I really don't want to be a doctor

Chapter 148 Intern Jing Xiaoran puts the stent and it is useless

The ECG machine has finished feeding paper.

Jing Xiaoran tore off the electrocardiogram, glanced at it briefly, and handed it to Zhu Zhu.

Zhu Zhu took the electrocardiogram, frowned and said, "The ST segment of the chest lead is raised higher than before. It seems that the infarction area has expanded."

Jing Xiaoran did not immediately take down the electrical level of the ECG, but asked the patient to turn sideways slightly, placed the V1-V3 leads of the ECG on the corresponding position of the right heart, and placed the V4-V6 leads of the ECG on the back.

"Xiao Jing, you actually know how to do an [-]-lead ECG?" Zhu Zhu looked at Jing Xiao Ran in surprise.

The [-]-lead electrocardiogram is based on the [-]-lead electrocardiogram plus six leads, which covers the comprehensive detection of cardiac electrical activity including the left and right atrioventricular and myocardium, and can more comprehensively reflect the situation of myocardial ischemia in various parts of the heart.

In clinical work, the [-]-lead ECG has a larger observation range and is easy to operate, especially in the case of extensive myocardial ischemia, which can provide doctors with very important information.

"When I was at school, the teacher taught in class." Jing Xiaoran smiled.

Zhu Zhu was surprised. When did the school teach students the [-]-lead ECG?Aren't many of them not even the simplest twelve-lead electrocardiogram?
Jing Xiaoran didn't pay attention to Zhu Zhu's expression, he connected all the leads, pressed the start button of the EKG machine, and continued to feed the paper.

A young woman stood at the gate of the intensive care unit of the Cardiology Department. She looked at Zhu Zhu anxiously and clasped her hands tightly.

"Doctor, what's wrong with my dad!"

"Our preliminary consideration is acute myocardial infarction." Zhu Zhu said.

"What kind of disease is this?" the young woman asked eagerly.

Zhu Zhu didn't answer right away, but turned to Jing Xiaoran and said, "Xiao Jing, first ask about the patient's medical history, and I will discuss the condition with the family."

"Okay." Jing Xiaoran nodded, he had already prepared the [-]-lead ECG, and handed it to Zhu Zhu.

The patient was a man in his 40s. His eyes were closed at this time, his face was pale, there was a trace of cold sweat on his forehead, and there were some vomit residues on the clothes on his chest.

"Uncle, when did you start to feel chest pain?" Jing Xiaoran looked down at the middle-aged uncle on the hospital bed.

Hearing someone's question, the middle-aged uncle slowly opened his eyes and said softly: "It was about five o'clock this morning, when I suddenly woke up with pain."

"When does it hurt the most?" Jing Xiaoran asked again.

"The most painful?" The middle-aged uncle frowned and recalled, "The most painful time should be at 06:30. At that time, I was sweating profusely, my chest seemed to be torn, and I felt like I was about to die. "

The middle-aged uncle spoke slowly, looking at his demeanor, he still had lingering fear.

"If the pain score was [-] when it was the most painful, how much is the pain now?"

Jing Xiaoran asked after thinking about it.

"Uh..." The middle-aged uncle paused, "Probably one or two points."

"Well, did you have any underlying diseases before, such as high blood pressure or diabetes?" Jing Xiaoran asked.

The middle-aged uncle nodded, "All of them."

"Smoking and drinking?"

"Occasional drinking, no smoking."

……

Zhu Zhu was communicating with the patient on the sidelines, and at the same time kept paying attention to Jing Xiaoran.

She found that this intern is really not simple, every consultation is not nonsense, and all of them are confidence in the most useful diagnosis at present.

Asking when the pain started is to judge the state of the disease.

Asking the most painful time is to judge the time from the myocardial infarction to the present. If the time is within 12 hours, emergency interventional surgery can be performed; if it exceeds 12 hours, only conservative drug treatment can be performed, and then elective surgery.

Inquiring about the patient's current pain score is of course to preliminarily judge the current state of the patient, and how the symptoms continue to aggravate may require immediate interventional surgery.

Ask the patient whether they have high blood pressure, diabetes, whether they have diabetes or high blood pressure, in order to determine whether the patient has high risk factors for acute myocardial infarction.

Regardless of the simple four questions, they have actually involved the most important links in diagnosis and treatment.

This is something that is not taught in books at all, and relies entirely on clinical experience and exploration.

"Xiao Jing, the family members of the patient have agreed to be hospitalized, please push the bed into the ward."

Zhu Zhu said to Jing Xiaoran, the way she looks at Jing Xiaoran has changed a little now.

"Okay, Teacher Zhu." Jing Xiaoran nodded, and pushed the bed into the intensive care unit together with the nurse.

……

There are two attending doctors in each group of the intensive care unit, and their work focuses are different. One is mainly responsible for communicating with patients, and the other is mainly responsible for the patient's diagnosis and treatment plan.

But this is not absolute, and the work of the two usually overlaps to a certain extent.

In Zhu Zhu's group, she was in charge of communicating with the family members about the condition, another teacher Cao was in charge of handling the patient's condition, and the students below were in charge of writing medical records and taking electrocardiograms.

"Junior brother, are you an intern from our group?"

As soon as Jing Xiaoran pushed the hospital bed to the bed in the intensive care unit, a girl hurried over.

"En." Jing Xiaoran nodded.

"Great, I finally don't have to be alone!" The girl excitedly clenched her fists, her face flushed slightly, "My name is Li Wenlin, and I'm a freshman this year."

"Senior sister, please pay more attention." Jing Xiaoran said with a smile.

"That's for sure." Senior Sister Li patted her small chest, and then began to turn her gaze to the patient on the hospital bed.

"Junior Brother, what does Teacher Zhu say is the patient's illness?" Senior Sister Li copied the patient's vital signs in her notebook.

"Acute extensive anterior wall myocardial infarction." Jing Xiaoran said.

"Yes." Senior Sister Li nodded, and then said to the bedside nurse, "Sister Nurse, please bring a purple tube for the patient."

"No problem." The nurse sister responded.

"Purple tube?" Jing Xiaoran didn't quite understand, this was the first time he encountered something that he didn't understand after entering the intensive care unit.

"Purple tubes are blood collected in purple test tubes for quick troponin detection." Senior Sister Li explained, "Tenoponin can be used to diagnose acute myocardial infarction. You may not understand this, and I will give it to you later. speak."

Jing Xiaoran nodded. It turned out that it was the monitoring of fast troponin. Of course he knew about it, but the name was different.

"Junior brother, I'll ask this patient first, remember how I asked, and you have to try it yourself for the patients who come later." Senior Sister Li said.

"Ah."

Senior Sister Li started the consultation.

Jing Xiaoran found that this little girl's basic skills are very good, and the content of the consultation is very comprehensive and detailed, from the current medical history to the past history, there is nothing missing.

"Junior Brother, go to the interview room to see what's going on with Mr. Zhu." Senior Sister Li suddenly said, "Generally, patients with acute myocardial infarction, if they are in the intervention time window, we have to push him to the catheterization room for surgery in time. But There is still no news from Mr. Zhu, it has been 10 minutes."

Upon hearing this, Jing Xiaoran nodded and left the ward.

As soon as he entered the interview room, Jing Xiaoran heard a young woman's voice.

"Doctor, you said so much just now, you just asked us to put a stent. I want to ask, can you guarantee that my dad's heart will fully recover after the stent is placed?"

"No, the necrotic myocardium cannot be saved. The purpose of our stent placement is to open the blood vessels, prevent the further development of the disease, and save the ischemic myocardium."

"Doctor, I don't quite understand what you are saying. But I heard that after the stent is placed, people are useless! I can't do any work."

"No. Take good care of it, and live like a normal person, but you may need to take some anti-platelet drugs for life."

"But I read on the Internet that you can't live for a few years with a stent. You yourself said that you need to take medicine for life. Isn't that equivalent to being useless?"

……

(End of this chapter)