medical road high rise

Chapter 486 Which bronchoscope to choose?

Chapter 489 Which bronchoscope to choose?

After prescribing the medicine, Qin Feng emphasized again that he should pay attention to rest and then sent the patient away.

As for whether the patient can listen to it, Qin Feng has no choice.

Everyone in the current working environment is overdrawn, not to mention ordinary migrant workers, even Qin Feng himself is overdrawn.

Stretching for a while, Qin Feng thought he could get off work, after all, it was already one o'clock in the morning.

Just as he was packing up his things and was about to go to the locker room to change and go home, the nurse from the emergency department came over and stopped Qin Feng.

"Doctor Qin, let's not talk about it, the emergency center called just now, saying that there is a heart patient who will be sent here soon."

"..."

Qin Feng was speechless, he must have been targeted by the God of Night Shift today.

What the medical staff fear most is the god of the night shift. If the night shift can be safe and sound, that is the most comfortable time. Once busy, they may be able to take off with their feet, and even drinking saliva is a luxury.

Qin Feng could only take a sip of water while he was waiting, and the heart patient saw it as a stubble.

Ten minutes later, the patient was pushed off the ambulance, and Qin Feng listened to the report of the doctor on board.

"Patient, 54 years old, fainted suddenly..."

Qin Feng supported the flat car and ran while listening to the report of the doctor on the car.

Entering the emergency room, Qin Feng performed a physical examination on the patient and connected the electrocardiogram and ventilator.

During Qin Feng's physical examination, he found that the patient's body was somewhat swollen, both upper and lower limbs had obvious edema, and there were symptoms of distended jugular veins on the neck.

And when the doctor on board reported, the patient had a history of hypertension.

Unlike the kidney injury of the programmer who just left, the only manifestation of kidney injury is edema on the face, but there is no edema in the hands and feet.

However, if it is edema of both lower extremities and suffers from chronic diseases such as high blood pressure, diabetes history, coronary heart disease, etc., then cardiogenic edema, that is, edema caused by heart failure, should be considered.

The characteristic of cardiogenic edema is that it first appears in the sagging part of the body. For people without mobility impairments, the earliest part may be at the ankle joint. It is most obvious when moving, but it has no effect when resting.

For patients who cannot move and stay in bed for a long time, the edema of the lower back is more obvious, and this kind of edema is generally symmetrical, concave, and difficult to rebound.

So the diagnosis of the 50-year-old man in front of me was heart failure.

With the connection of the ECG monitor, the patient's physical signs and data are also displayed.

The blood pressure is 198/130, which is very high. If it drops suddenly, it is considered a cardiac arrest.

The blood oxygen saturation is 94%. This is because heart failure causes blood to reflux and pulmonary edema occurs, which reduces the function of air exchange and closure in the lungs.

……

"First use sacubitril, gesartan, beta blockers..." Qin Feng said the names of the medicines one by one.

The nurse went to get the medicine and injected the patient, while Qin Feng listened to the patient's heart and lung sounds.

"Get an electrocardiogram." Qin Feng said after listening.

The electrocardiogram was pulled out, and the above results showed that the patient had ventricular hypertrophy, no myocardial ischemia, etc., which are typical characteristics of heart failure.

The B-ultrasound machine was also pushed over by the hospital manager, but Qin Feng did not point the probe at the patient's heart at the first time, but pointed at the aorta at the patient's neck to the clavicle fossa to measure the ejection function .

When the heart pumps blood, blood spurts out from the aorta, which is called ejection function.

In the ejection function test, there is a concept called ejection fraction, which is an index of volume ratio, which reflects the ventricular ejection function from the perspective of volume. If the ejection function is reduced, it means heart failure.

According to the Qin Feng probe test, the patient's ejection fraction is 36%, which is generally greater than 40% in normal cases. If it is lower than this value, it indicates cardiac insufficiency.

Waiting for all the inspections to end, Qin Feng's expression became more and more serious.

According to the examination results, the patient's condition is still very serious. Heart failure, pulmonary edema, high blood pressure and coronary arteriosclerosis are all hard nuts to crack.

After more than two hours of rescue and medication, the patient's condition can only be regarded as stable. In the middle of the rescue, it is fortunate that the patient did not suffer from cardiac arrest.

Immediately, the patient was transferred to the ICU for observation on a diet, and waited for the indications for surgery to appear before undergoing surgery.

It was also because the patient's condition was too serious that he was sent to the ICU, and something went wrong, so he might not be able to react.

After all this was done, the emergency department finally returned to its former calm. Qin Feng looked at the dawn that had already appeared, and sighed that he could finally get off work.

When I got home, after washing up, I felt sleepy and fell asleep directly on the bed.

When he woke up, it was already one o'clock in the afternoon. Qin Feng took a shower and went to work.

Qin Feng is different from other doctors now, he has the right to adjust his time. After all, he stayed up late the day before and got up early the next day, which would be very harmful to Qin Feng's body.

Taking this into consideration, the hospital gave Qin Feng the time to practice medicine freely, and he could arrange the time himself, and no one cared about Qin Feng.

If there is no serious illness in the emergency department, Qin Feng will be fine even if he doesn't come for a whole day.

Qin Feng still couldn't bear to keep Qin Feng from going to the hospital for a whole day.

Putting on a white coat, Qin Feng took a look at the child from yesterday.

The child's condition is still a little serious, and the ventilator cannot be stopped at all.

Fortunately, around eleven o'clock in the noon, the inspection department had already sent the inspection report.

The histopathological examination of the patient's bronchus showed that there was indeed plastic material in the patient's bronchi. At the same time, the patient was hospitalized and an imaging CT examination was added to the patient. Most of the patient's lungs were also blocked, and there was severe interstitial Inflammation, the bronchi show segmental stenosis.

Qin Feng first went to the CT room and asked for a machine. It took half an hour to reconstruct the CT [-]D reconstruction of the patient's bronchi. It was obvious that there were a lot of foreign objects in the patient's bronchi.

Qin Feng has dared to conclude that the patient is plastic bronchitis.

"Try first to see if the patient can cough up the shaping substance." Qin Feng said.

The key to this disease is that as long as the alveolar ventilation is improved, it can be cured, that is, during the acute period, keep the airway unobstructed, and use the methods of suctioning, expelling, and coughing up the plastic material.

If the patient cannot actively cough up, it can only be removed surgically.

It’s just that the patient in front of me, because there are many foreign bodies in the bronchus, it’s very likely that the bronchoscope will be completely dark, and the operation is completely without vision, which is very difficult.

Qin Feng still thinks to induce phlegm first, to see if he can induce the patient to cough up.

After half an hour, five attempts to induce phlegm failed.

"Get ready for the foreign body removal operation under the bronchoscope." Qin Feng said seriously.

"Brother Qin, what kind of bronchoscope are you going to use?" asked the hospital chief.

(End of this chapter)