The system takes me for surgery

The nurse urgently woke up Qin Hanyun. It was 05:30 in the morning, when she was most sleepy.
She clenched her fists, slapped her thighs, closed her eyes and let go: ten seconds, every time she was called up on duty, she would feel what she had done in her previous life to let herself be warmed by others at 05:30 Digging up from the bed, studying medicine is to be able to forcibly treat all kinds of wake-up qi.

When she came to the 32-bed ward, Qin Hanyun saw that the old lady's blood pressure had dropped to 75/ 50mmHg, her blood oxygen level was 86, and she experienced chest tightness and breathlessness again.

She quickly turned up the oxygen, but the old lady's symptoms did not ease.

Hurry up and call a cardiologist to come to the emergency consultation, and the diagnosis given is: "Consider "septic or cardiogenic shock", and treat with ceftriaxone and dopamine. Check chest CT: double lung consolidation and bilateral pleural effusion , Enlarged mediastinal lymph nodes. Abdominal B-ultrasound: liver congestion, bilateral moderate pleural effusion.

Liang Yi has always had doubts about the cardiologist's diagnosis yesterday. He is in the second-line emergency department today and is on standby.

He went to general surgery.

Qin Hanyun was sleepy but didn't dare to sleep. Her eyelids seemed to be filled with lead, and they fell down from time to time, but she didn't dare to close her eyes at all, for fear that she would really fall asleep as soon as she closed her eyes. If the old lady's situation It would be bad if it changed.

Gan Xiaoyi came to the ward after knowing it, saw Qin Hanyun dozing off, and said, "Senior sister, go and have a rest, I'll help you guard."

Qin Hanyun didn't say it was necessary, but she staggered and almost fell over, and said, "Then I'll have breakfast, and you can take a look for me."

"Hurry up, you look haggard." Gan Xiaoyi said.

When she just walked out of the ward, she ran into Liang Yi.

Seeing Qin Hanyun guarding the ward and her haggard face, Liang Yi could make a general guess and asked, "How is the old lady?"

Qin Hanyun shook her head, and said somewhat sadly: "Same as yesterday, I called the cardiology department for consultation again in the morning."

"Did the diagnosis change?"

Qin Hanyun nodded and said: "Dr. Li "considered "septic or cardiogenic shock" and gave ceftriaxone and dopamine. Now the blood pressure has gone up a bit. "

The old lady's son came and asked: "I heard that my mother was suffering again yesterday. Have you found the root cause of the disease? Why are there good times and bad times?"

Qin Hanyun said: "We have consulted with the cardiology department and will pay attention to the old lady's physical condition."

Her son asked: "I heard from the nurse that you called the cardiologist for consultation again this morning."

Qin Hanyun nodded and said, "Yes."

"What was the result of the consultation?"

At this time, Qin Hanyun was a little unconfident, and said: "This internal medicine doctor Li thinks it is septic or cardiogenic shock."

Her son said in a broken sentence, "Why does each doctor make a diagnosis? If it doesn't work, don't drag the patient along. People are not animals. If you let you try this way, you will kill people if they are good."

Her son left after speaking.

When encountering such an embarrassing situation, Qin Hanyun collapsed. In fact, no matter how hard she worked, it didn't matter how hard she worked. However, when encountering this kind of constant adjustment plan, but the condition is still getting worse, this is the easiest way to destroy a doctor's self-confidence.

This feeling is like having your feet stuck in the mud, the more you struggle, the deeper you sink, but if you don't struggle, you can only wait for death in the end. How much I hope that there is a God who can explain my doubts and doubts for myself in the dilemma.

And the reality is often even worse.

Afterwards, the old lady suffered from chest tightness, aggravated suffocation, and coughed up a little white frothy sputum.Re-examination of blood gas analysis: pH 7. 15, PO2 46. 4mmHg, only emergency tracheal intubation and ventilator-assisted breathing.

Even after the treatment, the old lady still felt palpitations, breathlessness, and a drop in diastolic blood pressure when she was in the supine position.

In the evening, the palpitation and breathlessness became paroxysmal, and the intensity of the third and fourth intercostal murmurs on the left sternal margin increased compared with before.

Check the echocardiogram for the old lady, several doctors in the voice changing department have different opinions,

The diagnosis was patent ductus arteriosus, ventricular septum combined with aortic regurgitation.

Aortic valve insufficiency, the possibility of rupture of septal tumors.

In the midst of double difficulties, the family members became very emotionally unstable, and they came to the doctor's office seven or eight times in one afternoon.

At this moment, the old lady's physical condition is like a time bomb, constantly counting down.

The family asked Qin Hanyun to copy all the prescriptions and medical records to him, and he took pictures of every detail.

Everyone knows that if something happens to the old lady, Qin Hanyun will definitely be sued by her family.

Qin Hanyun didn't dare to go home after being on duty, her face was swollen, her eye circles were as black as ink, her whole body was listless, and she completely entered a state of depression.

Xu Bowen said: "Xiao Yi go and ask Lu Chenhao to come over, he is an expert in this field."

Gan Xiaoyi quickly nodded and said, "Okay, I'll call right away."

And Liang Yi has been thinking about this disease, it seems that he is about to break out of the cocoon, but there is no way to pierce the layer of window paper.

Lu Chenhao came, with disheveled hair and a smell of alcohol. It looked like he had drunk a lot of alcohol. He quickly went through all the examinations the patient had done. His originally relaxed expression became a little complicated.

He saw Liang Yi drawing in front of the computer, took out his drawing paper, and asked with a smile, "Why are you drawing this?"

Liang Yi said: "I hope to sort out the clues."

The paper reads: 1 Heart failure, 2 Patent ductus arteriosus, 3 Ventricular defect combined with aortic regurgitation, 4 Aortic regurgitation, 5 High possibility of septal aneurysm rupture, 6 Aortic sinus.

Lu Chenhao laughed suddenly. He took out a red pen from Liang Yi's breast pocket and drew a circle on the aortic sinus, saying, "I didn't even think of it, but you kid thought of it! It's interesting!"

"You also think it might be the aortic sinus?"

"Maybe, I don't know, but the ultrasound can't see it, and the surgical exploration will know."

The aortic sinus is the space between the aortic valve and the aortic wall.

Aortic sinus aneurysm, also known as Valsalva's sinus aneurysm, is relatively rare clinically.

"You mean exploratory surgery?"

"Otherwise, what else can I do? Anyway, after using so many auxiliary examinations, I can't see it. I can only open the heart to check."

In theory, there is nothing wrong, there must be a problem with the heart, but without a clear diagnosis, he dared to perform surgery, could it be a lunatic?

Yes, he is a lunatic!

Liang Yi thought.

Seeing that Lu Chenhao's eyes were a little excited, he went through all the auxiliary examinations again, and said, "Brother Hao, I think there may be tumors in the interventricular septum and the aortic sinus."