I can see health

Chapter 442 Trap (Second Update)

Lu Chen took the electrocardiogram.

There are a total of five electrocardiograms, which were completed before and after the onset of the patient's illness.

At this time, Sun Guoguo's voice came from beside his ear.

"Junior brother, this is the patient who came yesterday."

"A young female, 22 years old, had repeated heart palpitations for 1 month, and was admitted to the hospital after 2 days of aggravation."

"In the past, a boy was born one month ago, and he denied family genetic medical history."

……

The patient's medical history is very simple, only a few simple sentences.

Lu Chen focused on the electrocardiogram.

"At present, the patient has repeated ventricular tachycardia and ventricular fibrillation, and amiodarone, lidocaine, and cardioversion have been given rescue treatments, but the condition still has not improved significantly."

Saying that, Sun Guoguo sighed, and said, "She just gave birth, and I don't know if she can make it through, it's so pitiful."

Lu Chen sighed slightly in his heart, but didn't say anything, and continued to study the electrocardiogram in front of him.

The electrocardiogram before the onset of the patient's onset showed normal sinus rhythm with occasional premature ventricular beats.

However, the electrocardiogram at the time of the onset was all ventricular fibrillation or ventricular tachycardia.

"Senior Sister, what do you think about this ECG?" Lu Chen put down the ECG and looked up at Sun Guoguo.

"Well, the patient's electrolytes showed a low potassium level of 3.02umol/L, which may be the ventricular tachycardia and ventricular fibrillation caused by low potassium." Sun Guoguo said, "But the strange thing is that we actively replenished potassium, and after the potassium ion returned to normal , the patient's symptoms did not improve significantly, and ventricular fibrillation and ventricular tachycardia still occurred frequently."

Ventricular fibrillation is an extremely malignant arrhythmia, and continuous attacks are likely to lead to hemodynamics in the human body and even sudden death.

"Senior Sister, what medicine did you take?" Lu Chen paused.

"Amiodarone, lidocaine, these anti-arrhythmic drugs have been used." Sun Guoguo said, "In addition to this, he has also used electrical defibrillation many times."

Amiodarone, a very common broad-spectrum antiarrhythmic drug in cardiology.

In other words, more than 95% of clinical arrhythmias, whether ventricular or atrial arrhythmias, can be treated with amiodarone.

The drug has a wide range of indications and the effect is not bad, so amiodarone is a panacea drug in clinical practice.

So much so that in the medical examination questions, there is an option of amiodarone, which can basically be selected, and the correct rate is extremely high.

However, Lu Chen pondered for a moment, frowned and said, "Senior Sister, you may have used the wrong medicine!"

"Huh?" Sun Guoguo was slightly taken aback, "What medicine is wrong?"

"Amiodarone!" Lu Chen's words made Sun Guoguo startled.

Amiodarone wrong?

Is it wrong to use amiodarone for patients with ventricular fibrillation and ventricular tachycardia?

Sun Guoguo picked up the electrocardiogram and compared it carefully, but still found nothing abnormal.

At this time, Lu Chen's voice came again: "Senior sister, look at this electrocardiogram, is there something abnormal about the patient's QT interval?"

"QT interval..." Sun Guoguo muttered silently, then shifted his gaze to the QT interval of the electrocardiogram, "This QT interval seems a bit long?"

Seeing this, Sun Guoguo was suddenly stunned.

Could it be the ventricular tachycardia caused by prolonged QT interval?
That is TDP (torsades de pointes)!

Seeing Sun Guoguo's expression, Lu Chen knew that she had thought of this.

"Sister, this electrocardiogram, I think it is probably the TDP caused by the long QT interval!"

There are many types of VT.

Most ventricular tachycardia and ventricular fibrillation can be treated with amiodarone.

Only the ventricular tachycardia caused by long QT interval is the contraindication to the use of amiodarone!

In this case, amiodarone should not be used.

Amiodarone can further prolong the QT interval and aggravate the patient's condition.

Thinking of this, a trace of cold sweat broke out on Sun Guoguo's forehead.

She didn't think about this at first, but after Lu Chen mentioned it, she immediately figured it out.

They all defaulted to conventional ventricular tachycardia and ventricular fibrillation before, but ignored the fact that long QT intervals lead to ventricular tachycardia!

I used the medicine for a day, but I used it wrong!
Not only is there no therapeutic effect, but it may aggravate the condition.

"Xiao Fang, hurry up and ask the nurse to stop the amiodarone pumped into bed 31! Then use magnesium sulfate!" Sun Guoguo hurriedly said to the interns beside him, "Forget it, I'll go in person!"

TDP requires not only potassium supplementation, but also magnesium sulfate, a polarizing solution, to fight against arrhythmia!

After speaking, Sun Guoguo left the office in a hurry.

Lu Chen put down the electrocardiogram in his hand and followed closely behind.

……

in the ward.

Sun Guoguo was instructing the nurses in the ward to stop amiodarone and give magnesium sulfate while supplementing potassium.

"Doctor, why do you want to stop this drug?" The patient's husband asked nervously.

"Because of the illness, I will explain to you later." Sun Guoguo said.

At the same time, Lu Chen also came to the ward.

In his eyes, the life value on the patient's head is 38 (----)!
Drug treatment has been continued, but the trend of the patient's life value is still three minus signs.

This shows that the drugs currently used may not have any effect.

After the nurse changed the patient's medicine, the patient's husband left the ward with Sun Guoguo.

……

In the corridor of the ward.

Sun Guoguo patiently explained the condition to the patient's husband.

"Doctor, are you saying that my wife's arrhythmia is relatively rare?" the man said.

Sun Guoguo nodded and said, "Well, amiodarone can be used for normal ventricular tachycardia and ventricular fibrillation, but your wife's arrhythmia is relatively rare, so amiodarone cannot be used, and the risk of sudden death is extremely high!"

As soon as the words fell, the patient's husband "plopped" and knelt down.

His eyes were already red, and he tightly pulled on the cuffs of Sun Guoguo's white coat, and there was a trace of crying in his hoarse voice: "Doctor, please, save my wife! I will repay you as a cow and a horse. "

Sun Guoguo hurried forward and grabbed the patient, "Don't do this, we will definitely do our best!"

Lu Chen also turned his face away, feeling a little uncomfortable in his heart.

Even though he was used to seeing life and death in the hospital, he still felt a little uncomfortable seeing such a scene.

"It's my fault!" The patient's husband was still kneeling, holding his hair tightly with one hand, "It's my fault! She is usually in poor health, and I insist on letting her have a child, yes I'm not good!"

The man's emotions seemed to erupt like a flood, and a feeling of regret and grief spread in his heart.

Sun Guoguo was at a loss for a while.

Seeing this, Lu Chen stepped forward, grabbed the man's arms, pulled him up, and said seriously: "Now is not the time for you to be sad! You need to be by the patient's side for 24 hours. If there is any change, you must inform the medical staff at any time."

Although nurses will often make rounds, it is impossible to accompany the nurse at the bedside 24 hours a day.

The man silently wiped away his tears, and finally stopped kneeling.

He nodded fiercely, looked at Lu Chen and Sun Guoguo, "Thank you doctor!"

Then, with heavy steps, he turned and walked towards the ward.

……

Go back to the doctor's office.

Sun Guoguo breathed a sigh of relief, and looked at Lu Chen gratefully, "Junior Brother, thank you."

At the same time, her eyes were a little sad.

Lu Chen said: "Senior sister, don't think too much. This patient is young, so I think there should be hope."

"I hope." Sun Guoguo said softly.

The QT interval prolongation in this ECG is very subtle.

Many doctors in the department have seen it, but none of them can find it.

There is nothing wrong with conventional treatments.

It's just that no one could have imagined that behind the ventricular tachycardia, there was a bigger trap hidden.

(End of this chapter)