Chapter 172

"What's your teacher's name? I'll be in the emergency department next month, and I want him to take me in!"

Yu Jian pursed his lips and shook his head:

"Nonono~! Teacher Zhang only wants those who are smart, that is, those who are diligent and capable, hehe, so he chose me!

You can't be Teacher Zhang's apprentice just because you want to. You have to be excellent to become Teacher Zhang's apprentice, you know?"

On the side, two interns in the same department heard Yu Jian bragging here, and they all pouted and stared at him with resentment.

Humph!

You're lucky!

...

Early the next morning.

Zhang Yi walked carefully to the hospital gate.

Observe first!

After confirming that no one was waiting there, he slowly came to the department.

It seems that what he said yesterday was still effective.

Today, all the fans have dispersed.

I believe that after waiting for a while, when the heat is completely over, no one will come.

Handover of the morning shift and ward rounds.

A busy day begins.

At two o'clock in the afternoon, the general surgery department reported that the patient with fasciitis had not yet developed an infection.

The effect of combined antibiotic application was also good.

The second skin graft can be performed in two days.

Chen Fang also took the opportunity to post Zhang Yi's surgery yesterday on the forum.

Swish!

Another wave of forwarding comments and likes.

In less than ten minutes, the number of likes exceeded 10,000!

There was also a burst of praise in the classmates group.

Even Lu Gao rarely praised Mr. Z.

Lu Gao: "It can be seen that Mr. Z must be a respected senior, right?

I don't know which hospital he is from. If there is a chance, I really want to be his apprentice and learn how to operate."

Wang Haiqing: "It's far away... ahem, this big guy may not want to accept you as his apprentice."

Zhang Yi: "Who said that? As long as you have a correct attitude, call me master, and offer a cup of tea, maybe the old senior will agree."

Zhang Yi and Wang Haiqing sang a double act in the group.

He acted out Lu Gao's trick.

Lu Gao thought that they also wanted to be Mr. Z's apprentice, so he said:

"Haha, even if the old senior doesn't accept me as his apprentice, I will find a connection to let him teach me. Is there anything in this world that money can't solve?

But you two, you have no background and no money, the old senior won't even bother with you!"

"Hahaha..."

On the other end of the phone, Zhang Yi laughed across the screen!

Lu Gao, Lu Gao.

God gave you a very good family background.

But took away half of your IQ!

I really don't know what his expression will be when he finds out that Zhang Yi is the respected old senior he mentioned? ?

...

At the same time, Imperial Capital Ping An Hospital.

Cardiac Surgery.

As soon as Lu Gao put down his phone, he heard a middle-aged woman with a Taiwan accent yelling and cursing outside the ICU next to him:

"Don't you have better doctors in the mainland?!

My mother has been treated for two days and there is still no improvement?

What is this??

Roar~ It's really annoying. Even now, the cause of the disease can't be found. Roar!

Are you mainlanders so rubbish?!"

Chapter 132 A patient with heart failure who can't find the cause? What to do

The person yelling outside the ICU is a family member of the patient.

She came from Taiwan to visit relatives.

The patient is a heart patient.

Female, 70 years old.

She suddenly had shortness of breath for an hour and was rushed to the hospital after a cardiac arrest.

She couldn't lie flat when she was short of breath, and could only sit up to breathe, and coughed up pink foamy sputum.

When she was admitted to the hospital, it was found that her heartbeat, breathing, and pulse had stopped.

Immediately gave cardiopulmonary resuscitation, adrenaline intravenous push, and a series of rescue measures such as electric shock defibrillation and ventilator-assisted breathing.

About fifteen minutes later, the patient recovered his heartbeat.

But his consciousness was still in a state of confusion.

After the rescue, the patient was examined, T36.7℃, P114 times/min, R15 times/min, BP88/58mmHg.

The pupils were equal in size and round, but the light reflex was weakened, the breath sounds of both lungs were coarse, and moist rales were heard.

The heart rhythm was regular, and a systolic jet murmur was heard at the apex.

There was no edema in both lower limbs.

Past medical history included diabetes and hypertension.

Blood routine white blood cell count: 17.31x10?/l (4-10x10?/l)

Neutrophil percentage: 44.2% (50-70)

Blood sugar: 25.4mmol/l.

High-sensitivity troponin T: >5000pg/ml.

(One of the markers of myocardial injury.)

Creatine kinase: 213u/l (0-25)

No abnormalities were found in other liver function, kidney function, thyroid function, and blood lipids.

ECG: QRS wave high voltage.

Coronary angiography showed: no stenosis was found in the left main trunk, anterior descending branch, and right coronary artery.

Cardiac ultrasound: the ventricular septum was thickened from the left ventricular wall, with a thickness of 38mm (20-35), and reduced compliance.

After all the test results came out, Wang Xiaomian immediately made a diagnosis:

1. Fulminant myocarditis 2. Acute pulmonary edema 3. Acute left heart failure 4. Coronary artery obstructive myocardial infarction?

Fulminant myocarditis does cause ventricular wall thickening, so Wang Xiaomian considered this as the primary diagnosis.

As for coronary artery obstructive myocardial infarction, there is a question mark after it, which means that further observation is needed to confirm it.

However, the patient's high-sensitivity troponin and creatine kinase were very high, so the possibility of myocardial infarction could not be ruled out.

After the diagnosis was made, Wang Xiaomian also told the family members about it.

The cause of the patient's illness was ventricular wall hypertrophy caused by myocarditis.

Ventricular wall hypertrophy will reduce the contractile function of the heart.

If the contractile function is reduced, the blood outflow of the left ventricle will be reduced, and all the blood will be piled up in the ventricle and cannot be discharged.

It will cause both heart failure and increased pulmonary venous pressure.

So left heart failure and pulmonary edema appeared together.

After the rescue, Wang Xiaomian also issued a long-term medical order for infusion.

First, dilate the blood vessels to increase cardiac output.