I can see health

Chapter 253 What a Thick Envelope!
Li Yao's complexion remained unchanged. She has encountered many patients like this, and patiently explained: "First of all, as long as you want to extract a tooth, you not only need to lower your blood pressure before the operation, but also do a routine electrocardiogram to evaluate the heart condition; It must be something wrong with the tooth itself, and possibly the pain caused by the heart disease."

"Ah? I heard that heart disease is chest pain, or chest tightness. Could heart disease also cause toothache?"

A trace of doubt flashed in the eyes of the man in front of him.

"And, I never had a heart attack before, and neither did my parents!"

Li Yao shook her head slightly: "The sudden onset of heart disease does not necessarily mean that there is any medical history in the past. Moreover, many diseases are not all a symptom. A small number of patients with coronary heart disease have a symptom, that is toothache! So, now you not only need to To reduce blood pressure, an electrocardiogram is needed to rule out heart disease."

"Then make one!" The woman on the side immediately said, "This electrocardiogram is not expensive. Let's take an electrocardiogram and treat it as a peace of mind. If there is a problem, we will solve it. If there is no problem, then that is the best." !"

The man ignored the woman, but said to Li Yao: "Doctor, as long as my blood pressure drops and the electrocardiogram is normal, can I pull my teeth?"

"Yeah." Li Yao nodded, "The blood pressure is stable, and the heart is fine, so you can pull out your teeth!"

"Okay, then I'll do an EKG!"

Seeing the patient's consent, Lu Chen immediately typed out the ECG application form and prescription for antihypertensive drugs.

"Then go quickly." Li Yao said, "The electrocardiogram room is in the next building."

The patient in front of him nodded with his family members, and then left the outpatient room together.

……

After the patient left, Li Yao glanced at Lu Chen appreciatively.

"Yes, it is more careful to ask about the medical history. Patients with toothache like this must not forget to ask about the history of heart disease. Many heart disease patients may not necessarily have chest pain, but may have toothache, sore throat, shoulder pain, and what's more, It's a headache!"

The heart itself has no pain-sensing nerves.

Once the myocardium is ischemic due to coronary heart disease, many metabolites, such as lactic acid and other substances, will accumulate.

These metabolites stimulate the autonomic nerves of the heart, and the stimulating signals are transmitted to the spinal cord center through the autonomic nerves.

Different people have slightly different afferent spinal cord segments, so the pain symptoms of coronary heart disease are also different.

Since the afferent segment of the cardiac autonomic nerve is usually the afferent segment of the left chest and left upper limb sensory nerve, most coronary heart disease patients present with pain in the left chest or left upper limb.

However, if the afferent segment of the cardiac autonomic nerve is too high, it may manifest as toothache and jaw pain.

Similarly, if the afferent segment is low, it may manifest as epigastric pain and be mistaken for symptoms of gastrointestinal disease.

Some people can also present with shoulder and back pain.

Lu Chen nodded, "Yes, I see, teacher."

Although his clinical career was short, he encountered many heart patients.

All kinds of strange complaints may be myocardial infarction!

It is impossible for every patient to get sick according to the typical symptoms in the textbook, so some rare diseases and symptoms must not be ruled out.

……

Finish this patient.

This is Li Yao's last patient this morning.

It's eleven o'clock now, Li Yao's clinic has been closed, and no one else can get her outpatient number.

"We'll sit for another half an hour before leaving get off work. We don't see new patients now, but some patients need to see test results in the morning." Li Yao said, "We'll wait for them."

Lu Chen nodded slightly, and sat beside Li Yao like a good student.

"How's it going in Corey during this time?" Li Yao asked suddenly.

"Fortunately, although I'm a little busy, I can learn a lot of knowledge." Lu Chen said.

"I heard that you also learned echocardiography by yourself?" Li Yao smiled, "It's not easy, is it? It's not easy to have time to learn ultrasound technology when you are so busy in clinical practice."

Lu Chen smiled and said, "It's just superficial, and I don't know much about the heart."

"Well, it's better to be humble." Li Yao said, "When you go to the CCU for rotation, then you have professional ultrasound equipment, and you can train at any time."

The current portable ultrasound in the eighth area of ​​the heart is a small castrated version of the ultrasound machine.

Professional cardiac ultrasound machines can more accurately judge the patient's condition.

"Teacher, it will be a long time before I go to CCU." Lu Chen said.

Li Yao said: "Well, where will you go to the next department?"

"After one and a half months, I should go to the emergency department." Lu Chen thought for a while and said.

"Go to the emergency room so soon?" Li Yao was taken aback, "I thought you would go to breathe or digest! But the emergency room is also good, going to the emergency room to exercise will do you a lot of good in the future."

While the two were talking, the toothache patient just now came back.

Walking into the outpatient room with him, besides his wife, was a young doctor in a white coat.

"Director Li, is this your patient?" The young doctor walked forward anxiously, holding an electrocardiogram in his hand.

"It's my patient." Looking at his expression, Li Yao's expression sank.

Could it really be a heart attack?

"Director Li, then you should take a look at the electrocardiogram." The young doctor handed the electrocardiogram to Director Li.

Li Yao looked down, and Lu Chen also moved his head closer.

"The anterior wall leads are elevated!"

Both of them were shocked.

If you don’t check it, you don’t know.
The patient's ECG showed widespread short ST elevations in the precordial leads.

No wonder the doctor in the EKG room brought the patient himself.

Now there is the possibility of acute anterior wall myocardial infarction!

Li Yao immediately said to the patient: "There is a problem with the electrocardiogram, we consider the possibility of acute myocardial infarction!"

The man became anxious when he heard this, "Aren't you kidding me, I... I have a heart attack?"

The patient's wife was also a little overwhelmed.

"Uncle, don't get excited." Lu Chen hurried forward and said, "We are just suspecting now, you need to go to the hospital for further examination."

At this time, the doctor in the electrocardiogram room took out a critical value registration book and asked Li Yao to sign the registration book.

The man hesitated for a while, "I don't feel much pain anymore, do I have to be hospitalized?"

Li Yao took a deep breath, held her temper, and said slowly: "I'll just say it directly, in your current situation, if you are diagnosed with acute myocardial infarction, it will be very dangerous."

After speaking, Li Yao also looked at the patient's wife.

"Acute myocardial infarction, the risk of sudden death is very high!"

The woman nodded quickly: "Doctor, I'll take a photo of this ECG and send it to a medical student at home."

"There is no rush to take photos. The most important thing now is to be hospitalized quickly and further improve the relevant examinations. If you have a heart attack, you need emergency surgery!" Li Yao said in a deep voice.

Lu Chen also kept emphasizing the danger of myocardial infarction to the patients and their families!
"Doctor, what do you think we should do now?" The woman bit her lip, with a look of sadness in her eyes.

"Now transfer to the emergency department, and ask the emergency department to send nurses and doctors to accompany you to the CCU ward for hospitalization." Li Yao said.

Although the outpatient building is only a few hundred meters away from the eighth inpatient department, it is uncertain what will happen during this period.

When encountering such emergency patients, they must be escorted by emergency nurses and doctors.

"Then listen to you, go live!" the woman nodded.

After the patient and his family agreed, Lu Chen brought them to the emergency department.

After explaining the condition to the emergency doctor, the doctor on duty in the emergency department immediately became alert and gave the patient a quick troponin screening test.

After 3 minutes, the result came out.

Troponin positive!
Heart attack diagnosed!
The emergency department immediately dispatched doctors and nurses, brought first-aid supplies, and sent the patient to the CCU!

……

This side of the outpatient building.

Lu Chen and Li Yao breathed a sigh of relief when they received this message.

I can finally leave work with peace of mind.

"It's almost time for get off work."

Li Yao smiled, and she suddenly took out an envelope from her carry bag, and handed it to Lu Chen.

Lu Chen subconsciously took the envelope and paused before realizing it.

Good guy, what a thick envelope!
(End of this chapter)