I can see health

Chapter 880 Lu Chen who can't be the chief swordsman

At this moment, the resident doctor ran over in a hurry.

"Director Tian, ​​Professor Shi, the emergency department called just now. This patient is critical!"

Shi Langqin was taken aback for a moment, then immediately found a computer.

Turn on the inspection system.

The patient's laboratory indicators jumped out immediately.

“脑钠肽（BNP)>35 000pg/ml、尿素28mmol/L、血清肌酐175.0μmol/L、血钾6.55mmol/L。”

"Aspartate aminotransferase 2373IU/L, alanine aminotransferase 1788IU/L, total bilirubin 131.7μmol/L and direct bilirubin 90.4μmol/L."

"Arterial blood gas prompt: pH 7.288, carbon dioxide partial pressure 53mmHg, oxygen partial pressure 67mmHg (mask oxygen inhalation 6L/min), alkali residual -6.96mmol/L."

"Myocardial markers: myoglobin 152.30ng/ml, troponin 125.0ng/ml."

Serum potassium, liver function, blood gas analysis, and troponin are all critical values!

When everyone saw this test indicator, their eyelids couldn't help but twitch.

Lu Chen's face was serious. In his sight, the patient's health was dropping rapidly!

"In this case, we need dialysis first!" Director Tian couldn't help but said.

All organs are basically in a state of failure, and the cause is cardiogenic shock, which leads to insufficient blood supply to various organs.

"This kind of cardiogenic shock can't tolerate dialysis at all!" Shi Langqin immediately rejected Director Tian's idea, "If the cause of cardiogenic shock is not solved as soon as possible, any other operations will be unnecessary. The effect is also very poor!"

"Professor Shi, you mean...emergency surgery?!"

Director Tian's eyes widened.

This kind of patient is doing emergency surgery, basically putting himself on the fire!
Narrowly escaped patients, narrowly escaped surgery.

When the two meet, what are the chances of success in the end?

"What is the treatment willingness of the patient's family?" Shi Langqin continued.

"I have already communicated with the family members." Director Tian whispered, "The family members are very active in treatment, and they are not short of money. The only request is to allow the patient to live an extra month."

"Live one more month?" Shi Langqin frowned, "Why is there such a need?"

Director Tian said: "His family has a grandson who will get married next month, and I want him to leave after that."

Shi Langqin fell silent immediately, and looked at Lu Chen beside him.

At this time, Lu Chen had already changed into a white coat and performed a physical examination on the patient himself.

half an hour.

He just put down the stethoscope in his hand.

"Director Lu, how are you?" Shi Langqin asked hastily.

What he asked was naturally the patient's condition and the chance of surgery.

"Surgery can be done, but the risk is extremely high!" Lu Chen said in a deep voice, "We must discuss it clearly with the patient's family. Now we are a dead horse as a living doctor. If we can be saved, let alone a month, two months or even half a year." There is a period of survival. However, if you are not saved, you will explain it here tonight!"

"Director Lu, it's fine if you say you can perform the operation." Shi Langqin nodded, "Are you going to be the chief surgeon of this operation?"

Lu Chen smiled and shook his head: "I have resigned from Mayo now, and I don't have any position in the country. Although I have a doctor's license, practicing medicine outside the scope of the license is illegal!"

"Then... this operation..." Shi Langqin immediately retreated.

The source of all his confidence is Lu Chen.

Now considering Lu Chen's identity, it would be troublesome!
"Although I can't be on stage, I can guide."

Just as Shi Langqin was frowning, Lu Chen suddenly said again.

"The technique of this operation is not difficult. The key is that the shape of the valve is not known before the operation. There are many unknown factors. As long as this problem is solved, the operation will be simple."

"That's fine too!" Shi Langqin's eyes lit up, "Can you do esophageal ultrasound?"

"Yes!" Lu Chen nodded.

Lu Chen is right, most patients have similar blood vessel conditions.

The reason why this patient is complicated is mainly because there are too many underlying diseases and his physical condition is too poor, so he may not be able to tolerate surgery.

As for the difficulty of the operation itself, the main reason is that the patient's valve condition is unknown.

Generally speaking, before performing TAVR surgery, it is necessary to carry out detailed inspections on the patient's valves, such as CT and other examinations.

After a comprehensive analysis of the shape, leaflets, calcification, etc. of the valve, a detailed surgical plan is specified.

But now it is too late for this patient to go for CT.

The only way now is to do a transesophageal echocardiogram!

An excellent surgeon can judge the status of the valve through esophageal ultrasound.

During the operation, an esophageal ultrasound can be performed to clearly see the general condition of the patient's valve.

Upon hearing this, Shi Langqin turned his head and immediately said to Director Tian: "Director Tian, ​​please communicate with the patient again, just as Director Lu said just now, a dead horse is a living doctor!"

"This..." Director Tian glanced at Lu Chen, a trace of doubt flashed in his eyes, who is this person?

So young, only in his early thirties?
Why did Professor Shi Langqin listen to him so much?
Director Tian came to Guanghai from the north recently, so he doesn't know much about Lu Chen.

Even though he had heard of Lu Chen's name, he had never actually seen it.

"Go quickly, don't waste time!" Shi Langqin urged.

"Oh, well, I'll go now."

Seeing that Shi Langqin had given such orders, Director Tian put away his doubts and went to the doctor-patient communication room to communicate with the patient's family members.

……

5 minute later.

Director Tian trotted all the way back to the CCU ward.

"Ms. Shi, the patient's family bears the risk and agrees to the operation!"

Shi Langqin was refreshed, and immediately stood up and said, "Okay, notify the cath lab and prepare for the operation!"

Everyone immediately got busy.

Some doctors are contacting the cath lab, and some doctors are preparing patients for transfer.

Everyone split up and moved quickly.

The patient entered the operating room under the support of large doses of vasoactive drugs and IABP.

入室HR 109次/分，BP 80/40mmHg，SpO2（吸氧浓度50%）为92%。

The first step in today's surgery is not a puncture, but an esophageal echocardiogram.

To put it simply, the ultrasound probe is inserted deep into the esophagus until it reaches the level of the heart.

Through the ultrasound of the esophagus, the condition of the patient's heart can be seen more clearly.

Including the state of the valve, whether there is thrombus in the atrium, and so on.

"Director Lu, can we start?" Shi Langqin, as the chief surgeon, looked at Lu Chen who was beside him.

"Yes." Lu Chen nodded slightly.

Although the main operation cannot be done today, the transesophageal echocardiography is the focus of this operation.

The degree of difficulty and importance is no less than the valve delivery process of the entire operation.

……

Induction of general anesthesia was successful.

Place the TEE probe after induction.

Lu Chen began to manipulate the esophageal ultrasound and entered the patient's body.

When they reached the heart, an image appeared on the ultrasound screen immediately.

Lu Chen recorded the image content while operating.

"The aorta is widened, the ascending aorta is obvious, the aortic valve is bicuspid, and the valve leaflets are obviously thickened and calcified, and the opening is obviously restricted."

"The aortic valve area (Ava) was 0.5cm2, the peak aortic valve velocity (AV) was 12.33m/s, and the left ventricular ejection fraction (LVEF) was significantly reduced by 27.7%."

(End of this chapter)