Chapter 1742 Said You Don't Understand

"Calculation of the inspiratory collapse rate of the inferior vena cava: (Max D-Min D)/Max D × 100%." ​​Zheng Ren explained Principal Zhang's face blankly.

"The probe was placed under the sword and turned to the right, and the scan plane was parallel to the inferior vena cava. The image showed the right atrium, inferior vena cava and hepatic vein.

In the normal state, the inferior vena cava has obvious collapse with deep inspiration, the diameter of the inferior vena cava is ≤ 2.1 cm and the inspiratory collapse rate is > 50%, that is, 3 mmHg.

When the right atrial pressure is elevated, the diameter can be >2.1 cm and the inspiratory collapse rate is <50%, i.e. 15 mmHg. "

Like a Darling machine gun, Zheng Ren finished speaking in one breath, without giving everyone time to think, and said, "The diameter of the inferior vena cava is 2.4cm, and the inspiratory collapse rate is less than 50%, which can obviously prove to be pulmonary embolism."

"The fifth point, the speed of tricuspid regurgitation is increased, according to the simplified Bernoulli equation..." After speaking, Zheng Ren paused, seeing Principal Zhang's blank face, he immediately sighed.

"You are not a doctor, so you may not understand. You only need to know that it is calculated according to the Bernoulli equation. From the perspective of tricuspid regurgitation, the embolus exists and is very large."

Principal Zhang almost cursed his mother.

What is Lao Tzu not a doctor? President of Tangtang Medical University, are you so hurtful? !

But I thought so in my heart, but I didn't dare to say it. Principal Zhang did not expect that Boss Zheng, who is skilled in anatomy, would talk about the theory in a set way.

He was unconvinced, looked up at Sun Chao, and wanted to find Aoyuan.

It would be great if Director Sun Chao could also say one, two, three, four, five to dispel Boss Zheng's arrogance.

However, what Principal Zhang saw was... Director Sun Chao with a confused look.

Echocardiography, Sun Chao understands, but definitely not so deep. What formula, what equation, is this what you should say when looking at an echocardiogram? !

Sun Chao knew that Principal Zhang looked at him, but he... didn't understand at all!

He could only pretend that he didn't see Principal Zhang's eyes, his eyes were dull, and he looked straight at Zheng Ren.

A few days ago, Director Tian of Cardiothoracic Surgery, was it as embarrassing as himself? People can't understand what they say, how can they fight?

This is not a battle at all, but a unilateral killing!

"The sixth point is that there is a notch in the mid-contraction period of the forward blood flow spectrum of the pulmonary artery, which is accompanied by a significant decrease in blood flow velocity, a shortened blood flow acceleration time, and an early right ventricular ejection period, which is usually referred to as the shortening of the RPEP period and the combination of ACT and right ventricular ejection. Decreased ventricular ejection time ratio, etc., is our diagnostic standard - "finger fist sign"."

It's not over yet...

After one, two, three, four and five, there are actually six!

People are numb.

There was no echocardiographic Dana at the scene, and what Boss Zheng said was paradoxical to everyone. But if you want to argue, you can't come up with strong evidence.

What a surprise!

Director Sun Chao was angry.

However, everything is not over.

"Seventh point, thrombus is the most typical feature of thrombotic pulmonary embolism.

The thrombus located in the right atrium or right ventricle can vary in morphology, but when located in the pulmonary artery, it usually presents as a large thrombus extending from the main trunk to one or both branches of the pulmonary arteries.

The right pulmonary artery thrombus is easy to display, but the left pulmonary artery is not easy to display because of its short display. In addition, attention should be paid to distinguish thrombus from right heart system tumors! "

"This patient's right pulmonary artery thrombus is not very clear because of gas interference. But we can roughly estimate its length - at least 10cm."

Zheng Ren said quickly in a deep voice.

"The thrombus can be seen partly in the main right pulmonary artery and a little in the right ventricle."

Having said that, he raised his head and glanced at Principal Zhang, "There is a differential diagnosis between thrombosis and heart tumor, because we have limited time, so I won't talk about it here."

Principal Zhang felt great contempt.

He felt that Boss Zheng's subtext was - Lao Tzu said it, but you didn't understand it, so he didn't say it. It's pointless, completely pointless, to talk so much with you bastards.

Sun Chao, as a mosaic, was directly ignored by Zheng Ren.

It's so... so special!

Sun Chao secretly cursed again in his heart.

"Eighth, abnormal movement of the interventricular septum..."

"Ninth, the foramen ovale reopens..."

However, Boss Zheng's words are not over yet.

After talking about thrombosis, Zheng Ren continued to talk about the eighth and ninth points.

After speaking, he put the list on the desk, pointed his finger on the reader, bang bang.

"The diagnosis has been relatively clear. Pulmonary embolism is a thrombus blocking the main trunk of the right pulmonary artery. Judging from echocardiography, the thrombus is very long, at least 10cm. This is one of the contraindications for interventional thrombectomy!"

"And the patient is in an emergency state. If I have time, I can successfully remove the thrombectomy in 2 hours. But now... I estimate that the patient's survival time is only about 1 hour. If the thrombus is removed or other tests are performed, the patient will surely die. "

"Principal Zhang, sign!" Zheng Ren frowned and said in a commanding tone.

Time is urgent, gentle wind and drizzle, and respect for old comrades are all nonsense.

Principal Zhang was stunned.

Is this a forced palace? Is time really so urgent?

"Boss, the patient's blood oxygen saturation is 75%! I'm going to the operating room first, and the operation is ready to start." Su Yun pushed the patient to run all the way, and shouted as he passed the office.

"Go." Zheng Ren took out a piece of white A4 paper, put it in front of Principal Zhang, and said, "Principal Zhang, there is no time, the surgery is very risky, and there is at least a 40% chance that the patient will not be able to get off the operating table. "

"..." Principal Zhang shuddered.

Not only him, but the directors of vascular surgery all over the country who were watching the excitement all shuddered.

But the two shivers mean different things.

Principal Zhang is because there is a 40% chance that the students will not be able to get off the stage, and the other directors are stunned that this young man has a 60% certainty that the operation can be performed!

This is a very difficult operation. According to him, the patient will die within an hour.

1 hour, can extracorporeal circulation be established?

He even said that he was 60% sure?

10cm pulmonary embolism, cut the heart, cut the pulmonary artery, remove the thrombus...

Impossible, absolutely impossible!

Subconsciously, many directors did not question the diagnosis, but put all their distrust on the success rate of the operation.

It can't be this high!

"I agree to the operation, please sign this. There is no time for other preoperative explanations." Zheng Ren said, "I will write this paragraph after the operation."

"If you can't pay attention..." Zheng Ren said, looking at Linger.

"Boss Zheng, don't worry, what the medical department has to do is to escort the clinic. Principal Zhang can't make up his mind, and the medical department also approves the operation!" Linger understood and said loudly without hesitation.