Chapter 567: Special Myocardial Infarction Patients, Systemic Arterial Vascular Distortion
"OK."
The waiter quickly brought over two take-away boxes.
As for the service attitude, the attitude of ordinary shops and restaurants is warm and considerate. The service attitude of banks and luxury stores is more hypocritical. If you have money, you can enjoy VIP service, but if you don’t have money, you will be treated coldly.
"Du Leng and I are planning to get married this year. You all must come to my wedding!"
Ma Xiaolan picked up some crayfish, lamb skewers and leeks and put them into the box.
At the same time, a shocking news was also announced to them.
When she was dating Du Leng, I'm afraid few people were optimistic about her.
Zhou Can even thought that Du Leng was just playing around and that the two would break up soon. He never expected that the two had already reached the stage of discussing marriage.
"I will definitely go to Xiaolan's wedding. I'm just a little afraid that I won't be able to take time off."
Qiao Yu was the first to express his opinion.
"Boss, marriage is a happy event that only happens once in a lifetime. You have to approve leave for everyone."
Ma Xiaolan immediately looked at Zhou Can.
"I won't hold you back, but doctors and nurses are special professions, and it's unlikely that everyone will take leave at the same time. If the wedding is held in this city, I can arrange two or three hours of leave, which won't be a big problem."
Zhou Can didn't dare to agree rashly.
Medical staff because patients cannot wait and they must be treated in time when they arrive at the hospital.
Hospitals are usually short of nurses, and many clinical nurses have to do the work of two people. Not only do hospitals not allow them to take leave, they also want them to work overtime day and night.
This phenomenon is extremely common, especially in large hospitals.
When a flu outbreak occurs, the medicines in the treatment room can be placed from one end of the cabinet to the other. Each patient's medicine needs to be checked at least twice, prepared in advance, and then given to the patient within the required time.
Even if it only takes one minute to prepare medicine for a patient, two to ten minutes to give an infusion or injection, it will take about one minute to recycle the used bottles, pull out the needle or deal with the indwelling needle.
It takes at least five to ten minutes, or even longer, to completely treat a patient.
Even if nurses' working hours are extended to twelve hours a day, it is still far from enough when there are too many patients.
When there are more patients, there is also a scary phenomenon: seriously ill patients and accidents are more likely to occur.
This will lead to severe overcrowding of multiple nursing resources.
Therefore, it is difficult for nurses to take leave.
Doctors are more special than nurses, and each doctor specializes in different areas. The more senior the doctor, the less replaceable he is in the department.
If a chief physician takes a break, that department may not be able to treat that type of patients.
Ordinary doctors are highly replaceable, but they do a lot of work!
The lower-level doctors, such as interns and residents, have to do more work. It is really too much to think that interns can just watch the senior doctors operate with their hands and learn slowly.
Take the emergency department where Zhou Can works as an example. When a patient comes to be rescued, interns have to go if the senior doctor is not present.
It is almost impossible for Ma Xiaolan to give the surgical team a day off for their wedding.
It is easier to get approval if you ask for a temporary leave of two or three hours from the department.
Everyone was happily eating the food when Zhou Can's cell phone rang.
I took it out and saw that it was a call from the hospital's emergency department.
Connected.
"Doctor Zhou, please go back to the emergency department of the hospital immediately. We have sent a patient with myocardial infarction here. His condition is very critical."
"Okay! I'll be there right away!"
Zhou Can stood up and hurriedly said to everyone, "I can't accompany you. There's a patient in the emergency room and I have to rush over immediately. Please feel free to order any food and drinks you like. I will reimburse you tomorrow."
After saying that, Zhou Can left quickly.
Fortunately, the alley where he had supper was very close to Tuya Hospital, so he trotted back to the emergency department of the hospital.
When he arrived, the patient had already been taken to the emergency room.
Patients with myocardial infarction must be rescued in time, otherwise they will die soon.
"Xiao Zhou, come and take a look at this patient's condition!"
Director Lou's forehead was covered with sweat.
It seems that he has led the nurses and doctors to launch a round of rescue for the patient.
I haven't seen any cardiothoracic or cardiovascular doctors come for consultation yet.
Both departments have the ability to treat patients with myocardial infarction.
The emergency department currently does not have the treatment capabilities, but simple vascular thrombolysis and cardiopulmonary resuscitation are no problem.
Zhou Can walked quickly to the emergency bed and was stunned when he saw the patient's face.
How could it be him?
The patient on the emergency bed was Zhang Qilian, the director of the Third Hospital, whom he had met twice.
At this moment, his face was pale, his eyes were indifferent, his breathing was short, and his heart rate was extremely unstable.
"Have you done an angiography?"
"Not yet. The patient was transferred from the Third Hospital. The biochemical test results showed that the patient's myocardial enzymes were severely elevated. After checking the electrocardiogram, it can be basically confirmed that it is a myocardial infarction."
Director Lou gave the patient's examination records to Zhou Can for review.
"Looking at his blood pressure, heart rate, complexion, and the dynamic changes in the ST-T of the electrocardiogram, the area of the myocardial infarction should be quite large. It would be great if he could be sent here earlier. Now I'm afraid he needs to be sent to the cardiac catheterization room immediately for interventional treatment."
After checking the patient's condition, Zhou Can quickly gave rescue suggestions.
This is the difference between a high level and an average level.
Even though Director Lou and others knew that the patient had a myocardial infarction, they could only perform some routine rescue efforts to stabilize the patient's life first.
After Zhou Can looked at it, he could directly give a specific rescue plan.
"Contact the cardiac catheterization lab immediately and send the patient there. I'll go talk to the family."
Director Lou is also extremely decisive.
…
After nearly two hours of rescue, Zhang Qilian's life was saved, but because of the long period of ischemia, he will definitely suffer serious sequelae.
Heart failure, arrhythmia and ventricular aneurysm, etc.
The main manifestation is heart failure.
He will feel breathless every time he walks, and his quality of life will be seriously reduced for the rest of his life.
The only solution is to replace the artificial heart or heart transplant.
Both myocardial infarction and cerebral infarction are irreversible damages.
In fact, prolonged ischemia of any tissue in the body may cause irreversible damage.
However, some parts are special. Even if the large blood vessels are blocked, there are still arteries that can supply blood. In this case, the body will have serious symptoms, but as long as it is treated in time, there will most likely be no sequelae.
Zhang Qilian's interventional thrombectomy surgery was very difficult.
His blood vessels are very special.
The doctors in the interventional department failed to succeed whether they tried femoral artery intervention, radial artery intervention, or percutaneous coronary intervention.
Later, Zhou Can took action and finally found the problem with the help of six-level injection and six-level insertion.
It turned out that there were two serious arterial plaques on the path from Zhang Qilian's femoral artery to the coronary artery, which caused the two blood vessels to be abnormally narrow, especially at a bend, where the blockage was quite serious.
This also greatly increases the difficulty of passing the guide wire through the blood vessel.
If only the femoral artery access is blocked, the interventional doctor is still not afraid. He can also access through the radial artery.
In clinical emergency, radial artery access is used more frequently.
Unfortunately, the passage between Zhang Qilian's radial artery and coronary artery was more severely blocked, and the blood vessels were severely deformed. This situation is very rare in clinical practice.
At least it was the first time that Zhou Can saw a patient with such severe vascular malformation.
He even discovered through coronary angiography that the patient's coronary arteries were severely deformed.
This made him wonder if all the arteries in the patient's body had this disease? Or was it just a special constitution, was it natural?
We can only find out the reason later.
Zhang Qilian's vascular condition is so special that it's no wonder that the Japanese cardiac surgeon at the Third Hospital was helpless.
Through this treatment, Zhou Can gained greater confidence in his interventional treatment skills.
Unconsciously, his level of intervention has surpassed many 'experts'.
When he walked out of the cardiac catheterization room, he had already roughly figured out Zhang Qilian's entire illness and treatment process.
It is very likely that Zhou Can launched a desperate counterattack in court, which made Zhang Qilian find it difficult to accept.
He was already relatively old, and had serious lesions in his arteries throughout his body. After severe mental stimulation, his blood pressure soared, aggravating blood vessel blockage and ultimately causing a heart attack.
Some people may be curious. When blood pressure rises, blood circulation in the body should speed up and blood flow should be smoother. How could a heart attack occur instead?
The pathogenic mechanism should be analyzed from multiple perspectives.
First, high blood pressure promotes the process of atherosclerosis, which directly leads to the narrowing of arteries.
Zhang Qilian's arterial vascular disease is so severe that he is most likely suffering from long-term hypertension.
Secondly, long-term poor blood pressure control can easily cause target organ damage and left ventricular enlargement.
As the left ventricle becomes larger, its ability to eject blood will weaken.
It's like a house that originally had a family of three living in it, and they lived very cozy . One day, the house was expanded and became much larger, but it still seemed empty with only three people living in it.
The same is true for the ventricles.
Even though the ventricle enlarges, the amount of blood entering remains the same, so its ability to eject blood is naturally weakened.
At the same time, enlargement of the ventricles can cause the myocardium to become weak, which is also an important reason for the weakening of blood ejection capacity.
If the left ventricle is enlarged and left unattended, it will affect the blood supply to the myocardium in the long run. At this time, the patient's risk of coronary artery spasm will increase significantly.
With the above conditions, the patient is stimulated and suddenly has a high blood pressure, and the unstable atherosclerotic plaque will fall off directly. At this time, a blood clot will be formed, eventually causing coronary artery obstruction.
Therefore, when communicating with patients with heart disease, you must be careful about your language.
Overexertion can cause the patient's blood pressure to rise, which is dangerous.
If you make someone angry to death, you will most likely be involved in a lawsuit.
Zhang Qilian lost the case in court, his blood pressure rose, and he unfortunately suffered a heart attack.
His own hospital was mainly engaged in cardiac surgery, so he naturally chose to be treated in his own hospital. However, he never expected that the Japanese cardiac surgery expert employed by the hospital with a high salary was such a rubbish.
He failed again at the critical moment.
In the end, after many efforts, we were still unable to remove the blood clot and clear the blocked arteries and cardiovascular system.
There is nothing we can do at this time.
After discussion, the family members and Vice President Zhang and others chose to trust Tuya's medical technology and took the patient directly to Tuya for emergency treatment.
As it turned out, their decision was very correct.
After more than two hours of hard work, Zhou Can placed two stents in the path from the patient's femoral artery to the coronary artery. After expanding the severely narrowed blood vessel, the guide wire was able to pass through smoothly.
The thrombectomy was finally successfully completed.
According to Zhou Can's criteria, he felt that the patient would need at least hundreds of vascular stents placed in his body.
Even so, I'm afraid it still can't completely solve the problem.
Zhang Qilian is still at risk for blocked arteries.
No matter what, he successfully rescued the person, which will definitely increase his fame again.
After coming out of the interventional room, family members surrounded him.
"Doctor, how is my husband?"
Zhang Qilian's wife looks very young, well-maintained, and has exquisite makeup.
If it weren't for her nasolabial folds, the slight crow's feet at the corners of her eyes, and her eyes that didn't match her youthful appearance, Zhou Can would really have thought that this woman was only in her twenties.
The skin is not only fair but also shiny.
The figure is also maintained very well.
The kind of person with a gentle temperament, beautiful and intelligent.
Zhang Qilian was ruthless and vicious, and he was not handsome, but he married such a beautiful wife. This reminded Zhou Can of a saying: flowers love to grow on cow dung.
"The patient is out of danger for now. However, his systemic arterial vascular disease is very serious, so he needs to be extra careful in the later stages and must not get angry again. Also, because he was sent here too late, the best time for rescue was missed. After recovery, the patient may suffer from heart failure and cannot do heavy work or strenuous exercise."
Zhou Can and Zhang Qilian are considered enemies.
But whether during the rescue process or now, he embodies the sacredness and nobility of the medical profession.
Always consider the patient's needs.
"It's so clear!"
After listening to this, she clasped her hands together and a happy smile appeared on her face.
It can be seen that she cares about Zhang Qilian very much.
Their love should be very sweet.
She just spoke Japanese, which was also an instinctive reaction. This made Zhou Can understand that this woman was probably from Japan.
Subconsciously, he lowered his head and glanced at her legs.
Sure enough, standard bow legs.
"Thank you, thank you!"
She expressed her gratitude to Zhou Can repeatedly.
"You're welcome! You'll be able to see the patient later. He may need to stay in the hospital for about three to seven days."
Zhou Can nodded to her and left.
…
The next day, after Zhou Can checked the emergency department ward in the morning, he went to see how Zhang Qilian was recovering.
As soon as I arrived at the cardiovascular department's inpatient ward, I saw a familiar figure.
Vice President Zhang, who was taken away by the security guards last time, was standing outside the ward and talking on the phone.
As the vice-president, he will certainly be very busy now that the president has fallen.
Seeing Zhou Can coming over, a subtle change appeared on Zhang Mingxing's face.
It's more embarrassing.
"Morning, Dean Zhang!"
Zhou Can was very generous and greeted with a smile.
