I can see health

Chapter 680 Needle into the pericardium? (seek wave double monthly pass)
There is one hospital in Shanghai, one area in the heart.

The doctors in the department are already sitting together.

"Senior Sister Jiao, what kind of patient? Need so many of us to discuss?"

Lu Chen walked forward quickly.

"Look at the patients who were just admitted yesterday."

Jiao Jingqiu handed over the medical record, Lu Chen took it, and sat down to check it.

The attitude of everyone in the department towards Lu Chen has obviously improved a lot.

Originally, everyone was a little unhappy about the application for the fund project last time.

But because there was a pre-determined candidate, Lu Chen was able to break through the blockade of the pre-determined personnel just like this, which made everyone boast.

In addition, Lu Chen can understand the feelings of the attending doctors. Seeing a doctor cannot determine the future and destiny.

However, this fund project has affected everyone's promotion.

Lu Chen reconciled with the young attending doctors.

……

At this time, Jiao Jingqiu introduced from the side:

"One week before admission, the patient experienced sudden chest pain symptoms, accompanied by profuse sweating, chest pain, unable to lie down, and the symptoms continued without relief, so he went to the local hospital for treatment."

"Considering acute extensive anterior wall myocardial infarction and heart failure, conservative medical treatment was given, and echocardiography revealed a large amount of pericardial effusion."

"Pericardial puncture and drainage were given, and the daily drainage volume exceeded 500mL, which was bloody pericardial effusion. Afterwards, the patient's symptoms improved compared with before, but the pericardial effusion continued to flow out, so he came to our hospital for treatment."

After quickly flipping through the medical records, Lu Chen already had a simple understanding of the patient.

Summarize in one sentence.

That is, a large amount of pericardial effusion occurred after myocardial infarction, and 500ml of pericardial effusion continued to flow out every day.

Local hospitals can't handle it.

The patient was transferred from the hospital below to the First Hospital of Shanghai.

"We are wondering why the patient's pericardial effusion keeps increasing?" Jiao Jingqiu frowned.

Lu Chen didn't reply right away. He pondered for a moment and said, "Go and see the patient first."

"Okay." Jiao Jingqiu nodded slightly.

Other doctors who wanted to check the patient's condition also followed Jiao Jingqiu and Lu Chen to the bedside.

……

Beside the hospital bed.

The patient is a 40-year-old male.Lie on the bed in a semi-recumbent position.

There was a middle-aged woman sitting beside the hospital bed, who seemed to be his wife.

At this time, the life value on the patient's head is only 38 (——).

Jiao Jingqiu said to the family members of the patients on the side: "The doctors in our department come to see the patients together."

"Okay, thank you doctors."

With a grateful look on her face, the middle-aged woman hurriedly stood aside, giving up her seat beside the bed.

Lu Chen took the stethoscope and walked to the bedside.

No nonsense, just start the physical examination.

The patient is in a semi-recumbent position with clear mind and clear speech.

Blood pressure 100/60mmHg, a drainage tube can be seen in the 5th intercostal space on the mid-clavian line, coarse breath sounds in both lungs, a little moist rales can be heard in both lung bases, low heart sounds, regular heart rhythm, heart rate 80 beats/min, no murmur , flat and soft abdomen, no tenderness, no edema in both lower extremities.

"What's wrong with you now?"

"It hurts here...and stuffy." The patient pointed weakly at his chest, "I can't breathe out when I'm lying on my back, I feel like I'm about to suffocate."

Lu Chen nodded.

The patient presents with evident signs of a massive pericardial effusion.

Review the patient's current exams.

Electrocardiogram: sinus rhythm, rS type in leads V1-V6, T wave inversion, heart rate 80 beats/min.

Cardiac color Doppler ultrasound: left ventricular ejection fraction (LVEF) 38%, abnormal segmental motion of left ventricular wall (left ventricular anterior wall and apex myocardium thinning, decreased motion, apex bulges outwards, paradoxical movement can be seen in class), Pericardial effusion (massive), with echogenic drainage tubes seen in the pericardium.

After seeing the patient, Lu Chen was about to leave the ward.

Unexpectedly, the patient's wife followed behind everyone.

"What's the matter?" Jiao Jingqiu asked suspiciously.

"Doctor Jiao, should I listen to your discussion of the condition?" The patient's wife gritted her teeth, her face full of anxiety.

"No!" Jiao Jingqiu shook her head resolutely, "It is impossible for family members to participate in the disease discussion, but we will tell you the results of the disease discussion."

"This...well then." The patient's wife pursed her lips, "Dr. Jiao, you must save my wife. He is the pillar of the family. Without him, I really don't know what to do."

As he spoke, the eyes of the patient's wife were already red.

"We will do our best." Jiao Jingqiu said calmly, "But the patient's condition is critical and there is a risk of sudden death at any time."

"I, I know." The patient's wife lowered her head.

Lu Chen could already hear her soft sobbing.

Everyone just offered a little consolation, didn't have too much time to pay attention, and then left silently.

This kind of thing, we have seen too much.

Many doctors have become numb after seeing this situation.

……

Go back to the doctor's office.

Everyone temporarily formed a team to discuss the disease.

Jiao Jingqiu took the lead and said: "After admission, it is considered that the patient has persistent bloody pericardial effusion and mild anemia, so he is given single antiplatelet therapy temporarily."

"After admission, all immune items, tumor markers, and tuberculosis antibodies were checked and all were negative. Pericardial effusion caused by other reasons is not considered for the time being."

"So we finally focused on the heart itself. Given that the patient's blood pressure was not high, fluids were added every day as appropriate, and the drainage tube was clamped after the daily drainage volume was about 500mL."

"The most urgent question at present is what is the cause of the patient's pericardial effusion? Tumor? Tuberculosis? Rheumatism? Inflammatory stimulation after myocardial infarction? Or is it something else."

Jiao Jingqiu asked questions one after another.

Lu Chen frowned slightly.

In his opinion, this patient may not be so simple, and there are still many doubts.

At this time, an older doctor in Corey said: "Hemory pericardial effusion is more common in tumors and infections, and infection is more common in tuberculosis patients in developing countries."

"The chest CT of the patient outside the hospital did not show obvious tuberculosis, and tuberculosis-related tests were negative, and the patient has no relevant medical history, so the probability of directly suffering from tuberculous pericarditis is relatively small."

Jiao Jingqiu nodded slightly, "Temporarily rule out tuberculosis and rheumatic diseases."

"What I want to ask is, did he have a medical history of pericardial effusion before this myocardial infarction?" The veteran attending doctor asked again.

At this time, Jiao Jingqiu continued to speak: "The patient should have no pericardial effusion before. If there was pericardial effusion before, it will not be the only symptom of heart failure this time, and the patient has no symptoms of wheezing in the past."

"Well, it makes sense." The attending doctor nodded.

This possibility was also ruled out.

"Sister Jiao, what about the pericardial effusion caused by inflammatory stimulation after myocardial infarction? Is it possible?"

A very young attending doctor in Corey put forward his own ideas.

"Impossible." Jiao Jingqiu immediately vetoed it. "Pericarditis and pericardial effusion belong to post-myocardial infarction syndrome, but most of them are a small amount of transudate, and the color should be light yellow. A large amount of bloody pericardial effusion is extremely rare."

Discussions reached a deadlock for a while.

What are the causes of pericardial effusion?

At this moment, Jiao Jingqiu frowned, and said, "Actually, I've been thinking about a possibility, could it be that the puncture needle penetrated into the ventricle during pericardiocentesis?"

As soon as the voice fell, everyone was shocked and echoed.

　During the double monthly pass period, ask for a monthly pass.

　　Starting tomorrow, a five-day mini-holiday.

　　I'm the donkey of the production team, so voting is a matter of death.

　　
　
(End of this chapter)