I can see health

Chapter 276 Take a look

Gestational hypertension refers to symptoms such as high blood pressure, edema, and proteinuria in women after 20 weeks of pregnancy, which are transient and disappear after delivery.

It is a pregnancy-specific disease and is one of the main causes of maternal and perinatal illness and death.

"Hypertension during pregnancy?" Dr. Xiao Lin shook his head quickly, "Dr. Lu means that the patient is pregnant? It's impossible...it's absolutely impossible..."

Doctor Kobayashi's face was full of disbelief.

Lu Chen frowned and said, "The patient said that he hasn't menstruated for two or three months..."

Before he finished speaking, he was interrupted by Doctor Xiao Liulin.

"I know this. I asked her about it on the day she was admitted to the hospital. The patient had this situation before, and her menstruation was irregular. After she drank the traditional Chinese medicine, her menstruation became regular. Besides, if she is pregnant, can I not know? "

Director Yin Chao on the side was a little silent.

He recalled the entire medical history of the patient, and vaguely felt that Lu Chen's words seemed to make sense.

The patient has not had menstruation for two or three months.

In this case, the first consideration is not menstrual disorders, but the possibility of pregnancy!

The most important point is that in the urine routine of the patient, occult blood and urine protein were positive, and the blood pressure has not been lowered!

This is more in line with the characteristics of hypertension during pregnancy!

Clinical diagnosis requires bold guesses, doubts, and finally the test results speak for themselves.

Lu Chen pondered for a moment, then slowly said: "I don't deny that this may be caused by menstrual disorders, but I still suggest to improve some gynecological ultrasounds, and it is best to rule out pregnancy-induced hypertension."

In case, the patient is really hypertensive during pregnancy, she cannot use many drugs.

Involving such a multidisciplinary disease, the condition is often complex.

Because once the medicine is used incorrectly or overdose, causing fetal problems, it will be bad.

Doctor Xiao Lin turned his head to look at Li Yao who was beside him.

Li Yao said softly: "Dr. Lu's opinion is my opinion. I suggest improving gynecological ultrasound."

Dr. Xiao Lin wanted to say something more, but Yin Chao waved his hand and interrupted: "Xiao Lin, it is absolutely necessary for this patient to perfect the gynecological ultrasound. I will listen to Dr. Lu's opinion and arrange a gynecological ultrasound for her immediately. If there is any problem , and then ask the gynecologist for consultation."

Seeing that the director had said so, Dr. Xiao Lin could only nod his head.

He immediately left the doctor's office to communicate with the patient's family.

The only thing I can be thankful for now is that the attitude of this patient and his family members is relatively mild, and he has no idea of ​​having children.

The little girl next to her bed was adopted by her.

"Professor Li, we were negligent in this case."

After Dr. Xiao Lin left, Yin Chao said to Li Yao, "The patient himself said that he had irregular menstruation, had taken traditional Chinese medicine, and had no childbirth history. We didn't think about high blood pressure during pregnancy at all."

The common secondary hypertension is mainly coarctation of the aorta, renal artery stenosis, adrenoma, etc. Few people think about hypertension during pregnancy.

Clinically, the doctor's judgment is easily affected by various factors.

For example, many patients with dyspnea came to the hospital and said that they had emphysema before. After half a day of treatment according to the lungs, they were not cured at all, but it was finally found that they were heart failure!
Therefore, how to correctly extract useful information from the medical history is very important.

……

The first patient was an episode.

However, after some analysis by Lu Chen, this case, which has not been diagnosed for three days, already has some clues.

The doctors in the Cardiology Department of Feng M County began to pay attention to this young doctor.

At first, everyone thought that Lu Chen was just here to make up the numbers.

After all, no one pays attention to a fresh graduate student.

But now, even Yin Chao was a little impressed.

Sure enough, Professor Li Yao is not aimless!
Her postgraduate student really has two brushes.

As for Li Yao, she thought that Lu Chen would have some stage fright.

But so far, she is quite satisfied with Lu Chen's performance.

……

Li Yao came to the Department of Cardiology on this trip to prepare for teaching rounds.

However, the patient in the teaching rounds was not this hypertensive patient, but someone else.

"Professor Li, shall we start teaching rounds?"

Seeing that it was getting late, Yin Chao asked Li Yao.

"Okay." Li Yao nodded.

Teaching ward rounds, as the name suggests, are conducted by superior physicians with all doctors to conduct ward rounds on patients.

Generally speaking, the form of this kind of teaching ward rounds is very standardized, and the patients in the ward rounds are also difficult cases.

"Professor Li, this is the medical record of this teaching round."

Wang Zhitao, another attending doctor of the Department of Cardiology, has prepared all the medical records.

Li Yao took the medical record with a smile, read it carefully, and handed it to Lu Chen.

Lu Chen also took the medical records curiously.

It was the first time he encountered this kind of teaching rounds, and he looked rather curious.

This is a 41-year-old male patient.

Admitted to hospital due to "cardiac arrest".

There was no family history of sudden cardiac death, no history of smoking or drinking.

The patient's wife discovered that the patient was not responding to calls in bed at night. After calling the emergency number, the doctor gave defibrillation and cardiopulmonary resuscitation.

After about 33 minutes of cardiopulmonary resuscitation, the patient returned to spontaneous circulation.

Wang Zhi explained from the side: "Professor Li, this patient is living in our 25th bed, and his condition is basically stable, but we have not found out the cause of his cardiac arrest so far. We mobilized the patient to go to the higher-level hospital for examination, but at home Because of economic conditions, he refused to be transferred to a higher-level hospital."

Li Yao nodded: "Go see the patient first."

A group of people followed Li Yao to bed No. 25.

Li Yao conducted a comprehensive medical history inquiry and physical examination on the patient.

"Are the myocardial enzymes and ions of the patient normal after admission?" Li Yao asked.

"Normal." Wang Zhidao, "In addition, the echocardiography showed no abnormalities in the size of the atria and ventricular chambers, LVEF was 65%, the valve movement function was normal, and there was no abnormality in the wall motion. Chest CTA showed no obvious abnormalities."

Lu Chen frowned.

The life value on the patient's head is 68, indicating that he is out of danger.

However, the results of echocardiography, laboratory tests, and CT are all normal, and the common causes of cardiac arrest such as myocardial infarction and cardiomyopathy can basically be ruled out.

Immediately afterwards, Li Yao asked a few more questions.

For example, the common causes of cardiac arrest, the possible diagnosis of the patient and the treatment measures are currently being considered.

All the doctors from the Cardiology Department of Fengm County answered one by one, but obviously none of them met Li Yao's wishes.

Go back to the doctor's office.

"What about the electrocardiogram after admission?" Li Yao asked.

"Here." Wang Zhi took out all the electrocardiograms taken before and after the patient, and there were five copies in total.

Li Yao frowned, "After doing so many electrocardiograms, what problems did you analyze?"

"This..." Wang Zhi paused.Then he scratched his head embarrassingly, "No."

Fan Zhiping, the only deputy director in the department who is good at reading ECG, has already gone to study.

Li Yao sighed slightly in her heart, and she handed the electrocardiogram to Lu Chen.

Lu Chen took the five ECGs.

After careful comparison, he found something abnormal, "There should be a broken QRS wave and early repolarization J wave."

Yin Chao looked at Lu Chen with a surprised expression.

Good guy, just take a look and you will find the problem?

　The real case of the county-level hospital below shows that the patient finally had an abortion and his blood pressure returned to normal.

　　
　
(End of this chapter)