"Calculation of aspiration collapse rate of inferior vena cava: (Max.
D)/Max.
D×
100%, "Zheng Ren explained directly when he saw Principal Zhang's blank expression.
"Place the probe under the sword and tilt it to the right. The scan plane is parallel to the inferior vena cava. The image shows the right atrium, inferior vena cava, and hepatic vein.
Under normal conditions, the inferior vena cava collapses significantly with deep inhalation. The diameter of the inferior vena cava ≤ 2.1
The aspiration collapse rate is more than 50%, which is 3
mmHg。
When the right atrial pressure is elevated, the diameter can be > 2.1
Cm. The aspiration collapse rate is less than 50%, which is 15
mmHg。”
Zheng Ren was like a machine gun. He finished in one breath and did not give anyone time to think. "The diameter of the inferior vena cava reaches 2.4 cm. The aspiration collapse rate is less than 50%. It's obvious that it's a pulmonary embolism.
"Fifth point, the speed of tricuspid regurgitation increases. According to the simplified Bernoulli equation …"
As he spoke, Zheng Ren paused. Seeing Principal Zhang's blank face, he immediately sighed.
"You're not a doctor, so you might not understand. You just need to know that according to the Bernoulli equation …"
Based on the tricuspid regurgitation, the embolus exists and is very large. "
Principal Zhang almost cursed.
What did he mean by 'I'm not a doctor'? How could the dignified principal of a medical university be so sarcastic?!
However, he did not dare to say it out loud. Principal Zhang did not expect Boss Zheng, who was proficient in dissection, to talk about theory.
He was unconvinced and looked up at Sun Chao, looking for help.
It would be great if Chief Sun Chao could also say something to dispel Boss Zheng's arrogance.
However, what Principal Zhang saw was … a dumbfounded Chief Sun Chao.
Sun Chao had some understanding of echocardiography, but it was definitely not this deep. What formula, what equation, these were all words that should be said when looking at an echocardiography?!
Sun Chao knew that Principal Zhang was looking at him, but he … did not understand at all!
He could only pretend not to see Principal Zhang's gaze. His eyes were dull as he stared straight at Zheng Ren.
A few days ago, was Chief Tian of the cardiothoracic surgery as embarrassed as he was? How could he fight if he did not understand anything the other party said?
This was not a battle at all, but a one-sided massacre!
"Sixth, the notch appears in the middle of the contraction of the forward flow spectrum of the pulmonary artery. At the same time, it is accompanied by a significant decrease in blood flow velocity, a shortening of blood flow acceleration time, a shortening of the right ventricular ejection period, which is commonly referred to as the RPEP period, and a decrease in the ratio of ACT to right ventricular ejection time. This is our diagnostic criteria — the 'finger fist sign'."
It was not over yet …
After one, two, three, four, five, there was still six!
Everyone was numb.
There was no big shot at the scene with an echocardiogram. Everyone felt that Boss Zheng's words were specious. But even if he wanted to refute it, he couldn't produce any strong evidence.
What the f * ck!
Department Head Sun Chao felt bitter.
However, it was not over yet.
"Seventh, thrombosis is the most typical feature of thrombotic pulmonary embolism.
Thrombosis in the right atrium or ventricle can have different forms, but in the pulmonary artery, it usually appears as a large thrombus, extending from the main trunk to one or both pulmonary branches.
The thrombosis of the right pulmonary artery was easy to display, but it was not easy to display the thrombosis of the left pulmonary artery due to its shorter length. In addition, pay attention to differentiate thrombosis from right heart system tumor! "
"This patient's right pulmonary artery thrombosis is not very clear due to gas interference. But we can roughly estimate its length — at least ten centimeters. "
Zheng Ren spoke quickly in a deep voice.
"We can see that part of the thrombosis is in the right pulmonary artery, and a small part is in the right ventricle."
At this point, he raised his head and glanced at Principal Zhang. "Since we have limited time, I won't go into the differential diagnosis of thrombosis and heart tumor."
Principal Zhang felt a great deal of contempt.
He felt that Boss Zheng's subtext was: 'Even if I tell you, you won't f * cking understand, so I won't go into it.' There's no point in talking so much to you good-for-nothings. It's completely meaningless.
Sun Chao, on the other hand, was ignored by Zheng Ren as a mosaic.
Really … What the f * ck!
Sun Chao cursed again in his heart.
"Eighth, abnormal ventricular septal motion …"
"Ninth, reopening of foramen ovale …"
However, Boss Zheng was not done yet.
After explaining the thrombosis, Zheng Ren continued with the eighth and ninth points.
After that, he placed the list on the desk and tapped his fingers on the radiographic film viewer.
"The diagnosis is relatively clear. Pulmonary embolism. The thrombosis is blocking the right pulmonary artery. Based on the echocardiogram, the thrombosis is very long, at least ten centimeters. This is one of the contraindications of interventional embolectomy!
"Also, the patient's condition is urgent. If there was time, I could successfully remove the thrombosis in two hours. But now … I estimate the patient's survival time is only about one hour. If the thrombosis is removed or other tests are performed, the patient will die. "
"Principal Zhang, sign!" Zheng Ren said in a commanding tone with a frown.
Time was tight. What kind of gentle breeze and drizzle? What kind of respect for the old comrades? It was all f * cking nonsense.
Principal Zhang was stunned.
Was this a forced abdication? Was time really that tight?
"Boss, the patient's oxygen saturation is 75%! I'll send him to the operating theater first. The surgery is ready to start, "Su Yun shouted as he ran past the office with the patient in his wheelchair.
"Go." Zheng Ren took out a piece of white A4 paper and placed it in front of Principal Zhang. "Principal Zhang, there's no time. The surgery is very risky. There's at least a 40% chance that the patient will not be able to leave the operating table."
"…" Principal Zhang shuddered.
Not only him, but the chief physicians from all over the country who had come to watch the commotion also shuddered.
However, the two shudders had different meanings.
Principal Zhang's was because there was a 40% chance that the patient would not be able to leave the operating table, but the other chief physicians were stunned because this young man had a 60% chance of performing the surgery!
This was an extremely difficult surgery. According to him, the patient would die within an hour.
Could extracorporeal circulation be established in an hour?
Yet, he said he had a 60% chance of success?
A ten-centimeter pulmonary artery embolization, cutting the heart, cutting the pulmonary artery, removing the thrombosis …
Impossible, that's absolutely impossible!
Subconsciously, many chief physicians did not question the diagnosis. Instead, they placed all their distrust on the surgery's success rate.
It could not be that high!
"I agree to the surgery. Please sign here. There's no time for other preoperative instructions," Zheng Ren said. "I'll write this by hand after the surgery."
"If you can't make up your mind …" Zheng Ren said as he looked at Lin Ge.
"Boss Zheng, don't worry. The medical administration division's job is to protect the clinic. If Principal Zhang can't make up his mind, the medical administration division will approve the surgery! "Lin Ge understood and said loudly without hesitation.
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