socalfunplaces Chapter 511
Chapter 511
"Khan, call me Dr. Lin..."
"Doctor Lin, I have a more troublesome patient here, I can't find the reason, you help to palm the eyes?"
Lin Feng naturally would not refuse.
"Well..."
Leave the office and go to the emergency ward.
"Say, what's the situation?" Lin Feng asked curiously.
"During the day, there was a patient, a 68-year-old lady, with abdominal pain, low blood pressure, and was sent to the emergency room..."
Low blood pressure is a red flag, indicating that the patient has gone into shock, and it is decompensated shock, which is life-threatening at any time.
Because blood perfusion to organs and tissues throughout the body is definitely reduced, there will be a lack of oxygen everywhere.
(At this time, blood will give priority to the two most important organs of the brain and heart, and other organs will begin to reduce blood perfusion and begin to damage...) ）
After 30 seconds,
Came to the ward.
On the hospital bed, an old lady with white hair was lying on the bed, breathing oxygen.
On the table next to the bed is an ECG monitor.
Blood pressure 90/50mmHg...
Lin Feng was surprised: "This blood pressure is okay..."
Wang Jiayi: "She has a history of hypertension for more than 10 years..."
Lin Feng nodded, if the patient is considered to have a history of hypertension in the past, then this 90/50 blood pressure appears very low.
Then Dr. Wang Jiayi continued the introduction.
"The old lady nodded and said that it hurt for a few days, and she also tried injections and medicine halfway, but the effect was not satisfactory..."
"When we were sent to the emergency department, we started ruling out things like acute appendicitis, kidney stones, renal colic, cholecystitis, pancreatitis, gastric perforation, etc... Neither..."
"Then the blood draw and other test results came out, and it was suspected that the patient was abdominal pain caused by diabetic ketoacidosis, because the patient had a history of type 2 diabetes, and the ketones were high when admission, and there was acidosis, so ketoacidosis could be considered..."
"But... But after treatment such as lowering blood sugar and rehydration, the abdominal pain did not improve..."
And then
Wang Jiayi showed all the inspection results to Lin Feng one by one.
Abdominal ultrasound, chest CT...
Blood routine, urinalysis, electrolytes...
Kidney function...
Lin Feng looked at these materials.
Abdominal ultrasound does not find much, can exclude appendicitis, cholecystitis, kidney stones, intestinal obstruction...
"Another point is that the patient's blood pressure is constantly falling..."
Wang Jiayi said cautiously.
Lin Feng groaned.
What is the reason for low blood pressure and continuous falling?
Abdominal infection?
Septic shock?
Because of unknown reasons, it will be more troublesome, it is like a time bomb, it can explode at any time.
"Although the reason cannot be found, it can be treated with anti-shock first, and rehydration and vasopressors are used..."
"Well, it's already in use..."
Lin Feng continued to stare at the ECG monitor.
soon
Lin Feng noticed that something was wrong.
"Huh..."
"Do you feel that this heart rate seems to be a little uneven?"
Lin Feng pointed to the ECG monitor and asked.
"Yes?"
"There is... Forget it, I'll give him a heart sound..."
In the emergency department, the stethoscope often has to be brought on, and Lin Feng just has it.
The old lady was asleep at this time.
Lin Feng gently used the stethoscope to listen to the old lady's heart.
One minute......
Two minutes......
Lin Feng's brows stretched.
"The heart rate is really not very aligned, and it looks like I want atrial fibrillation... Push an ECG over and pull her an ECG..."
Ventricular fibrillation was written earlier.
Ventricular tremor, is the whole heart, like shaking pork, constantly shaking ...
And atrial fibrillation, which is not the same as ventricular fibrillation, is that a single house is shaking, irregular kind...
Discover new continents.
This is a problem that doctors did not notice during the day.
If it's atrial fibrillation, there's definitely a big problem.
soon
The electrocardiometer pushed over.
Pull electrocardiogram.
Soon, the results came out.
The P wave disappears, the baseline disappears, and the RR interval is absolutely unequal!
These are the three basic characteristics of atrial fibrillation!
Sure!
"It's atrial fibrillation!"
Lin Feng from atrial fibrillation, thought of abdominal pain...
Suddenly I thought of an "answer!"
「Mesenteric artery embolism」!!
When atrial fibrillation, the blood flow in the atrium is irregular, so it is easy to cause local thrombosis, which are generally attached to the atrium.
Once the thrombus falls off, it may flow to different organs with the bloodstream, causing corresponding embolism, such as the cerebral infarction written earlier...
It may also cause superior mesenteric artery embolism, limb artery embolism, renal artery embolism...
Once embolized, what are the consequences?
Local tissue ischemia, hypoxia, and then necrosis!
This disease is a very dangerous disease!
So
The old lady in front of her is likely to be "superior mesenteric artery embolism"!
Lin Feng informed the doctor Wang Jiayi of his guess.
"Huh? Superior mesenteric artery embolism? "
The Wang family was dazed at first, and then became serious again.
Recall the entire course of the case,
"It's really possible!"
"Yes, I think it's very likely... You go and communicate with the family, if you have this disease, you need to go for an enhanced CT angiography, otherwise there is no way to diagnose it..."
"Okay, I'll go now... However, angiography has certain damage to the kidney, but the old lady is so old, I'm afraid the kidney is not very good, there are risks..."
"There is no way to risk it, to confirm whether it is "superior mesenteric artery embolism", this contrast must be done. If you are afraid of side effects, you really can't do it at that time, you can give the old lady a dialysis..." Lin Feng gave a suggestion.
Dr. Wang Jiayi pondered and nodded: "This idea can..."
Next
It's family communication.
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ps: End today...
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