Chapter 1134 Can This Medicine Be Used?

Did the interlayer rupture?

Thinking of this, cold sweat began to ooze out of everyone!

Part of the ascending aorta is in the pericardium. Once rupture occurs here, arterial blood will soon flood the entire pericardium, forming a pericardial tamponade to the heart!

And this performance is precisely the most dangerous, and also the reason for the highest mortality rate!

Therefore, after hearing Chen Cang's statement about cardiac tamponade, whether it was Yu Yonggang, Li Baoshan, Xu Ziming and others, they couldn't help but feel a little cold in their hearts!

How to do?

Even Yu Yonggang, the director of the emergency department, is powerless in the face of such a patient!

Because even Xu Ziming from Cardiac Surgery, it is difficult to form a series of clear rescue ideas at this time!

Sometimes, many diseases come in a hurry, and they come with the most serious complications and attitudes, like a flood, and the patient is just a small boat on the sea!

"Dr. Chen, is the cardiac tamponade going to be lifted?"

Chen Cang took a deep breath. At this time, many of the echocardiograms were unclear because the pericardium was full of blood!

Only a lot of blood can be seen in the pericardium.

What is the state of the patient at this time?

Can it be lifted?

Should it be lifted?

Will it induce other risks?

No one can guarantee it!

Unless you check it out!

But check at this moment?

Where to go to check?

What to check?

To be honest, any inspection now is tantamount to a death sentence!

However, without a clear diagnosis, how can we make a systematic and accurate judgment on the patient's condition?

How can we develop a set of effective treatment plan?

For a time, the patient has entered an infinite loop!

The unclear diagnosis leads to the inability to formulate a plan, and the inability to formulate a plan leads to the continued deterioration of the condition. The continued deterioration of the condition prevents the patient from having time for other examinations and treatments.

Mezzanine separation?

Or the interlayer rupture?

Whatever it is, it is very dangerous.

Even, there may be a combination of multiple risk factors.

Thinking of this, Chen Cang directly handed the pericardiocentesis needle to Xu Ziming.

Staring at him, he said, "Director Xu, take it, I'll let you draw blood and you'll draw blood!"

Xu Ziming looked solemn and nodded seriously!

And Chen Cang went straight to the other side of the patient, put on the stethoscope, and pressed the head of the stethoscope to different positions in the precordial area with one hand, while the other hand was placed on the patient's wrist!

He took a deep breath and calmed himself down at such a critical juncture!

At this time, in the room, the nurse said nervously:

"Heartbeat 60 beats per minute!"

Everyone seems to be at a loss.

It happened so suddenly, and the disease progressed so fast!

Maybe many people don't understand why most Marfan syndromes don't live in their thirties, it's because of the way they are now!

The disease develops too fast, like a tornado!

Too late to rescue!

Chen Cang closed his eyes, and the people around him quickly quieted down.

Don't dare to disturb Chen Cang.

At this moment, through the pericardium, Chen Cang still heard a sudden diastolic murmur accompanied by a systolic murmur in the vague auscultation area of ​​the aortic valve!

After hearing this sound, Chen Cang was instantly overjoyed!

This is a diagnostic sign!

The murmur is caused by the aortic root dissection hematoma causing the aortic valve to displace, prolapse, and expand the valve annulus.

At this time, Chen Cang felt the peripheral signs such as widened pulse pressure and edema pulse on his wrist!

Thinking of this, Chen Cang was instantly overjoyed!

Dissecting aneurysm of the ascending aorta for sure.

However, there was no serious rupture of the aortic blood vessels, but because of the damage to the blood vessels in the ascending aorta, blood leaked into the pericardial cavity through the wound!

Symptoms of cardiac tamponade developed.

However, now the aortic dissection is not completely ruptured, but the dissection hematoma is very serious.

Otherwise, it is impossible to produce such a series of pathological reactions.

The four-dimensional map in Chen Cang's mind constantly simulates the situation in the patient's chest through various imaging results.

Through various diagnostic information, the patient's situation at this time was gradually understood bit by bit.

Thinking of this, Chen Cang hurriedly said to Xu Ziming, "Puncture!"

"Can you wear it?" Lao Yu was a little worried.

Chen Cang nodded: "Yes! No problem!"

After speaking, Chen Cang turned to the nurse and continued: "Propranolol intermittently administered intravenously and intravenous sodium nitroprusside combined to lower blood pressure!"

...

Chen Cang continued to issue various temporary rescue orders.

Now is not the time to struggle with who the director is.

Because Chen Cang knows that now he is the one who knows the patient's internal conditions best.

It is necessary to stabilize the patient's critical symptoms at this time and prepare to be sent to the operating room!

If surgery is performed here, the mortality rate of patients is as high as 95%.

Emergency surgery is simply not enough to support such a huge, cumbersome and precise operation!

All of a sudden, everyone started to mobilize.

The doctor's orders are constantly being executed.

Xu Ziming had already prepared for the puncture.

Under echocardiography, begin to slowly withdraw fluid from the pericardial space.

A minute later, the puncture is complete.

250ml of blood was drawn.

Various medicines have also been injected into the patient's body.

"Is it possible to lower blood pressure like this? The patient already has some hypotension?" At this time, the second group leader Hou couldn't help asking.

Indeed, is propranolol combined with sodium nitroprusside too much?

Everyone is a little worried!

Although the patient has aortic dissection now, the patient has been in shock. If hypotension causes hypoperfusion, can he insist on getting off the operating table?

This seems to come to a point of contradiction.

High blood pressure can easily induce aortic dissection rupture!

Hypotension, will the patient cause cerebral ischemia and hypoxia due to hypoperfusion?

This is the intractable disease!

Every doctor's order needs to be considered and considered again and again!

Chen Cang shook his head and immediately denied: "No!"

"The patient's low blood pressure is not the real blood pressure!"

As soon as these words came out, everyone around was stunned!

Blood pressure and true blood pressure and false blood pressure?

Xu Ziming's eyes suddenly lit up, and he asked suspiciously, "Is the patient a dissecting hematoma spread?"

Chen Cang nodded!

"Yes, I clearly felt the peripheral signs such as widening pulse pressure and edema pulse on the radial side of the patient just now, and the heart sound also showed that a diastolic murmur accompanied by a systolic murmur suddenly appeared in the auscultation area of ​​the aortic valve!"

"This shows that the patient has no rupture of blood vessels, and the reason for cardiac tamponade is that the aortic root dissection hematoma causes the aortic valve to displace, prolapse, and expand the valve annulus. After the intima is ruptured, it protrudes into the lumen like a valve Causing a vortex of blood flow."

"Also, the patient's ascending aortic dissection did have blood oozing out, causing this manifestation of cardiac tamponade."

Hearing Chen Cang's words, the surroundings suddenly became quiet!

At this moment, it seems to be explained!