This doctor is great

Chapter 50 Patent foramen ovale...

This elderly patient has such exaggerated varicose veins, so there must be a lot of thrombus.

Because varicose veins will make the blood flow poor, and then in the veins, especially in the vein valves, blood clots are easy to form, and this blood clot is - thrombus.

There is another corroboration.

The legs of the elderly patients are edematous.

There are many reasons for lower extremity edema, one of which is that there are many thrombus, the blood flow is not smooth, and the excess blood will seep into the subcutaneous soft tissue, which is manifested as edema.

Therefore,
Based on the above factors, varicose veins + thrombus + edema, it is speculated that the elderly patients have a high probability of pulmonary embolism.

Emergency doctor Cao Yun said: "We considered pulmonary embolism, so we did a bedside color Doppler ultrasound."

"Our emergency department specially invited a B-ultrasound teacher to come over, and then performed a bedside color ultrasound for the patient..."

Bedside ultrasound,

Zhou Mo's heart skipped a beat.

This thing is a little smaller than ordinary color Doppler ultrasound, and the cardiology department also has one, but few people know how to use it.

"Can you learn it yourself?"

"See if you can master the technology of bedside color ultrasound?"

"In this case, wouldn't it be much easier for me to diagnose patients in the future?"

Cardiac color Doppler ultrasound can measure blood flow and organic changes in the human body, and it is very useful in cardiology.

"Go back and find the "Instruction Manual"..."

Temporarily suppressing this thought, Zhou Mo continued to listen to the emergency doctor Cao Yun.

Cao Yun: "Unfortunately, after the bedside color ultrasound diagnosis by the B-ultrasound teacher, the patient did not have pulmonary embolism, and the blood flow is completely fine..."

No pulmonary embolism?
Chen Bing: "..."

Zhou Mo: "..."

Zhang Yang: "..."

To be honest, when the three of them heard about the patient's condition, without exception, their first reaction was pulmonary embolism.

Senior Brother Chen Bing: "Have you done a color Doppler ultrasound for your lower limbs?"

Cao Yun in the emergency department: "It has been done... It shows that there are many thrombi, up to 18 thrombi..."

hiss~~~
18 places!
Too much!
If one falls out at random, the life may be gone.

Senior Brother Chen Bing couldn't help asking: "Could the B-ultrasound not see clearly? There are so many blood clots, how could there be no pulmonary embolism?"

The thrombus goes all the way up the blood, and first enters the right atrium and right ventricle of the heart through the inferior vena cava. During this process, the thrombus is relatively small and can definitely pass through.

The thrombus travels all the way to the pulmonary artery and then into the pulmonary capillaries...

At this time, because the capillary is too small, the thrombus will definitely block a part, and then cause some part of lung function damage.

This is a pulmonary embolism.

(A book friend posted a picture of the blood circulation in the human body?)
Therefore,
Generally, if there is a thrombus in the lower extremities, the first (and only) one that will embolize must be the lungs!
It cannot reach the brain, nor can it reach other parts of the human body, because the thrombus is blocked by the capillaries in the lungs and cannot enter the next location.

So everyone will invariably think of pulmonary embolism.

Instead of thinking about cerebral embolism, other embolisms...

Emergency doctor Cao Yun shook his head: "At that time we also thought so, and felt that it was unlikely that there was no pulmonary embolism, so I asked the B-ultrasound teacher to read it a few more times... The results are still very good, and there is no pulmonary embolism."

Chen Bing pondered.

Zhang Yang: "Why don't you go for a CT scan, the lungs, the head, all done, if there is any problem, it will come out right away..."

Cao Yun shook his head: "No, the patient's blood pressure is too low and he is still on a ventilator, so he dare not go for CT at all, for fear of accidents along the way...I want to go to the ICU now..."

Chen Bing nodded: "Yes, I can't do CT..."

Zhou Mo: "Wait a minute, I have a question. Why did the patient suddenly have low blood pressure 10 minutes ago (when Chen Bing was called to the emergency room for consultation)? It doesn't make sense. It doesn't matter what kind of cerebral infarction, cerebral embolism, or pulmonary embolism. causing hypotension..."

Chen Bing caught a flash of inspiration: "Yes, what's the matter with low blood pressure? Is it heart failure?"

Cao Yun nodded: "We also consider heart failure, because if the patient has a stroke, it will cause certain breathing disorders, and then cause low blood oxygen. When the blood oxygen is low, the heart will increase the power, and then the high power for a long time, It can cause heart failure..."

Chen Bing: "Have you done the arterial blood gas analysis?"

Cao Yun wiped his sweat: "Not yet..."

I was busy with rescue just now, and then Chen Bing came, and I forgot all of a sudden.

Arterial blood gas analysis should be the fastest way to detect heart failure.

Chen Bing: "Go for an arterial blood gas analysis... I suspect it's heart failure..."

The nurse quickly took arterial blood.

"You can give mannitol empirically."

"Correct!"

Zhou Mo stood aside and didn't speak.

In fact, heart failure is not the point now, the point is to understand what happened to the old man's head.

Because the cause is in the head, if it is not resolved, the heart failure will continue next time (if it was really heart failure more than ten minutes ago).

Zhou Mo suddenly thought of a disease, and couldn't help asking, "Have you had a heart ultrasound?"

Cao Yun nodded: "I have done it..."

Zhou Mo frowned suddenly: "Didn't you find anything?"

Chen Bing glanced at Zhou Mo: "Did you think of something?"

Zhou Mo expressed his thoughts: "I suspect it's a disease—a patent foramen ovale."

Note: patent foramen ovale: the left atrium and right atrium are close to each other (located in the upper part of the heart), and they are not connected under normal circumstances, but there is a foramen ovale between the left and right atria during the fetal period. It closes gradually after birth.

If the "foramen ovale" is not closed, it is "patent foramen ovale".

Some adults also have this.

Zhou Mo expressed his thoughts: "If the patient has a patent foramen ovale, the thrombus can completely skip the pulmonary capillaries, from the right atrium --> foramen ovale --> left atrium --> left ventricle --> —> High pressure pumped into the aorta of the heart —> Reaching the cerebral artery —> Leading to cerebral embolism and further cerebral infarction!!”

Everyone listens.

Immediately, his eyes lit up.

"It's really possible!"

"Makes sense..."

"If this is the case, it will indeed lead to cerebral thrombosis, and then ischemic infarction..."

"There are so many blood clots in the patient's lower limbs, plus a "patent foramen ovale", it is really possible to have cerebral thrombosis! "

"It feels like this should be the real cause!"

"Although the B-ultrasound teacher has done a color ultrasound of the heart, but if you don't take it seriously, you may really ignore it..."

"How about I go and call the B-ultrasound teacher?"

"Go quickly..."

quickly,

About 8 minutes,

The B-ultrasound teacher came quickly.

"A patent foramen ovale? I rarely see this..."

The B-ultrasound teacher is excited!

quickly,

Color Doppler ultrasound results came out.

Make sure - the foramen ovale is not closed! !
"God!"

"It turned out to be true!"

"That makes sense..."

Everyone looked at Zhou Mo in unison, and their eyes suddenly changed.

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ps: It's a bit troublesome to write the reasoning of the disease... It's not as fast as the water comes every day...

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(End of this chapter)