This doctor is very stable

Chapter 95 Aortic Dissection

Lin Ran shook his head vigorously, "No."

Chen Qiufeng said cheerfully: "Then, would you like to introduce one to you? Your teacher's wife is in the fashion design industry, and she knows quite a lot of girls."

"Let's forget it! Teacher, I'm going out first."

Finding a girlfriend has to be done by yourself, and relying on introductions is a bit unreliable.

Seeing that Lin Ran refused decisively, Chen Qiufeng began to tease, "You won't be shy, boy! You can't do this! I have to talk to your teacher's wife when I go back."

"Teacher, I'm just 26 years old and I'm still young. I'm going to go if I have nothing to do."

After speaking, Lin Ran ran away.

Back on the first floor of the emergency department, Lin Ran originally wanted to find Qian Xuan and the others to do a simple ward round for liver resection patients.

But he didn't expect to be caught by the nurse Li Xiaowu as soon as he stepped out of the elevator.

"Doctor Lin, I have a patient with sudden chest pain."

One patient, Lin Ran, never slacked off, "Go, let's have a look."

Walking into the treatment room, I saw a patient, a middle-aged uncle in his 50s and [-]s, lying flat on the treatment table.

Standing next to him turned out to be Zhang San.

Lin Ran looked at Zhang San and couldn't help asking, "What's the matter with you?"

Zhang San was both helpless and a little excited: "Doctor Lin, I just drove out of the house today, and I ran into an uncle who was sitting on the side of the road and clutching his chest. When I see someone in trouble, I will naturally use my sword to help!"

"You're really doing well."

After Lin Ran said something, she hurried forward to check on the patient's condition.

Seeing that the old man was pale, sweating, and clutching his chest, Lin Ran hurriedly asked, "Uncle, what's your name? Do you have high blood pressure? Is it a chest pain?"

Lin Ran asked, but the middle-aged uncle who was lying on the disposal table seemed to have never heard of it.

Lin Ran looked at Zhang San and asked, "Did this uncle get hit?"

Zhang San shook his head, "I don't know, I was driving, and I saw this uncle sitting on the ground with his hands on his chest from a distance, and his clothes didn't look like a sloppy person, so I thought he was sick. So I directly pulled into the car and took you to the hospital."

Lin Ran nodded, took off the stethoscope, untied the patient's clothes, and wanted to examine the patient.

【V4 patients】

[Crimson chest, acute aortic clip (Stanford type A), high-risk patients need surgical treatment. 】

Hold the grass!

Lin Ran's hands, which had never been shaken for thousands of years, couldn't help but pause, and his heart began to beat faster.

'Okay Zhang San, find me some critically ill patients all day long. '

calm down!

Lin Ran's brain immediately turned to the left.

What is aortic dissection?

A breach occurs in the intima of the aortic wall, through which blood enters the middle layer of the arterial wall, forming a dissection hematoma, and gradually extending and stripping the intima and media of the aorta to cause dissection.The aortic lumen at the lesion site is divided into true lumen and false lumen by the intima. The true lumen and the false lumen may or may not communicate, and blood flow between them may form a thrombus.

What should be done if a patient with aortic dissection is found?
an examination!
Pair check.

The current situation of the patient should be that the severe pain in the chest has caused disturbance of consciousness.

Looking at the nurse Lin Ran, he said urgently and seriously, "Call a chief physician over immediately."

"Okay." Li Xiaowu has never seen Lin Ran so nervous, she hurriedly responded, and then ran out of the treatment room.

Seeing this, Zhang San also asked, "Doctor Lin, what's wrong with uncle?"

Lin Ran inserted the earpiece of the stethoscope into the patient's ear to auscultate the patient, but did not answer his question.

[Diastolic murmur in the aortic valve area, decreased breath sounds on the left side. 】

Weakening of the breath sound on the left side indicates that a large amount of exudation or bleeding has occurred in the aortic dissection, blood has entered the chest cavity, and the left side of the breath sound is weakened only when the trachea moves to the right.

This situation is very dangerous!In other words, the situation of patients with aortic dissection is very dangerous.

If the aorta ruptures at this time, it will form a cardiac tamponade and lead to myocardial infarction.

The patient will die within a few minutes, and it will be too late to rescue, and many conventional rescue methods will not work.

Thinking of the danger of aortic dissection, Lin Ran hurried to the medicine cabinet in the treatment room, and quickly found out the analgesic (morphine) and antihypertensive drug (metoprolol).

Clinical studies have shown that 20.00% of patients with aortic dissection died before being sent to the hospital.

Two percent of aortic patients died because they were misdiagnosed as hypotension.

40.00% of eight patients with aorta died during the treatment.

That is to say, the mortality rate of patients with aortic dissection is as high as 70.00%.

After effective treatment, the 10-year survival rate of patients with aortic dissection is about 50%.

Lin Ran decisively took out the syringe and manually injected the patient with intramuscular morphine and intravenous metoprolol.

After Lin Ran made the injection, Zhang San saw Lin Ran's serious and tense expression, and he also started sweating, and asked, "This uncle really has some incurable disease, right?"

Lin Ran nodded fiercely.

At this moment, the nurse led Xu Hong into the treatment room.

Lin Ran looked at Xu Hong as if he saw a savior, and before he could ask, he quickly said: "Mr. Xu, the patient is suspected to have Stanford type A aortic dissection. The main symptoms are chest pain, disturbance of consciousness, auscultation: aortic valve diastolic murmur, decreased breath sounds on the left."

"There may have been a large amount of exudation or hemorrhage in the aortic dissection, and the blood has entered the chest cavity before the trachea moves to the right and the breath sound on the left side weakens."

After hearing Lin Ran's words, Xu Hong felt his heart twitch violently. He immediately took out his flashlight and hurried forward to check the pupils of the patient.

Lin Ran added again: "I injected the patient with morphine for pain relief and metoprolol, an antihypertensive drug."

After checking pupils, Xu Hong said: "Lin Ran, you have done a good job, let's go, hurry up and ask the radiology department for a CT."

Lin Ran and the three hurriedly pushed the patient out of the treatment room and rushed to the radiology department.

Even Zhang San could feel Lin Ran and Xu Hong's nervousness, and kept helping push the hospital bed.

Only those high-risk patients in the emergency department, doctors and nurses will use running.

Seeing Lin Ran and the others push out the disposal table, Li Min also followed and asked, "Director Xu, what's going on?"

During the fast and rhythmic running, Xu Hong turned his head, "Suspected aortic dissection."

After Li Min listened, he also looked serious, and asked again, "Send it to the radiology department for a CT examination?"

When encountering aortic dissection, it is estimated that there is no doctor who is not nervous. Aortic dissection is a high-risk emergency with a high fatality rate. Once the aortic dissection ruptures, it is too late to rescue it.

Several people pushed the hospital bed all the way to the emergency radiology department. The bald deputy chief doctor of the emergency department radiology department on duty poked his head. Xu Hong said anxiously: "Hurry up, Mr. Wang, CT, I can't wait."

The patients who come to the emergency radiology department are usually rushed, but Xu Hong came in person, which is of course urgent.

And the other patients and doctors who were filming the team all turned their attention to Lin Ran and the others.

"This is Lin Ran?"

"What patient are they in charge of? No obvious trauma!"

"Come and jump in line."

Lin Ran and the others pushed the patient into the examination room, and Xu Hong rushed directly into the computer observation room next door.

Two minutes later, after viewing the CT imaging on the computer, Xu Hong immediately took out his mobile phone and called Yang Xu, a cardiothoracic surgeon. Aortic dissection (Stanford type A) required immediate surgery, which could not be done in the emergency department, and there was no People can do it.

With the patient in front, how could Xu Hong care about any departmental struggles?
"Hello, is this Director Yang? I'm Xu Hong. We found a patient with type A aortic dissection in the emergency department. The male patient is between 40 and 50 years old. I will send you to the cardiothoracic surgery department immediately."

In a few words, Yang Xu heard Xu Hong's words and immediately said: "Okay, I understand, you can send it up! I will prepare for the operating room right now."

After hanging up the phone, Xu Hong ran out of the computer observation room and said without looking back, "When the film comes out, send someone to the cardiothoracic surgery department immediately."

Immediately afterwards, the door of the examination room was opened, and under Xu Hong's command, Lin Ran and the others began to push the hospital bed to the cardiothoracic surgery department without stopping.

Taking the emergency elevator, Lin Ran and the others pushed the beds of patients with aortic dissection to the cardiothoracic surgery department.

At this time, Yang Xu, the director of the cardiothoracic surgery department, brought his medical team and two chief physicians of cardiovascular and cerebrovascular diseases, and was already waiting at the elevator door.

The elevator door opened, and Xu Hong relaxed his tense nerves.

Lin Ran and the others pushed the patient out of the elevator, and the nurses and doctors from the cardiothoracic surgery department took over.

Yang Xu looked up at Xu Hong and asked, "Old Xu, what's the patient's condition?"

"We performed a CT scan on the patient. The dissection was located in the proximal aorthothoracic artery. He had symptoms of exudation and bleeding. He had already been injected with analgesics and antihypertensive drugs..."

After listening to Xu Hong's medical statement, Yang Xu nodded and turned to look at Li Min and Lin Ran.

His gaze stayed on Lin Ran, and he said with a smile, "Lin Ran, do you want to go into the operating room?"

Just after Yang Xu finished speaking, Wang Bingsheng, who was standing next to him and also knew Lin Ran, immediately gave Lin Ran a wink and asked him to agree.

In his opinion, it is rare for Yang Xu, as the director of the cardiothoracic surgery department, to invite a small-scale training doctor!

How many doctors dream of such an opportunity!

As long as Lin Ran agrees, isn't cardiothoracic surgery a certainty?
The small-incision appendicitis resection performed by Lin Ran in the emergency department, in the eyes of Wang Bingsheng, the head of cardiothoracic surgery, is like playing house, pediatrics.

Yang Xu's behavior is clearly an obvious provocation!

Seeing that Yang Xu started poaching in front of everyone, Xu Hong's old face immediately turned red with pain, and he said in a deep voice: "Director Yang, Lin Ran is a doctor in our emergency department, and he came to the hospital just to see patients."

"is it?"

Yang Xu didn't care about Xu Hong's words, and kept staring at Lin Ran, as if he was convinced of Lin Ran.

The more difficult, complicated and high-risk large-scale surgery is more attractive to doctors, especially for those talented doctors, the temptation of large-scale four-level surgery combined with multiple departments such as aortic dissection is fatal.

Lin Ran paused, he never expected Yang Xu to ask such a question.

Lin Ran naturally wants to see the vascular repair surgery for grade four large aortic dissection!
(End of this chapter)