I can see health

Chapter 35 Acute Left Heart Failure
"Junior brother, hurry up and push the electrocardiogram machine, come to bed 10!"

"receive."

Lu Chen immediately ran to the nurse's station and found an EKG machine in a corner.

Quickly unplug the charging plug of the electrocardiogram machine, find the blood pressure monitor in the drawer, then push the machine, and rush to the No. 10 hospital bed with the blood pressure monitor in hand.

Bed No. 10.

As soon as Lu Chen came in, he saw an old man sitting on the bed panting heavily.

The color of his head is bloody red!
The head of the bed has been shaken almost vertically to the ground.

The sweat on his forehead dripped down his cheeks, his expression was extremely restless, and his hands were waving wildly.

Sun Guoguo was already holding a stethoscope, quickly auscultating the old man for a physical examination.

At the same time, a nurse ran into the ward pushing the ambulance.

"Give the patient oxygen, and then push a furosemide, a breather!"

"Urgent blood check! Blood routine, kidney function, ions, BNP, myocardial enzymes, coagulation items and D-dimer"

Sun Guoguo began to give orders.

"Roger that!"

The nurse started dispensing the medicine immediately.

Lu Chen was not idle either, he immediately took out the blood pressure monitor to measure the patient's blood pressure.

The patient was agitated and had difficulty controlling his hands.

"Mother-in-law, please help me hold down a little bit."

The patient's family member is an old woman, and her son is not around, so she takes care of her wife and children alone.

The mother-in-law's body was still strong. She came to the bedside and reached out to hold the patient's palm.

"Old man, don't move around, the doctor wants to measure your blood pressure."

With the help of her mother-in-law, Lu Chen successfully measured the patient's blood pressure.

"Sister, the patient's blood pressure is 204/114mmHg!"

Sun Guoguo nodded, and immediately told the nurse: "Add 50ml of sugar and a bottle of sodium nitroprusside, and pump it intravenously at a speed of 5m/h."

"Roger that!"

The nurse has finished pushing the antidepressants and furosemide, and immediately starts to dispense new fluids.

"Senior sister, should I take an electrocardiogram for the patient?" Lu Chen asked from the side.

"Okay!" Sun Guoguo nodded in relief.

This little junior is quite clever, and he is not a rookie who doesn't know any clinical knowledge.

Because some graduate students spend all their internship time on postgraduate entrance examinations.

Although he passed the postgraduate entrance examination, he knew nothing about clinical practice.

There is a huge gap between book knowledge and clinical practice!
What's more, he can't even do an electrocardiogram or measure blood pressure!

Fortunately, Lu Chen is quite reliable, and he is very skilled in various operations.

……

Lu Chen quickly connected the lead wires of each limb to the chest lead.

However, the old man was sitting on the bed, with a thin body and dry skin, and the leads of the electrocardiogram machine were not easy to stick to.

"Mother-in-law, come and help me again, press the three leads here tightly, don't let go."

The old woman walked to the bed again, and her skinny old hand pressed the lead tightly.

On the screen of the electrocardiograph, the waveform of the electrocardiogram slowly turned on and stabilized.

"Okay, let's take a picture."

Sun Guoguo has been paying attention to the situation here.

In the case of a sudden illness in the cardiology department, an electrocardiogram is extremely necessary.

It can quickly help doctors judge the patient's condition.

Upon hearing this, Lu Chen immediately pressed the "Paper Out" button.

"Buzz...buzz..."

ECG completed.

Sun Guoguo took the ECG drawing, glanced at it, and put it down.

Good guy, extensive lead ST depression, severe myocardial ischemia.

"Nurse, push another furosemide!"

"Okay, received!"

As soon as Sun Guoguo finished issuing the oral doctor's order, the nurse would start to execute it immediately.

In just 5 minutes, Lu Chen could clearly feel that the old man on the bed was panting slowly, and his pale face regained a tinge of blood.

Sun Guoguo and the nurses present breathed a sigh of relief.

Heart failure, come fast, go fast!
"Junior brother, do you know what disease this patient just had?"

Sun Guoguo started the daily teaching part.

Teaching is a relatively important part of the tertiary hospitals.

Lu Chen recalled all the symptoms and signs of the patient.

Sitting upright, sweating profusely, short of breath.

Obvious moist rales could be heard in the lungs, and pitting edema of both lower extremities.

"Acute left heart failure." Lu Chen said, "The specific cause of heart failure may be a sudden increase in blood pressure, resulting in increased load."

Heart failure, that is, heart failure.

To put it simply, the heart has no strength to beat and cannot pump blood to the various organs and tissues of the body.

This has two main consequences.

First, various organs and tissues in the body suffer from ischemia and hypoxia, leading to functional failure.

Second, the blood that cannot be ejected will accumulate in the pulmonary circulation, causing acute pulmonary edema, which is often called acute left heart failure in medicine.

"Well, not bad." Sun Guoguo nodded, with a hint of appreciation in his eyes, "This patient is a typical acute left heart failure, so what are the principles of treatment for acute left heart failure?"

She wanted to see what level her young junior brother was at, exactly!
"The general principle is to strengthen the heart, diuresis, and dilate blood vessels." Lu Chen said, "In addition, there is oxygen inhalation. If necessary, morphine can be used for sedation, but attention should be paid to avoid respiratory depression."

"Well, not bad." Sun Guoguo smiled.

Strengthening the heart, diuresis, and dilating blood vessels, these are the three axes for the treatment of heart failure.

"What do the doctor's orders I asked the nurse to carry out correspond to?"

Lu Chen recalled all of Sun Guoguo's verbal medical orders just now.

Furosemide, asthma, sodium nitroprusside!

"Furosemide is a diuretic, Chuanding is an antiasthmatic, and sodium nitroprusside is a vasodilator!" Lu Chen replied seriously.

"Then why didn't I use heart-strengthening drugs?"

Sun Guoguo said to Lu Chen with a smile.

"Because among the three methods of strengthening the heart, diuresis, and dilation of blood vessels, diuresis is the most important, followed by dilation of blood vessels. Cardiac acupuncture is only suitable for use when the first two methods do not work or the effect is relatively poor!"

"Why is diuretic in the first place? Cardiopulmonary is the last?"

Sun Guoguo was going to get to the bottom of it.

Lu Chen frowned. This question seems to be difficult to explain with medical theoretical knowledge.

So, let's try another way of explaining it.

"Actually, heart failure can be likened to a donkey carrying cargo on a muddy path."

"The effect of diuresis is to reduce the load, which is equivalent to reducing the load on the donkey's back."

"The effect of dilating blood vessels is to dilate the moving and static blood vessels, which is equivalent to repairing the muddy path and making it easier for donkeys to walk."

"The effect of strengthening the heart is to enhance the contractility of the heart, which is equivalent to beating a donkey with a leather whip to make the donkey run faster."

"Comparing the three methods, we can know that although the third method of strengthening the heart can make the donkey run faster, it may cause long-term damage to the donkey and shorten its lifespan."

"The first method of diuresis is the method with the fastest effect and without too many side effects!"

After listening to Lu Chen finished speaking, Sun Guoguo's expression was very surprised.

Is Lu Chen really just a freshman in graduate school?

If she took off the mask at this time, Lu Chen would definitely see her opening her small mouth in shock.

Most people know "cardiac strengthening, diuresis, and blood vessel expansion", but they don't know the adaptability of each method.

Stimulant injection is very useful, but it is not the first choice, because it may increase the mortality of patients in long-term hospitalization.

"Congratulations, received a thank you value from Warwick +1!"

Suddenly receiving the notification sound from the system made Lu Chen look happy.

He looked at the system panel, and the system completion rate became 60%.

(End of this chapter)