I can see health

Chapter 744

It took Lu Chen about 10 minutes to walk back to the apartment for single talents.

He is the deputy chief physician now, and he doesn't need to stay in the department all the time.

The time to commute to and from get off work is also relatively free.

If this was placed during his Ph.D. reading time, and if it took him 10 minutes to get home at noon, then there was no need for him to go back.

After coming and going, it may take less than ten minutes to rest before I have to go to the hospital again.

Now Lu Chen can boldly go back to the apartment, and even enjoy the scenery on the way.

Back in the community, it was peaceful. Most of the people didn't come back, they were all taking a lunch break at work.

The apartment that Lu Chen returned to alone looked very leisurely.

It's quiet on the opposite side and upstairs, and they probably haven't come back.
Lu Chen brewed a cup of tea, found the latest papers, and began to read them.

It is Lu Chen's habit to maintain a certain amount of reading every day.

And, whether it's from the cardiology department or not, he will take a look at it.

He didn't lie back in his bedroom until he was tired of watching, and prepared to take a half-hour lunch break before going to work.

Lu Chen smiled slightly, could he be living the life of a retired director ahead of schedule?
……

in the afternoon.

Lu Chen stepped on the spot and came to the second area of ​​the heart.

This surprised Jin Miao, because none of the senior doctors from the other groups came at this time.

The senior physicians in other groups will not be so punctual, and may stay in the department for a while before leaving.

Lu Chen was one of the earlier ones.

After returning to the lounge and putting on his white coat, he sat firmly in front of the computer and continued to familiarize himself with the hospital's medical records and doctor's order system.

He will go out to the clinic tomorrow, so Lu Chen has to get acquainted as soon as possible.

Jin Miao didn't pay too much attention to the early morning, he had a lot to do!
It is not an ordinary job to not only admit new patients, but also adjust the treatment plan of old patients.

However, Jin Miao has a lot of students, including regular trainees, graduate students, and interns. With these free labor, he can handle it.

In addition, Jin Miao also made an appointment for a cardiac MRI examination for the patient with elevated "myocardial enzymes".

Waiting for the results to return, it is possible to judge whether the patient is myocarditis.

Lu Chen can occasionally guide Jin Miao and earn a small amount of gratitude.

However, in the current system mall, the thank you value needed to redeem skill cards can easily be tens of thousands or 10,000+.

The gratitude value obtained from students is already insignificant.

On the other hand, Lu Chen is now the deputy chief physician. When most medical students encounter questions they don't understand, the first thing they consider is to ask the attending doctors.

Therefore, except for Jin Miao who occasionally asked Lu Chen to discuss a few issues, there were very few students who came to ask Lu Chen questions.

This channel for obtaining gratitude is blocked!
This made Lu Chen quite melancholy!

……

However, Lu Chen couldn't be idle after all.

At three o'clock in the afternoon, Lu Chen got familiar with the medical record system, and when he was about to take a break, Jin Miao ran into the doctor's office with small steps.

He came to Lu Chen and said, "Director Lu, a patient who came this morning had a heart attack!"

He took an electrocardiogram in his hand and handed it to Lu Chen.

Lu Chen looked down.

This EKG is also really problematic.

ST-segment elevation in the anteroseptal leads suggests myocardial infarction.

Ordinary patients, Jin Miao would not take the initiative to find Lu Chen.

Unless the illness is serious or complicated, he will take the initiative to find the superior doctor.

And the patient in front of him belongs to the category of serious illness.

Even if he can treat patients, he still has to fulfill his obligation to inform.

"What are the symptoms of the patient?" Lu Chen asked.

"It's mainly chest tightness, no obvious chest pain." Jin Miao thought for a while and briefly described the patient's condition.

The patient is a 60-year-old woman who has had chest tightness for 4 days. She feels uncomfortable when she walks. She just needs to sit down and rest for a few minutes.

The children in the family are busy, so I didn't take it seriously at first, but I didn't expect it to get worse.

Now when I lie down, I feel bored, suffocated, cough, and don't like to eat.

Only then did she agree to ask her wife to bring her to the hospital for a look.

"The patient said that he had gastritis, bile reflux, and old cold legs. He usually just took some painkillers, but he never had a heart attack."

Lu Chen nodded slightly, "What about other risk factors for coronary heart disease?"

Jin Miao answered eloquently: "Except for age, high blood pressure, diabetes, dyslipidemia, obesity, smoking, drinking, and family history have nothing to do with her. The heart examination is generally normal, and there are a few rales on lung auscultation."

While listening to the narration, Lu Chen flipped through the patient's examination and test results.

Blood routine: WBC 11.13×109/L, neutrophil percentage 86.5%, neutrophil absolute value 9.63×109/L, hemoglobin 131g/L.

Myocardial injury markers: Troponin T (cTNT) 42.2ng/L (0-14ng/L).

Brain natriuretic peptide (BNP): 12723pg/mL (<100pg/mL).

There were no obvious abnormalities in biochemistry, coagulation function, and thyroid function.

Jin Miao continued: "The increase in troponin T is not as high as expected, but the increase in BNP is particularly obvious."

Lu Chen thought for a while, and then said: "Severe heart failure can also cause a slight increase in troponin, which may be ischemic cardiomyopathy. First, basic treatment for coronary heart disease will be performed to improve heart function, and then a color Doppler ultrasound will be arranged. Elective coronary angiography."

Even considering acute myocardial infarction, the patient missed the best time for surgery—within 12 hours of onset, the patient's heart is now extremely fragile, like a mass of tofu.

If coronary intervention is performed now, it is easy to puncture the heart.

Therefore, we can only wait for the patient's heart function to recover and make the heart stronger before performing coronary interventional surgery.

Jin Miao agreed with Lu Chen, "I'll go and communicate with the patient's family."

……

Just when Lu Chen felt that everything was in order, the patient's condition suddenly took a turn for the worse.

At around four o'clock in the afternoon, the patient suddenly developed nausea and vomiting. The vomitus was like coffee grounds, and the vomitus occult blood test was positive.

Lu Chen immediately ordered Jin Miao to check the blood routine again.

The patient's hemoglobin dropped from 125g/L to 100g/L.

Is it upper gastrointestinal bleeding?

"This is a big trouble!" Jin Miao walked up to Lu Chen.

Lu Chen frowned deeply.

To avoid rats, it is necessary to fast and rehydrate, but also to take into account heart function, and to stop using antiplatelet drugs.

Coronary heart disease is a thrombus, which is contradictory to the treatment of gastrointestinal bleeding!

Coronary angiography has become nowhere in sight!
Lu Chen recalled that he had seen cases of gastrointestinal bleeding after taking aspirin before, but most of them had the basis of gastrointestinal tumors and peptic ulcers.

"He used to have gastritis, bile reflux, and old cold legs..."

In Lu Chen's mind, he suddenly remembered what Jin Miao had just said when he explained the medical history.

The foundation of the digestive system is indeed not good, and then there is "old cold legs", which is another "folk diagnosis".

However, no detail can be missed.

Lu Chen looked at Jin Miao, "I'll go with you to see the patient again."

(End of this chapter)