Chapter 272 Take a Look

Pregnancy-induced hypertension refers to the symptoms of hypertension, edema, proteinuria, etc. that occur after 20 weeks of pregnancy in women. They are transient and disappear after delivery.

This is a pregnancy-specific disease and is one of the main causes of illness and death in pregnant women and perinatal infants.

"Pregnancy-induced hypertension?" Dr. Xiao Lin shook his head quickly, "Doctor Lu means that the patient is pregnant? This is impossible... This is absolutely impossible..."

Dr. Xiao Lin's face was full of disbelief.

Lu Chen frowned and said, "The patient said that she has not had her period for two or three months..."

He was interrupted by Dr. Xiao Liulin before he finished speaking.

"I know this. I asked her on the day she was admitted to the hospital. The patient had this situation before, with irregular menstruation. After she drank Chinese medicine, her menstruation became regular. Besides, if she was pregnant, how could she not know it?"

Director Yin Chao on the side was a little silent.

He recalled the patient's entire medical history and felt that Lu Chen's words seemed to make some sense.

The patient has not had her period for two or three months.

In this case, the first thing to consider is not menstrual disorders, but whether there is a possibility of pregnancy!

The most critical point is that the patient's urine routine test shows positive occult blood and urine protein, and the blood pressure has not been lowered!

This is more in line with the characteristics of gestational hypertension!

Clinical diagnosis requires bold guesses and doubts, and finally the test results speak.

Lu Chen pondered for a moment and said slowly: "I don't deny that this may be caused by menstrual disorders, but I still suggest that some gynecological ultrasounds be improved, and it is best to rule out gestational hypertension."

In case the patient really has gestational hypertension, many of her drugs cannot be used.

When it comes to this kind of multidisciplinary disease, the condition is often complicated.

Because once the drug is used incorrectly or excessively, it will cause problems for the fetus, which is terrible.

Dr. Kobayashi also turned his head and glanced at Li Yao beside him.

Li Yao said softly: "Dr. Lu's opinion is my opinion. I suggest improving gynecological ultrasound."

Dr. Xiaolin wanted to say something, but Yin Chao waved his hand and interrupted: "Xiaolin, it is absolutely necessary for this patient to improve gynecological ultrasound. Just listen to Dr. Lu's opinion and arrange a gynecological ultrasound for her immediately. If there are any problems, ask for a gynecological consultation."

Seeing that the director said so, Dr. Xiaolin could only nod.

He immediately left the doctor's office and went to communicate with the patient's family about the condition.

Now the only thing to be thankful for is that the attitude of this patient and her family is relatively gentle, and they have no intention of having children.

The little girl next to her bed was adopted by her.

"Professor Li, this case is still our negligence."

After Dr. Xiaolin left, Yin Chao said to Li Yao, "The patient herself said that it was irregular menstruation, she had taken Chinese medicine for adjustment, and she had no history of childbirth. We didn't even think about gestational hypertension."

Common secondary hypertension is mainly aortic coarctation, renal artery stenosis, adrenaloma, etc. Few people would think about gestational hypertension.

In clinical practice, doctors' judgments are easily affected by various factors.

For example, many patients with breathing difficulties come to the hospital and say that they had emphysema before. They were treated for a long time according to the lungs, but they did not get better at all. But in the end, they were diagnosed with heart failure!

Therefore, it is very important to correctly extract useful information from the medical history.

…

The first patient is a small episode.

However, after Lu Chen's analysis, this case that has not been diagnosed for three days has already had a little clue.

The doctors in the cardiology department of Fengm County have begun to pay attention to this young doctor.

At first, everyone thought that Lu Chen was just making up the numbers.

After all, no one would pay attention to a newly enrolled graduate student.

But now, even Yin Chao is a little impressed.

Sure enough, Professor Li Yao is not aimless!

Her master's student is really good.

As for Li Yao, she originally thought that Lu Chen would be a little nervous.

But so far, she is quite satisfied with Lu Chen's performance.

…

Li Yao came to the Department of Cardiology to conduct teaching rounds.

However, the patient for the teaching rounds was not this patient with hypertension, but someone else.

“Professor Li, shall we start the teaching rounds?”

Seeing that it was getting late, Yin Chao asked Li Yao.

“Okay.” Li Yao nodded.

Teaching rounds, as the name suggests, are conducted by senior doctors and all doctors to conduct rounds on patients.

Generally speaking, this form of teaching rounds is very standardized, and the patients for rounds are also difficult cases.

“Professor Li, this is the medical record for this teaching round.”

Wang Zhita, another attending physician in the Department of Cardiology, has prepared all the medical records.

Li Yao took the medical record with a smile, she read it carefully, and then handed it to Lu Chen.

Lu Chen also took the medical record with curiosity.

This was the first time he encountered this form of teaching rounds, and his expression was quite curious.

This was a 41-year-old male patient.

The main reason for admission was “cardiac arrest”.

There was no family history of sudden cardiac death, smoking or drinking.

The patient's wife found the patient lying on the bed unresponsive at night. After calling the emergency number, the doctor gave defibrillation and cardiopulmonary resuscitation.

After about 33 minutes of cardiopulmonary resuscitation, the patient recovered spontaneous circulation.

Wang Zhi explained on the side: "Professor Li, this patient is staying in our bed 25. His condition is basically stable, but we have not found out the cause of his cardiac arrest. We mobilized the patient to go to a higher-level hospital for examination, but his family refused to transfer him to a higher-level hospital due to financial conditions."

Li Yao nodded: "Let's go see the patient first."

The group followed Li Yao to bed 25.

Li Yao conducted a comprehensive medical history inquiry and physical examination on the patient.

"Are the patient's myocardial enzymes and ions normal after admission?" Li Yao asked.

"Normal." Wang Zhi said, "In addition, the cardiac ultrasound showed that there was no abnormality in the size of the atrial and ventricular cavities, LVEF  65%, normal valve motion function, and no ventricular wall motion disorder. Chest CTA showed no obvious abnormalities."

Lu Chen frowned.

The patient's life value on his head was 68, indicating that he was out of danger.

But the results of cardiac ultrasound, laboratory tests, and CT were all normal, which basically ruled out common causes of cardiac arrest such as myocardial infarction and cardiomyopathy.

Immediately afterwards, Li Yao asked a few more questions.

For example, the common causes of cardiac arrest, what are the possible diagnoses and treatment measures for patients currently considered.

The doctors in Fengm County's cardiology department answered one by one, but it was obvious that none of them met Li Yao's expectations.

Back to the doctor's office.

"Where is the electrocardiogram taken after admission?" Li Yao said.

"Here. UU Reading www.uukanshu.net "Wang Zhi took out all the electrocardiograms taken by the patient, a total of five.

Li Yao raised her eyebrows, "You have done so many electrocardiograms, and you didn't analyze any problems?"

"This..." Wang Zhi paused. Then he scratched his head embarrassedly, "No."

Deputy Director Fan Zhiping, the only one in the department who was good at reading electrocardiograms, had gone for further studies.

Li Yao sighed slightly in her heart, and she handed her electrocardiogram to Lu Chen.

Lu Chen took the five electrocardiograms.

After a careful comparison, he found something abnormal, "There should be a broken QRS wave and an early repolarization J wave here."

Yin Chao looked at Lu Chen with a surprised expression.

Wow, you found the problem after just one look?

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