Chapter 585 Right heart failure, sudden death of a young female patient
"Young man, our argument is meaningless. I will first perform interventional and thrombolytic treatment on the patient. When the time is right, the patient's heart's blood pumping capacity will naturally improve."
Professor Song Bo has extensive experience in diagnosis and treatment, and his words reveal strong confidence.
Li Quan didn't say anything more.
Professor Song Bo first gave the patient urokinase, a commonly used thrombolytic drug, which is often used in the treatment of myocardial infarction patients.
Through cardiac angiography, it can be found that there is a white dead plaque near the left coronary artery of the heart.
This is where blood clots occur.
A closer look reveals that this artery is atherosclerotic.
After thrombolysis, the situation was still not ideal.
Professor Song Bo's forehead was already beginning to sweat.
"It seems that the patient must undergo a percutaneous coronary intervention immediately." In fact, in the patient's case, it would be better to directly undergo interventional treatment and implant a stent.
Professor Song may have tried drug thrombolysis first in order to save costs for the patient.
Interventional treatment is actually also considered surgery.
It is a high-precision, minimally invasive surgery.
Its benefits are self-evident: it is efficient, quick, and far less harmful to the patient than major surgery, and the patient will recover faster.
However, its cost is relatively high.
…
Professor Song Bo's medical skills are unquestionable and his interventional treatment was very successful.
A stent was implanted in the patient's hardened and weakened coronary artery, restoring .
The blood flow ability has been greatly improved.
At this point, the treatment should be considered successful and the patient's condition will surely improve quickly and he will wake up.
The anesthesiologist just stared at the screen of the monitoring device with a frown on his face.
"The patient's pulse has not yet been restored, his blood pressure is low and he is still in a deep coma."
The anesthesiologist's words were like pouring a bucket of cold water on Professor Song Bo.
All the joy he felt after successfully completing the interventional treatment was dashed.
Professor Song Bo frowned and thought intently about what to do next in treatment.
After a brief thought, he said to the nurse.
"Give the patient a shot of dopamine to raise blood pressure."
Dopamine is the most abundant catecholamine neurotransmitter in the brain. It is produced in large quantities when people feel pleasure. It makes people excited.
The dopamine hormone extracted by people is often used to raise the blood pressure of some emergency patients with low blood pressure.
"I don't recommend using pressors." Li Quan shouldn't have interfered, because it was Professor Song Bo who was treating the patient. But for the patient's life safety, he had to be the bad guy even if it offended Professor Song Bo.
"Please tell me your reasons." Professor Song Bo's face showed anger.
The patient's condition is still not optimistic and he must be in a bad mood.
We finally came up with a way to treat the patient, and in theory, there would be no risk at all in giving the patient a pressor.
Now Li Quan openly rejected his medical advice, which made Professor Song Bo very unhappy.
"First, even if you use a pressor, the patient's blood pressure still won't increase much. The pulse won't go up either. Second, if you insist on using it, it's likely to poison the patient. After the patient fell into a coma, two injections of adrenaline were already given during first aid."
Li Quan showed the patient's medical records.
"Ah... Is this true?" Professor Song Bo couldn't help but break out in a cold sweat.
"It's true! The ambulance doctor who received the patient at the time gave the patient two injections of epinephrine for rescue." The speaker was a nurse in her forties.
It may also be the level of charge nurse or even head nurse.
Those who can enter the operating room are the elite among the elite.
"Dean Li, thank you for your reminder." Professor Song Bo felt like he had survived a disaster.
A lifetime of fame was almost ruined.
After using adrenaline, it will stay in the body for a period of time and will take a long time to be metabolized by the body.
If pressors are used at this time, the patient will suffer from drug poisoning.
Epinephrine and pressors cannot be used at the same time, which is knowledge that doctors should know.
Professor Song Bo naturally knew this taboo.
Just now, after he performed drug thrombolysis and interventional treatment on the patient, the patient's condition still did not improve, which made him a little anxious.
When people are in a hurry, they tend to make mistakes.
He forgot to check what medicines the patient had used before and blindly prescribed a pressor for the patient, which almost caused a big mistake.
Thinking of this, Professor Song Bo felt ashamed.
"President Li Quan, please tell me your diagnosis and treatment opinions."
Professor Song Bo put aside his airs and face and humbly asked Li Quan for advice.
"I think the patient's weak pulse, lower heart rate and low blood pressure are due to heart failure," Li Quan said seriously.
"You mean the patient is suffering from heart failure?"
Professor Song Bo's eyes lit up slightly.
Director Pi, who was standing not far away, also had a thoughtful expression, and when he looked at Li Quan, there was a hint of appreciation in his eyes.
The nurses and anesthesiologists also looked with high regard on Li Quan's diagnosis and treatment suggestions.
Even Professor Chi Zhiyin of the Provincial People's Hospital, who was eliminated first, looked at Li Quan with admiration.
When the heart fails to eject enough blood, people would easily think of heart failure as the cause.
It was just because when the patient was brought in, he was diagnosed with acute myocardial infarction after examination.
So everyone fell into myopia of thinking and didn’t think in other directions.
It's like we have an object in our hands but are looking for it all over the house.
"If the patient really has heart failure, the cause must be found out and treated." After Professor Song Bo finished speaking, he looked at Li Quan.
"The patient should be suffering from right heart failure! Look at the patient's neck veins, they are dilated and full. The patient's feet are slightly swollen. These symptoms are common in right heart failure."
Li Quan gave his further diagnostic opinions with good reasoning.
From diagnosing the patient's heart failure to further determining that the patient was suffering from right heart failure, Li Quan did not use any instruments. He made the diagnosis simply by taking the patient's pulse and observing him.
This kind of ability is enough to put the experts present to shame.
Although they have rich experience in diagnosis and treatment and are all well-known throughout the country, their eyesight is far inferior to Li Quanke's.
Before Li Quan said it, they didn't think that the patient's low pulse was caused by heart failure.
"Give the patient a cardiac catheterization immediately." This time it was Director Pi who spoke.
As an examiner, you must be responsible for the patient's life.
After carefully observing the patient, he found that the symptoms Li Quan mentioned were quite obvious, and it was basically confirmed that the patient was indeed suffering from right heart failure.
However, medicine is a rigorous discipline and a diagnosis can only be made after a series of examinations.
It is impossible to confirm the diagnosis based on just some symptoms.
Soon, the cardiac catheterization examination was completed.
As Li Quan said, the patient was suffering from right heart failure.
"Young man, come and treat the patient!" Director Pi should have some friendship with Professor Song Bo. When he said this, he deliberately glanced at Professor Song Bo.
The two made brief eye contact.
Proposing that Li Quan be the treatment leader is tantamount to eliminating Professor Song Bo.
Professor Song Bo felt somewhat embarrassed.
"Why don't you let Professor Song treat me? I am not as experienced or skilled as you old experts." Li Quan said modestly.
Give these two old experts some face so that we can meet again in the future.
A true king is one who can win but does not necessarily have to win.
Many martial arts masters can clearly defeat their opponents during competitions , but they often stop at just a few points.
This kind of demeanor that only experts have also applies to doctors.
"President Li, I, Old Song, have rarely admired others in my life, and you are one of the few." Professor Song Bo looked at Li Quan with a kind expression and eyes. "The purpose of our doctors is to cure patients. I see that your medical skills are very high. Let's consult together."
"Yes, Mr. Song's suggestion is very good. It would be right for us to consult together and cure the patient as soon as possible." Director Pi even changed the way he addressed Professor Song.
Just call him Lao Song.
As Li Quan observed, the two men knew each other and should have a certain relationship.
In fact, at their level, they must have some medical exchanges on a regular basis.
"Okay, I'll listen to the two seniors. I suggest that we check the patient for hyperthyroidism first." Li Quan said this for a reason.
There are many reasons that cause patients to suffer from right heart failure, such as diabetes, hyperthyroidism, etc.
In fact, these diseases can be cured or controlled as long as they are treated in time.
It will not cause serious harm to the body.
This patient's illness was completely delayed.
The coronary arteries have hardened into atherosclerosis, and the patient must have had palpitations, shortness of breath, and heart pain. If he had gone to the hospital for a checkup in time, he would not have nearly lost his life.
If acute myocardial infarction is not treated in time, the chance of death is very high.
"Dean Li believes that the patient's right heart failure is related to hyperthyroidism. How did you know that?" Professor Song asked.
"I just noticed that the patient's neck was a bit thick, so I made this suggestion." Li Quan did not say that his diagnostic skills had reached the master level and that he could see potential symptoms and lesions that other doctors could not.
After Professor Song Bo examined the patient for hyperthyroidism, he miraculously discovered that Li Quan's diagnosis was correct again.
The patient's hyperthyroidism is far beyond normal levels.
Once the cause is identified, it will be easy to treat.
Only symptomatic treatment is needed.
…
When Li Quan came out of the operating room and returned to the competition venue with Professor Song Bo and others, he once again enjoyed the attention of the public.
He made a great contribution to this question.
"Dean Li, let's keep in touch and exchange more medical ideas when we have time." People like Professor Song Bo rarely take the initiative to make friends with others.
At this moment, the two were about to return to their respective areas, and he took the initiative to ask Li Quan to communicate more.
"As long as you are not afraid of being disturbed by me, I would be very happy to communicate with top experts like you." Li Quan agreed happily with a smile.
"Haha, then we're settled. Leave your phone number to me." Professor Song Bo laughed.
Li Quan left his phone number to the other party.
Jin Leiming, who was standing next to him, felt jealous.
He also wanted to establish a relationship with Professor Song Bo so that he could ask Professor Song for advice when he encountered difficult problems in the future.
But Professor Song didn't even look at him.
If you try to make friends with them now, they may not agree.
Jin Leiming was smart, and quickly looked at Li Quan for help. He blinked at Li Quan with a pitiful expression on his face.
Li Quan was slightly stunned.
Why is Director Jin winking at me for no reason?
Then, he caught a glimpse of Jin Leiming looking at Professor Song Bo with a flattering look, and immediately understood a little bit.
"Professor Song, when it comes to surgical skills, I am just a latecomer. Director Jin Leiming is the chief physician of the general surgery department of our Huier Hospital. His surgical skills are very advanced. Before coming here, he wanted to meet you very much..."
Li Quan smiled and spoke well of Jin Leiming.
Create opportunities for friendship.
"Oh, really?" Professor Song then looked at Jin Leiming straight in the eye.
"Professor Song, I wonder if I can have the honor of meeting you. If I have any medical problems in the future, I can ask you for advice." Jin Leiming's shoulders slumped and he bent slightly.
An extremely humble attitude.
"No problem. Please call Dean Li for it. If you encounter any medical problems in the future, we can discuss them together." Professor Song did not refuse and agreed readily.
This is most likely done for Li Quan's sake.
Jin Leiming was overjoyed and thanked him repeatedly.
After they returned to their seats, the host announced the judges' scores for the three contestants.
Professor Song Bo scored two points, Jin Leiming from Huier Hospital scored two points, and Professor Chi Zhiyin from the Provincial People's Hospital scored only one point.
With Jin Leiming's performance, he definitely wouldn't get two points.
Half of the credit for this goes to Li Quan.
"Now, please answer question 12 this morning." As soon as the host finished speaking, a patient appeared on the big screen.
His face looked pale and gloomy, and he lay on a makeshift flat bed, motionless.
The patient's eyes were closed, looking exactly like a dead person.
The patient was very young, only about 27 or 28 years old, and she was a woman.
"I'll answer! The patient has fulminant myocarditis and must be treated immediately."
Jin Leiming was the first to answer again.
It must be said that Jin Leiming's skills and abilities are quite good, but he is a little arrogant sometimes.
"I also support the diagnosis of fulminant myocarditis." The second person to answer was a doctor from Yuanyang Hospital.
Seeing that Huier Hospital, which was once inferior to itself, has been making frequent efforts and stealing the show, Yuanyang Hospital is really getting anxious.
If this trend continues, the reputation of Yuanyang Hospital will plummet.
This is not a good thing.
You must seize the few remaining opportunities to answer questions and get more points.
"I think the patient died suddenly, and I cannot rule out the possibility of fulminant myocarditis. If he needs to be rescued, ECMO should be used immediately."
The person who stood up to answer the question this time was the chief physician of the Department of Critical Care Medicine at Beijing No. 1 Hospital.
There is no doubt that the Department of Critical Care Medicine of Beijing No. 1 Hospital treats the most patients with sudden death because of its strong medical team and advanced and complete high-tech treatment and examination equipment.
Because extremely critically ill patients nearby are usually sent to them for emergency treatment.
