Chapter 1743

"Calculation of inspiratory collapse rate of inferior vena cava: (max D-min d) / max D" × 100%。” Zheng Ren saw principal Zhang's face blank, so he explained directly.

"Place the probe under the sword to the right, and the scanning plane is parallel to the inferior vena cava. The image shows the right atrium, inferior vena cava and hepatic vein.

In normal state, the inferior vena cava collapsed obviously with deep inspiration, the diameter of inferior vena cava was ≤ 2.1 cm, and the inspiratory collapse rate & amp; gt; 50%, i.e. 3 mmHg.

When the right atrial pressure rises, the diameter can be & amp; gt; 2.1 cm, inspiratory collapse rate < 50%, i.e. 15 mmHg. "

Zheng Ren, like a Dalin machine gun, said without giving people time to think, "the diameter of the inferior vena cava has reached 2.4cm, and the inspiratory collapse rate is less than 50%, which can obviously prove to be pulmonary embolism."

"The fifth point is that the tricuspid regurgitation velocity increases. According to the simplified Bernoulli equation..." Zheng rendun said. Seeing president Zhang's face at a loss, he immediately sighed.

"You are not a doctor. You may not understand it. As long as you know it is calculated according to Bernoulli equation. From the perspective of tricuspid regurgitation, the embolus exists and is very large."

Headmaster Zhang almost scolded his mother.

What do you mean I'm not a doctor? The headmaster of Tangtang Medical University, are you so hurtful?!

But I think so, but I dare not say it. President Zhang didn't expect that boss Zheng, who is proficient in anatomy, spoke theory one by one.

He was not satisfied. He looked up at Sun Chao and wanted to find Olympic aid.

If only director Sun Chao could say one, two, three, four, five to dispel boss Zheng's arrogance.

However, what president Zhang saw was... Director Sun Chao with an ignorant face.

Sun Chao knows about echocardiography, but he will never be so deep. What formula, what equation, is this what you should say when looking at echocardiography?!

Sun Chao knew that President Zhang looked at himself, but he... Didn't understand at all!

He can only pretend not to see principal Zhang's eyes. His eyes are dull and straight at Zheng Ren.

A few days ago, Director Tian of cardiothoracic surgery was as embarrassed as himself? People can't understand what they say. How can they fight?

This is not a war at all, but a unilateral killing!

"Sixth, the notch appears in the middle of the forward flow spectrum contraction of the pulmonary artery, accompanied by a significant decrease in blood flow velocity, a shortening of blood flow acceleration time, a shortening of the right ventricular pre ejection period, that is, the RPEP period, and a reduction in the ratio of act to right ventricular ejection time, which is our diagnostic standard -" finger fist sign. "

Not yet

After one, two, three, four, five, there are six!

People are numb.

There was no echocardiography at the scene. What boss Zheng said was specious to everyone. But if you want to argue, you can't bring out strong evidence.

Really special!

Director Sun Chao is very angry.

However, everything is not over.

"Seventh, thrombosis is the most typical feature of thrombotic pulmonary embolism.

Thrombus located in the right atrium or right ventricle can have different forms, but when located in the pulmonary artery, it often shows large thrombus, extending from the trunk to one or both pulmonary artery branches.

The thrombus in the main right pulmonary artery is easy to display, while the thrombus in the left pulmonary artery is not easy to display due to its short display. In addition, we should pay attention to distinguish thrombus from right cardiac system tumor! "

"This patient can't see clearly because of gas interference, but we can roughly estimate its length - at least 10cm."

Zheng Ren said quickly.

"The thrombus can be seen partly in the trunk of the right pulmonary artery and partly in the right ventricle."

Speaking of this, he looked up and looked at headmaster Zhang. "There is a differential diagnosis of thrombosis and heart tumor. Because our time is limited, we won't say it here."

President Zhang felt great contempt.

He thought boss Zheng's subtext was that I said it, but you couldn't understand it, so he didn't say it. It's meaningless to talk so much to you waste firewood. It's totally meaningless.

Sun Chao was directly ignored by Zheng Ren as a mosaic.

Really... Really special!

Sun Chao scolded himself again.

"Eighth, abnormal ventricular septal motion..."

"Ninth, the foramen ovale reopens..."

However, boss Zheng's words are not over.

After talking about thrombosis, Zheng Ren continued to talk about the eighth and ninth points.

With that, he put the list on his desk, pointed his finger on the film reader and banged.

"The diagnosis has been relatively clear. Pulmonary embolism and thrombus block the main right pulmonary artery. Judging from echocardiography, the thrombus is very long, at least 10cm. This is one of the contraindications of interventional thrombectomy!"

"Moreover, the patient is in an emergency. If I have time, I can take 2 hours to remove the thrombus successfully. But now... I estimate that the survival time of the patient is only about 1 hour. If the thrombus is removed or other examinations are done, the patient will die."

"Principal Zhang, sign!" Zheng Ren frowned and said in a commanding tone.

Time is urgent, what gentle wind and rain, what respect for old comrades, are all special nonsense.

Principal Zhang was stunned.

Is this forced palace? Is time really so urgent?

"Boss, the patient's oxygen saturation is 75%! I'll send it to the operating room first. The operation is ready to start." Su Yun pushed the patient all the way. When he passed the office, he roared.

"Go." Zheng Ren took out a piece of white A4 paper and put it in front of president Zhang. He said, "president Zhang, there is no time, the operation risk is great, and the possibility that patients can't get off the operating table is at least 40%."

"..." principal Zhang shivered.

Not only him, but also the directors of vascular surgery around the country shivered.

But two shivers mean different things.

President Zhang is because students have a 40% chance of not coming down, while other directors are stunned that this young man is 60% sure that he can do the operation!

This is a highly difficult operation in the cloud. According to him, the patient will die within an hour.

1 hour, can cardiopulmonary bypass be established?

He said he was 60% sure?

10cm pulmonary embolism, cut off the heart, cut off the pulmonary artery, and take out the thrombus

No way, that's absolutely impossible!

Subconsciously, many directors did not question the diagnosis, but put all their mistrust on the success rate of the operation.

It can't be so high!

"Agree to the operation. Please sign here. There is no time for other preoperative explanations." Zheng Ren said, "I will write this paragraph after the operation."

"If you can't pay attention..." Zheng Ren said, looking at ringer.

"Boss Zheng, don't worry. All the medical department has to do is escort the clinic. President Zhang can't make up his mind, and the medical department also approves the operation!" Ringer understood and shouted without hesitation.