2753 Cardiac tampons
As the night grew darker, the circulatory system Department of Nanshan city People’s Hospital was still busy.
Associate Chief physician lang, who was in charge of the emergency department, had been busy for a whole twelve hours, seeing an endless stream of patients. He did not see any signs of rest yet.
The weather was getting colder, and the temperature in the North had plummeted. Cardiovascular and cerebrovascular diseases were reported. Today alone, Nanshan city People’s Hospital had received 12 patients with acute myocardial infarction.
Associate Chief physician lang arranged the order of the surgery according to the severity of the patient’s condition. During the intervals between the surgeries, he would take a look at the other patients ‘conditions and their medication.
He was extremely busy.
Director lang was already used to it, which was why he would cause such a disturbance every year when the temperature fluctuated greatly.
The difficult part was that there were very few people who were willing to perform interventional surgeries, not the patients, but the doctors.
In the past, when there was a problem with the patient’s coronary artery, they had to undergo bypass surgery to build the sternum. The sternum saw would buzz, and it was scary just thinking about it. But now, all they had to do was to puncture the wrist or neck and insert a tube. Every patient knew which one to choose.
However, when there were more patients, there would definitely be a lack of doctors.
In the past, when the income was high, there were still people who had to undergo interventional cardiac surgery. However, with the introduction of a series of measures such as the two-vote system, income became more and more transparent, and the disadvantage of the overall low salary level in the North was exposed.
If it had been last year, there would have been three groups of people on stage. Now, there was only him. Department Director lang put his hand on his waist, took off his lead coat, and started to transfer to another Ward.
He had been in contact with interventional surgeries for quite a long time. At first, he studied in Fuzhou hospital, and then he went to 912 hospital for further study. He was very familiar with the leading professors and department directors of both hospitals.
Although he was old, he could still teach others once he learned the skills.
Department Director lang had already made a plan. After he taught his disciple, he just had to sit down and watch. However, things didn’t go according to his wishes, and one of them left after he finished learning. Department Director lang was also very helpless.
In ancient times, heavy armored soldiers were paid more, but this did not exist in Nanshan People’s Hospital. The radiation allowance was only that much, and it was said that the rules were set in 2004.
At the thought of this, director lang was furious. How could the prices of goods in 2004 be compared to the current ones? How much did a house cost back then? how much did it cost now?
Was he going to the South too? Recently, Department Director lang would occasionally think of this question.
However, that was only something he would think about when he had nothing to do. There were so many patients with heart problems in the ward in front of him, who had the time to think about this?
Department Director lang was only able to catch his breath after he took off his lead coat and went to see the patient. He was already more than fifty years old, and he really could not stand being dressed in lead while performing surgery.
Moreover, they worked more or less, and their income was almost the same. They could only rely on their “noble medical ethics” to survive.
When he saw that there were two more emergency patients, Department Director Lang’s face turned bitter. ‘When will this end?’
However, he had no choice but to do it.
He chose a critically ill patient, and the preoperative instructions and surgical preparations began at the same time. Director lang was quite satisfied with his team, but he didn’t know how long they could last.
Department Director lang took some time to smoke a cigarette and took another look at the patient’s electrocardiogram. It was a typical case of myocardial infarction. Department Director lang put on the lead coat again and entered the operating theater.
The patient complained about chest pain for six hours, and the electrocardiogram showed that he had extensive anterior myocardial infarction. Other tests also supported this diagnosis.
The electrocardiogram showed that the patient’s condition was extremely serious, and there was no obvious relief after taking the medicine. At the very least, he needed to do an angiography.
The surgery went smoothly. The scan showed that the left front descending branch was completely blocked from the first pair of horn branches at the near end. The opening of the first pair of horn branches was narrow for more than 85%, and the near section of the left spiral branch was narrow for more than 90%. The blood flow in the front was TIMI2, and the right coronary artery was extensively diffused and had a lesion.
‘Fortunately, I did it,’ Department Director lang thought. If this dragged on for a night, there was a possibility that he would be gone.
If the patient’s coronary artery was blocked, there was no other way. He could only get a stent.
After the left front hatch was opened, two 2.5mm x 18.0mm, and 2.5mm x 29.0mm Firbird brackets were placed in succession.
After the two metal brackets were inserted, director lang heaved a sigh of relief. There shouldn’t be any problems this time.
“Are you feeling better?” Department Director lang did not perform angiography. Instead, he asked out of habit.
“Chief, I’m not done yet.” The patient’s voice was a little low, as if he was trying very hard to force himself to say this.
The old man was a very kind person, and he tried his best not to cause any trouble for director lang and the nurses during the surgery.
“Eh? Not done? How do you feel now?” Department Director lang asked in surprise.
“My chest and back … They’re so, so tight.” The patient said,”it’s even more stuffy than before the surgery.”
Department Director lang frowned as he stared at the blood pressure value on the ECG monitor. The blood pressure was falling from the normal and slightly high blood pressure before the surgery. Although it wasn’t fast, it was a smooth and steady descent.
It was still 90/60 mmhugo earlier, but it had dropped to 80/57 mmhugo in such a short time.
Strange, what was going on?
Could it be a cardiac tamponade caused by a ruptured coronary artery? Department Director lang woke up with a start. He was secreting a large amount of adrenaline and glucose, and the fatigue and sleepiness he felt earlier were all gone.
MB! Coronary artery rupture was one of the most serious surgical complications of interventional Cardiovascular Surgery, and one could even remove the word “
His hands trembled a little, but he immediately calmed down and began to perform the angiography.
However, Department Director lang was very puzzled by the results of the angiography. There was no obvious leakage of the contrast agent in the coronary artery! However, he couldn’t rule out the possibility of slight damage.
Director lang looked at the patient’s blood pressure, which continued to drop, and immediately said,”Epinephrine, 0.45 μ g per kilogram of enzymes per minute.”
The patient’s blood pressure was initially stabilized after the use of epinephrine. However, after a brief rise under the effect of the drug, the blood pressure began to fall again in less than five minutes, which allowed Department Director lang to catch his breath.
Although the angiography showed no leakage of the contrast agent, Department Director lang still suspected that it was cardiac tamponade. Otherwise, there was no way to explain these problems.
She called for an ultrasound, and there was a moderate amount of pericardium effusion.
“There should be a problem with the heart muscle. The bleeding entered the muscle gap due to the increased pressure, causing a blood clot to press on the small arteries. There’s not much blood,” Department Director lang analyzed.
However, a ruptured coronary artery … Department Director lang was extremely depressed.
The occurrence rate was about 1%. The basic cause of occurrence was mainly related to the closed pericardium after the occurrence of a coronary artery perforation, which led to cardiac relaxing dysfunction.
Department Director lang was considered to be quite lucky. He had encountered two similar patients over the years. He had not encountered many medical cases, but he had seen them before and had some experience.
Immediately prepare for cardiac puncture.
Department Director lang tried local anesthesia with lidocaine on the patient’s lower left fifth intercostal space. He implanted a single-spear drainage soft tube using the sliding method. After about ten minutes of open drainage, only 150 ml of blood was drawn out.
Department Director lang was a little confused as he observed the patient’s condition.
The blood loss was so small, and the patient’s blood pressure was still dropping … What the f * ck!