When doctors have a simulated operating room

The patient was a family member who was yelling outside the ICU.

They came from Taiwan to visit their relatives.

The patient was a heart patient.

Female, 70 years old.

She was rushed to the hospital after experiencing shortness of breath for an hour and cardiac arrest.

She could not lie flat when she was short of breath, but could only sit and breathe, and coughed up pink foamy sputum.

When she was admitted to the hospital, it was found that her heartbeat, breathing, and pulse had all stopped.

Cardiopulmonary resuscitation, adrenaline injection, electric shock defibrillation, ventilator-assisted breathing and other rescue measures were immediately given.

About fifteen minutes later, the patient resumed her spontaneous heartbeat.

But her consciousness was still in a fuzzy state.

After the rescue, the patient was examined and found to have T36.7℃, P114 times/min, R15 times/min, and BP88/58mmhg.

The pupils were equal in size and round, but the light reflex was weakened, the breath sounds in both lungs were coarse, and moist rales were heard.

The heart rhythm was regular, and a systolic jet murmur was heard at the apex.

There was no edema in both lower limbs.

Past medical history included diabetes and hypertension.

Blood routine white blood cell count: 17.31x 10⁹/L (4-10x 10⁹/L)

Neutrophil percentage: 44.2% (50-70)

Blood sugar: 25.4mmol/L.

High-sensitivity troponin T: >5000pg/ml.

(One of the markers of myocardial injury.)

Creatine kinase: 213U/L (0-25)

No abnormalities were found in other liver function, renal function, thyroid function, and blood lipids.

Electrocardiogram: QRS wave high voltage.

Coronary angiography showed: no stenosis was found in the left main trunk, anterior descending branch, and right coronary artery.

Echocardiography: the ventricular septum was thickened from the left ventricular wall, with a thickness of 38mm (20-35), and reduced compliance.

After all the test results came out, Wang Xiaomian immediately made a diagnosis:

1. Fulminant myocarditis 2. Acute pulmonary edema 3. Acute left heart failure 4. Coronary artery obstructive myocardial infarction?

Fulminant myocarditis does cause ventricular wall thickening, so Wang Xiaomian considered this as the primary diagnosis.

As for coronary artery obstructive myocardial infarction, there is a question mark after it, which means that further observation is needed to confirm it.

However, the patient's high-sensitivity troponin and creatine kinase are very high, so the possibility of myocardial infarction cannot be ruled out.

After making the diagnosis, Wang Xiaomian also told the family members about it.

The cause of the patient's illness was ventricular wall hypertrophy caused by myocarditis.

Ventricular wall hypertrophy will reduce the contractile function of the heart.

If the contractile function is reduced, the blood outflow of the left ventricle will be reduced, and all the blood will be piled up in the ventricle and cannot be discharged.

It will cause both heart failure and increased pulmonary venous pressure.

So left heart failure and pulmonary edema appear together.

After the rescue, Wang Xiaomian also issued a long-term medical order for infusion.

First, dilate the blood vessels and increase cardiac output.

Then increase the myocardial contractility of drugs, dopamine.

(The dosage of dopamine must be strictly controlled, and different dosages have different effects.)

Sodium nitroprusside, lowers arterial pressure and reduces left ventricular outflow tract afterload.

As a result, after two days of medication.

The old lady showed no signs of improvement.

And the condition worsened!

The family members would definitely not be happy.

"Your Imperial Capital Ping An Hospital is such a big hospital, right?

I heard that it can be ranked in the top 20 or top 10 hospitals in the mainland!

Can't you cure the disease?!

One heart failure and pulmonary edema, I see other people with the same disease can be discharged from the hospital!

But our family's condition is getting worse?

Hey! Is this your medical level?!

Or do you deliberately treat us differently?!

Do you bully us just because we came from Taiwan?"

The family member said with a red face and thick neck.

Today is the third day of hospitalization.

The patient's condition has not improved but worsened, and Wang Xiaomian also overturned the previous diagnosis after the morning rounds.

Common sense says that the condition will be much better after taking the medicine.

But this old lady has become more serious.

So this medicine can no longer be used.

Stop the medicine first.

In the morning, the patient did not take the medicine, and no new diagnosis was given.

The family member's emotions naturally reached a breaking point.

She walked into the doctor's office while yelling.

Wang Xiaomian came out immediately after hearing the noise.

"Family members, please be patient. We are currently discussing the real cause of your mother's illness. We will notify you when there is a result."

The family members were obviously not buying it.

"Notify?! When will you notify?! Will you notify after everyone dies?"

"Don't get excited yet. We didn't mean to bully you. Don't worry. We will keep your mother stable. She won't be in danger for the time being."

"I want a specific result!" the family members roared.

"We will let you know as soon as possible after the consultation."

Wang Xiaomian said patiently.

In the hospital, it is common for the family members of patients to get emotional because of the patient's condition.

Some doctors with good tempers will try to explain.

If they meet a bad temper, they will just quarrel.

Fortunately, Wang Xiaomian's temper is pretty good.

There are actually many diseases that cannot be found, and doctors can only keep learning and moving forward in the process of exploration.

Suddenly, just after this, several other family members in the ICU rushed out and said:

"Doctor! Come and see, why did the blood pressure suddenly drop?!"

In the doctor's office and the nurse's office, when they heard that the blood pressure dropped, they all came to the ICU consciously.

He was originally a patient with heart failure. Now the medication is not effective. He may die if he is not careful.

He can only monitor vital signs at any time.

"Director Wang, he has stopped beating!"

"Hurry up and give CPR. Give 1 mg of epinephrine intravenously!"

"Put on a ventilator!"

"Give 1 amp of lobeline intravenously!"

"Give 50 mg of lidocaine intravenously!"

The ICU instantly became an emergency room.

The patient with heart failure whose cause could not be found was in danger.

The family members could only pray silently at the door:

"The rescue must be successful... Please!"

Finally, thirteen minutes later, the patient resumed his spontaneous heartbeat.

The doctors and nurses who rescued him breathed a sigh of relief, and the family members outside the door also breathed a sigh of relief.

But this can't solve the urgent problem at all.

The problem of this patient with heart failure now is ventricular hypertrophy leading to myocardial weakness.

But after taking drugs that increase myocardial contractility, the situation has not improved but worsened!

This makes Wang Xiaomian feel tricky.

After thinking for a while, Wang Xiaomian decided to ask the other two vice presidents to take a look.

Then he turned around and saw Lu Gao standing in the corner watching the rescue.

Wang Xiaomian glanced at him.

Suddenly!

He stopped!

Alas? !

Lu Gao!

Isn't this Lu Gao Zhang Yi's college classmate? !

That's right!

Why didn't I think of Zhang Yi?

Zhang Yi is so smart that he can think of someone who has a heart outside the body and keeps beating for coronary artery bypass grafting.

Does he have a way to treat this patient?

Immediately, Wang Xiaomian raised his hand and patted Lu Gao's shoulder and said:

"Lu Gao, Lu Gao! It's a good thing you are here, otherwise I would have forgotten such a person."

"Ah?"

Lu Gao was confused.

What's wrong with him?

Is it because my face is too handsome that Director Wang thought of someone?

After leaving the ICU, Wang Xiaomian quickly called Zhang Yi.

…

Tianhe City.

Zhang Yi was stitching up the forehead of an eight-year-old boy in the treatment room.

The child was playing too hard and stumbled and hit the corner of the table.

This time, the outer part of the eyebrow bone was broken and blood was pouring out.

The family members hurriedly brought the child to the hospital.

The wound on the forehead was about 1.5 cm and needed two or three stitches.

The child was crying and struggling.

The whole treatment room was filled with the child's crying.

So Zhang Yi didn't notice that his cell phone was ringing at all...