I can see health

Chapter 104 Professor Lu, It's Really Hypokalemia!
Zhang Wulong recognized the doctor who spoke in the group.

His name is Yu Songbei, and he is the deputy chief physician of the Cardiology Department of Pingshui County Hospital of Traditional Chinese Medicine.

The level of reading electrocardiogram is not bad, usually very active in the group, has been very enthusiastic to help others answer electrocardiogram.

"Thank you, Teacher Yu, for your guidance."

Yu Songbei replied with a smiley face: "You're welcome."

Zhang Wulong's anxious mood calmed down a little.

If you can have a preliminary impression diagnosis, it will be easy to deal with.

Since the myocardial ischemia is considered to be caused by coronary heart disease, it is enough to wait for the consultation of the cardiology department and send it to the cardiology department for hospitalization.

……

"Doctor Zhang, the heart consultation doctor is here!"

The nurse yelled in the corridor.

Zhang Wulong immediately walked out of the ward and welcomed the cardiologist in.

"Old Fan, why did you come here? It's been almost 10 minutes. This patient is a relative of the county leader. The dean has already spoken, so we can't neglect it."

"Hey, Corey is busy. I also took time out." Fan Zhiqingping, the chief physician of the Department of Cardiology, shook his head slightly and said, "Let me see what kind of patient it is."

Zhang Wulong handed the electrocardiogram to Fan Zhiping.

"The patient had general fatigue in the last day, and it was progressively aggravated. He had no special medical history in the past, but he had high blood pressure, and his blood pressure has not been well controlled."

Fan Zhiping glanced at the electrocardiogram, and then gave the patient a simple physical examination.

"The patient's myocardial ischemia is very serious."

"Well, we also considered coronary heart disease just now." Zhang Wulong nodded, "However, the patient did not have obvious symptoms of chest tightness or chest pain, and the symptoms of coronary heart disease do not seem to match."

"It may be fatigue and poor appetite caused by coronary heart disease and heart failure." Fan Zhiping said, "Some heart failure patients have atypical symptoms, which may be serious symptoms of the gastrointestinal tract, such as poor appetite and poor long-term nutritional status. , it may lead to fatigue and poor appetite.”

At present, the diagnoses of Fan Zhiping and Zhang Songbei in the group are similar, both of which consider myocardial ischemia caused by coronary heart disease.

"Then I will issue a hospital certificate from the cardiology department and let him go to your heart." Zhang Wulong said.

"Okay." Fan Zhiping nodded, "Then I'll go back to the department."

"Thanks."

Zhang Wulong smiled. He was about to issue a hospital certificate for the patient, but the phone vibrated beside him.

With a slight glance in his eyes, he found that it was news from the electrophysiological communication group, as if someone was attacking him.

Zhang Wulong frowned, and opened the WeChat group suspiciously.

Seeing the news in the group, he was stunned.

Then he immediately shouted to Fan Zhiping who was preparing for the emergency department: "Old Fan, wait before leaving!"

Fan Zhiping stopped, turned around in doubt, and said, "What's wrong?"

"Look at this electrocardiogram again!"

Fan Zhiping's eyes froze for a moment, and he quickly walked back to Zhang Wulong's side at any time, and picked up the electrocardiogram on the table.

"Could it be hypokalemia?" Zhang Wulong asked softly.

Fan Zhiping's eyes froze, "Hypokalemia?"

He concentrated his attention and carefully analyzed every waveform in the electrocardiogram.

This is...U wave?
Fan Zhiping found that behind the T wave in this ECG, there is a very small wave, U wave!
The small U wave is a specific waveform of hypokalemia.

Fan Zhiping's frown suddenly relaxed.

"Yes, this is hypokalemia!"

"The patient has symptoms of general fatigue, which is caused by hypokalemia!
"In addition, the patient's heart rate is relatively slow, which is also due to hypokalemia!"

In this way, all the symptoms and signs of the patient can be explained!
"Is it really hypokalemia?" Zhang Wulong asked in surprise.

"Well, at present, it seems that it is very likely to be hypokalemia!" Fan Zhiping nodded, "The report of the blood test may be a little late, so take a blood gas analysis immediately to see the potassium in the blood gas analysis ion levels."

"Okay!" Zhang Wulong immediately ordered the nurse to collect arterial blood gas.

Emergency departments are equipped with rapid blood gas analyzers, usually with results available in minutes.

For blood gas analysis, blood is drawn from the patient's arteries.

It can preliminarily evaluate the lung ventilation function and acid-base balance in the patient, and the value of potassium ions is also included in the blood gas analysis.

The nurse started taking arterial blood gas.

But Fan Zhiping did not leave, but stayed in the emergency department, waiting for the results of the blood gas analysis.

Arterial blood gas collection is completed, 3 minutes later.

"Doctor Zhang, the results of the blood gas analysis are in!"

The nurse handed Zhang Wulong the small note of blood gas analysis.

Fan Zhiping immediately moved his head closer.

"Serum potassium: 1.9mmol/L..."

The normal blood potassium range is 3.5-5.5mmol/L.

1.9mmol/L, which already belongs to the standard of severe hypokalemia.

Patients are at risk of cardiac arrest or even sudden death at any time!

"Severely low potassium!" Zhang Wulong said.

"Supplement potassium quickly!" Fan Zhiping nodded, "Although generally speaking, the potassium ion level in arterial blood is lower than that in venous blood, the value of serum ion in this patient should be higher than 1.9mmol/L , but not much higher."

Zhang Wulong immediately issued a doctor's order to start potassium supplementation at the same time, both oral and intravenous.

"Old Fan, based on this patient's history of high blood pressure, is it possible that he may have primary aldehyde?"

Fan Zhiping glanced at Zhang Wulong quite unexpectedly, "You are not simple, have you been diagnosed?"

We are all colleagues for many years, Zhang Wulong's level, he is very clear.

Normally, I can't even see an electrocardiogram of myocardial ischemia, so why did I directly judge hypokalemia today?
Also said primary aldosteronism?
"Hey, I don't have the ability to read an electrocardiogram."

Zhang Wulong took out his phone and clicked on the WeChat group.

"No, I posted this picture in the electrophysiological communication group. At the beginning, some doctors said it was coronary heart disease and myocardial ischemia."

"However, just now a teacher said that it might be hypokalemia. Combined with the medical history, the original aldehyde was considered, so I called you back."

Fan Zhiping took the phone and looked through the chat records in the group.

The last message in the group was sent by a person with the nickname "Jinghua Electrophysiology Association".

"@凤M县人民医院医院张君龙, there is a possibility of hypokalemia, combined with the medical history, consider the original aldehyde."

Fan Zhiping asked suspiciously: "Old Zhang, what do you guys do in this group?"

"Oh, this group is a group established by the Jinghua Electrophysiology Association to facilitate academic exchanges in grassroots hospitals. The members are doctors from some nearby county-level hospitals, and they usually communicate about electrocardiograms. In each group, there are Several of them are members of Jinghua Electrophysiology Association, basically doctors from Jinghua University Hospital, some even at the professor level." Zhang Wulong smiled, "But this teacher named Lu Chen, I seem to be the first time today. When I saw him speak, I had no impression of him before."

"Do you still have this kind of group?" Fan Zhiping became interested.

"That's right, it only started recently." Zhang Wulong said, "I also joined the group through a good friend."

"Old Zhang, then quickly drag me into the group!" Fan Zhiping patted Zhang Wulong on the shoulder.

"Hey, do you still want to find someone else to look at the picture in your heart?" Zhang Wulong teased.

"Oh, it's not that you don't know that the cardiology department of our grass-roots hospital doesn't specialize in electrophysiology." Fan Zhiping shook his head slightly, "There are many difficult electrocardiograms that even our director can't understand. It’s a big hospital. But some patients’ family conditions don’t allow it, so it’s very difficult for us to stay in our department.”

"Okay, then I'll pull you into the group."

"Old Zhang, thank you, please give me a massage in a few days."

"Good talk, good talk."

……

Jinghua Second Hospital, dormitory of Guipei Building.

Lu Chen lay on the bed.

"Congratulations, received the thank you from Zhang Wulong +1!"

Lu Chen looked happy, it seems that this picture is really hypokalemia!
as predicted.

Not long after, Zhang Wulong sent a message in the WeChat group.

"@京华electrophysiological association Lu Chen, thank you Professor Lu! It's really hypokalemia!"

　Thank you for the rewards of I want a girlfriend, Daluzi, Yuntianxing, Kunlinyuanshan, Fushengbencun, 20190623.

　　
　
(End of this chapter)