【1536】Doctors should consider comprehensive when making decisions
The pericardium is a membranous sac, divided into fibrous layer and serous layer, and the serous layer is divided into visceral layer and parietal layer. The visceral layer covers the surface of the heart, the parietal layer is attached to the fibrous layer, and there is a cavity in the middle called the pericardial cavity. Under normal circumstances,
The wall layer is very smooth, and the pericardial friction sound now indicates the occurrence of inflammation. Inflammation will produce exudate and flow into the pericardial cavity, and the resulting fluid is called pericardial effusion.
When the pericardial effusion increases to a certain amount, the visceral layer and the parietal layer are separated, and there is no friction between them, the pericardial friction sound will disappear. This is why clinical cases of pericardial friction sound with large amounts of effusion are rare and special.
, this old lady should not be. Because after auscultation, the sound of the patient's first heart sound and second heart sound are not far away.
There is not a large amount of effusion and the condition has not reached the level of cardiac tamponade, which can be called lucky.
Xie Wanying put down the stethoscope and asked the patient about the location and characteristics of the pain in the chest: "Does it hurt like a knife cutting, or does it hurt like being hit by a sandbag?"
The old lady said: "It was like being hit in the chest by something heavy."
It's a dull pain. Although myocardial infarction is also a dull pain, this pain may come from the pressure pain caused by pericardial effusion. Xie Wanying analyzed and calculated in her brain based on the examination data she had obtained at this stage, and believed that the patient may have a myocardial infarction.
The sex is small. The main problem is a bit of acute heart failure.
The flight attendant brought an oxygen mask and handed it to the nurse. The nurse put the oxygen mask on the patient. The flight attendant took this time to coo in Xie Wanying's ear.
"The captain asked, is it necessary to make an emergency landing to a nearby airport? If necessary, please tell us immediately. We will contact the nearby airport for landing, which also requires coordination from the airport."
The plane does not land immediately if it wants to. Even if it is a temporary emergency landing, it must be coordinated with the airport first. If a collision occurs, the aircraft will be destroyed and people will be killed.
"How long will it take to continue flying from Capital Airport?" Xie Wanying asked.
"About an hour." the flight attendant replied.
In this way, the plane is almost flying over the capital. The medical conditions in the surrounding areas are incomparable to the capital. And what’s even more frightening is that everyone around knows that the doctors in the capital go to the capital for medical treatment, which leads to the poor medical technology in the surrounding areas.
Some hospitals are far worse than those in the capital and are not as good as those in local hospitals far away from the capital.
"If we find a nearby airport to land temporarily, how long will it take? It will take ten or twenty minutes, right?" Xie Wanying asked again.
"Yes." The flight attendant was mentally surprised by her quick calculation ability, as if she was more than just a doctor.
Laymen don’t know it, but doctors often have to count, whether they are physicians or surgeons. What counts? Counting is a much older thing. Making doctor’s orders and calculating the patient’s drug dosage every day is a basic skill of a clinician. Light.
This item already involves calculation. Doctors should try their best to calculate the specific dosage of medication before the patient's condition changes. The more accurate the calculation, the better.
On-site emergency physicians also need to estimate the best transportation option for the patient.
Can this patient's condition wait until he lands safely at the Capital Airport an hour later before being sent to the hospital? If so, both the patient and his family will definitely choose the Capital Hospital as their first choice for treatment.
Xie Wanying needs to consider this for this patient because this patient is not a common heart disease, but a relatively rare type of hypothyroidism here.
