The night is getting darker, and the Department of Circulation Medicine at Nanshan People's Hospital is still busy.
Deputy Director Lang, who is in charge of the emergency department, has been busy for 12 hours. Looking at the endless stream of patients, there is no sign of rest yet.
The weather is getting colder, the temperature in the north has dropped sharply, and cardiovascular and cerebrovascular diseases have been reported. Today alone, Nanshan People's Hospital admitted 12 patients with acute myocardial infarction.
According to the severity of the disease, Deputy Director Lang arranged the order of operations and took time to check on other patients' conditions and medications during the intermission period.
Very busy.
Director Lang is used to this kind of trouble happening every year when the temperature fluctuates greatly.
The difficulty lies in the fact that there are relatively few people willing to perform interventional surgeries, not the patients but the doctors.
In the past, I had a coronary problem and needed bypass surgery. The sternum was split, and the sternum saw made a buzzing sound. It was scary just thinking about it. Now, as long as the wrist or neck is punctured and the tube is inserted, every patient knows what choice to make.
But with more patients, the number of doctors must be relatively insufficient.
In the past, when incomes were high, some people still performed cardiac interventional surgeries. However, with the introduction of a series of measures such as the two-invoice system, incomes have become increasingly transparent, and the shortcomings of low overall wage levels in the north have been fully exposed.
Last year, there were three groups of people on stage together, but now I am the only one. Director Lang held his waist, took off his lead clothes, and began to move to the ward.
He came into contact with interventional surgery relatively early. He first went to Fuwai for further training, and later went to 912 for further training. He was very familiar with the leading professors and directors of the two hospitals.
Even though I am older, I can teach others the skills I have learned.
Director Lang had made a good plan. After guiding his apprentice, he only had to sit down and take a good look. But things went counterproductive, and Director Lang was helpless as he started learning one thing after another.
It's just that he doesn't like to complain. In ancient times, soldiers with heavy armor were given more military pay during wars, but this did not exist at Nanshan People's Hospital. The radiation subsidy is only a small amount, and it is said that the rules were formulated in 2004.
Director Lang became very angry when he thought of this. Are the prices in 2004 comparable to those now? How much was a house per square meter at that time, and how much is it now
Are you going to the south too? Director Lang has occasionally thought about this issue recently.
But those are things I only think about when I have nothing to do. With so many myocardial infarction patients in the ward in front of me, who has time to think about these things.
Director Lang can take a breather when he takes off his lead clothes and goes to see the patient. I am over 50 years old, and it is really unbearable for me to keep wearing a lead suit while undergoing surgery.
Moreover, the income is about the same if you do more or less, and you only rely on the fairy tale of "noble medical ethics".
When he saw that two more emergency patients had arrived, Director Lang's face turned into a bitter gourd. When will this happen
But there is no other way, just do it.
A critically ill patient was selected, and preoperative explanations and surgical preparations were carried out at the same time. Director Lang is still very satisfied with the work he has done, but he doesn't know how long he can persist.
After taking the time to smoke a cigarette and take another look at the patient's electrocardiogram, which was a typical myocardial infarction, Director Lang put on the lead suit again and went into the operating room.
The patient complained of chest pain for 6 hours. The electrocardiogram diagnosed extensive anterior wall myocardial infarction. Various other examinations also supported this diagnosis.
The electrocardiogram showed that the patient's condition was extremely serious and there was no obvious relief after taking the medicine. At least an angiogram was required.
The operation went smoothly. The angiography showed that the left anterior descending artery was completely occluded from the first diagonal branch in the proximal segment, the opening of the first diagonal branch was more than 85% narrowed, and the proximal segment of the left circumflex artery was more than 90% narrowed, with forward blood flow. TIMI grade 2, extensive and diffuse lesions of the right coronary artery.
Fortunately, I did it, Director Lang thought to himself. If this drags on all night, there may be no one left.
If the coronary artery is seriously blocked and there is no other way, then a stent is needed.
After the left anterior descending artery was opened, two Firbird stents of 2.5mm×18.0mm and 2.5mm×29.0mm were inserted.
After the two stents were put in, Director Lang breathed a sigh of relief. There should be no problem now.
"Are you feeling better?" Director Lang asked habitually without doing any imaging.
"Director, it's okay." The patient's voice was a little low, as if he was trying to hold back the words.
The old man was very kind, and he tried his best not to cause trouble to Director Lang and the nurses during the operation.
"Huh? Not okay? How do you feel now?" Director Lang asked in surprise.
"My chest and back are... stuffy, very stuffy." The patient said, "It's even more stuffy than before the surgery."
Director Lang frowned and stared at the blood pressure value on the ECG monitor. The blood pressure was dropping from the normal and slightly higher level before the operation. Although not fast, it is a smooth and determined descent.
It was still 90/60mmHg just now, but it has dropped to 80/57mmHg after a while.
Strange, what's going on
Could it be cardiac tamponade caused by coronary artery rupture? Director Lang woke up with a start, a large amount of adrenaline and glucocorticoids were secreted, and the fatigue and sleepiness just now were gone.
MB! Coronary artery rupture is one of the most serious surgical complications of cardiac circulatory interventional surgery. One or two words can even be removed.
His hands were shaking a little, but he calmed down immediately and started doing the angiography.
However, the angiography results puzzled Director Lang. There was no obvious contrast agent leakage from the coronary arteries! However, we do not rule out the possibility that minor damage may cause problems.
Director Lang looked at the patient's continuously falling blood pressure and immediately said: "Norepinephrine 0.45μg per kilogram-per minute."
After the administration of norepinephrine, the patient's blood pressure was initially stabilized. However, after a brief rise under the effect of the drug, the blood pressure began to drop again before Director Lang could take a breath for 5 minutes.
Although the angiography did not show leakage of the contrast agent, Director Lang still suspected cardiac tamponade, otherwise there would be no way to explain these problems.
An echocardiogram was ordered and there was small-to-moderate effusion in the pericardium.
There should be a problem with the myocardium. The increased pressure caused the bleeding to enter the intermuscular space, causing the hematoma to compress the small arteries. Not much blood came out. Director Lang analyzed it himself.
But the coronary artery ruptured... Director Lang was extremely frustrated.
Coronary artery rupture is a serious complication with a low incidence rate during PCI, with an incidence rate of about 1%. The basic cause is mainly related to myocardial diastolic dysfunction caused by closed intrapericardial hemorrhage after coronary artery perforation.
Director Lang is relatively lucky and has encountered two similar patients in so many years. I haven't encountered many cases, but after all I have seen them and have some experience.
Prepare for pericardiocentesis immediately.
Director Lang tried local anesthesia with lidocaine in the fifth intercostal space under the left chest wall of the patient, and used the sliding method to puncture and implant a single spear drainage hose. After about 10 minutes of open drainage, only 150ml of blood was drawn out.
Observing the patient's condition, Director Lang was a little confused.
The amount of bleeding is so small, but the patient's blood pressure continues to drop... What the hell!