Start From Emergency Doctor

Chapter 195

The reason why we don’t say 100% is because nothing can guarantee success.

The scalpel broke suddenly?

Is there a problem with the assistant?

Is the power out?

It can only be said that under all normal circumstances, Zhou Yuan’s operation cannot fail.

He Jianyi thought for a while: “It’s okay to have reperfusion therapy first. But on the side of heart bypass surgery, our emergency department doesn’t have bypass tools, so we have to go to the cardiovascular department to ask for it.”

How can a general heart bypass patient do it for an emergency doctor…it is normal if there is no corresponding equipment in the emergency department.

Zhou Yuan smiled.

Going to the Department of Cardiovascular Medicine to borrow tools will definitely cause them to spit out their jobs, and they will also suffer blindfolds.

This kind of work, Zhou Yuan, the culprit cannot go.

He glanced at He Jianyi and smiled knowingly: “Teacher, I have to be busy doing perfusion treatment for Qian Wei, or… you go?”

He Jian’s face was black.

Sure enough… this little rabbit bastard pushed himself out!

“I’ll go!” He Jian sighed.

My own disciple, no matter how bad the teacher is, I have to endure it.

“Teacher trouble.”

He Jianyi went to the Department of Cardiology and Zhou Yuan was preparing for perfusion therapy.

In the previous electrocardiogram, Qian Wei’s ST segment was obviously elevated. It can be judged that Qian Wei’s myocardial infarction was due to this reason.

The perfusion therapy is the most important treatment for acute ST-segment elevation myocardial infarction.

Open and occlude the coronary arteries within 12 hours of onset, restore blood flow, reduce the area of myocardial infarction and reduce death. The sooner the coronary artery is recanalized, the greater the patient benefit.

Therefore, all patients with acute ST-segment elevation myocardial infarction must be diagnosed as soon as possible after treatment, and the strategy of reperfusion therapy must be made as soon as possible.

The so-called reperfusion therapy is a method in which the completely occluded blood vessels are reopened through thrombolytic drugs, interventional therapy or surgical treatment, and the ischemic tissue is reperfused.

Since interventional therapy is not suitable for left main disease and the patient is very concerned about the cost, Zhou Yuan chose to use thrombolytic drugs for reperfusion therapy.

This method is widely applicable, easy to implement, and cheap.

The method of thrombolytic therapy is very simple, through intravenous injection, systemic or selective administration of thrombolytic drugs urokinase, streptokinase and so on.

However, thrombolytic therapy has many contraindications, such as intracranial hemorrhage, cerebrovascular injury, occurrence of aortic dissection, and so on.(Read more @ wuxiax.com)

You must wait for Qian Wei’s past medical history to be clear and the examination results to come out before you can start doing it.

“Make another brain angiogram.” This is to prevent brain diseases from happening.

Soon, everything turned out to be normal. Qian Wei had no other symptoms except acute myocardial infarction, so after simple preparation and treatment, he started intravenous injection of thrombolytic drugs.

After the drug was given, Zhou Yuan was about to leave, and Qian Wei, who had been silent for a long time, suddenly spoke.

“Doctor Zhou, can I ask you a few questions…”

Zhou Yuan stopped, “What’s the problem.”

“Can you explain my illness. I have never had a heart problem. Why do I have to undergo heart surgery suddenly?”

Qian Wei didn’t believe in doctors, but simply didn’t understand.

Zhou Yuan nodded and explained: “Your acute myocardial infarction is caused by the left main stem disease. The so-called left main stem disease refers to the degree of stenosis of the left main stem of coronary angiography greater than or equal to 50%, and your blood vessels The degree of stenosis has reached 80%, and surgery must be performed…”

“It’s like a traffic jam. If the road is blocked, you can take an overpass. If the blood vessel in the heart is blocked, you can also build a bridge to allow the blood flow to bypass. This is heart bypass surgery.”

“To put it more rigorously, it is to establish a channel at the proximal and distal ends of the coronary artery stenosis, allowing blood to bypass the stenosis and reach the distal end, thereby restoring the blood supply of the coronary arteries.”

Qian Wei thought about it for a while. After understanding it, he nodded and said with some embarrassment: “You said that the cost of heart bypass surgery ranges from 40,000 to 100,000… Can it be as cheap as possible? I don’t want to drag the whole thing down by myself family!”

Qian Wei said, “Why is there such a big difference? Can you choose the cheapest one as far as possible and help me perform surgery for only 40,000 yuan!”

It took Qian Wei so hard for so many years to bring his family to the city. At this juncture, he just finished buying the house. Where did he spend so much money…

Zhou Yuan hesitated for a while, and explained: “There are three main reasons for the difference in cost. The first is the number of bridges. For example, if you take a bridge with three blood vessels, it will definitely cost more than one blood vessel. .”

“Second, it is the way of performing heart bypass surgery. The heart stops beating and the bridge is bypassed. Because the cardiopulmonary bypass needs to be established, it needs to be transferred, and the cost is higher than the non-stop bypassing… Of course, it is not necessary to stop the beating. Heart bypass depends on the degree of blockage in your blood vessels, and no one can do it.”

“In addition, if the saphenous vein needs to be taken as a bridge, the cost of how to take the bridging vessel is different. If it is minimally invasive under the endoscope, it is much more expensive than the open area.”

“Is there any difference?” Qian Wei finally heard a step that seemed to be cheaper by himself.

“In terms of difference, minimally invasive is a small wound, which heals quickly after surgery and has less pain. It is definitely better than open area.”

“What’s the effect! Will the blood vessels taken out of the open area be worse than the blood vessels taken out of the minimally invasive endoscopic?”

Zhou Yuan frowned: “Theoretically not. If the technology is good, it is actually the same.”

“Doctor! Help me get it from the open area! It’s nothing painful!” Qian Wei gritted his teeth.

Zhou Yuan couldn’t bear it, and said, “I will try my best.”

“You said that there are three influencing factors, and another reason that affects prices?”

Zhou Yuan smiled helplessly: “The third thing you should have no way to change is the difference between regions and hospitals. Different regions and different levels of hospitals have different charging standards for bypass surgery, and different regions have different medical treatments. Insurance has different reimbursement rates for bypass surgery.”

“Although this kind of operation is not very risky, it can also be very dangerous. If the small hospital doesn’t pick it up, let’s stay here with peace of mind.” Zhou Yuan dispelled Qian Wei’s idea of going to other hospitals to save money.

After a while, He Jianyi came back with a black-faced director of cardiovascular medicine.

Obviously, cardiovascular medicine came because of job grabbing.

As soon as I saw Zhou Yuan, the director of cardiovascular medicine asked, “Which surgical method do you plan to use?”

There are many specific methods for heart bypass surgery.

For example: Hungarian bypass surgery under cardiopulmonary bypass;

Coronary artery bypass graft with beating heart;

Minimally invasive coronary artery bypass graft under Hungarian endoscopy;

Hybrid surgery for coronary artery bypass graft;

The whole artery graft is used for bypass surgery;

Left anterior Hungarian small incision to do left internal mammary artery bypass, etc.

As to which one to choose, it all depends on the patient’s physical condition.

Zhou Yuan smiled when he heard the director of cardiovascular medicine.