When a doctor opened a plug-in

Is the interlayer broken?

Thinking of this, everyone began to see cold sweat!

Part of the ascending aorta is in the pericardium. Once it ruptures here, arterial blood will soon fill the entire pericardium, forming a pericardial tamponade to the heart!

And this performance is precisely the most dangerous and also the cause of the highest mortality!

Therefore, after hearing Chen Cang's pericardial tamponade, whether it was Yu Yonggang, Li Baoshan, Xu Ziming, and others, they couldn't help but feel cold!

How to do?

Even Yu Yonggang, as the director of the emergency department, is powerless to face such a patient at this time!

Because even Xu Ziming of cardiology surgery, it is difficult to form a series of clear rescue ideas at this time!

Sometimes, many diseases come in a hurry, and come with the most serious complications and attitude, like a monstrous flood, and the patient is just a flat boat on the sea!

"Doctor Chen, do you want to remove the tamponade?"

Chen Cang took a deep breath. At this time, because of the blood in the pericardium, many of the echocardiograms were unclear!

You can only see a lot of blood filling the pericardium.

What kind of state is the patient at this time?

Can it be lifted?

Should it be lifted?

Will it induce other risks?

No one can guarantee it!

Unless it is clear!

But check it now?

Where to check?

What to check?

To be honest, doing any check now is tantamount to a death sentence!

However, without a clear diagnosis, how can we make a systematic and accurate judgment of the patient's condition?

How can we formulate a set of effective treatment plans?

For a time, the patient has entered an endless loop!

The unclear diagnosis led to the inability to formulate the plan, and the inability to formulate the plan led to the continued deterioration of the disease. The continued deterioration of the disease did not allow the patient to have time to do other examinations and treatments.

Interlayer separation?

Or is the interlayer broken?

Whatever it is, it is very dangerous.

Even, there may be a combination of two multiple risk factors.

Thinking of this, Chen Cang directly handed Xu Ziming the pericardiocentesis needle.

Staring at him, he said, "Director Xu, take it, and if I ask you to draw blood, you will draw blood!"

Xu Ziming looked solemn and nodded seriously!

And Chen Cang went directly to the other side of the patient, put on a stethoscope, one hand pressed the head of the stethoscope to different positions in the precordial area, and the other hand was placed on the patient's wrist!

He took a deep breath and calmed himself down at such a critical juncture!

At this time, in the room, the nurse said nervously:

"Heartbeat 60 times per minute!"

It seems that everyone is at a loss.

Things are too sudden, and the disease develops too fast!

Perhaps many people don't understand why most Marfan syndromes will not live in their thirties, because they are now like this!

The condition develops too fast, just like a tornado!

Too late to rescue!

Chen Cang closed his eyes, and the people around quickly calmed down.

Dare to disturb Chen Cang.

At this moment, across the pericardium, Chen Cang still heard a diastolic murmur accompanied by a systolic murmur in the faint aortic valve auscultation area!

After hearing this sound, Chen Cang was overjoyed!

This is a sign of diagnostic significance!

The murmur is caused by the dissection of the aortic root hematoma that causes the aortic valve to shift, prolapse, and the annulus expands. After the intima ruptures, it protrudes into the lumen in the shape of a valve, causing blood flow vortex.

At this moment, Chen Cang felt the pulse pressure widened and edema pulse and other peripheral signs on his wrist!

Thinking of this, Chen Cang was overjoyed!

Dissection of the ascending aorta is affirmative.

However, there was no serious rupture of the aortic vessels, but because the ascending aorta was damaged by the blood vessels, the blood leaked into the pericardial cavity through the wound!

Symptoms of pericardial tamponade occurred.

However, the aortic dissection is not completely ruptured, but the dissection hematoma is very serious.

Otherwise it is impossible to produce such a series of pathological reactions.

The four-dimensional map in Chen Cang's mind constantly uses various image results to simulate the situation in the patient's chest at this time.

Through a variety of diagnostic information, bit by bit, the patient's situation at this time was gradually understood.

Thinking of this, Chen Cang hurriedly said to Xu Ziming: "Punch!"

"Can you wear it?" Lao Yu was a little worried.

Chen Cang nodded: "Yes! No problem!"

After speaking, Chen Cang turned to the nurse and continued: "Intravenous intermittent propranolol combined with sodium nitroprusside to lower blood pressure!"

...

Chen Cang continuously issued various temporary emergency medical orders.

Now is not the time to entangle who is the director.

Because Chen Cang knew that now he is the person who knows the patient's body best.

It is necessary to stabilize the critical symptoms of the patient at this time and prepare to be sent to the operating room!

If surgery is performed here, the mortality rate of patients is as high as 95%.

Emergency surgery is simply not enough to support such a large, cumbersome and sophisticated operation!

For a while, everyone began to mobilize.

The doctor's orders are constantly being executed.

Xu Zi is ready for the puncture tomorrow.

Under echocardiography, the fluid in the pericardial cavity is slowly drawn.

After one minute, the puncture is complete.

250 ml of blood was drawn out.

And various drugs have also begun to be injected into patients.

"Can the blood pressure be lowered like this? The patient already has some hypotension?" At this moment, the leader of the second group Hou couldn't help asking.

Indeed, is propranolol combined with sodium nitroprusside too strong?

Everyone is a little worried!

Although the patient now has aortic dissection, the patient has been in shock. If hypotension causes hypoperfusion, can he continue to step off the operating table?

This seems to have entered a contradiction point.

High blood pressure can easily induce rupture of aortic dissection!

Hypotension, will the patient cause cerebral ischemia and hypoxia due to hypoperfusion?

This is an intractable disease!

Every doctor's order needs to be considered and then considered!

Chen Cang shook his head and immediately denied: "No!"

"The patient's low blood pressure is not the real blood pressure!"

As soon as this words came out, everyone around was taken aback!

Blood pressure is also true blood pressure and false blood pressure?

Suddenly Xu Ziming's eyes lit up and he asked suspiciously, "Is the patient a dissecting hematoma spreading?"

Chen Cang nodded!

"Yes, I just clearly felt the pulse pressure widened and edema pulse on the radial side of the patient, and the heart sounds also showed a sudden diastolic murmur with systolic murmur in the aortic valve auscultation area!"

"This shows that the patient has no blood vessel rupture, and the reason for the pericardial tamponade is that the aortic root dissection hematoma displaces the aortic valve, prolapses, and the annulus expands. After the rupture of the intima, it protrudes into the lumen like a valve Cause blood flow vortex."

"Moreover, the patient's ascending aortic dissection did have blood oozing, causing this kind of cardiac tamponade."

Hearing Chen Cang's words, the surrounding area suddenly became quiet!

At this moment, the explanation seems to be clear!