Dr. Lin was so confused that he grabbed the medical record from the nurse's hand and complained: "You didn't tell me!"
"Didn't Dr. Zhang tell you when he handed over the shift, Dr. Lin? We asked Dr. Zhang before if this patient has any family members, and she said she would ask. Later, she didn't tell us what the situation was." The nurse replied that she was not going to accept this.
pot.
Zhu Huicang raised his glasses, first recognized Xie Wanying's facial features, and recalled the meeting more than three years ago: the girl who made Cao Yong lose his soul?
"Is she studying in our hospital now?" Zhu Huicang asked his old classmate Ren Chongda.
"Wouldn't you like to follow Huang Zhilei when you go to the neurosurgery department for internship?" Ren Chongda said.
"Oh." Zhu Huicang wondered: Could someone be so happy because the junior sister came to his department for internship?
Doctor Lin looked over the electrocardiogram done by Liu's father before: "This, this -"
Zhu Huicang leaned over to take a look, then glanced at Dr. Lin: "The patient you are seeing?"
"No, it's not me!" Dr. Lin denied with all his strength, "She didn't say there was a change in his electrocardiogram. She said that the electrocardiogram looked fine and the three items in the blood test for myocardial infarction were normal."
Such a big thing happened, and he couldn't afford to take the blame!
"Isn't this okay? Isn't the ST segment depressed?" Zhu Huicang pointed out the problem at once, "Isn't this a typical sign of myocardial ischemia?"
Of course Dr. Lin saw the same thing, otherwise why would he deny it so hard: "Yes, yes, it's myocardial ischemia."
"It's not just myocardial ischemia, right? The patient's main complaint is that the chest pain seems to have been vague since the morning, and the pain lasted for at least several hours before being sent to the hospital. It must be ACS. If it is ACS, it must be vigilant. Part 1
Monitor him for at least eight hours. How long has it been since he entered the emergency department of our hospital?" When Zhu Huicang asked, he looked at the watch on his hand to calculate the time.
acs stands for acute coronary syndrome.
First of all, normal myocardial enzyme test does not mean that there is no myocardial infarction.
The standard diagnosis of myocardial infarction is not based solely on myocardial enzyme testing, but is based on electrocardiogram or myocardial enzymes or clinical symptoms. If two of the three are consistent, the diagnosis can be confirmed.
Secondly, the electrocardiogram may also appear pseudo-normal.
For example, some patients with myocardial infarction may happen to have an electrocardiogram performed by a doctor during the hyperacute phase. At this time, the patient is in the acute myocardial injury phase and before the ST-T abnormality reaches the full development phase, the electrocardiogram just returns to the normal state. It does not take more time.
It is said that normality at this time is pseudo-normal.
Therefore, the electrocardiogram produced during this period can easily cause doctors to misjudge the patient. Father Liu may be a typical case like this.
Experienced hospitals must have guidance and requirements for clinicians in the diagnosis and treatment of myocardial infarction.
For example, the National Association of China stipulates that if the first electrocardiogram is generally normal, but Liu’s father complains that the abnormality is suspected to be ACS, as Zhu Huicang said, he needs to be monitored for more than eight hours.
Eight hours of ECG monitoring does not mean that the doctor can just ignore the equipment connected to the patient. Such monitoring is meaningless. What is needed is that the doctor comes back from time to time to see if there are any changes in the patient's ECG. The subtle changes in the patient's condition are more
Doctors need to be vigilant and responsible enough to catch it. If they are doctors with a strong sense of responsibility, they will even perform another ECG on the patient every once in a while. Because as Xie Wanying started to argue with Dr. Jiang, ECG monitoring
There is no electrocardiograph standard for analog leads.