This Doctor is Great

pulmonary embolism,

How should it be diagnosed?

Pulmonary angiography, the gold standard for diagnosis!

But it takes time, and I am afraid that the patient will have a cardiac arrest at any time.

The bedside B-ultrasound is much simpler, although it is not very accurate.

"There is one in the emergency room..."

Although the emergency senior brother was surprised, he quickly took out a B-ultrasound from under a storage box.

Zhou Mo quickly turned on the machine, adjusted the parameters, and then began to examine the pulmonary artery.

result:

pulmonary hypertension!

Enlarged right atrium and right ventricle!

In other words, the heart cannot pump blood into the pulmonary artery, because the blood in the pulmonary artery cannot get out.

This is actually evidence of pulmonary embolism.

In addition, adding the patient's low blood oxygen, it was only 63...62%.

It must be a pulmonary embolism. The blood in the pulmonary artery cannot enter the pulmonary capillaries and alveoli, and cannot exchange air.

Although the patient continuously inhales oxygen, the oxygen only stays in the alveoli and cannot be exchanged with the blood. It is useless to inhale more oxygen, so the patient's finger pulse oxygen saturation is so low.

Zhou Mo told Mr. Huang Li about his examination results.

"I think it's a pulmonary embolism..."

"I suggest sending it directly to the interventional diagnosis and treatment center of our Cardiology Department, while doing angiography. If a pulmonary embolism is found, the thrombus should be removed immediately..."

"If the family thinks it's expensive, I suggest doing pulmonary angiography immediately, and then doing thrombolysis..."

After listening to Mr. Huang Li, he nodded.

"Just do it!"

There are two ways to solve embolism - intervention and thrombolysis.

Intervention is expensive, has a higher vascular patency rate, wider indications, and fewer bleeding complications.

Thrombolysis, the price is cheap, the risk will be higher, because once the thrombolysis is overdone, the consequences will be very serious, and it is easy to cause bleeding everywhere, especially cerebral hemorrhage, which may directly lead to death.

By the way, Zhou Mo has also read a lot of papers, and the thrombolysis of pulmonary embolism is still controversial.

Many doctors believe that the long-term prognosis of thrombolytic therapy for pulmonary embolism is no different from that of non-thrombotic therapy, so they are not very supportive of thrombolytic therapy.

Of course, there are more doctors who support thrombolytic therapy for pulmonary embolism.

At this moment,

The patient's arterial blood gas analysis results also came out:

The partial pressure of oxygen is 66.2, the partial pressure of carbon dioxide is 27.9, and the lactic acid is 4.6...

Hypoxemia, hypocapnia...

Obviously, they are all consistent with pulmonary embolism.

Mr. Huang Li said to his senior in the emergency department: "Ask the family members to see the choice of the patient's family members."

Emergency senior: "I'm telling my family now."

He ran out quickly.

Not long after, the emergency senior took the patient's son into the emergency room.

"Mr. Huang, the family members are hesitant to choose what to choose. I would like to ask for your opinion..."

"Doctor, I don't understand, I want to ask, what's the best way?" The patient's son looked at his mother on the bed with worry, nervousness, and anxiety.

Naturally, it was impossible for Mr. Huang Li to make suggestions. To Huang Yiming, who had never had the chance to amaze everyone, he said, "Yiming, tell your family about the difference between intervention and thrombolysis..."

Huang Yiming was overjoyed, I finally had a chance to perform.

"To intervene in this method, specifically..."

Huang Yiming introduced the difference, advantages and disadvantages of intervention and thrombolysis in detail. He is still very clear about this.

The son thought for a while, and finally gritted his teeth!

"Intervene!"

Although the family's conditions are average, he doesn't want his mother to have any good or bad. Although the cost of intervention is 10 times more expensive, the complications will be much less severe.

"Okay! Let's go, go to the Cardiology Department!"

"Yi Ming, contact the intervention center to get the thrombectomy as soon as possible!"

"Okay, I'll call right away."

soon,

The elderly patient was relieved of the endotracheal intubation, put on non-invasive breathing, and went into battle lightly.

Huang Li, Zhou Mo, and family members pushed the patient to the Cardiology Department.

Just as Zhou Mo and others pushed the patient through the green channel and left the emergency room not long after,

"Beep beep beep~~~~~~"

Brake————

An ambulance stopped at the emergency door.

A patient was carried down.

"President Liu, President Liu, hold on!!"

A beautiful secretary shouted anxiously at the middle-aged man in a suit and leather shoes on the flat car.

……

Cardiology,

Zhou Mo and others pushed the patient all the way into the Cardiology Department and directly to the interventional diagnosis and treatment center.

Professor Lu walked out.

"Is this the pulmonary embolism patient you just mentioned?"

"Yes, I'll trouble Professor Lu..."

"Fortunately, the previous patient has already done it, so there's no need to wait... let's go ahead and do it right now..."

The patient advances into the operating room.

The patient's son took Professor Lu's hand and pleaded, "Doctor, you must save my mother."

The corner of Professor Lu's mouth twitched, he pulled out his hand, and comforted: "We will do our best..."

Just when Zhou Mo wanted to go in for an interventional operation,

A nurse's shout came from the nurse station.

"Dr. Huang, there is a consultation in the emergency room, a patient with myocardial infarction..."

"Okay, come right away... Zhou Mo, are you going?"

"go!"

"I'll go too!" Huang Yiming raised his hand quickly, for fear of being missed by himself.

So, Huang Li, Zhou Mo, and Huang Yiming quickly went to the emergency room~www.readwn.com~ emergency room,

emergency room.

When Zhou Mo walked in, he immediately saw a familiar person.

A beautiful and capable female secretary, at the bedside, with an anxious look on her face: "Mr. Liu! Please wake up, Mr. Liu!"

And Mr. Liu, who was originally arrogant, suffered a cardiac arrest at this time, and the ECG monitor displayed the compression waveform.

And the emergency senior was at the bedside, constantly doing CPR to Mr. Liu.

Zhou Mo: "..."

"Teacher, I know this patient...the one who was hospitalized at the Cardiology Department this morning, and then refused to be hospitalized..." Zhou Mo introduced.

"It's him..." Mr. Huang Li had an impression of this patient who didn't believe in medicine.

Zhou Mo: "This morning, he was diagnosed with myocardial infarction. He was in a coma for about an hour. After waking up, he could act and think without any problem... Now he has a sudden cardiac arrest, and the myocardial infarction may have occurred again."

The nurse next to him introduced to Zhou Mo and the three: "When the patient was brought in, he had severe chest pains and profuse sweating, and just after calling the Cardiology Department for consultation, he went into cardiac arrest."

Next,

Mr. Huang Li looked at the electrocardiogram drawn by the 120 ambulance on the road and determined that it was myocardial infarction.

Obviously, the myocardial infarction area has further expanded.

1 minute……

10 minutes……

20 minutes……

The cardiopulmonary resuscitation continued, and 6 doctors were changed, and Zhou Mo also went up.

After 5 doses of epinephrine were used, the patient still showed no signs of rebounding.

.