As the night deepened, the Department of Circulatory Medicine of Nanshan City People's Hospital was still busy.
Associate Chief Physician Lang, who was in charge of the Emergency Department, had been busy for a whole 12 hours. He saw an endless stream of patients, but there was still no sign of him taking a break.
The weather was getting colder, and the temperature in the north plummeted. Cardiovascular and cerebrovascular diseases were reported. Just today, Nanshan City People's Hospital had received 12 patients with acute myocardial infarction.
According to the severity of the patient's condition, Associate Chief Physician Lang arranged the order of the surgeries. During the intervals between surgeries, he took some time to check on the other patients' conditions and medication.
He was extremely busy.
Every year, when the temperature fluctuated greatly, there would be such trouble. Director Lang was already used to it.
The difficulty lay in the fact that few people were willing to perform interventional surgery, not the patients, but the doctors.
In the past, there was a problem with the coronary artery and he had to undergo bypass surgery. He had to cut the sternum, and the sternum saw would buzz. It was scary just thinking about it. Now, all they had to do was to puncture the wrist or the neck and insert the tube. Every patient knew which option to choose.
However, if there were more patients, the number of doctors would definitely be relatively insufficient.
In the past, when their income was high, some people would even go for interventional surgery. But with the introduction of a series of measures such as the two-piao system, income became more and more transparent, and the drawbacks of low wages in the North were exposed.
If it was last year, there would be three groups of people going on stage together. But now, there was only him. Department Chief Lang held his waist, took off his lead apron, and started to move around the wards.
He had come into contact with interventional surgery relatively early. At first, he had studied at Fuwai University. Later, he went to the Imperial Capital Hospital for further study. He was very familiar with the professors and chief physicians of the two hospitals.
Although he was old, he could teach others the skills he had learned.
Director Lang had a good plan. After teaching his disciple, all he had to do was sit down and watch. However, things did not go as he wished. The successful students left one after another. Director Lang was also very helpless.
However, it was not appropriate for him to criticize them silently. In ancient times, soldiers in heavy armor were paid more than soldiers. However, this did not exist in Nanshan People's Hospital. The radiation subsidy was only a small amount, and it was said that the rules were set in 2004.
Thinking of this, Director Lang was furious. How could the prices in 2004 be compared to now? How much was the price of a square meter back then? How much is a square meter now?
Should he go to the south as well? Recently, Chief Lang had occasionally thought about this problem.
However, he would only think about it when he had nothing to do. There were so many patients with myocardial infarction in the ward. No one had time to think about it.
Chief Lang could only catch his breath when he took off his lead apron and went to see the patient. He was already in his fifties, and he really could not stand it when he had to wear a lead apron to perform surgeries.
Moreover, the income from doing more or less seemed to be about the same. They were only hanging on by their "noble medical ethics".
When he saw two more emergency patients, Chief Lang's face twisted into a bitter gourd. When was this going to end?!
However, he had no choice but to do it.
After selecting a patient with severe illness, preoperative instructions and surgical preparations were carried out at the same time. Director Lang was very satisfied with his team, but he didn't know how long they could last.
He took some time to smoke a cigarette and looked at the patient's electrocardiogram again. It was a typical myocardial infarction. Chief Lang put on his lead apron again and went into the operating theater.
The patient complained of chest pain for 6 hours. The electrocardiogram diagnosed extensive anterior myocardial infarction. Other examinations also supported this diagnosis.
The electrocardiogram showed that the patient's condition was very serious, and there was no obvious relief after medication. At the very least, an angiogram was needed.
The operation was very successful. The angiography showed that the left anterior descending branch was completely occluded from the proximal first diagonal branch. More than 85% of the first diagonal branch was narrowed, and more than 90% of the proximal left circumflex branch was narrowed. The anterior blood flow was TIMI2, and the right coronary artery was extensively diffuse lesion.
Fortunately, he did it, Director Lang thought. If it had dragged on for a night, the patient might have died.
The coronary artery was seriously blocked. There was no other way, so a stent was inserted.
After the left anterior descending branch was opened, 2.5mm x 18.0mm, 2.5mm x 29.0mm were inserted.
Two Firbird stents were inserted.
When the two stents were inserted, Chief Lang heaved a sigh of relief. There should be no problem this time.
"Is it better?" Chief Lang asked out of habit without an angiogram.
"Chief, it's not good." The patient's voice was a little low, as if he was trying hard to say it.
The old man was very kind. During the operation, he tried his best not to cause trouble for Chief Lang and the nurses.
"Huh? It's not good? How do you feel now? "Chief Lang asked in surprise.
"My chest and back … It's stuffy, very stuffy," the patient said. "It's even stuffier than before the operation."
Chief Lang frowned as he stared at the blood pressure value on the electrocardiogram monitor. The blood pressure was dropping from a slightly higher level before the operation. Although it was not fast, it was very smooth and steady.
It was 90/60mmHg earlier, but it had dropped to 80/57mmHg in a short while.
Strange, what was going on?
Could it be a coronary artery rupture that caused cardiac tamponade? Chief Lang woke up with a start. Adrenaline and glucocorticoids were secreted in large amounts, and the fatigue and drowsiness from before were gone.
MB！ Coronary artery rupture was one of the most serious complications of cardiac circulation interventional surgery. The word 'one of' could even be removed.
His hands were a little shaky, but he quickly calmed down and started the angiogram.
However, the results of the angiogram puzzled Chief Lang. There was no obvious leakage of contrast medium in the coronary artery! However, he could not rule out the possibility of minor damage leading to problems.
Chief Lang looked at the patient's continuously dropping blood pressure and immediately said, "Norepinephrine 0.45μg per kilogram per minute."
After the norepinephrine was used, the patient's blood pressure was initially stabilized. However, under the effect of the drug, there was a brief rise, and in less than five minutes, Chief Lang's blood pressure began to drop again.
Although the angiogram did not show any leakage of contrast medium, Chief Lang still suspected that it was a cardiac tamponade. Otherwise, there would be no way to explain these problems.
He called for an echocardiogram, and there was a small to medium amount of fluid in the pericardium.
There should be a problem with the heart muscle. The blood had entered the muscle space due to the increased pressure, causing the hematoma to press on the small arteries. Chief Lang analyzed the situation himself.
However, the coronary artery rupture … Chief Lang was extremely depressed.
Coronary artery rupture was a serious complication with a low incidence of PCI, about 1%. The main cause of the rupture was the hematoma in the airtight pericardium after the coronary artery perforation, which led to myocardial diastolic dysfunction.
Chief Lang was relatively lucky. After so many years, he had only encountered two similar cases. He did not encounter many cases, but he had some experience.
He immediately prepared for a pericardial puncture.
Chief Lang tried local lidocaine anesthesia in the fifth intercostal intercostal area of the patient's left chest wall. He used the sliding puncture method to implant a single-spear drainage tube. After about ten minutes of open drainage, only 150ml of blood was drained.
Chief Lang was a little confused as he observed the patient's condition.
The blood loss was so small, and the patient's blood pressure was still dropping … What the f * ck!
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