Chapter 2752 Cardiac Tamponade

As the night darkened, the Circulatory Department of Nanshan People's Hospital was still busy.

Deputy Director Lang, who is in charge of the emergency department, has been busy for 12 hours, seeing the continuous stream of patients, and has not seen any signs of taking a 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 sequence of operations, and took time to take a look at the conditions and medication of other patients during the intermission period of the operation.

I'm so busy.

Every year when the temperature fluctuates greatly, such moths will come out. Director Lang is used to it.

The difficulty is that there are relatively few people willing to do interventional surgery, not patients, but doctors.

In the past, I had a problem with my coronary artery and had to undergo bypass surgery, sternum splitting, and the buzzing of the sternum saw. It was scary to think about it. But now, you only need to puncture the wrist or neck, and put a tube in. Every patient knows how to choose.

But with more patients, the number of doctors must be relatively insufficient.

In the past, when the income was high, some people still underwent interventional heart surgery. With the introduction of a series of measures such as the two-invoice system, the income has become increasingly transparent, and the disadvantages of the low overall wage level in the north have been fully exposed.

If there were three groups of people on stage last year, now there is only myself. Director Lang supported his waist, took off the lead jacket, and began to transfer to the ward.

He has been in contact with interventional surgery relatively early. He first studied in Fuwai, and later went to 912 for further study. He is very familiar with the professors and directors of the two hospitals.

Although old, learning technology can teach others.

Director Lang made a good plan. After leading the apprentice, he just needs to sit down and take a good look at it. But things backfired, Director Lang was also very helpless as he learned to walk away one by one.

It's just that he doesn't like to slander. In ancient wars, heavily armored soldiers were paid more, but this didn't exist at Nanshan People's Hospital. The radiation subsidy is only a little money, and it is said that the rules were formulated in 2004.

Thinking of this, Director Lang became very angry. Is the price in 2004 compared with what it is now? How much was a house at that time, how much is a house now.

Are you going to the south yourself? Director Lang occasionally thought of this question recently.

But that's what I think about when I have nothing to do. There are so many patients with myocardial infarction in the ward in front of me, who has the time to think about it.

Director Lang could only catch his breath when he took off the lead suit to see the patient. There are more than 50 people, and it is really unbearable to have surgery in lead clothes all the time.

And doing more and doing less is about the same in terms of income, only relying on the fairy spirit of "noble medical ethics".

Seeing that two more emergency patients came, Director Lang's face twisted into a bitter gourd, when will he be big!

But there is no way, let's do it.

A critically ill patient was selected, and the preoperative explanation and operation preparation were carried out at the same time. Director Lang is still very satisfied with his team, but he doesn't know how long he can persist.

Taking the time to smoke a cigarette, he took another look at the patient's ECG. It was a typical myocardial infarction. Director Lang put on a lead suit again and went into the operating room.

The patient complained of chest pain for 6 hours. The electrocardiogram revealed extensive anterior myocardial infarction, which was supported by other tests.

The electrocardiogram showed that the patient's condition was extremely serious, and there was no obvious relief after taking the medicine. At least an angiography was needed.

The operation went well. Angiography showed that the left anterior descending branch was completely occluded from the first diagonal branch in the proximal section, the opening of the first diagonal branch was more than 85% narrow, and the proximal left circumflex branch was narrowed by more than 90%, with forward blood flow. TIMI 2, extensive diffuse lesions in the right coronary artery.

Fortunately, it did, Director Lang thought to himself. If this drags on for one night, there is a possibility that people will be gone.

The coronary artery is severely blocked, and there is no way to do it, then a stent will be used.

After opening the left anterior descending branch, two 2.5mm×18.0mm and 2.5mm×29.0mm Firbird stents were placed successively.

Director Lang breathed a sigh of relief when the two brackets went in. There should be no problem this time.

"Is it better?" Director Lang asked habitually first instead of doing a radiography.

"Director, it's not alright." The patient's voice was a little low, as if trying to hold back the words.

The old man is very kind, and he tried his best not to cause trouble to Director Lang and the nurse during the operation.

"Huh? No good? How do you feel now?" Director Lang asked with some surprise.

"Chest and back...stuffy, very stuffy." The patient said, "It's even more stuffy than before the operation."

Director Lang frowned and stared at the blood pressure value on the ECG monitor. The blood pressure was dropping from the normal slightly higher level before the operation. Not fast, but a smooth, firm descent.

It was still 90/60mmHg just now, but after a while it has dropped to 80/57mmHg.

Strange, what's going on?

Is it coronary rupture, resulting in cardiac tamponade? Director Lang woke up with a start, adrenaline and glucocorticoids were secreted in large quantities, and the fatigue and drowsiness just disappeared.

MB! Coronary artery rupture is one of the most serious surgical complications of cardiac circulation interventional surgery, and one or two words can even be removed.

His hands were trembling a little, but he calmed down immediately and started to do radiography.

However, Director Lang was puzzled by the results of the angiography. There was no obvious contrast agent leakage in the coronary arteries! However, it does not rule out the possibility of minor damage causing problems.

Director Lang looked at the patient's continuously dropping blood pressure, and immediately said: "Norepinephrine 0.45 μg per kilogram-per minute."

After taking norepinephrine, the patient's blood pressure was initially stabilized, but after a brief rise under the action of the drug, it took less than 5 minutes for Director Lang to take a breath, and the blood pressure began to drop again.

Although the radiography did not show any leakage of the contrast agent, director Lang still suspected it was cardiac tamponade, otherwise there was no way to explain these problems.

An echocardiogram was called, and there was a small-medium amount of fluid in the pericardium.

There should be a problem with the myocardium, and the bleeding entered the intermuscular space due to the increased pressure, causing the hematoma to compress the arterioles, but not much blood came out. Director Lang analyzed it himself.

But the coronary artery ruptured... Director Lang was extremely depressed.

Coronary artery rupture is a serious complication with a low incidence rate in PCI, with an incidence rate of about 1%. The basic cause is mainly related to myocardial diastolic dysfunction caused by hemorrhage in the closed pericardium after coronary artery perforation.

Director Lang was quite lucky, having encountered 2 similar patients over the years. There are not many cases encountered, but after all, I have seen it and have some experience.

Immediately prepare for pericardiocentesis.

Director Lang tried local anesthesia with lidocaine in the lower left fifth intercostal space of the patient's chest wall, 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.

With such a small amount of bleeding, the patient's blood pressure continued to drop... What the hell!