medical road high rise

Chapter 316 The problem ignored by Qin Feng
Chapter 317 The Problem That Was Ignored by Qin Feng
"Have you had atrial fibrillation before?" Qin Feng confirmed again.

"Well, I always felt powerless before, so I went to the hospital for an examination, and the doctor said it was atrial fibrillation." The patient said.

Atrial fibrillation is a relatively common persistent arrhythmia disease. The probability of onset is related to the age of the patient. Among the people over 60 years old, the probability of atrial fibrillation is as high as [-]%.

The heart rate of normal people is generally around [-], and rarely reaches [-], but for patients with atrial fibrillation, the lowest is [-], and the highest can even reach [-] beats per minute.

Moreover, atrial fibrillation is also closely related to coronary heart disease, hypertension, heart failure and other diseases, which is also a serious test for the health of patients.

However, the patient's medical records did not show that the patient had had a stroke, and it was impossible to judge whether there was a thrombus in the patient's atrium.

"Xiao Qin, do you have a clue?" Li Xuewen asked.

"A little bit." Qin Feng continued to look at the patient and asked, "Have you taken the medicine for atrial fibrillation on time recently?"

The most famous drug for atrial fibrillation is warfarin. When Qin Feng asked about warfarin directly, the patient definitely didn't know about it.

The vast majority of patients don't look at the names of the medicines, but classify the medicines and take them every day according to the doctor's requirements.

Qin Feng asked this question mainly because warfarin is an anticoagulant drug, the purpose is to prevent atrial thrombosis.

"I have eaten it before, but I haven't eaten it now." The patient thought for a while.

All doubts were resolved at this moment.

The function of anticoagulant drugs is to prevent blood clots. If the patient does not take the medicine on time, it means that blood clots will form in the patient's atrium at any time, and they will accumulate and become larger. Finally, a small part will fall off and enter other parts with the blood circulation.

For example, if it enters the brain, it is cerebral embolism, if it enters the moving limbs, it is limb ischemia, and if the patient has abdominal pain, it is destined to be related to the small intestine.

It is very likely that the atrial thrombus fell off and entered the small and narrow intestinal vascular network, resulting in superior mesenteric artery embolism.

However, if the diagnosis is superior mesenteric artery embolism, there is still one point that cannot be explained.

That is blood in the stool.

Qin Feng asked about the patient's condition, and there was no blood in the stool.

For further confirmation, Qin Feng asked again.

"Are you sure you don't have blood in your stool?"

"No, I remember it clearly." The patient said firmly.

However, most of the patient's symptoms corresponded to superior mesenteric artery embolism, but there was no blood in the stool. Qin Feng was thinking whether it might be superior mesenteric artery embolism without blood in the stool.

"Let's arrange for you to have an abdominal CT scan + enhancement first." Qin Feng said.

The patient glanced at Qin Feng suspiciously, said nothing, and went for CT under the guidance of an intern doctor.

The CT results showed that there was indeed a thrombus in the patient's intestine, but it was not blocked. This is good news.

After confirming that it was superior mesenteric artery embolism, Qin Feng quickly arranged for surgery.

Once the superior mesenteric artery is completely blocked, the patient will undoubtedly die. The operation was directly arranged at ten o'clock in the evening, which is the fastest time that the emergency department operating room can be discharged.

While there was still time, Qin Feng entered the operating room and performed embolization of the superior mesenteric artery a hundred times, and then returned to the outpatient clinic, quietly waiting for the time for the operation to arrive.

At ten o'clock in the evening, the operation officially began.

When Qin Feng came to the stage, he used interventional surgery to remove the thrombus, so he didn't call an assistant.

The patient was given local anesthesia first, and the left brachial artery was approached. The 6F vascular short sheath and COBRA catheter were inserted into the superior mesenteric artery for opening, which was convenient for angiography and thrombus removal.

Then pass the micro-guide wire through the thrombus and send it to the far side of the embolism, pull out the micro-guide wire, and perform microcatheter angiography to confirm the patency of the blood vessels distal to the thrombus, then cover the thrombus with a stent, and mark the thrombus at the 5mm far side .

Withdraw the catheter, release the stent, and wait for 5 minutes to allow the stent and thrombus to fully fit.

"Prepare a 50ml syringe, and manually suction at the end of the G catheter to maintain negative pressure to prevent the thrombus in the catheter from falling off." Qin Feng instructed the equipment nurse.

The equipment nurse nodded and kept the syringe. Qin Feng withdrew the stent. There was no thrombus attached to it. He directly took the syringe from the equipment nurse's hand and drew back the remaining thrombus.

Then use the filter to fish out the scattered tiny thrombi, and the whole operation is declared complete.

Except for the waiting time, the whole operation only took 10 minutes.

When she came out, the old woman still couldn't believe it.

In the end, she watched the uncle who woke up in the ward, and said that her abdomen did not hurt anymore. Only then did the old woman believe that Qin Feng had indeed completed the operation, and almost took Qin Feng for a liar.

After Qin Feng learned from the patient that the abdominal pain had disappeared, he was also relieved, and it was finally resolved satisfactorily.

"Grandpa, you can't follow your temper in the future, you must take your medicine on time, this time the abdominal pain was caused by the thrombus dislodged from the atrial fibrillation, which caused embolism of the superior mesenteric artery, but next time, you won't be so lucky. "Qin Feng warned.

The uncle nodded quickly in fright, "Don't worry, I will definitely take the medicine on time."

The old man's wife at the side also understood it, and was about to pull the old man's ears when he went up, and the old man backed away in fright.

If Qin Feng hadn't stopped him in time, it would have been the scene of domestic violence.

"Let me tell you, if you don't listen to the doctor anymore, let alone the hospital, I'll send you to the crematorium to be burned directly." The old man's wife said fiercely.

The uncle nodded in fright.

Although he is an uncle with abs alone, his wife is strict, and no matter how strong his abs are, it is useless.

Qin Feng explained a few words again, and left the ward directly.

Before going far, Qin Feng was called from the Respiratory Department, saying that it was the patient in the morning, whose condition suddenly worsened, and cholecystitis was detected.

Qin Feng rushed to the respiratory department and took a look at the respiratory doctor's color Doppler ultrasound.

The patient's gallbladder wall thickened, the gallbladder enlarged, there were excessive deposits inside the gallbladder, and there was obvious acute cholecystitis.

Qin Feng's breathing became short of breath. This was a misdiagnosis of Qin Feng. Qin Feng himself missed the most common case of cholecystitis.

Although this disease is usually not serious and can be cured by surgery, if it is mixed with respiratory failure and acute exacerbation of COPD, it is very serious.

Once the gallbladder is perforated, the respiratory doctor will suffer along with Qin Feng.

This is not to blame for Qin Feng. Qin Feng has handled too few common cases. When encountering a slightly more complicated case, he will think about difficult cases.

In addition, this patient did not have typical symptoms of abdominal pain and vomiting, so Qin Feng ignored this problem.

The respiratory doctor didn't blame Qin Feng either. Everyone makes mistakes. Everyone is not a god, even those big bosses make mistakes.

In the final analysis, although Qin Feng has sufficient experience in surgery and excellent consultation, but because of too many meetings, the simplest questions will be ignored.

(End of this chapter)