I can see health

Chapter 132 The Strange Cedilan (Ticket Request)
These days, Lu Chen also allocated part of his energy to pay attention to the "WeChat group of Jinghua Electrophysiology Exchange".

In this group, doctors send out electrocardiograms every day and exchange some interpretation experience with each other.

Before, Lu Chen had been reviewing the skills test and didn't have much time to pay attention.

Now, he will open WeChat from time to time to see if there are some difficult ECGs that need to be interpreted.

Perhaps, you can earn some gratitude from it.

……

Feng M County People's Hospital.

Cardiology.

Fan Zhiping is in the doctor's office, sharing his experience in the stock market with his colleagues.

"Oh, the current market is not very good. Some time ago, the position was liquidated, and the loss was heavy!" Fan Zhiping sighed, beating his chest and feet.

"Director Fan, you're pretty good. You made a lot of money a while ago, but I lost money this time." A resident doctor in the department shook his head, "My mother-in-law is almost impatient with me. Why."

Just when the two sighed.

The head nurse hurriedly walked into the doctor's office and knocked on the door of the office.

"Director Fan, a patient with acute heart failure has been brought to the emergency department! I think the patient's condition is quite serious, so go and see him!"

Fan Zhiping was startled, immediately put away his smile, and grabbed the stethoscope.

"How many beds? I'll go now!"

"The patient is in the rescue room!"

"it is good."

Fan Zhiping immediately walked out of the ward, followed by the resident doctor who was chatting with him just now.

Soon to the emergency ward.

On the hospital bed was an old lady in her 80s and [-]s, sitting by the bed, panting heavily, her lips were a little cyanotic.

There was also a young doctor wearing glasses standing beside the hospital bed.

"Director Fan, you are here. This should be a patient with heart failure."

The emergency doctor breathed a sigh of relief when he saw Fan Zhiping coming, and immediately began to report the medical history.

"The patient, a 78-year-old woman, complained of palpitations for more than 10 days."

"The patient felt that the heartbeat was fast, persistent, and sometimes aggravated. There was no chest tightness, chest pain, dyspnea, cough, sputum, dizziness, syncope, abdominal pain, abdominal distension and other discomforts."

"The old lady complained that she was usually in good health, denied any other medical history or any history of taking medicine, and seldom went to the hospital to see a doctor."

"Admission physical examination: blood pressure 125/75mmHg, heart rate 125 beats/min, absolutely irregular rhythm, heart sounds ranging in strength, no murmurs, clear breath sounds in both lungs, no dry or wet rales, no edema in both lower limbs."

"Electrocardiogram after admission: rapid atrial fibrillation with frequent premature ventricles. Chest CT has been done, and the result has not yet come out."

Fan Zhiping nodded and began the physical examination.

At the same time, he ordered the nurse to monitor the patient's heart and inhale oxygen.

The emergency doctor handed the electrocardiogram and emergency medical records to the resident doctor on the side.

"Director Fan, the patient will be handed over to you. I'll go first."

"Okay." Fan Zhiping nodded.

The emergency doctor pushed the flat cart and left.

"Director, this is acute left heart failure caused by rapid atrial fibrillation, right?" The young resident doctor picked up the electrocardiogram and took a closer look. "At the same time, it is accompanied by secondary ST-segment changes."

"Yes." Fan Zhiping nodded in relief, and at the same time said to the nurse, "First check the blood, kidney function, ions, myocardial enzymes, and BNP urgently, and then inject a furosemide intravenously, and then inject half a dose of Cedilan!"

"Okay, Director."

The nurse quickly returned to the treatment room to dispense the medicine.

Fan Zhiping said to the resident doctor beside him: "Xiao Fang, when we usually encounter heart failure, the first choice is to use furosemide. If the effect is not good, we can use cedilan to strengthen the heart. But this patient is different. , I chose cardiotonic drugs from the beginning, do you know why?"

Xiao Fang paused, pondered for a moment, and said slowly: "I remember the internal medicine book said that the best indication for Cedilan is rapid atrial fibrillation accompanied by heart failure. This patient... just fits it!"

"Yes." Fan Zhiping nodded slightly, "Yes, Cedilan can control the ventricular rate of atrial fibrillation and quickly relieve the symptoms of heart failure."

At this time, the nurse just brought furosemide and cedilan.

"Director, let me check the oral doctor's order for you again. One dose of furosemide is administered statically, and half of Cedilan is administered statically."

"Yes."

After receiving Fan Zhiping's affirmative reply, the nurse began to carry out the doctor's order.

Furosemide static push!
Sidilan pushes slowly!
……

Fan Zhiping has already returned to the doctor's office, leaving only Fang Yong in the ward to observe the changes in the patient's condition.

At this time, the nurse had just finished pushing Cedilan.

"Grandma, do you feel better about your chest tightness?" Fang Yong leaned over to the hospital bed and asked softly.

On the hospital bed, the old lady was still breathing hard and waved her arms weakly.

Fang Yong frowned.

Looking at the patient's condition, not only did it not improve, but it seemed to be getting worse!

This is not quite right!

"I, I have some chest pains and tightness..." The old lady struggled to utter a few words.

The family members of the patients on the side were a little anxious when they heard this.

"Doctor, what's going on, I feel that my mother's symptoms are getting worse after taking these medicines just now!"

"Don't worry, just observe again!" Fang Yong held his breath, turned his head and said to the nurse, "Quickly call Director Fan over."

At the same time, he picked up the stethoscope to auscultate the patient's lungs.

As soon as he put the stethoscope on the auscultation area of ​​the patient's lungs, Fang Yong felt something was wrong.

When the patient first came to the department, her lungs were clean on auscultation without any dry or wet rales.

But now.

The old lady's lungs had new wheezing sounds mainly in the expiratory phase, and a little moist rales could be heard in both lower lungs.

Why is it happening like that?

"Xiao Fang, what's the matter?"

At this time, Fan Zhiping arrived.

"Director, the nurse just finished pushing the cedilan, and the patient felt more chest tightness!" Fang Yong said immediately, "I just auscultated the patient's lungs. Compared with before, there are changes!"

Fan Zhiping frowned, and quickly auscultated his lungs again.

"There are indeed changes. You can hear wheezing, and there are even some wet rales at the bottom of the lungs, which I haven't heard before."

This is a sign of getting worse!

"Push a dose of furosemide, and then give the patient a set of nebulization! Push another breather!"

Fan Zhiping immediately began to issue oral doctor's orders.

Now is not the time to ponder the reasons for a patient's exacerbation.

Stabilize your condition first, this is the most important thing!
After about ten minutes.

The patient's symptoms began to ease, and the symptoms of chest tightness and chest pain gradually disappeared.

Everyone breathed a sigh of relief.

……

At the same time, Fan Zhiping began to speculate about various possible reasons.

"This patient had symptoms after taking Cedilan. Could it be the drug reaction of Cedilan?"

Go back to the doctor's office.

Fan Zhiping looked through all the test indicators of the patient, but was still confused for a long time.

"Director Fan, I just checked another ECG."

Fang Yong was very diligent, and after the patient's symptoms eased, he checked an electrocardiogram.

Fan Zhiping got the recheck ECG and took a closer look.

The re-examination of the electrocardiogram showed atrial fibrillation and frequent premature ventricular, and the heart rate returned to normal.

However, compared with the electrocardiogram at the time of admission, ST-segment depression and T-wave inversion were common, and changes in myocardial ischemia appeared.

"Director Fan, why did the patient's condition suddenly worsen?" Fang Yong asked in a low voice.

"I don't know." Fan Zhiping shook his head, but he didn't find the source of the aggravation of his condition.

But according to the usage specifications of Cedilan, in the current situation, it is definitely right to push Cedilan statically!
The only thing that has changed now is the two ECGs before and after!

But after pondering for a long time, he couldn't find any thoughts in the electrocardiogram.

Suddenly, Fan Zhiping thought of the "Jinghua Electrophysiological Exchange Group" he had just joined.

Perhaps the professors at the superior hospital can see the difference!

thought here.

He quickly took pictures of the two kinds of electrocardiograms with his mobile phone, and then sent them to the Jinghua electrophysiology communication group.

Fan Zhiping also gave a brief description of the patient's medical history, and at the end of the day, specially asked Lu Chen.

"@Professor Lu, please take a look at these two ECGs for me if you have time, thank you."

　Still owed three more.

　　Thank you for your rewards!
　　
　
(End of this chapter)