Auto chess in the operating room

Chapter 414 Already lost the opportunity for surgical treatment?

After Tang Xianhu communicated with Tang Lou for a while to ensure that Tang Lou had a full understanding of the Mayo Clinic, he said: "Tang Lou, Dr. Patricia will be arriving soon. I'll go greet him. There will be one in a while. Special cases will be transferred from lower-level hospitals. I will arrange a consultation with Patricia, and then she will perform the surgery. After a while, I will invite doctors from the department to observe and learn, and you will come with me. After the operation is over , I will arrange for you to meet Patricia."

"Okay, Dean Tang. Then I'll go back first, and there happens to be another case that needs to be designed with a surgical plan. I'm also looking forward to seeing what the level of the doctors from the Mayo Clinic is."

After Tang Lou finished speaking, he left Tangxianhu's office.

However, Tang Xianhu also went out to meet Dr. Patricia who came from Shanghai.

Ten minutes later, Tang Xianhu arranged for Patricia to start a consultation with Director Huang and Professor Liu.

The patient was sent from a lower-level hospital. The situation is very complicated and urgent.

After getting the patient's treatment, I looked at it in the consultation room:
A 48-year-old female patient came to the doctor because of "chest tightness and shortness of breath for 20 days after exercise, accompanied by palpitation, weakness of limbs, inability to lie down at night, aggravated for 1 week"; she had no history of hypertension or cerebrovascular disease.

Physical examination: Chest percussion was unvoiced, both lungs breath sounds were clear; percussion of the precordial area relative to dullness increased, and no obvious heart murmur was heard in each valve auscultation area.

Transthoracic echocardiography: The left atrium was probed into an echogenic mass of approximately 45 mm × 40 mm, with large mobility. Part of the tumor entered the left ventricle through the mitral valve during diastole, and retracted into the left atrium during systole, with a narrow pedicle attached. In the atrial septum, mild tricuspid regurgitation, moderate pulmonary hypertension 65 mmHg; consider the possibility of myxoma.

After reading the information and the preliminary diagnosis of the lower-level hospital, several doctors quickly had a preliminary idea.

There were all the big guys present, and Director Huang was of course the one who suggested this: "The initial suspicion is that it is myxoma. Myxoma can occur in various chambers and ventricular cavities of the heart. The most common one is this patient's situation, located in the left atrium. .”

Professor Liu also agreed: "Yes, through the impact data, it can be observed that there are shadows in the patient's pulmonary artery ostium and ventricular cavity. The typical appearance of myxoma is a gelatinous tissue, often in the shape of lobes or grape beads. The size is different, ranging from 1cm to 10cm. The tumor tissue is very fragile and easily broken, and if it falls off, it can cause peripheral arterial embolism or cerebral vascular embolism, and a very small number of myxomas can undergo malignant transformation and become myxosarcoma.”

While several big shots were having a consultation, the resident doctor in charge of the bed under Director Huang rushed over. As soon as he came in, he immediately reported to Director Huang: "Director Huang, the patient suddenly suffered from epilepsy. Now his limbs are twitching and his mouth is white. Mo, we are now undergoing symptomatic treatment."

After listening to the resident doctor's report, Director Huang and others immediately rushed to the patient together.Patricia, an American doctor, followed closely behind, holding the patient's impact information in her hand. She seemed to have thought of some possibility, but her expression was not very good anyway.

Soon, several people arrived at the ward. Director Huang took the lead and started to deal with it, while Patricia at the side also started to observe. He was still a little disappointed when he saw the cooperating medical staff of Zijingang Hospital and the equipment in the ward. .

After all, the biggest feature of the Mayo Clinic is the abundance of medical staff. For example, Mayo’s operating rooms are divided into central, northern, and pediatric departments.Among them, in the middle of Patricia, although there are only a few 50 operating rooms, there are more than 120 anesthesiologists, as well as various residents, STAFF and CRNA.

In addition, Mayo's equipment and medicines have reached the top level. Some medicines are not even available in other hospitals in the United States. As long as Mayo's doctors think it is useful, they can propose it to the hospital and finally use it in clinical practice. middle.

This also ensures that Mayo can always be at the forefront of medical development.So, after seeing the situation in Zijingang, Patricia shook her head inadvertently, feeling some contempt in her heart.

Afterwards, Director Huang and Professor Liu began to conduct further physical examinations on the patient. Seeing Zijingang's very backward diagnosis methods and judgment of the condition, Patricia stood aside and remained silent.

Although empirical diagnosis can sometimes achieve an accurate judgment through a doctor's individual diagnosis, at the Mayo Clinic, they do not rely solely on short-term on-site observation.

When Patricia was at Mayo, for the diagnosis of many patients, in addition to her own judgment, she also relied on Mayo's large, efficient and multi-disciplinary data analysis department.

Mayo's data analysis department specializes in analyzing the massive information collected in the medical information system, aiming to improve clinical processes and outcomes.

For example, in the case of this patient, in addition to the on-site diagnosis, the patient’s information will be input into the system for later big data analysis. It can be said that many diseases that cannot be diagnosed in China can be obtained through Mayo’s database, which is complex and efficient. calculations for the most accurate diagnosis.

In the ward, various latest medical examinations were quickly completed.

"The patient's breathing gradually deepened and accelerated, breathing 30-40 times/min, oxygen saturation 95%-99%, blood pressure 150 mmHg/82 mmHg, deep coma, clammy and cold limbs, low breath sounds in both lungs and dull heart sounds on auscultation. Palpable dorsalis pedis artery pulse in both lower extremities. Bedside echocardiography: no iso-echoic clusters were seen in the left atrium, and the left ventricular ejection fraction was 56%; consider myxoma detachment."

"Further brain CT is needed, the patient's left lateral ventricle is compressed and deformed, and the left ventricular ejection fraction drops to 39%"

After 10 minutes, the further examination was finally completed, and all the doctors returned to the consultation room. Patricia also followed behind, carrying out a comprehensive and objective analysis and evaluation of the entire process of Zijingang Hospital in her heart.

Of course, based on further physical examination, he also had his own judgment.

Director Huang was still the first to put forward the idea: "The patient has multiple vascular embolisms all over the body. Combined with the disappearance of the echo group in the left atrium, it is basically certain that the systemic circulation embolism is caused by the detachment of the myxoma. However, the occurrence of epilepsy and subsequent shock is still unknown Find out what the reason is."

After Director Huang finished speaking, Professor Liu also put forward her opinion, which was basically the same as that of Director Huang, but put forward another idea of ​​his own: "The patient's left atrial myxoma split caused multiple vascular embolism, and it is not ruled out that it has already invaded the brain. , blood vessels of the lower extremities, renal arteries and coronary arteries, which is why epilepsy occurs. Moreover, disseminated intravascular coagulation in the late stage of shock will aggravate multiple embolisms. In short, the patient's condition is very dangerous, and it is very likely that he cannot pass simple surgery. save."

Professor Liu's tone was a little low. If the myxoma had been ruptured in the initial stage, left atrial myxoma could still be resected. It is possible to enter the brain and blood vessels of the lower extremities, as well as the renal arteries.

After listening to Professor Liu's analysis, Tang Xianhu also agreed, and the three doctors from Zijingang Hospital all looked at Patricia at the same time.

Of course, Dr. Patricia has unparalleled skills and experience, cleared his throat, and said directly: "I agree with Professor Liu's point of view, and based on my experience, the patient's myxoma is very likely to cause multiple cerebral vascular embolism, and Vascular embolism in the surrounding important organs does not rule out the renal artery and blood vessels of the lower extremities, and the patient is already in a state of garbage poisoning failure. It is also accompanied by liver and kidney dysfunction. Therefore, I judge that the patient has lost the opportunity for surgical treatment."

(End of this chapter)