This Doctor is Great

Chapter 49: Patent foramen ovale...

This elderly patient has such exaggerated varicose veins, so there must be a lot of blood clots.

Because varicose veins can make the blood flow poorly, and then in the veins, especially in the venous valves, it is easy to form blood clots. This blood clot is a thrombus.

There is another evidence.

The patient's old man's legs are swollen.

There are many reasons for lower extremity edema, one of which is that there are many thrombi, and the blood flow is not smooth.

so,

Combining the above elements, varicose veins + thrombosis + edema, it is speculated that the elderly patients are likely to have pulmonary embolism.

Emergency doctor Cao Yun said, "We thought about pulmonary embolism, so we did a bedside ultrasound."

"Our emergency department specially invited a B ultrasound teacher to come over, and then performed a bedside color ultrasound for the patient..."

bedside ultrasound,

Zhou Mo's heart moved.

This thing is a little smaller than the general color Doppler ultrasound, and there is one in the Cardiology Department, but few people use it.

"Can you learn it yourself?"

"Let's see if you can master the technique of bedside color Doppler ultrasound?"

"In this case, wouldn't it be much easier for me to diagnose patients in the future?"

Heart color Doppler ultrasound can measure the blood flow of the human body, as well as the organic changes, which is much more useful in the Department of Cardiology.

"Go back and look for the "Manual"..."

Temporarily suppressing this thought, Zhou Mo continued to listen to the emergency doctor Cao Yun.

Cao Yun: "But unfortunately, after the bedside color Doppler ultrasound diagnosis, the patient does not have pulmonary embolism, and the blood flow is completely fine..."

No pulmonary embolism?

Chen Bing: "......"

Zhou Mo: "…………"

Zhang Yang: "......"

To be honest, after the three heard the patient's condition, without exception, their first reaction was pulmonary embolism.

Senior Brother Chen Bing: "Have you done a color Doppler ultrasound on your lower body?"

Cao Yun from the emergency department: "I have done it... It shows a lot of thrombosis, as many as 18 thrombosis..."

hiss~~~

18 places!

Too much!

If any one falls out, life may be lost.

Brother Chen Bing couldn't help but ask: "Is it possible that the ultrasound did not see clearly? With so many blood clots, how could there be no pulmonary embolism?"

The thrombus travels all the way up the blood, and first enters the right atrium and right ventricle of the heart through the inferior vena cava. During this process, the thrombus is relatively small and can definitely pass through.

The thrombus travels all the way to the pulmonary artery, and then enters the pulmonary capillaries...

At this time, because the capillaries are too small, the thrombus will definitely block a part, and then cause some part of the lung function damage.

This is pulmonary embolism.

(A book friend posted a picture of your blood circulation?)

so,

Generally, there is a blood clot in the lower extremities, and the first (and only) embolism must be the lungs!

It cannot reach the brain or other parts of the human body, because the thrombus is blocked by the capillaries in the lungs and cannot enter the next location.

So everyone will think of pulmonary embolism invariably.

Instead of thinking about cerebral embolism, other embolisms...

Cao Yun in the emergency department shook his head: "We also thought so at the time, and thought it was unlikely that there was no pulmonary embolism, so I asked the ultrasound teacher to see it a few more times... The result was still very good, and there was no pulmonary embolism."

Chen Bing pondered.

Zhang Yang: "Why don't you do a CT angiography? I'll do the lungs and head. If there is any problem, it will come out all at once..."

Cao Yun shook his head: "No, in this case, the patient's blood pressure is too low, and he is still on the ventilator, so he doesn't dare to do CT at all, for fear of an accident in the middle of the journey... I want to go to the ICU now..."

Chen Bing nodded: "Yes, you can't do CT..."

Zhou Mo: "Wait a minute, there is a question, why did the patient suddenly have low blood pressure 10 minutes ago (when he called Chen Bing to the emergency room for consultation)? It doesn't make sense. It doesn't make any sense for cerebral infarction, cerebral embolism, or pulmonary embolism. low blood pressure..."

Chen Bing caught a flash of inspiration: "Yes, what's the matter with low blood pressure? Heart failure?"

Cao Yun nodded: "We also consider heart failure, because considering the patient's stroke, it will cause certain breathing disorders, and then cause low blood oxygen. When blood oxygen is low, the heart will increase its power, and then high power for a long time, Heart failure..."

Chen Bing: "Have you done arterial blood gas analysis?"

Cao Yun wiped his sweat: "Not yet..."

Just as he was busy rescuing, then Chen Bing came, and he forgot all of a sudden.

Arterial blood gas analysis should be the fastest test for heart failure.

Chen Bing: "Go for an arterial blood gas analysis... I suspect heart failure..."

The nurse quickly took arterial blood.

"You can give mannitol empirically."

"right!"

Zhou Mo was on the side and did not speak.

In fact, heart failure is not the key point yet. The key point is to understand what happened to the old man's head.

Because the head is the cause, if it is not solved, the heart failure will continue next time (if it was really heart failure ten minutes ago).

Zhou Mo suddenly thought of a disease and couldn't help but ask, "Have you had a heart ultrasound?"

Cao Yun nodded: "I did..."

Zhou Mo immediately frowned: "Didn't you find anything?"

Chen Bing glanced at Zhou Mo: "Did you think of something?"

Zhou Mo explained his thoughts: "I suspect it is a disease - patent foramen ovale."

Note: Patent foramen ovale: the left atrium and right atrium are close to each other (located in the upper part of the heart), and they are not connected under normal circumstances, but there is a foramen ovale that communicates between the left and right atria during the fetal period. It gradually closes after birth.

If the "foramen ovale" is not closed, it is "patent foramen ovale".

Some adults also have this~www.novelmt.com~ Zhou Mo expressed his thoughts: "If the patient has a patent foramen ovale, the thrombus can completely skip the pulmonary capillaries and flow from the right atrium——> ;Foramen ovale -> left atrium -> left ventricle -> high pressure pumping into the heart aorta -> reaching the cerebral artery -> leading to cerebral embolism and further cerebral infarction!!"

Everyone listens.

Immediately, his eyes lit up.

"It's really possible!"

"It makes sense..."

"If this is the case, it will indeed lead to cerebral thrombosis and then ischemic infarction..."

"There are so many blood clots in the patient's lower extremities, plus a "patent foramen ovale", it is really very likely that cerebral thrombosis will occur! "

"It feels like this should be the real cause!"

"Although the B-ultrasound teacher has done a heart ultrasound, but if you don't take it seriously, you may have really overlooked it..."

"Why don't I call the ultrasound teacher over here?"

"Go quickly..."

soon,

about 8 minutes,

The ultrasound teacher came quickly.

"Patent foramen ovale? I rarely see this..."

Teacher B is excited!

soon,

The ultrasound results came out.

Confirmed - patent foramen ovale! !