Doctor Zhao, help!

Chapter 83 The cause is hard to find
"Doctor, how are you?"

The girl's mother asked Zhao Sheng very nervously and anxiously.

The female teacher and the girl's father also looked at Zhao Sheng nervously.

"The child's condition is a bit bad. It is now suspected that he has pericardial effusion and pulmonary edema. Some tests must be done first to confirm the diagnosis."

Zhao Sheng said with a solemn expression.

"Okay, okay, doctor, start the examination quickly. We'll take Miaomiao to do it right away!"

The girl's mother nodded repeatedly, she didn't want to wait any longer.

"You take them for check-ups, and they are all expedited. Just say it was me who said so."

Zhao Sheng nodded and quickly ordered emergency blood tests, chest CT and cardiac ultrasound, and said to Song Wei at the same time.

"it is good."

Song Wei nodded and led the girl and her parents for a checkup.

after an hour.

Rescue the interior.

At this moment, the girl Miaomiao is already lying in the emergency room. Zhao Sheng has given the girl assisted ventilation, diuresis, anti-infection, and ECG monitoring. Now she is waiting for the test results to come out to confirm the diagnosis.

"Doctor, will Miaomiao be okay? Why is it so serious?"

The girl's mother looked at the pale and very weak girl lying on the rescue bed, and tears suddenly flowed out.

My daughter is the hope of the whole family. Not only does she study well, she is also very sensible and has no bad habits. Other children start to be rebellious in junior high school. However, my daughter is more sensible and can even understand the difficulty for adults to accompany her to study in Zhongdu. .

In today's terms, this daughter is an angel sent by God.

Therefore, both the couple and the elderly on both sides loved this child very much.

"We still have to wait for the test results to come back before we know."

Zhao Sheng said.

He had a vague idea in his mind, but he wasn't quite sure. There were too many and complicated diseases that could cause chest tightness and asthma.

After a while, the girl's father came in with a bunch of urgent test results.

"Doctor, the results are back."

The girl's father anxiously handed a stack of test results to Zhao Sheng and said.

"it is good."

Zhao Sheng took the test results and looked at them carefully.

However, upon taking a closer look, Zhao Sheng couldn't help but frown.

Blood test results showed no abnormalities in electrolytes, liver, kidney function, troponin, blood sugar, thyroid function, and respiratory viruses.

Blood routine: white blood cells and C-reactive protein were slightly elevated, but NT-proBNP reached 24913pg/mL! ! !

NT-probnp is the precursor brain natriuretic peptide, and the normal range should be less than 300pg/ml.

NT-probnp is currently an important biomarker reflecting cardiac function.Under normal circumstances, NT-probnp should be less than 300pg/ml.When NT-probnp is greater than 1000pg/ml, it indicates a higher risk of long-term death; when NT-probnp is greater than 5000pg/ml, it indicates that patients with heart failure have a higher risk of short-term death.

After working in the emergency department for so long, the NT-probnp usually only needs to reach 1000 to [-], or more than [-], which means that the patient must be given a critical illness notice, indicating that the patient's life may be in danger at any time.

Twenty thousand?

This is equivalent to saying that the girl in front of her has a very serious heart failure and is on the verge of death at any time.

Looking at the chest CT again, it turned out that there was pulmonary edema, pericardial effusion and pleural effusion. The results of the cardiac color picture were: mild left ventricular enlargement, left ventricular ejection fraction 25%, severe aortic valve regurgitation, and mitral valve center Degree of reflux, ascending aorta dilation, wall thickening, descending aorta reflux.

Electrocardiogram: sinus tachycardia, poor R wave progression in leads V1-V4, and nonspecific ST-T changes.How could a perfectly good 14-year-old junior high school girl become so serious?

After reading the examination results, Zhao Sheng's face was unusually solemn.

"Contact Dr. Li Mujia in the ICU and plan to transfer there, and then contact the cardiac surgery department for consultation."

Zhao Sheng said to Song Wei very seriously.

"Ok."

Seeing Zhao Sheng's serious expression, Song Wei immediately nodded and went to execute it.

"Doctor...Miaomiao her?"

Seeing that Zhao Sheng's face became so solemn after reading the test results, and he was transferred to ICU and called for consultation. The girl's mother suddenly felt that the situation was not good, and asked Zhao Sheng in a trembling voice.

"The child now has severe heart failure, which is heart failure, and must be transferred to the ICU immediately."

Zhao Sheng said quickly.

"I think it's okay. Miaomiao is just a little out of breath and her face is a little pale. It's not that serious..."

When the girl's mother heard this, she felt like a bolt from the blue, and she said in disbelief.

"It doesn't seem serious now because the child is young and the heart still has compensatory function. Once it cannot compensate, cardiac arrest may occur at any time."

Zhao Sheng explained that the situation was so serious that he had to make it clear to his family.

"what?!"

When the girl's mother heard this, her eyes suddenly darkened and her body became weak.

"Miaomiao's mother!"

The female teacher standing nearby exclaimed, and the girl's father and the girl's father immediately supported the girl's mother.

Soon, the girl Miaomiao was transferred to the ICU. At the ICU bedside, the ICU attending doctor Li Mujia and the attending cardiac surgeon Lin Yi arrived for consultation.

The girl Miaomiao was already unconscious at the moment. She was lying on the ICU bed in a semi-recumbent position, wearing an oxygen mask. Li Mujia, the attending doctor in the ICU, had already given the girl measures to control acute heart failure, such as dilation, diuresis and dilation of blood vessels. Although the condition was serious, At this time the girl was still in a relatively stable state.

There’s still time to find out the cause!

At this time, the three experienced attending doctors standing beside the ICU bed were thinking about it.

According to the girl Miaomiao's examination results and condition, the only four possible diseases she may suffer from at this time are valvular heart disease, cardiomyopathy, lung disease and aortic disease.

"Judging from the results of electrocardiogram, cardiac color Doppler ultrasound and troponin, the patient does not have cardiomyopathy and has no obvious fever recently. The cardiac function is impaired but the troponin is not significantly increased. The course of the disease may be relatively long, which can rule out coronary artery disease. Possibility of cardiac disease and acute fulminant myocarditis.”

Lin Yi, the chief physician of cardiac surgery, spoke first and spoke very methodically.

"Yes, combined with the patient's chest CT and clinical manifestations, the patient's pulmonary edema is considered to be related to pulmonary edema caused by heart failure, and the possibility of lung disease can also be ruled out."

Li Mujia, the attending doctor in the ICU, thought for a while and said, once again ruling out an alternative.

"The aortic valve and mitral valve have no deformity, thickening, adhesion, vegetation or perforation. Mitral valve regurgitation is considered to be related to left ventricular enlargement, and aortic valve regurgitation is considered to be related to ascending aorta dilation. Therefore, the heart valve Diseases can also be ruled out.”

After the two attending doctors finished talking, Zhao Sheng then ruled out the third possibility.

"The possibility of atherosclerosis in such a young child is too small."

After a pause, Zhao Sheng said again.

By saying this, he ruled out the last possibility, which was aortic disease.

All four possibilities have been ruled out. The three doctors look at each other and look at each other. This is really a difficult situation.

(End of this chapter)