Professor Tong is not polite either. People who are used to being teachers still value this kind of teaching opportunity very much:

"Okay, Dean Xiao Chen asked me, an old man, to discuss it with you. Everyone knows that myocardial infarction can cause acute coronary artery ischemia, which in turn can lead to cardiac ischemia and hypoxia.

But what everyone doesn’t know is that when the heart is ischemic, the heart’s autonomic nervous system will be abnormal, which may stimulate the vagus ganglion in the ischemic area of ​​the lower wall of the heart, causing upper abdominal pain. This is one of them.

One reason.

There is another possibility that acute myocardial infarction leads to persistent coronary artery ischemia and hypoxia, which will cause myocardial necrosis. Clinically, there is often severe and long-lasting retrosternal pain. Since the heart is located behind the sternum, close to the xiphoid process

, so severe pain can easily be mistaken for upper abdominal pain.

Of course, the above two possibilities are just my guesses. I don’t know whether Dr. Lan is satisfied or not, and I don’t know if Dean Xiao Chen has anything to add.”

In fact, when Professor Tong was answering the question, Chen Qi remembered what happened to his grandmother in his previous life, and said with emotion:

"I have personally experienced a case in which a gastroenterologist misdiagnosed a myocardial infarction, which is what Professor Tong said. An old lady had pain at the junction between her chest and abdomen. She mistakenly thought it was a stomachache and ran to the hospital.

go to hospital.

At that time, the medical director asked the old lady to study gastroenterology. Most of you here are gastroenterologists. When you meet patients with pain here, the first thing that comes to your mind is stomach or duodenal pain? Isn’t that right?

Think it's easy?

The doctor who treated the patient at the time thought so too, but the doctor did not inquire carefully at all because the old lady had basic medical histories such as hypertension, diabetes, hyperlipidemia, and coronary heart disease, and the old lady had already had

A history of two strokes.

This is a typical high-risk group. However, because the gastroenterologist is confident and does not have an overall view in his mind, he only thinks about the diseases in his own system, so the doctor prescribed some stomach medicine and asked the old lady to return.

Home.

What was the result? The old lady saw a doctor in the morning and died of a myocardial infarction in the afternoon. Do you think it is a pity? It can even be said that the gastroenterologist has misdiagnosed. If it were a foreign country, this medical lawsuit would undoubtedly be lost.

If you think about it, if the doctor had been more careful, asked more carefully, and done an electrocardiogram and emergency cardiac enzyme test on the old lady, it would have been possible for the old lady to have discovered her myocardial infarction in advance and treated her in advance and might have survived.

Instead of waiting until the afternoon to die suddenly.

This case is a big tragedy, and it is completely avoidable. So when you see a doctor in the future, don’t simply think of abdominal pain as enteritis and dismiss it as gastritis. Asking more questions is a waste of time at most, but

Maybe you can save a life."

Chen Qi's example made the atmosphere in the small restaurant suddenly dull.

Many gastroenterologists recall that when they were seeing patients in outpatient clinics, they met some patients who said they had stomachache or stomachache. They just prescribed some medicine and sent the patients home without asking them to do electrocardiograms or

Cardiac enzymes.

And there are many such patients. In the gastroenterology department, more than half of the patients with abdominal pain and stomachache will be outpatients in one day. In one year or ten years, will there be hundreds or thousands of patients?

Among so many patients, how many may be patients with myocardial infarction?

How many people have lost an opportunity to detect it in advance and ended up dying suddenly at home or on the road?

When thinking that many lives may have been lost in their own hands, every doctor feels heavy in his heart.

Chen Qi also took a deep breath. Although he had been reborn in this world for 10 years and his previous life seemed far away, it always reminded him of his relatives in his previous life inadvertently.

Thinking of my grandma losing her last hope because of the doctor's misdiagnosis, I felt helpless and distressed.

It was definitely not a good thing to have an awkward moment at the banquet, so Comrade Lao Guo promptly smoothed things over:

"Ah, Professor Tong, colleagues from Xijing Hospital, as well as our colleagues from Yuezhong Hospital, we are now having an academic discussion, not accountability. There is no need for everyone to look sad. Doesn't this show that we Yuezhong people are not welcoming?

Zhou, hehehe.

"

After Yi Zewen became the chief of the emergency department, his emotional intelligence kept rising, and he hurriedly stood up:

"Come on, come on, this is a rare opportunity, because our emergency department encounters more acutely ill patients, giving us less time to identify, so I would like to ask Dean Chen and Professor Tong, in addition to the retrosternal manifestations of myocardial infarction,

In addition to pain, abdominal pain, and stomach pain, are there any other atypical pains?”

Chen Qi also came to his senses at this time, put the longing for his relatives in his previous life in his heart, and said with a smile:

"Then there are many atypical pains. Many of them are pains that no one can imagine, such as jaw and toothaches. Yes, toothaches. This is the most common atypical pain caused by myocardial infarction.

Why? Because myocardial infarction often leads to myocardial ischemia or hypoxia. Once the heart supplies insufficient blood or oxygen, it will prompt the body to secrete acidic metabolites. This is called hypoxic pain.

At this time, these metabolites greatly stimulate the sympathetic nerves of the individual, so the nerves will experience severe pain, and the nerve pain will also spread to the mandible and teeth, with the main site being the gums.

Therefore, patients often feel pain in their jaws or teeth. Once the pain is excessive, they may even faint. In the future, if you encounter patients whose toothache cannot be stopped even after taking painkillers, you must pay close attention to them and ask them to do an electrocardiogram quickly.

"

Oh~~~

Many doctors nodded repeatedly. What Chen Qi said was based on experience and was not written in books. It was very precious.

At this time, Ma Xiaona also got excited and shouted: "Chen Qi, are there any other unexpected pains?"

This chapter is not finished yet, please click on the next page to continue reading the exciting content! Chen Qi was already laughing at this time:

"Yes, another common one is migraine. This is because when an individual has a myocardial infarction, the blood supply to the heart will be blocked.

The brain's blood pressure mainly relies on the heart's supply. Once the blood supply to the brain is insufficient, the blood vessels and nerves in the patient's head will be damaged, and the patient will suffer from migraines due to vasospasm."

A young doctor from Xijing Hospital also raised his hand and said: "Director Chen, are there any more?"

"Also, everyone should be careful about sore throats. When a person often suffers from sore throats, it may be caused by myocardial infarction, because the heart and throat are controlled by the same spinal nerves and are in the same nervous system.

If an individual has a myocardial infarction, the segmental nerves will also experience pain. At this time, the human body will secrete a large amount of polypeptide substances. Once these substances spread to the vagus nerve in the pharynx, throat pain will occur."

Everyone asked questions one by one, and Chen Qi answered one by one. The atmosphere at the scene became more and more enthusiastic.

At this time, Yang Xiuxiu, a young nurse in the emergency department, raised a sobering question:

"Dean Chen, you just taught us all kinds of atypical myocardial infarction pain, but now there is a problem, let alone atypical, even if it is a typical myocardial infarction, the patient himself knows that it may be a myocardial infarction.

But if the patient is at home or at work and cannot reach the hospital in time, how should he help himself?"

As soon as this issue came up, many people slapped their thighs.

"Yes, if it's a family, if you go to your neighbor's house and borrow a donkey cart to drive to the city, the body may be too cold."

The person who said this was a doctor from Xijing Hospital, who is very characteristic of Northwest China.

"No, we people in Vietnam all go to see a doctor by boat. The bigger one is a hand-cranked boat, and the smaller one is a awning boat. But no matter which kind of boat you go from home to our people's hospital, the precious rescue time is just like this.

wasted."

This was said by a doctor in Yuezhong. Yuezhong is a water town, and the main means of transportation for ordinary people is by boat.

"You are talking about rural areas or countryside. Even in our city, how many people have to call 120 emergency ambulance? Patients with myocardial infarction must be sent to the hospital in a resting state. If they come to the hospital on foot or by bicycle,

I’m afraid I might have had a seizure on the way and died.”

Is the 120 ambulance expensive? From Chen Qi's point of view, it's really not expensive.

Because of the cost of gasoline and car depreciation, the labor costs of a driver, a doctor, and a nurse, and the cost of emergency equipment and medicines on the road, it is normal to charge 10 or 20 yuan for a trip.

If you drive out of town, it will be a little more expensive.

But from the perspective of ordinary people, it costs 120 or dozens of yuan to hire a car. It is better to find a few neighbors and relatives to row a small boat to see a doctor in the city.

The question is, what is an emergency department? What is an emergency? Where are you allowed to take your time by rowing a boat or riding a donkey cart?

If a patient dies suddenly, the golden rescue time is only 5 minutes.

For example, in case of cardiac arrest, the success rate of CPR within one minute is over 90%. If CPR rescue is performed within four minutes, the success rate of rescue is about 50%;

If CPR rescue is started within about six minutes, the chance of success is about 10%;

If no rescue is carried out within ten minutes, the chance of success is very slim, close to 0.

For a disease like myocardial infarction, if you are sent to the hospital before sudden death, there is still a chance of survival. If you have a myocardial infarction at home and die suddenly on the spot, the possibility of being sent to the hospital to revive you is very slim, even if you die suddenly.

The same will be true in 2023.

In 2023, when a family member's heart and breathing stopped, they would call 120 and send them to the emergency department for final rescue no matter what, even if they were fulfilling their duties as a relative.

But in 1989, people died suddenly at home due to heart attack, and almost no people sent the patients to the hospital for emergency treatment.

One is that there is too little time, and the other is that the people are poor and have no choice but to live or die. If they die, they can only blame themselves for their bad luck.

This is also the main reason why in the 1980s, there was very little research on coronary heart disease, or myocardial infarction, cerebral infarction or cerebral hemorrhage, there were very few specialists, and there were very few treatment options and drugs.

Because there is no "market".

It is rare to encounter several myocardial infarctions in a year, but your hospital has to prepare a set of myocardial infarction-related machines and medicines for this. It is a waste for the hospital and is not cost-effective.

Just like the reason why some people in later generations were bitten by snakes and encountered obstacles everywhere after being sent to the hospital, because not every hospital prepared anti-venom, the same reason.

Why aren't hospitals ready? Because snake venom serum is very expensive, and if no one uses it until it expires, the hospital will lose a lot of money, so the hospital is unwilling to reserve these drugs.

This is the contradiction of an era.

From a philosophical point of view, it is the contradiction between the people's growing material needs and backward social productivity.

Medically speaking, it is the contradiction between the people's growing health needs and backward medical technology.

But this problem cannot be solved by Chen Qi, a small dean. It depends on the top-level design and even more on economic conditions. Without money, everything is in vain.

Chen Qi originally didn't want to answer Ma Xiaona's question, because some of the things he wanted to say might be quite advanced, and he would make mistakes if he said too much.
To be continued...