Since 1981 Health School Chapter 598

  Chapter 598 The cause of abdominal pain lies in the heart

  Professor Tong took the medical report handed over by Chen Qi, put on reading glasses and looked at it for a while, then pursed his mouth.

  The other doctors from Xijing Hospital next to him didn't dare to say anything after seeing it. Everyone knew that Teacher Tong's mouth was shrunken, and it was often because he encountered a problem.

  Professor Tong handed the medical records to the students behind him:

   "Look at it too, everyone talks about their opinions."

  Cui Tongzhi's colleagues started talking after seeing it, because these doctors are obviously foreigners, why did they suddenly intervene in the patients of the People's Hospital?

  Intellectuals are more or less particular about "privacy".

  One of the staff knew Chen Qi, so he asked softly: "Dean Chen, who are these..."

  Chen Qi laughed and joked:

"You guys don't know Mount Tai with your eyes. This is a great professor of Xijing Hospital. You can see that the doctors behind him are almost at the level of professors and directors. With the number of this Professor Tong, you don't have to wait for seven days to go to Xijing Hospital. Qiye's team can't get in at all."

  The staff member was taken aback: "Xijing Hospital? Just the one in Xi'an? This hospital is amazing."

   "That's right, so the big professors will help you see a doctor for free today. Do you think that Lao Cui has gotten lucky?"

   Several staff members of the post office nodded again and again, and then looked expectantly at these great professors from the Northwest.

   As a result, the doctors from the northwest had a headache.

  Everyone gathered together to study the medical records first, and then took out all the inspection reports. Many doctors even took the initiative to do physical examinations and auscultate the heart and lungs of the patients.

   results in nothing.

  General doctors believe in the results of auxiliary examinations.

   Diagnoses came out of their mouths one by one, and then they were overturned by their colleagues one by one. Everyone's eyebrows were furrowed.

  Someone is already complaining: "This Yuezhong is really evil, why are there all these intractable diseases."

  "Organic diseases can be ruled out. The stomach, pancreas, gallbladder, liver, and spleen seem to have no problems so far, and the test results do not support that there are lesions in these parts. So is the problem still in the intestines?"

   "Could this also be epileptic abdominal pain?"

  Chen Qi's performance just now was too amazing. The gastroenterology department of the entire Xijing Hospital couldn't find out the problem. He fixed a few details, which made people have to admire.

  Professor Tong also looked at Chen Qi: "Xiao Chen, I see that you look confident, do you have any ideas for diagnosis and treatment?"

  Experts just ask if they don't know how to speak, do you know what kind of disease he has?

   This is too difficult, the doctor can only say that he doubts...

  Just like when Chen Qi diagnosed Yu Sisi's epileptic abdominal pain before, he didn't identify it at the beginning, but verified his own diagnosis and treatment ideas based on reasoning.

  For example, when he saw the corner of the girl's mother's mouth twitching, he thought of the possibility of epilepsy?

   If the mother has epilepsy, will the disease be passed on to the children?

   If it can be passed on to girls, will epilepsy cause abdominal pain?

   If the abdominal pain is guessed to be caused by epilepsy, what tests should be done to verify it? What medicines are taken for treatment?

  After this set of diagnosis and treatment ideas, it is like doing a math problem, listing the steps one by one, and finally getting a result.

  Medicine is the same as mathematics. The result is very important, but the process is also very important. During the medical examination, the way of solving problems is the same as mathematics. There are steps and scores.

   Explain the process, or the importance of ideas.

  This problem-solving process is the "clinical path". As long as the diagnosis and treatment ideas are correct, it can provide other doctors with a brand-new clinical path. This is the embodiment of the characteristics of empirical medicine.

  Chen Qi asked back: "Professor Tong, what do you think?"

"Now we can only do exclusion. Trauma can be ruled out because there is no relevant record in the medical history. Inflammatory causes such as acute gastroenteritis, appendicitis, various perforations, and peritonitis can also be ruled out according to the inspection report. of."

  Chen Qi nodded slightly, and continued to listen to Professor Tong's analysis:

   "Then is it possible that it is secondary pain? The patient's abdominal pain is just a symptom, that is to say, the real cause is not in the abdomen, but in other surrounding parts. This is also something that is ignored by everyone."

   "Oh, it seems that Professor Tong has the same idea as me."

  Professor Tong lost his temper at this time: "Then Xiao Chen, let's take a gamble and see who can guess which part is wrong."

  Chen Qi's personality is not prudent, and he became interested as soon as he heard the bet:

   "Okay, let's compare with Professor Tong today. Let's write down the parts we guessed on the paper, and then light it up to see who is more accurate."

   "Okay, it's a deal, bring a pen and paper."

  Professor Tong and Chen Qi are mostly joking. Of course, there is also a factor of "not admitting defeat" to their peers in their bones.

  Although Professor Tong Shanggao wanted to stimulate and teach his disciples and grandchildren more and more, but as Liang Pingjian said, should Xijing Hospital still have its cards?

  For Yu Sisi, Xijing Hospital lost face this time, although the trip to Vietnam was a good thing for the patient, because the cause of the disease was found out for her.

   But to save face, the gastroenterology department of Xijing Hospital has become a laughing stock of the national health system when the news spreads.

  So Professor Tong wanted to win back the game through this kind of joke.

  Cui Tongzhi's medical record can be regarded as an intractable disease. If Chen Qi guessed wrong, Tong Shanggao guessed right based on his decades of experience, it would be a one-to-one tie, right?

  The face of Xijing Hospital was somewhat restored.

  When they heard that their ancestors wanted to make a bet with Chen Qi, the doctors in Xijing Hospital all cheered secretly, and all of them blushed.

  The medical staff at the People's Hospital looked calm. Their own director, Chen, was on the job, and there was still a bad disease?

  Anyway, of the more than 1,300 employees of the People's Hospital, except for a certain deputy secretary, almost everyone else is Chen Qi's brainless fan.

   After a while, the little nurse brought a pen and paper, Chen Qi and Professor Tong wrote a word at random, and handed in the paper.

  The two put the white paper together on the desk, and the people next to it eagerly surrounded it, and then made a burst of "嗤~~~~" sound.

   I saw that Chen Qi and Professor Tong wrote a word together on the paper: heart

  Chen Qi and Professor Tong looked at each other and smiled, saying everything without saying anything.

  Yi Zewen is the head of the emergency department, and he was the first to ask:

   "Teachers, why did you answer that there was a heart problem? This is obviously a patient with abdominal pain."

  The doctors of Xijing Hospital also had doubts, except for the veteran directors Liang and Zhou who were thoughtful and seemed to reason about this possibility.

  Cui Tongzhi just had abdominal pain, not dead or comatose, he didn't care to be surprised when he heard this answer, instead he touched his left chest and was scared to death.

  Good guy, what can I do if my stomach hurts? If there is a problem with this heart, it is really going to die.

   "Doctor, save, save me~~~"

Other doctors are also eager to ask their own questions, especially the doctors at the Yuezhong People's Hospital. Chen Qi has always advocated this kind of open and enthusiastic academic atmosphere. Anyone can ask questions. Don't be afraid of any authority. authority.

   "Dean Chen, what's going on?"

   "Dean Chen, why do you think there is a heart problem?"

  But Chen Qi waved his hand,

"Now is not the time to explain. If Professor Tong and I have the right idea of ​​diagnosis and treatment, the patient is already in great danger. Zhang Xing, you should do an electrocardiogram right away. Chen Li, you should go to the laboratory in person and ask them to expedite the examination immediately." Cardiac enzymes, and troponin, fast."

  Everyone saw that Chen Qi's face became serious, and they started to act one after another.

  Professor Tong saw Zhang Xing running over with the electrocardiogram in his arms, and grabbed it: "I will do this electrocardiogram myself."

  Zhang Xing was still a little afraid: "Professor Tong, how can I let you do this kind of rough work..."

   "Okay, there is no time, since we have guesses, let's race against time!"

   After finishing speaking, Professor Tong had already started to install the leads on the patient himself, and the little doctors next to him were frightened and rushed to help.

  The electrocardiograms of the Yuezhong People's Hospital are all imported from the United States. Although they are second-hand, they are still very sensitive. When the switch is pressed, the electrocardiogram will be spit out.

   Everyone including Chen Qi surrounded him, and many doctors even stood on stools, wanting to see the results of the electrocardiogram.

  Suddenly, the doctors at the front of the crowd exclaimed:

   "Inferior myocardial infarction!"

  Hearing the heart attack, everyone trembled. Cui Tongzhi almost fainted when he heard it, and the colleagues next to him were obviously anxious.

  Myocardial infarction was almost a fatal emergency in the 1980s, and everyone avoided it.

  In fact, even in 2023, when the medical science is highly developed, the out-of-hospital mortality rate of myocardial infarction will reach more than 30%. Note that it is "above".

  Because in many remote areas, many patients obviously died of myocardial infarction, but because there was no autopsy or timely help, the mortality rate was more than 70% or even higher.

  Even in a well-equipped "hospital heart attack", the mortality rate has reached about 13%, which can be described as "notorious".

  Chen Qi stared at the electrocardiogram, while introducing to the presbyopic Professor Tong:

"ST-segment elevation in leads II, III, and AVF, ST-segment depression in leads I, AVL, and ST-segment depression in leads v1~v3 greater than or equal to 0.1 millivolts, it is indeed an inferior wall myocardial infarction, and the infarct size is relatively large." Large, the posterolateral wall and the posterior 1/3 of the interventricular septum have been involved."

  Professor Tong sighed: "Xiao Chen, you can deal with the patients in your hospital."

  He understands that when he encounters a patient with myocardial infarction, this is a dead end, and the patient is already in danger.

  Chen Qi immediately shouted to the doctors and nurses in the surrounding emergency department:

   "Immediately perform thrombolytic therapy, and at the same time perform coronary angiography immediately, and if the situation permits, perform interventional surgery immediately. And several of your colleagues, please inform Cui Tongzhi's family as soon as possible."

  Several employees of the post office have already lost their minds:

   "Oh, okay, notify the family members, yes, notify the family members, but where are the family members?..."

   At this time, Yi Zewen coughed a few times, and reminded in a low voice: "President Chen, our hospital has not yet carried out coronary angiography."

  Chen Qi slapped his forehead, thinking that he was preoccupied with endoscopy, and didn't take into account the specific operations being carried out in other departments.

  In fact, he can't be blamed. Chen Qi has only been the dean for so long, and there are so many departments in the whole hospital. Even a dean can't handle it.

   "No Coronary Angiography... No Interventional Procedures..."

  Chen Qi was stunned for a moment. As a rebirth doctor, he was very aware of the critical nature of myocardial infarction. He also knew that coronary angiography is the gold standard for diagnosing heart disease, and intervention is the key to life and death for myocardial infarction.

  Thrombolytic therapy alone is not safe, especially the efficacy of thrombolytic drugs in the 1980s was very poor.

   This is why everyone's face changed when they heard about a heart attack, and even the doctors of Xijing Hospital were helpless.

  Coronary angiography, this is not a rare thing, as early as 1958, a foreign hospital completed the first case of angiography.

   is the gold standard for diagnosing coronary heart disease and macrovascular lesions,

  Coronary angiography can find out whether the coronary artery is narrowed, which vessel is narrowed, and to what extent. According to the results of coronary angiography, it is evaluated whether to perform stent implantation on the narrowed vessel or coronary artery bypass surgery.

  If coronary angiography shows coronary artery stenosis, and the stenosis of a single diseased vessel is more than 75%, it is recommended to insert a stent.

  If coronary angiography shows that two or more blood vessels are diseased, and the degree of stenosis exceeds 75%, coronary artery bypass surgery is recommended.

  So this inspection is very important, and it is also the key to the success of subsequent rescue.

  The so-called interventional treatment, which was originally percutaneous coronary angioplasty (PTCA), was invented by Swiss doctors in 1977.

  Surgical method Infuse the catheter through the peripheral artery, send the balloon catheter to the vascular lesion, release the stenosis of the blood vessel through balloon expansion, restore the coronary blood flow, and then remove the balloon.

  However, in the subsequent clinical application, it was observed that PTCA had serious problems, including restenosis and acute vascular occlusion.

  So medical researchers from all over the world had to make improvements. The most direct idea is to prop up a scaffold at the narrowed blood vessel as a support, and the stent was born, thereby significantly reducing the restenosis rate of PTCA.

  In 1986, French doctors performed the first coronary stent implantation.

  The problem is that it is only 1989, people have just invented and developed abroad, and new clinical techniques have just been introduced, so it is impossible to spread them to China all at once.

  The country of Hua these days is half a beat behind the developed countries, and this is something that cannot be helped.

  But Chen Qi can do radiography and interventional surgery that others can't do.

   This thing is almost universal in the hospitals of later generations, not to mention the tertiary and second-level hospitals, even the awesome first-level hospitals, that is, the central town health center can do it.

  But in the Yuezhong Hospital in 1989, it was not so simple to play interventional therapy. One is whether the equipment is allowed?

  This requires a set of special tools, a professional medical angiographic X-ray machine, and a dedicated catheter guide wire bracket.

   This set of gadgets is available in Chen Qi's space operating room, but the problem is that when it is used, how to keep it secret has become a big trouble.

  (end of this chapter)

Chapter end