v3 Chapter 2751： Pericardial tamponade

The night was getting dark, and the Department of Circulation Medicine of Nanshan People's Hospital was still busy.

副 Deputy director Lang, who is in charge of the emergency department, has been busy for a full 12 hours. He has seen a continuous stream of patients and has not seen any signs of rest.

The weather is getting colder, the temperature in the north has plummeted, and cardiovascular and cerebrovascular diseases have been reported. Today, Nanshan People's Hospital has received 12 patients with acute myocardial infarction.

According to the severity of the illness, Deputy Director Lang arranged the order of the surgery, taking time to look at the other patients' conditions and medication during the interval of the operation.

Busy.

Every year, when the temperature fluctuates greatly, such moths come out. Director Lang is used to it.

There are fewer people who are willing to undergo interventional surgery, not the patient, but the doctor.

In the past, there was a problem in the coronary artery to do bypass surgery, splitting the sternum, the sternum saw buzzing, and it was scary to think. Now as long as a puncture is made on the wrist or neck, the lower tube can be inserted, and every patient knows how to choose.

But with more patients, the number of doctors must be relatively inadequate.

In the past, when people had high incomes, people still had cardiac interventional surgery. With the introduction of a series of measures such as the two-vote system, incomes became more transparent, and the disadvantages of low overall wage levels in the north were exposed.

If last year, there were three groups of people on the stage together, now they only have themselves. Director Lang leaned on his waist, took off his lead, and started to move to the ward.

He was relatively early in contact with interventional surgery. He started training in Fuwai, and then went to 912 for another training. He was familiar with the professors and directors of the two hospitals.

Although old, learning technology can teach others.

Director Jilang made a good calculation and showed the apprentice that he could just sit and look down. But things didn't work out as expected. Director Lang was very helpless when he learned one by one.

He was just not good at defamation. In ancient times when fighting, heavy armored fighters gave more soldiers. However, this did not exist at Nanshan People's Hospital. Radiological subsidies are just a little bit of money. It is said that the rules were made in 2004.

As soon as I thought of this, Director Lang became very angry. Is the price in 2004 comparable to what it is now? How much was the house at that time?

Is n’t he going to the south by himself? Director Lang has occasionally thought of this problem recently.

But I only think about it when I have nothing to do. With so many patients with myocardial infarction in the ward, who has time to ponder these.

Only after taking off the lead coat to see the patient, Director Lang could breathe. More than 50 people have been wearing the lead coat for surgery and can't stand it.

And doing more and doing less is almost the same in terms of income, just relying on the "noble medical ethics" of this fairy hang.

At first glance, two more emergency patients came, and Director Lang's face turned into bitter gourd. When is it the head!

I ca n’t help but do it.

A critically ill patient was selected, and the preoperative explanation and surgical preparation were carried out at the same time. Director Lang is still very satisfied with his staff, but I don't know when it will last.

I took a moment to smoke a cigarette and re-examined the patient's ECG. It was a typical MI, and Director Lang put on a lead coat again and went into the operating room.

The patient complained of chest pain for 6 hours. The ECG was diagnosed as a broad anterior myocardial infarction. Other examinations also supported this diagnosis.

The ECG showed that the patient was very ill and there was no obvious remission after the medication. At least an angiogram was needed.

The operation was very smooth. During the angiography, the left anterior descending branch was completely occluded from the first diagonal branch of the proximal segment. The opening of the first diagonal branch was more than 85% narrow. TIMI grade 2, extensive diffuse lesion of the right coronary artery.

Fortunately, Director Lang thought to himself. If it is delayed for one night, people may be gone.

The coronary artery is severely blocked.

After the left anterior descending branch is opened, .0mm and .0mm Firbird brackets are placed one after the other.

After the two brackets went under, Director Lang was relieved. There should be no problem this time.

"Are you better?" Director Lang didn't have radiography, but asked habitually first.

"Director, it's not good." The patient's voice was a little muffled, as if trying to utter the sentence.

Mr. Xun is very kind, and in the process of surgery, he also endured not to make trouble for Director Lang and the nurse as much as possible.

"Huh? Not good? How do you feel now?" Director Lang asked in amazement.

"The chest, back ... stuffy, stuffy." The patient said, "more stuffy than before the operation."

Director Jilang frowned at the blood pressure value on the ECG monitor, and the blood pressure was falling from the normal slightly higher level before surgery. Although unpleasant, the decline was smooth and firm.

Hg was just now, so Kung Fu has dropped to Hg after a while.

I wonder, what is going on?

Is it the rupture of the coronary arteries that causes the pericardial tamponade? Director Lang was awakened, a large amount of adrenaline and glucocorticoids were secreted, and the fatigue and drowsiness just disappeared.

MB! Coronary rupture is one of the most serious surgical complications of cardiac circulation intervention surgery, and even one or two words can be removed.

His hand was shaking a little, but he calmed down immediately and started to do the radiography.

But the result of the angiography made Director Lang very puzzled that there was no obvious contrast agent leakage in the coronary artery! However, the possibility of problems caused by minor damage is not ruled out.

Director Lang watched the patient's continuously falling blood pressure and immediately said: "Norepinephrine 0.45 μg per kilogram-per minute ~ www.novelhall.com ~ After the norepinephrine application, the patient's blood pressure has initially stabilized, but After a brief rise under the action of the drug, it was not 5 minutes before Director Lang breathed and his blood pressure began to drop again.

Although angiography did not show leakage of contrast agent, Director Lang still suspected pericardial tamponade, otherwise there was no way to explain these problems.

Howling called an echocardiogram, and there was small-to-medium volume in the pericardium.

It should be a problem with the myocardium. The bleeding entered the muscle space because of the increased pressure, which caused the hematoma to compress the small arteries.

But the coronary rupture ... Director Lang is extremely frustrated.

Coronary rupture is a serious complication with a low incidence during PCI. The incidence rate is about 1%. The basic cause is mainly related to myocardial diastolic dysfunction caused by closed intrapericardial hemorrhage after coronary perforation.

Director Jilang had better luck, and encountered two similar patients over the years. There are not many cases encountered, but after all, I have seen it and have some experience.

Immediately prepare a pericardial puncture.

Director Jilang tried local anesthesia of lidocaine in the fifth lower intercostal space of the chest wall of the patient. He used the sliding method to insert a single spear drainage hose, and after about 10 minutes of open drainage, only 150ml of blood was drawn out.

Observing the patient's situation, Director Lang is a little embarrassed.

The amount of bleeding is so small, the patient's blood pressure is still falling ... this is special!