I can see health

Chapter 263 I'm a Beginner
Since the family members of the patient did not agree to be transferred to the ICU, Yin Xinhua decided to give the patient an echocardiogram before making further plans.

If the patient really has a pulmonary embolism, it can also be found by doing a color Doppler echocardiography.

Color Doppler ultrasound can find that the patient's right heart pressure has increased, and it may also see that the pulmonary artery pressure has increased. If you are lucky or skilled, you can even see the emboli blocked in the pulmonary artery.

If that's the case, the diagnosis will be firmly established.

However, the emergency echocardiography at night cannot come immediately, and it takes about 10 minutes to wait.

Just like the last night shift, Yin Xinhua called the chief resident of the cardiology department and asked the chief resident to do an ultrasound first. After a preliminary diagnosis, he waited for the professional doctor of the ultrasound department.

However, it was a coincidence that the chief inpatient of the Cardiology Department happened to be in the second heart area to help rescue patients, so he couldn't come right away.

"Senior Sister, why don't you let me try this first?"

Yin Xinhua was extremely surprised when Lu Chen showed up in the ward with a portable heart ultrasound machine.

"You know this?"

Recalling the last night shift, Lu Chen couldn't even read the most basic aspects of the heart.

Diagnosing pulmonary embolism now requires looking at images of the pulmonary arteries, which is more difficult than looking at the structure of the heart.

"Senior Sister, I'm just learning, so I'll give it a try." Lu Chen smiled.

But Fan Zhiping stood beside Lu Chen, but he "scorned" Lu Chen's words in his heart.

Are you just learning?

What a liar!
Fan Zhiping remembered that Lu Chen used this portable ultrasound to diagnose myocardial hypertrophy for others.

Yin Xinhua only thought that Lu Chen was really going to try it, so he nodded in agreement.

Waiting is also waiting, it is better to let Lu Chen practice his hands.

……

Come to the bedside.

Lu Chen brought the ultrasound probe close to the patient's chest wall.

After scanning twice, it freezes.

He frowned tightly: "Look, senior sister, the patient's right ventricle is really dilated, and the pressure is high!"

Yin Xinhua was stunned for a moment, then took a closer look.

The patient's right ventricle seems to be really enlarged!

At this point, the probe is turned to the cutting plane of the pulmonary artery.

Lu Chen didn't see the embolus in the pulmonary artery, but what he could see was that the pulmonary artery had thickened!
This ultrasound operation technique is so skillful!

Yin Xinhua looked at Lu Chen in surprise.

This kid, are you pretending to be stupid on the night shift?
Lu Chen didn't notice Yin Xinhua's expression, he said slowly: "Sister, although I didn't see a pulmonary embolism, but through the increase of right heart pressure and pulmonary artery pressure load, can I indirectly think that the patient still has pulmonary embolism? ?”

Hearing Lu Chen's words, Yin Xinhua regained consciousness.

"If you can actually see these signs on an ultrasound, then you can indeed diagnose a pulmonary embolism."

After saying these words, Yin Xinhua still looked at Lu Chen in disbelief.

This junior brother is also too versatile.

Skill operation, electrocardiogram, echocardiography...all of them!
The only thing that won't happen is that he hasn't published a paper yet.

……

At this moment, the inpatient in the cardiology department came to the eighth district of the heart.

"Teacher Li Qinghua again?" Lu Chen was quite surprised when he saw who was coming.

He felt that Li Qinghua was always hospitalized in the cardiology department.

You can meet him almost every night shift.

Doesn't he stay in the hospital every day?

Li Qinghua also noticed Lu Chen.

"Lu Chen, why is it you again?" Li Qinghua looked at Lu Chen in surprise, then smiled.

This student left a deep impression on him.

You can meet them on the night shift.

"Ms. Li, this is fate..." Lu Chen chuckled.

Black face, that does not exist.

Holding the echocardiography machine, Li Qinghua said with a smile: "Then our fate is really not shallow!"

After chatting for a few words, Li Qinghua immediately started using the ultrasound.

He noticed couplant residue in the patient's heart.

"Have you seen it?"

Lu Chen nodded, "I took a look."

"What did you see?" Li Qinghua looked up at Lu Chen who was beside him. He thought Yin Xinhua had tried an ultrasound, "What did you see?"

Lu Chen immediately said: "The right ventricle is enlarged, and the pulmonary artery is thickened."

Li Qinghua smiled, did not reply, and concentrated on checking the condition of the patient's heart and pulmonary artery.

Although he is not as good as a professional ultrasound doctor, he can probably handle it.

About 5 minute passed.

Li Qinghua said slowly, keeping his eyes on the ultrasound screen for a moment, "The right ventricle is obviously enlarged, and the pulmonary artery can also be seen thickened, but the embolus of the pulmonary artery cannot be seen."

Li Qinghua's ultrasound results were basically consistent with Lu Chen's!

"Thrombolysis should be arranged." Li Qinghua looked up at Lu Chen, this kid's skills are good!

Thrombolysis for pulmonary embolism is different from thrombolysis for myocardial infarction.

Although both of them are thrombus blocking the blood vessels, the thrombolytic drugs for myocardial infarction are much more urgent and need to be completed in 1-2 hours, otherwise the cardiomyocytes will be necrotic, and it may be meaningless to use thrombolysis again.

But pulmonary embolism is different. The lungs have many blood supply channels. If the pulmonary artery is blocked, the bronchial artery is still supplying blood, so it will not die so quickly. Therefore, thrombolysis for pulmonary embolism can be considered within 14 days.

But as the patient in front of me is so serious, it cannot be delayed.

If the embolus does not melt for a moment, it will block the pulmonary artery all the time, and the patient is still extremely hypoxic, which is quite choking.

Now it is barely maintained because the ventilator has given enough horsepower, and it is still prone to accidents if there is a slight disturbance.

"Then melt it." Yin Xinhua said. "I'm going to communicate with the family and sign."

This communication is extremely important, Yin Xinhua did not let Lu Chen go.

Because the complications of thrombolysis are very serious, especially cerebral hemorrhage, don't get a cerebral hemorrhage without melting the embolus at that time, it will be a big loss.

"However, in order to be sure, let the teacher of cardiac color Doppler ultrasound come over, let them guide and confirm the possibility of pulmonary hypertension and whether there is a possibility of thrombus, so we can rest assured." Li Qinghua said.

"Okay." Yin Xinhua nodded, "I'll go to the ultrasound room and then communicate with the patient's family."

……

Yin Xinhua left the ward, leaving only Lu Chen, Fan Zhiping and Li Qinghua behind.

At this time, Lu Chen looked at the patient on the bed, and asked his doubts again.

"Mr. Li, the patient has no high-risk factors for pulmonary embolism, nor does he have any tumors, only this pneumonia. Could it be the pulmonary embolism caused by pneumonia?"

Li Qinghua didn't answer right away, he pondered for a moment, and then said: "Pneumonia is not a high-risk factor for pulmonary embolism, but it's hard to say, and it needs to be carefully considered."

But at this moment, the nurse at the side suddenly said: "Doctor Li, Doctor Lu, look, what happened to the patient's arm?"

Her tone was unbelievable, obviously she had discovered something unusual.

Lu Chen and Li Qinghua followed the direction she pointed, which was the patient's arm, near the elbow joint.

Lu Chen and Li Qinghua were shocked when they saw it.

Why is this hand densely covered with rashes?
　This is the fifth update today.

　　
　
(End of this chapter)