I can hear the voice of Chinese medicine

Chapter 147 Emergency Coronary Angiography Stent Implantation

"Did you say anything?"

"No, but from the tone of the head nurse, it seems to be an urgent matter. She said she wanted you to call Director Zheng back."

Urgent?

Could it be that there is a critically ill patient in my heart?
However, I haven’t heard of patients in critical condition being admitted to the hospital recently!

Zhou Qihua couldn't think of the reason for a while, so he had to take out his mobile phone and nodded to the nurse: "Okay, I understand. You can go back and do your work first."

After finishing speaking, Zhou Qihua had already called Director Zheng of the Department of Cardiology.

Director Zheng was probably busy, so it took a while before he answered the phone.

But after the call was connected, Director Zheng's anxious voice came: "Old Zhou, haven't you left yet?"

"No, isn't it time for shift handover yet?"

"As long as you don't leave, that's okay. As long as you don't leave, that's okay."

It could be heard that Director Zheng was highly concentrated at the moment. At the same time, he was relieved to know that Zhou Qihua hadn't gone back yet.

But not long after, he said in a solemn tone: "If you haven't left yet, please come and see me. I have something urgent to ask you."

"Now?"

"I'm in a meeting right now. You know as well in the past two days that after a group of interns came to our emergency department, there were various situations every day last week. I can't do it without a few words of advice. If I really keep going like this, something will happen this week. " Zhou Qihua explained.

"Put the meeting aside for now and come over first."

"No, Lao Zheng, what are you so anxious about?" Zhou Qihua was a little confused.

"You don't want to treat patients with more serious conditions, so why do you have to let me go there?"

"Even if you want to go there, you have to explain the situation clearly to me first. Otherwise, it won't be easy for me to explain in the emergency department. I can't just leave everyone else here."

Director Zheng had no choice but to say: "We have just received a patient, and the situation is a bit critical. We need your cooperation, Lao Zhou. Let's diagnose and treat the patient together and think about whether there is any good way."

"Just received a diagnosis?"

"Ah."

When he heard that a patient in critical condition had been admitted to his heart, Zhou Qihua's expression suddenly became solemn: "Okay, I'll be there right away."

"Ok, I will wait for you."

"It's in the special needs ward of the heart."

Zhou Qihua ended the phone call with Lao Zheng and said directly to Lao Li and others: "I have received a patient in the heart who is in a critical condition. I will go over and have a consultation. You will take over the shift as normal in a while, especially for those interns." Sir, be sure to keep an eye on him and stop causing trouble for me."

After saying that, Zhou Qihua turned around and hurried towards the cardiology special needs ward.

The emergency department is still a little far away from the inpatient building, but Zhou Qihua also knew that the situation was dangerous, otherwise Lao Zheng would not have been so anxious to let him go there. He walked in the wind and arrived at the cardiology inpatient department not long after.

Before entering the ward, Zhou Qihua had already seen people crowding around the door of the special needs ward. He immediately knew that the patient admitted to the special needs ward was unusual, and he was also much faster on his feet.

At this moment, the sharp-eyed nurse at the door of the special needs ward saw Zhou Qihua walking out of the elevator, and immediately greeted him: "Director Zhou, Director Zheng is waiting for you in the consultation room over there."

Zhou Qihua nodded, changed direction, and walked towards the consultation room.

When he arrived at the door of the consultation room, Zhou Qihua knocked on the door, then pushed the door open and saw that it was already full of people. Several directors from the First Hospital of the City were there, as well as several directors from other departments. .

This was not the first time Zhou Qihua had seen such a big battle, but this kind of thing rarely happened in the First City Hospital.

"Lao Zhou, you came just in time."

Zhou Qihua pushed in the door and attracted everyone's attention. Director Zheng, who was standing there describing the patient's condition, immediately stopped talking when he saw that it was Zhou Qihua and gestured: "Come on, Old Zhou, sit here. , we have just started discussing, today’s situation is really not going to work without you.”

"Who is critically ill and there is such a big battle?"

"There were a lot of people at the door of the special needs ward just now. When they came to your place, my good fellow, there were even more people. You have brought all the directors of our hospital who have some connections with you, right?"

Zhou Qihua clicked his tongue.

"more than."

Director Zheng smiled bitterly: "I also called a few people who are on vacation at home. The dean is also on the way. He may arrive in about ten minutes."

Even the dean was alerted?

Zhou Qihua immediately realized the seriousness of the matter. The person who was admitted to the special needs ward at the moment probably had a high status, and was most likely in the system. It was impossible for ordinary people to have the dean rush over.

The director of the First City Hospital has a high administrative level.

Even the dean had to come over in person, so one can imagine.

Thinking of this, Zhou Qihua asked solemnly: "Who is the one who is admitted to the special needs ward..."

"The one in charge of our health in the city." Director Zheng said with a wry smile.

hiss~
Zhou Qihua took a breath of air, and his expression instantly became extremely solemn. There was no trace of curiosity on his face, but full of seriousness. At this moment, he completely understood why Lao Zheng was so nervous.

Moreover, the reason why the dean came is also known.

If it was that person, it wouldn't be surprising.

He was the chief officer in charge of the entire health system in Yongcheng, and he was sent to the First City Hospital for rescue. That was a sign of trust in the First City Hospital. Who dared to lose control at this time?

If they hadn't been rescued, they would have been walking around without food.

At this time, not to mention that the dean was just not in the hospital, even if he had a meeting in other provinces or cities, he would have to rush back. Although Lao Zheng was in charge of the rescue this time, the dean was still worried. Even though he has not seen patients for some years, the dean will still participate in some major cardiac surgeries and even play an important role in them.

In the First City Hospital, the dean is still very authoritative in his heart.

At this time, he will rush back, which is expected.Moreover, even if he is not an expert in his heart, he still has to come back at this time.

Thinking of this, Zhou Qihua quickly sat down in his seat.

When Zhou Qihua sat down, Director Zheng said directly: "I won't introduce too much about who the patient is. This mission is different from the past."

Director Zheng didn't say what the difference was.

Those who can sit in this consultation room are at least deputy chief physician level, and they are also very capable. He didn't call out to someone with little ability, and it would be useless to call. These people don't know the special needs of rescue. The one in the ward means something.

This is no longer just a medical mission.

Hearing this, everyone nodded.

Director Zheng continued: "That person had undergone an electrocardiogram at the Eastern Hospital before and was diagnosed with coronary heart disease for more than a month. He took a break during this period, but this person did not listen to the advice and has been working overtime every day recently. I was still reading reports and giving instructions in the early morning.

According to that person’s secretary, he had an angina pectoris attack in the afternoon and took nitroglycerin tablets to relieve the pain for half an hour. He didn’t pay attention to it at the time. His secretary tried to persuade him, but to no avail. The person didn’t take it seriously at all.At about 16:[-], the colic recurred, and the nitroglycerin tablets were ineffective, so he was finally sent to our hospital for rescue.

Before you came, I also used lozenges and isoamyl nitrite to inhale, but it still didn't work.

I have invited a few of you here because I want to hear your opinions. What should we do in this situation?How to take medicine?What medicine to use?

The dean had already spoken to me on the phone on the way here, and he would save people at all costs. However, the medicine should not be used indiscriminately, and the man is not young. If something happens to the medicine that is too powerful, no one can bear it. this responsibility. "

"Old Zheng, from what you said, that person must have had an acute myocardial infarction!" Zhou Qihua interjected.

Director Zheng nodded: "Yes, coronary heart disease and angina pectoris attack."

"The medicine we just took has also been used. If it doesn't work, it will be difficult to deal with. Moreover, once the disease attacks, it can easily kill people." Zhou Qihua said with a solemn face.

Acute myocardial infarction is myocardial necrosis caused by acute and persistent ischemia and hypoxia of coronary arteries.

Clinically, there are often severe and long-lasting retrosternal pain, rest and nitrate drugs can not be completely relieved, accompanied by increased serum myocardial enzyme activity and progressive changes in electrocardiogram, can be complicated by arrhythmia, shock or heart failure, often life-threatening.

Moreover, since the person was old, the situation was even more serious. If one person was not good, he might be gone within an hour.

The key point is that the best time for rescue is within half an hour. A lot of time has passed. If no other treatment is given, the consequences will be too serious.

"So we have to race against time!"

"Old Zheng, we already understand the situation. Let's go to the scene and have a look. It's best to invite Chinese medicine doctors to come and take a look. In this case, maybe Chinese medicine doctors can find a way. The city's Traditional Chinese Medicine Hospital is not far from us. Let them come and take a look. , maybe there is some good way, otherwise it won't work if it keeps dragging on like this." Zhou Qihua thought for a while and put forward his own opinion.

Lao Zheng said: "I have already mentioned it to the director, and he has contacted the director of the city's Traditional Chinese Medicine Hospital. He should be arriving soon by this time."

"But you're right. We can't come up with a solution even if we discuss it here. Go to the scene and see. There may be other ways. Lao Ye is helping out there right now."

"Then let's go, don't waste the best time for treatment."

Everyone stood up and walked towards the special needs ward.

When Zhou Qihua and others arrived, several chief traditional Chinese medicine doctors from the city's traditional Chinese medicine hospital also arrived at the scene.

Not only a few people from the city's Traditional Chinese Medicine Hospital, but also those who had been attending the Liannan Traditional Chinese Medicine Association also came over.

Huang Beishan, Ye Haishen and Zhang Jingcai were all present.

At this time, these people came, and Director Zheng also gave a brief introduction to the situation.

While everyone was discussing how to save people, Zhang Jiwei, the director of the First City Hospital, hurriedly walked in: "How is the situation?"

Everyone looked at each other and shook their heads: "The situation is not optimistic. We have used all the available medicines, but none of them have had very good effects."

"What about taking nitroglycerin quickly under the tongue?"

Quickly take nitroglycerin under the tongue, so that nitrate drugs can quickly circulate with the blood to the diseased blood vessels, expand the diseased blood vessels, and relieve symptoms.

Zhang Jiwei is a cardiologist, and has often participated in intracardiac first aid in recent years. Naturally, he is very familiar with these drugs and their functions, so he mentioned the topic of taking nitroglycerin by mouth.

"It's no use, it's already been used."

As the attending doctor, Director Zheng shook his head and stood up and said: ""This person prepared this medicine when he was diagnosed with coronary heart disease and angina pectoris. He used it on his own when he had angina pectoris in the afternoon. It was relieved at that time. .

But because this person has been working overtime recently and hasn't had much rest, nitroglycerin only had some effect, but he soon developed angina again, and was sent to us for the second time. Nitroglycerin was also used, but This time it has no effect. "

After saying that, Director Zheng felt helpless.

"What about treatments such as dual antiplatelet aggregation, stabilizing plaques, reducing myocardial oxygen consumption, dilating blood vessels, etc.?" Zhang Jiwei frowned deeply. If nitroglycerin has no effect, it proves that this person's condition is really serious. .

"I've used it too, but it hasn't had any effect yet."

Zhang Jiwei took a breath and made a quick decision: "Then the only treatment is emergency coronary angiography and stent implantation."

"Isn't this too risky?" Director Zheng hesitated.

Coronary artery stent implantation is a mechanical interventional treatment method. Stent implantation is the most effective method to treat acute PTCA vascular occlusion. It permanently places a metal stent in the coronary artery lesion through a balloon. The dilation release or self-expansion method supports the blood vessel wall to keep the coronary lumen open and reduce the mortality rate of acute myocardial infarction.

Aspirin and clopidogrel should be taken before stent implantation to prevent thrombosis.People with diabetes should monitor their blood sugar in a timely manner, relieve their tension and anxiety, ensure good sleep, and eliminate mental stress; they should also prepare their skin before surgery.

After coronary angiography, percutaneous transluminal coronary angioplasty is used to percutaneously puncture the femoral artery or radial artery, and then use a special catheter to deliver the stent to the coronary artery stenosis and expand it to achieve the desired effect. Recanalize occluded vessels or minimize residual stenosis of vessels.

Because the stent can treat acute occlusion caused by balloon dilation, the safety of interventional treatment can be improved, and it can have more satisfactory results in treating complex lesions than balloon dilation. At the same time, it can reduce the restenosis rate of balloon dilation and improve Long-term effects of treatment.

However, during coronary stent implantation, when the blood vessel is punctured, femoral artery pseudoaneurysm, retroperitoneal hematoma, dissection, thrombosis, embolism, arteriovenous fistula, etc. may easily occur.

When entering the coronary arteries for operations, it is easy to cause coronary artery spasm, coronary dissection, various arrhythmias, severe ventricular arrhythmias, acute vascular occlusion, stent thrombosis after implantation of the stent, and no reflow. , coronary perforation, coronary ventricular fistula, cardiac tamponade, acute pulmonary embolism.

There are also some other complications that may occur, such as sudden hypotension, stroke, cardiac function damage, and the use of contrast media can cause allergic reactions to contrast media nephropathy, etc.

This person is already quite old, and no one can guarantee whether there will be serious sequelae during the operation.

(End of this chapter)