG monitor?

  Lu Chen frowned slightly, this was another topic of pacing electrophysiology.

  Fortunately, he was already familiar with the scope of the exam in advance. During this time, he had done intensive training in pacing electrophysiology, and now he can deal with these questions calmly.

  Lu Chen clicked on the big picture of the electrocardiogram.

   "The fifth heartbeat on the monitoring chart was sinus capture, and ventricular pacing pulses were seen after the escape interval."

   "The ventricular pseudo fusion wave and different degrees of true fusion wave can be seen on the monitoring map and conventional ECG, and the pulse signal is located at different positions of the QRS."

   For the second question, Lu Chen spent seven minutes.

   This time, Lei Cui took six minutes.

  …

   After ten questions.

In the conference room, besides Li Yao, finally someone noticed Lu Chen's performance.

   "Look at Lu Chen, his answering speed is not slow?"

   Cheng Guowen looked at the live exam on the screen in surprise.

  Shi Qinghua nodded: "It's quite fast, I just don't know how he answered the previous questions..."

  Although the real-time ranking will appear on the screen, everyone answers the questions at a different speed and there is a certain lag.

  The current real-time results only count the results of the first six questions.

   (end of this chapter)