In the past few years, some patients said that they had prescribed too many medicines, and some medicines that were totally unmatched appeared on the list. Later, the hospital paid for the mediation to end the incident. But some people were inspired by this and simply broke the law. Of the business. It is reselling prescription drugs. "
Brother Chuan scratched his head and said: "My dear, no matter how much you say, I can't understand it. Just tell us how to investigate the case."
Liang Yin said: "Then you go to the medical record of Wei Qiang's wife, and I will find the suspicious prescription list."
Brother Chuan nodded and said, "Isn't it over if I didn't say this a long time ago?"
Liang Yien flipped through the various prescriptions, and at the beginning, he would go through the brain to scrutinize it carefully. At the end, when the sleepiness was about to pass, he really glanced at the cause and pathology of the disease.
Liang Yi'en glanced over, not paying attention to the medicine, but saw Guanzheng's name.
Liang Yien, who was originally drowsy, awoke a lot in an instant. Liang Yien clicked on the medical record of the switch, and Liang Yien went to look at the past: "Guan Zheng, male, 30 years old, married, from Nanyi City, due to heart injury, in 2017 He was admitted to the emergency department on October 2. The patient suffered a severe heart injury when he was admitted, causing a wound with a heart length of 1.8 cm and a width of 0.5 cm, and repeated atrial fibrillation and hemorrhagic shock.
When the patient was admitted to the hospital, there was no deformity of the head, no sores, scars and tenderness on the scalp, and no hair loss. There is no swelling of the eyelids, the eyeballs are slightly protruding, and the movement is free. The conjunctiva is mildly hyperemic, without edema, the sclera is mildly yellowish, the cornea is transparent, the pupils on both sides are of the same circle, and the response to light is weak. There is no deformity of the auricle, no pus in the outer ear, no tenderness of the mastoid, and normal hearing. No wing flapping, no deflection of the septum, smooth ventilation, and no tenderness of the sinuses. Mild cyanosis at the corners of the mouth and no herpes. There was no swelling, bleeding, or pus in the gums. The tongue is stretched in the center, and the tongue muscles have no tremor. There was no ulcer on the oral mucosa, and the posterior pharynx wall was slightly hyperemia, and there was lymphoid follicular hyperplasia. The tonsils are not enlarged and there is no purulent discharge. The uvula is centered and the soft palate moves symmetrically.
The neck is soft, the trachea is in the middle, the thyroid gland is not enlarged, the jugular vein is distended, the thorax is not deformed, bilaterally symmetrical, the chest wall is free of varicose veins, no tenderness, bilateral ** symmetrical. Both sides have the same respiratory movement, enhanced respiratory movement, equal voice tremor, and no pleural friction. The percussion was unvoiced. The lung-liver boundary was located in the fifth intercostal space of the right midclavicular line. Breath sounds were rough and no abnormal breath sounds were heard. There was a little dampness in the subscapular area, and there was no pleural friction sound. The apical beat is located in the sixth intercostal space of the left anterior axillary line, with a diffuse range of pulsation and no limited bulge. Both the precordial area and the apex of the heart have lifting impulses, and the apex can be palpable for diastolic tremor. The heart voice boundary expands to both sides, mainly to the lower left. The heart rate is 120 beats per minute, and the heart rhythm is absolutely irregular, and the heart sounds vary in strength. The apex area hears the rough level IV blowing murmur during the total systole and conducts to the left armpit. And localized middle and late diastolic grade IV rumbling murmurs, the second auscultation area of the aortic valve, the mid-systolic grade IV jet murmur and the diastolic grade I decreasing murmur, are transmitted to the neck. The pulmonary valve area and the tricuspid valve area can hear the systolic level I soft blowing murmur, which is non-conducting. The entire abdomen was distended, bilaterally symmetrical, the abdominal wall veins were visible, the abdominal breathing disappeared, and no intestinal pattern and peristaltic waves were seen. The abdomen is soft, with mild edema of the abdominal wall, no tenderness and rebound pain, no masses, 10 cm below the liver ribs, 13 cm below the xiphoid process, hard in nature, blunt edges, smooth surface, light tenderness. The spleen is 2 cm below the ribs and the sides are blunt, and the gallbladder and kidneys are not palpable. The hepatic jugular vein reflux sign was positive, and the abdominal circumference was 83 cm. There are mobile dullness in the abdomen, liver dullness in the fifth intercostal space of the upper right midclavicular line, mild percussion pain in the liver area, bowel sounds, and no sound of air and water or vascular murmurs are heard.
After cardiac repair, low cardiac output syndrome occurs many times. The treatment of hypoxemia by mechanical ventilation must be performed on the basis of supplementing blood volume, enhancing myocardial contractility and reducing peripheral vascular resistance. Under the condition of ensuring that the return blood volume does not decrease, try to give the ventilation value of large tidal volume, high concentration of oxygen, and low frequency long inhalation. For some LCOS patients with refractory hypoxemia mainly due to poor lung function, they should be given positive end-expiratory pressure with appropriate pressure and time under close monitoring.
At the same time, it replenishes blood volume and increases central venous pressure. Proper use of inotropic drugs and vasodilator drugs. Dobutamine and dopamine are important drugs for the treatment of heart failure and anti-low cardiac output. They can increase cardiac output and help improve tissue perfusion and oxygenation. The two are often used in combination. For patients with slow heart rate and poor perfusion of surrounding tissues, isoproterenol can be used. When blood pressure is still unstable, epinephrine is used in combination with vasodilators.
At the same time, use cardiotonics and diuretics. Milrinone can better reduce body and pulmonary circulation resistance, improve right ventricular diastolic function, and reduce the occurrence of postoperative LCOS. For severe LCOS, the combination of PDE-Ⅲ inhibitors and catecholamines can complement each other and help stabilize hemodynamic indicators. Correct acidosis, maintain water and electrolyte balance.
The patient was admitted to the hospital again on the evening of October 8, 2017. Due to repeated high fever caused by wound infection, low cardiac output syndrome still exists... ”
Liang Yien kept seeing the end. Guan Zheng was repeatedly admitted to the hospital, and the attending doctor was also changed. The heart was so big that he suffered a lot of injury.
Liang Yien was thinking, Brother Chuan came in from outside and said, "What are you looking at?"
"Guanzheng's medical record." Liang Yien pouted.
Brother Chuan smiled and said, "Why do you see him?"
"Of course I'm worried... Wait a minute! Have you known about Guan Zheng's injury a long time ago?" Liang Yin asked suspiciously.
Brother Chuan smiled and said, "It's not important."
Liang Yien patted the table and said, "Why not important? Low cardiac output syndrome, or low cardiac output syndrome, or low cardiac output for short, is the most serious physiological abnormality in cardiac surgery and one of the main causes of postoperative deaths. Low cardiac output syndrome is a low cardiac pump function caused by myocardial damage in the early postoperative period of open heart surgery, accompanied by the response of surrounding tissues to the hypoperfusion state. It is one of the main causes of early death of postoperative patients and is relatively common. . People are dying, do you think it's important?"
"All right, you are right." Brother Chuan first accepted the defeat.
Liang Yien asked, "Does Xu Jiuyan know about this?"
Brother Chuan replied: "I don't know, Guan Zheng didn't let me say it."
"Does Guan Nuo know about this?" Liang Yin asked again.
Brother Chuan said: "I don't know, he is a person who reports good news but not bad news."
Liang Yin nodded and said, "I'm a relative anyway. Since I've come here, I'm exhausted anyway. Come with me to see Guanzheng."
"Okay, listen to you." Brother Chuan said. (End of this chapter)