Chapter 437: Trap
Remember [New] in one second! Lu Chen took the ECG.
There were five ECGs, which were completed before and after the patient's onset.
At this time, Sun Guoguo's voice came from his ear.
"Junior brother, this is the patient who came yesterday."
"Young woman, 22 years old, repeated palpitations for 1 month, worsened for 2 days and was admitted to the hospital."
"She gave birth to a boy 1 month ago and denied a family history of genetic diseases."
...
The patient's medical history was very simple, with only a few simple sentences.
Lu Chen stared at the ECG intently.
"Currently, the patient has repeated ventricular tachycardia and ventricular fibrillation. She has been given amiodarone, lidocaine and cardioversion, but her condition has not improved significantly."
Sun Guoguo sighed and said, "She just gave birth to a child. I don't know if she can survive. It's so pitiful."
Lu Chen sighed slightly in his heart, but didn't say anything, and continued to study the ECG in front of him.
The ECG of the patient before the onset of the disease was normal sinus rhythm, with occasional premature ventricular beats.
But the electrocardiograms at the time of the onset of the disease were all ventricular fibrillation or ventricular tachycardia.
"Sister, what do you think about this electrocardiogram?" Lu Chen put down the electrocardiogram and looked up at Sun Guoguo.
"Well, the electrolytes of the patient admitted to the hospital showed low potassium of 3.02umol/l, and it is considered that low potassium may cause ventricular tachycardia and ventricular fibrillation." Sun Guoguo said, "But the strange thing is that we actively supplement potassium, and after the potassium ions return to normal, the patient's symptoms have not improved significantly, and ventricular fibrillation and ventricular tachycardia still occur frequently."
Ventricular fibrillation is an extremely malignant arrhythmia. Continuous attacks are likely to cause human hemodynamics and even sudden death.
"Sister, what medicine did you use?" Lu Chen paused.
"Amiodarone, lidocaine, these antiarrhythmic drugs have been used." Sun Guoguo said, "In addition, electric defibrillation has been used many times."
Amiodarone, a very common broad-spectrum antiarrhythmic drug in cardiology.
In other words, more than 95% of arrhythmias in clinical practice, whether ventricular or atrial arrhythmias, can be treated with amiodarone.
The drug has a wide range of indications and is quite effective, so amiodarone is a panacea in clinical practice.
So much so that in medical exam questions, if there is an option of amiodarone, basically everyone can choose it, and the correct rate is also extremely high.
However, Lu Chen pondered for a moment, frowned and said: "Senior sister, you may have used the wrong medicine!"
"Ah?" Sun Guoguo was slightly startled, "What medicine was used wrong?"
"Amiodarone!" Lu Chen's words made Sun Guoguo suddenly stunned.
Amiodarone was used wrong?
Is it wrong to use amiodarone for patients with ventricular fibrillation and ventricular tachycardia?
Sun Guoguo picked up the electrocardiogram and compared it carefully before and after, but still found nothing abnormal.
At this time, Lu Chen's voice came again: "Senior sister, look at this electrocardiogram, is the patient's QT interval abnormal?"
"QT interval..." Sun Guoguo muttered silently, and his eyes shifted to the QT interval of the electrocardiogram, "This QT interval seems a bit long?"
Seeing this, Sun Guoguo was suddenly stunned.
Could it be that the QT interval is prolonged, causing ventricular tachycardia?
That is, TDP (torsade de pointes)!
Seeing Sun Guoguo's expression, Lu Chen also knew that she had thought of this.
"Senior sister, this electrocardiogram, I feel that it is probably TDP caused by a long QT interval!"
There are many types of ventricular tachycardia.
Most ventricular tachycardia and ventricular fibrillation can be treated with amiodarone.
But only ventricular tachycardia caused by a long QT interval is a contraindication for the use of amiodarone!
In this case, amiodarone cannot be used.
Amiodarone can cause the QT interval to be further prolonged, aggravating the patient's condition.
Thinking of this, a trace of cold sweat appeared on Sun Guoguo's forehead.
She hadn't considered this at first, but after Lu Chen pointed it out, she immediately figured it out.
They had assumed that it was conventional ventricular tachycardia and ventricular fibrillation before, but ignored the situation where long QT interval caused ventricular tachycardia!
After using the medicine for a day, it turned out to be used wrongly!
Not only did it have no therapeutic effect, but it might even aggravate the condition.
"Xiao Fang, go and ask the nurse to stop the amiodarone pumped into bed 31! Then use magnesium sulfate!" Sun Guoguo hurriedly said to the intern beside her, "Forget it, I'll go myself!"
TDP, not only potassium supplements are needed, but also polarized liquid magnesium sulfate is needed to fight arrhythmias!
After speaking, Sun Guoguo left the office in a hurry.
Lu Chen put down the electrocardiogram in his hand and followed closely.
...
In the ward.
Sun Guoguo was directing the nurses in the ward to stop the amiodarone and use magnesium sulfate while supplementing potassium.
"Doctor, why do you want to stop this drug?" The patient's husband asked nervously.
"Because of the condition, I'll explain it to you later." Sun Guoguo said.
At the same time, Lu Chen also came to the ward.
In his eyes, the life value on the patient's head was 38 (---)!
He has been using drugs for treatment, but the trend of the patient's life value change is still three minus signs.
This means that the current drugs may not have any effect.
After the nurse changed the medicine for the patient, the patient's husband followed Sun Guoguo out of the ward.
...
In the corridor of the ward.
Sun Guoguo patiently explained the condition to the patient's husband.
"Doctor, are you saying that my wife's arrhythmia is a relatively rare one?" the man said.
Sun Guoguo nodded and said, "Well, conventional ventricular tachycardia and ventricular fibrillation can use amiodarone, but your wife's arrhythmia is relatively rare, so amiodarone cannot be used, and the risk of sudden death is extremely high!"
As soon as the voice fell, the patient's husband "thumped" and knelt down.
His eyes were red, and he tightly pulled the sleeves of Sun Guoguo's white coat, and his hoarse voice was a little crying: "Doctor, please, save my wife! I will repay you even if I work hard for you."
Sun Guoguo hurried forward and held the patient, "Don't be like this, we will definitely try our best!"
Lu Chen also turned his face away, feeling a little uncomfortable in his heart.
Even though he was used to seeing life and death in the hospital, he still felt a little uncomfortable when he saw this scene.
"It's my fault!" The patient's husband still knelt for a long time, one hand still grasping his hair tightly, "It's my fault! She is usually in poor health, and I insisted on letting her have a child. It's my fault!"
The man's emotions seemed to burst out like a flood, and a feeling of regret and grief spread in his heart.
Sun Guoguo was a little overwhelmed for a while.
Seeing this, Lu Chen walked forward, grabbed the man's arms, and pulled him up, saying seriously: "Now is not the time for you to be sad! You need to stay with the patient 24 hours a day. Once there is any change in the condition, you must inform the medical staff at any time."
Although nurses often patrol the ward, it is impossible to stay by the bed 24 hours a day.
The man wiped away a tear silently, and finally stopped kneeling.
He nodded fiercely, looked at Lu Chen and Sun Guoguo, "Thank you, doctor!"
Then dragged his heavy steps and turned to walk towards the ward.
...
Back to the doctor's office.
Sun Guoguo breathed a sigh of relief and looked at Lu Chen with gratitude, "Junior Brother, thank you."
At the same time, her eyes were a little dim.
Lu Chen said: "Senior Sister, don't think too much. This patient is young, I think there should be hope."
"I hope so." Sun Guoguo said softly.
The QT interval of this electrocardiogram is prolonged, which is very hidden.
Many doctors in the department have seen it, and no one has found it.
There is nothing wrong with conventional treatment methods.
But no one could have imagined that behind ventricular tachycardia, there is a bigger trap hidden.