Dr. Lin's head was getting bigger, and he snatched the medical records from the nurse and complained: "You didn't say anything!"
"Didn't Dr. Zhang tell you about the shift, Dr. Lin? We asked Dr. Zhang before if this patient had any family members. She said she would ask, but she didn't tell us what happened later." The nurse replied that she didn't plan to take this. pot.
Zhu Huicang raised his glasses, first recognized Xie Wanying's facial features, and recalled the meeting more than three years ago: Is it the girl who made Cao Yong lose his soul
"Is she studying in our hospital now?" Zhu Huicang asked his old classmate Ren Chongda.
"Aren't you following Huang Zhilei to train in neurosurgery?" Ren Chongda said.
"Oh." Zhu Huicang thought: Could someone be crazy with joy because the junior sister came to his department as an intern.
This doctor Lin flipped through the electrocardiogram that Liu's father had taken before: "This, this—"
Zhu Huicang closely followed his head and looked over, then glanced at Dr. Lin: "The patient you see?"
"No, it's not me!" Dr. Lin denied with all his strength, "She didn't say that there was a change in his electrocardiogram. What she said was that the electrocardiogram looked fine, and the three blood tests for myocardial infarction were normal."
He can't afford to take the blame for such a big incident!
"Isn't this nothing wrong? Isn't the ST segment depressed?" Zhu Huicang pointed out the problem at once, "Isn't this a typical sign of myocardial ischemia?"
Of course, Dr. Lin could see the same, otherwise why would he deny it desperately: "Yes, yes, it is myocardial ischemia."
"It's not just myocardial ischemia, is it? The patient's main complaint is that the chest pain seems to have been faint since the morning, and the pain was at least several hours before being admitted to the hospital. It must be ACS. If it is ACS, it must arouse vigilance. Go up At least eight hours of monitoring. How long has it been since he entered the emergency department of our hospital?" Zhu Huicang looked at the watch in his hand to calculate the time when he asked.
acs stands for acute coronary syndrome.
First of all, a normal myocardial enzyme test does not mean that there is no myocardial infarction.
The standard diagnosis of myocardial infarction is not based solely on myocardial enzyme examination, but on electrocardiogram or myocardial enzyme or clinical symptoms. Two of the three can be confirmed.
Second, the electrocardiogram may also appear pseudo-normal.
For example, in some patients with myocardial infarction, the electrocardiogram taken by the doctor in the hyperacute period may just happen. At this time, the patient is in the period of acute myocardial injury and before the ST-T abnormality fully develops, the electrocardiogram just returns to a normal state. It is said that the normal at this time is a pseudo-normal.
Therefore, the electrocardiogram taken during this period is very easy to cause the doctor to misjudge the patient, and Liu's father may be such a typical case.
Experienced hospitals must have guidance and requirements for clinicians in the diagnosis and treatment of myocardial infarction.
For example, the National Association of China stipulates that if the first electrocardiogram is generally normal, but Liu's father complains that it is abnormal and suspects it is ACS. As Zhu Huicang said, he needs to be supervised for more than eight hours.
The eight-hour ECG monitoring does not mean that the doctor can ignore the equipment connected to the patient, such monitoring is meaningless. What is needed is for the doctor to come back from time to time to see if there is any development or change in the patient's ECG. Such subtle changes in the patient's condition require the doctor's vigilance and sense of responsibility to catch them. If it is a doctor with a strong sense of responsibility, he will even take an electrocardiogram for the patient every once in a while. Because as Xie Wanying argued with Dr. Jiang at the beginning, ECG monitoring belongs to analog leads and there is no standard for ECG machines.