Since 1981 Health School

  Chapter 603 Ordinary Pain Kills

  Professor Tong is also welcome. People who are used to teachers still value this kind of teaching opportunity:

   "Okay, Dean Xiao Chen asked me, an old man, to discuss it with you. Everyone knows that myocardial infarction can cause acute coronary artery ischemia, which in turn leads to cardiac ischemia and hypoxia.

But what everyone does not know is that when the heart ischemic, the autonomic nervous system of the heart will be abnormal, which may stimulate the vagus ganglion in the ischemic area of ​​the lower wall of the heart, and the phenomenon of epigastric pain will appear. One reason.

   There is also a possibility that acute myocardial infarction leads to continuous coronary ischemia and hypoxia, which will cause myocardial necrosis, and clinically there is often severe and persistent retrosternal pain. Since the heart is located behind the sternum and close to the xiphoid process, it is easy to mistake it for upper abdominal pain when there is severe pain.

  Of course, the above two possibilities are just my guesses. I don’t know if Dr. Lan is satisfied, and I don’t know if Dean Xiao Chen has anything to add. "

  Actually, when Professor Tong was answering the question, Chen Qi remembered what happened to his grandmother in his previous life, and said with emotion:

"I have personally experienced a case where a gastroenterologist misdiagnosed myocardial infarction, which is what Professor Tong said. An old lady mistook it for stomach pain because of the pain at the junction between the chest and abdomen, and ran to the hospital. go to hospital.

  At that time, the doctor asked the old lady to go to the gastroenterology department. Most of the people present here are gastroenterologists. When you encounter patients with pain here, is the first thing that comes to your mind is stomach or duodenal pain? Do you think it is very simple?

The doctor who received the consultation thought so too, but the doctor did not ask carefully at all, because the old lady had a history of basic medical conditions such as hypertension, diabetes, hyperlipidemia, and coronary heart disease, and the old lady had already had History of two strokes.

This is a typical high-risk group, but because of the gastroenterologist's self-confidence and lack of an overall view in his mind, he only thinks about the diseases in the system he is in charge of, so the doctor prescribed some stomach medicine and asked the old lady to return home. home.

The results of it? The old lady saw a doctor in the morning, and died of a myocardial infarction in the afternoon. Don't you think it's a pity? It can even be said that this gastroenterologist has misdiagnosed. If it is a foreign country, this medical lawsuit will undoubtedly lose.

Think about it, if the doctor had been more careful at that time, asked more seriously, and had done an electrocardiogram and an emergency myocardial enzyme for the old lady, it was entirely possible for the old lady to detect myocardial infarction in advance, and she might have survived if treated in advance. Instead of waiting until the afternoon to die suddenly.

This case is a great tragedy, and it is completely avoidable. Therefore, when you see a doctor in the future, don’t simply dismiss the abdominal pain as enteritis or gastritis. Asking a few more questions is at best a waste of time, but Maybe you can save a life. "

  Chen Qi's example made the atmosphere in the small restaurant suddenly dull.

Many gastroenterologists are recalling that when they saw a doctor in the outpatient clinic, they encountered some patients who complained of stomach pain or stomach pain. They just prescribed some medicine and asked them to go home. They would not ask them to do electrocardiogram or Cardiac enzymes.

   And there are many such patients. In the gastroenterology department, more than half of the patients suffer from abdominal pain and stomach pain in one day. After one year or ten years, the number of patients will be hundreds or thousands?

  Among so many patients, how many may be patients with myocardial infarction?

   How many people lost an opportunity to detect in advance, and finally died suddenly at home or on the road?

  Thinking that many lives may have been lost in his hands, every doctor feels heavy and uncomfortable.

  Chen Qi also took a deep breath. Although he has been reborn in this world for 10 years, his previous life seems to be very far away, but it always reminds him of his relatives in the previous life inadvertently.

  Thinking of my grandma losing her last hope because of the doctor's misdiagnosis, I feel helpless and distressed.

  The silence at the banquet is definitely not a good thing, so Comrade Guo made a smooth game in time:

"Ah, Professor Tong, comrades from Xijing Hospital, and our colleagues from Yuezhong Hospital, everyone is now discussing academically, not pursuing responsibility. There is no need for everyone to cry. Doesn't it seem that we Yuezhong people can't entertain you? Zhou, hehehe..."

  After Yi Zewen became the chief of the emergency department, his EQ has been rising, and he hastily stood up at this time:

"Come on, it's a rare opportunity, because our emergency department encounters more acutely ill patients, and the time for us to identify them is shorter, so I would like to ask Dean Chen and Professor Tong, this myocardial infarction is not only manifested as retrosternal Besides pain, abdominal pain, stomach pain, are there any other atypical pains?"

  Chen Qi also came back to his senses at this time, put his longing for his relatives in his heart in his heart, and said with a smile:

   "Then there are many atypical pains. Many pains are unexpected, such as jaw and toothache. Yes, it is toothache. This is the most common type of atypical pain in myocardial infarction.

why? Because myocardial infarction often leads to myocardial ischemia or hypoxia, once the heart's blood supply or oxygen supply is insufficient, it will prompt the body to secrete acidic metabolites, which is called hypoxic pain.

  At this time, these metabolites stimulate the individual's sympathetic nerves very much, so the nerves will experience severe pain, and the nerve pain will spread to the jaw and teeth, mainly the gums.

  So patients often feel jaw or tooth pain, and once the pain is excessive, they may even faint. In the future, when you encounter patients whose toothache cannot be stopped after taking painkillers, you must pay close attention to it and ask them to take an ECG as soon as possible. "

   Oh~~~

  Many doctors nodded repeatedly. What Chen Qi said was based on experience, which was not written in the book, and it was very precious.

   At this time, Ma Xiaona also got excited and shouted: "Chen Qi, is there any other unexpected pain?"

  Chen Qi was already laughing at this time:

   "Yes, another common one is migraine. This is because if a person has a myocardial infarction, the blood supply to the heart will be blocked.

  The blood pressure of the brain is mainly supplied by the heart. Once the blood supply to the brain is insufficient, the blood vessels and nerves in the patient's head will be damaged. At this time, the patient will suffer from migraine due to vasospasm. "

  A young doctor from Xijing Hospital also raised his hand and said, "President Chen, are there any more?"

   "Also, you should also be careful when you have a sore throat. When a person often has a sore throat, it may also be caused by a myocardial infarction, because the heart and throat are controlled by the same spinal nerve and belong to the same nervous system.

  If the individual has a myocardial infarction, the segmental spinal nerve will also experience pain. At this time, the human body will secrete a large amount of polypeptide substances. Once these substances spread to the vagus nerve in the pharynx, throat pain will appear. "

  Everyone asked questions one by one, and Chen Qi answered one by one. The atmosphere at the scene became more and more enthusiastic.

  At this time, Yang Xiuxiu, a nurse in the emergency department, raised a sobering question:

"Dean Chen, you just taught us all kinds of atypical myocardial infarction pain, but now there is a problem, let alone atypical, even if it is a typical myocardial infarction, the patient himself knows that it may be a myocardial infarction. But if the patient is at home or at work and cannot get to the hospital in time, how should he save himself?"

  When this problem came up, many people slapped their thighs.

   "That's right, if it's at home, go to the neighbor's house and borrow a donkey cart to drive to the city, the corpse may be completely cold."

   The person who said this was a doctor from Xijing Hospital, with great Northwest characteristics.

"No, we Yuezhong people always take boats to see a doctor. The bigger ones are hand-cranked boats, and the smaller ones are awning boats. But no matter what kind of boat you roll from home to our People's Hospital, the precious time for emergency treatment is just that. wasted."

   It is a doctor from Yuezhong who said this. Yuezhong is a water town, and the main means of transportation for ordinary people is by boat.

"You are talking about the countryside or the countryside. Even in our city, how many people have to take the 120 emergency car? Patients with myocardial infarction must be sent to the hospital in a resting state. If they come to the hospital on foot or by bicycle, I'm afraid he died on the way."

  120 ambulance is not expensive, from Chen Qi's point of view, it is really not expensive.

  Because of your gasoline money and car depreciation costs, the labor costs of a driver, a doctor, and a nurse, the cost of rescue equipment and medicines on the road, it is normal to charge 10 yuan and 20 yuan for a trip.

   If you are going to the township, it will be more expensive.

  But from the common people's point of view, it is better to find a few neighbors and relatives to row a boat to the city to see a doctor if it costs more than 120 yuan.

   The question is, what is an emergency department? What is an acute illness? Where are you allowed to row a boat and ride a donkey cart slowly?

  If the patient dies suddenly, the golden rescue time is only 5 minutes.

  For example, in cardiac arrest, the success rate of CPR within one minute is over 90%, and if CPR rescue is performed within four minutes, the success rate of rescue is about 50%;

  If CPR rescue is started at about six minutes, the probability of success is about 10%;

  If no rescue is carried out within ten minutes, the probability of success is very small, close to 0.

  For a disease like myocardial infarction, if you are sent to the hospital before sudden death, there is still a possibility of survival. If you suffered a myocardial infarction at home and died suddenly on the spot, the possibility of being sent to the hospital for rescue is very small, even in 2023.

  In 2023, the family’s heartbeat and breathing stopped. In any case, the family members will call 120 and send them to the emergency department for final rescue, even if they are doing their duties as relatives.

   But in 1989, ordinary people died suddenly at home due to myocardial infarction, and almost no ordinary people sent patients to the hospital for emergency treatment.

  One is that the time is too late, and the other is that the common people are poor, and life and death are unimportant. If you die, you can only blame yourself for your bad luck.

  This is also the main reason why in the 1980s, there were few studies on coronary heart disease, or myocardial infarction, cerebral infarction or cerebral hemorrhage, few specialists, and few thought about treatment options and drugs.

   Because there is no "market".

  It is rare to encounter a few myocardial infarctions in a year, but your hospital has to prepare a set of myocardial infarction-related machines and medicines for this, which is a waste for the hospital and uneconomical in terms of cost.

  It’s the same reason why some people in later generations were bitten by snakes and hit a wall everywhere after being sent to the hospital, because not every hospital has prepared antivenom, the reason is the same.

  Why aren’t the hospitals ready? Because snake venom serum is very expensive, if no one uses it until it expires, the hospital will lose a lot of money, so the hospital is unwilling to reserve these drugs.

   This is the contradiction of an era.

  From a philosophical point of view, it is the contradiction between the people's growing material needs and the backward social productivity.

  From a medical point of view, it is the contradiction between the people's growing health needs and backward medical technology.

   But this problem cannot be solved by Chen Qi, a small dean. It depends on the top-level design, and it also depends on the economic conditions. Without money, everything is empty.

  Chen Qi didn't want to answer Ma Xiaona's question at first, because some of the words he wanted to say might be relatively advanced, and he would lose his words if he said too much.

  But seeing everyone's trusting eyes on him, as well as their desire for new technology and new knowledge, Chen Qi felt that he was too ashamed of these colleagues for not saying anything.

   "Okay, since everyone wants me to talk about it, I will talk about it, but what I said is still in the clinical research stage, and it may not be accurate. I will give you a reference, that is, how do patients with myocardial infarction help themselves at home?

When a myocardial infarction occurs, the blood vessels are often occluded. At this time, chest compressions, epinephrine or other cardiotonic injections are ineffective. Therefore, some foreign experts have proposed a new concept in private, that is, Called 'a pack of medicine'.

  What is a pack of medicine? There are often three ingredients in it: aspirin, clopidogrel and atorvastatin; it may also be a combination of aspirin, ticagrelor and atorvastatin. "

   Speaking of this, Chen Qi looked around the scene and found that everyone's eyes were blurred, with obvious stupidity in the clarity.

  Chen Qi knows it well. Everyone knows about aspirin. It is estimated that clopidogrel, ticagrelor, atorvastatin, rosuvastatin and other drugs have not been invented yet, or have not attracted attention in China.

   This is where Chen Qi worries, and where his knowledge is advanced.

   Now that the story is over, he is willing to go all out.

  After all, medicine does not study military industry, or study materials or chips, so it will not attract the attention of relevant state departments and arrest him as a walking 500,000.

"It doesn't matter if you haven't heard of these drugs. They are all imported from abroad, and they will also cause domestic problems in the future, so you just need to remember this concept. For example, aspirin and ticagrelor are anti-platelet drugs, and rosuvastatin and ticagrelor are anti-platelet drugs. Atorvastatin is a lipid-lowering and plaque-stabilizing drug.

When a myocardial infarction occurs, chew aspirin or ticagrelor immediately, because it can be quickly absorbed by the body, quickly inhibit platelets, dilate blood vessels, and effectively relieve various symptoms such as angina pectoris, which can reduce complications. , prolong the treatment time. "

  Oh~~~~ so amazing~~~~

  Chen Qi thought he was doing science popularization, but he didn’t expect that he had talked a lot about what happened abroad and what medicine they used, but he planted the idea of ​​going abroad to the doctors of Xijing Hospital.

If he knew that he had unknowingly become a "running dog lobbyist of the US emperor", he would also play the main theme when he was killed, scolding free America, how the **** was pressed by his knees and necks on the first day of the attack dead.

   But what Chen Qi didn't know was that the doctors at Yuezhong People's Hospital were very calm, because they had seen some foreign dignitaries, rich people, and ran to Yuezhong to see Chen Qi.

  It’s so good abroad, why don’t people go to Vietnam for treatment instead?

   This also means that the level of our dean Chen has far surpassed that of developed countries such as the United States, Japan and Europe. His own dean is so good, why should he envy others?

  A good leader can make the atmosphere of the whole hospital flourish. This is the importance of choosing a leader.

  (end of this chapter)