This Doctor is Great

Chapter 41: The printer is broken again...

28 beds,

The consultation took about 20 minutes...

Zhou Mo asked very detailed questions and wrote down a lot of things on the paper.

Next to Huang Yiming, sweat dripped from his forehead, because he found that he could not follow Zhou Mo's train of thought. There are many things that he has not considered, but must consider.

"How do you feel, I have been opened a big gap by Zhou Mo?"

"Ke's education is higher than his..."

Huang Yiming is a little suspicious of life.

If at the beginning, I was inexperienced, and I was widened by Zhou Mo until I could pay it back, why is it that I am on the right track now, and I still can't see the taillights because of Zhou Mo?

at this time,

Zhou Mo put away the plywood and said to the patient:

"I've basically finished my questions. Next, I need to do a physical examination for you..."

"Okay, okay, I'll trouble Dr. Zhou..."

The patient Zhang Yan was not impatient, but felt that this doctor was particularly responsible.

It made him very happy.

Zhou Mo took out the 3M stethoscope sent by Huang Yiming.

After using it last time, he fell in love with this **** high-end sound, and couldn't bear the more than 600 stethoscopes he bought.

Of course, this thing was borrowed. After Zhou Mo hooked up with a rich woman, he would repay the money to Huang Yiming.

Put on the distinguished 3M stethoscope,

Start auscultation.

first,

Listen to the voice of the whole heart.

Heart sound.

First, let’s talk about the concept of heart sound.

"Heart sound": refers to the sound produced by the mechanical wave phenomenon caused by myocardial contraction, closure of heart valves, and blood hitting the walls of the ventricle and aorta.

One cardiac cycle can produce four heart sounds.

That is, the first heart sound (S1), the second heart sound (s2), the third heart sound (s3), and the fourth heart sound (s4).

Under normal circumstances, the first heart sound and the second heart sound can be heard normally, the third heart sound (S3 is usually heard only in children and adolescents), and the fourth heart sound (rarely heard under normal circumstances).

Zhou Mo put the stethoscope over.

listen,

One cardiac cycle...another cardiac cycle...another cardiac cycle...

Very clear:

: The first and second heart sounds are normal.

: Zhou Mo heard a distinct fourth heart sound, which was produced by the strong contraction of the hypertrophic left atrium.

It is clear,

This heart sound is problematic.

This fourth heart sound confirms "aortic valve stenosis", because "aortic valve stenosis" will cause the left atrium to be overloaded for a long time, causing the myocardium of the left atrium to grow and become hypertrophic.

The elements are assembled.

Next step,

Zhou Mo placed it in the 1-2 intercostal space on the right border of the sternum.

This is where the most pronounced peculiar heart sounds of aortic stenosis occur.

Listen to this!

Immediately, Zhou Mo heard a rough and loud jet noise, and it was very loud. According to Zhou Mo's assessment, it was at least grade 3/6 or higher, and it was an increasing-decreasing type, which was transmitted to the neck...

This is a typical heart sound of aortic stenosis.

And according to Zhou Mo's experience, it should be calcification.

The calcified aortic valve is different from the non-calcified aortic valve in terms of softness and hardness, and the sound will be different.

This point was written on P308 of Internal Medicine.

Zhou Mo looked at Huang Yiming and said, "I will test you a question..."

Huang Yiming was taken aback: "Test me?"

Immediately, there was a sense of nervousness about being selected by the teacher for the exam.

But soon I realized: I'm so nervous, Zhou Mo is not my teacher, I'm afraid of ghosts!

Huang Yiming relaxed: "Ask..."

Zhou Mo smiled: "Are you familiar with the textbook?"

Huang Yiming: "It's alright!"

Head up!

I am a scholar!

What is a textbook!

Moreover, in the past two weeks, he has re-finished the textbook, and he has reviewed everything about cardiology.

With regards to teaching materials, he is confident that he will not be troubled by it!

Zhou Mo smiled: "I can judge the patient in front of me to be calcified aortic valve stenosis..."

"In "Internal Medicine" P308 the heart sound of aortic stenosis preached: If the valve leaflet activity is normal, the aortic valve jet sound can be heard in the right sternum, left border and apex area, if the valve leaflet is calcified and stiff, the jet sound disappears . Mentioned in the heart murmur: a rough and loud jet murmur, which is most clearly auscultated in the 1-2 intercostal space on the right sternal border. The louder the murmur and the longer the duration, the more severe the stenosis."

Zhou Mo immediately said the relevant content of "Internal Medicine" p308.

Huang Yiming nodded: "I remember that the book really said that..."

Zhou Mo smiled: "Then the problem is, since the more severe the stenosis, the louder the murmur. When the valve leaflets are calcified and stiff, the stenosis should become heavier. Why do you say that the jet sound will disappear? Why does it feel like a contradiction? ?"

Huang Yiming thought for a while and replied, "Is it possible that the description in the book is wrong, or that it is not accurate enough?"

Zhou Mo: "Tell me about it..."

Huang Yiming pondered for a while, and said: "Because the murmur is caused by turbulent flow, not valve closure, calcification only makes the valve less active or stiff and the closing amplitude is small, resulting in weakened heart sounds. Calcification causes stenosis to increase, turbulence formation increases, and murmur increases. …”

Zhou Mo nodded: "Yes, yes!"

Involuntarily, he patted Huang Yiming's shoulder.

Praise!

Huang Yiming was instantly flattered.

A burst of excitement in my heart!

I was praised!

Wow, is this what it feels like to be praised?

I want to do it again~

and many more!

Huang Yiming looked at Zhou Mo and blinked.

No, I wasn't praised by the teacher.

It's just that Zhou Mo praised me. I'm so excited!

囧rn—3...

……

It took 3 minutes to give the patient Zhang Yan a complete physical examination.

Zhou Mo picked up the pen and wrote it down on the paper.

Huang Yiming followed suit, holding a stethoscope to auscultate the patient.

Zhou Mo writes and draws on the paper. According to the current diagnosis, the patient Zhang Yan's disease is undoubtedly "calcified aortic stenosis"!

Next, a more detailed inspection is required.

ECG: There will be severe left ventricular hypertrophy with strain and left atrial enlargement.

X-ray: aortic valve calcification under lateral fluoroscopy;

Color Doppler: The opening of the aortic valve is greater than 18mm, the valve area is greater than 1.8cm2, and the transvalvular pressure is greater than 20mmHg...

In particular, color ultrasound is an important method for diagnosing and determining the degree of aortic valve stenosis. It is very sensitive to detect aortic valve abnormalities and helps to display the number, size, thickening, calcification, valve size and shape, Valve structure, such as the size of the annulus, can help determine the etiology of stenosis, while continuous Doppler measurements of maximum blood flow velocity through the aortic valve allow calculation of mean transmembrane pressure, peak transmembrane pressure, and valve area . In addition, it can also provide various information such as the size of the cardiac chamber, left ventricular hypertrophy and function~www.novelmt.com~ Okay, the basic examination is over, I will give you some examinations later, such as electrocardiogram, X-ray, cardiac color Doppler... There are also blood draws such as blood routine and myocardial enzymes..."

Zhou Mo said a series of inspections.

The patient Zhang Yan was a little confused, because he didn't understand, he could only keep nodding.

"Okay, thank you doctor."

"Heart ultrasound and X-rays both need an appointment. X-rays are quicker and can be done tomorrow. Echocardiography depends on the schedule, and I will try to arrange it..."

"Okay okay, thank you doctor..."

Zhou Mo finished the ward round after he warned him a few more things.

Looking at the time, it has been 40 minutes.

I went back to make a doctor's order, and asked the nurse to come over to draw blood and do an electrocardiogram...

In addition, medical records, hospital admission reports, etc. have to be written...

By the way, the opening report of the thesis should also be written...

"Why so many things?"

Zhou Mo scratched his head in distress.

Her hair was messed up a bit, but she was still handsome and handsome.

On the other hand, Huang Yiming, who was next to him, had a happy expression on his face.

learnt!

Following Zhou Mo's ward rounds, I really learned a lot.