MTL - I Can See Health-Chapter 35 acute left heart failure

  Chapter 35 Acute Left Heart Failure

   "Junior brother, hurry up and push the electrocardiograph, and come to bed number 10!"

"receive."

  Lu Chen immediately ran to the nurse station and found an electrocardiograph in a corner.

   Quickly unplug the charging plug of the electrocardiograph, find the blood pressure monitor in the drawer, push the machine, and quickly rush to bed number 10 with the blood pressure monitor in hand.

   Bed 10.

   As soon as Lu Chen came in, he saw an old man sitting on the bed panting heavily.

   The color on his head is **** red!

   The head of the bed has been rocked almost perpendicular to the ground.

   Sweat dripped from his forehead down his cheeks, his expression was extremely irritable, and his hands were waving randomly.

  Sun Guoguo was already holding a stethoscope and quickly auscultated the old man.

   At the same time, a nurse pushed the ambulance and ran into the ward.

   "Give the patient oxygen, then push a furosemide and a panting!"

  "Urgent blood check! Blood routine, renal function, ion, BNP, myocardial enzyme spectrum, coagulation item and D-dimer"

  Sun Guoguo began to issue orders.

"receive!"

  The nurse immediately started dispensing the medicine.

  Lu Chen was not idle either, he would immediately take out the blood pressure monitor to measure the patient's blood pressure.

   The patient was a little restless, and it was difficult to control his hands.

   "Mother-in-law, please help me to press a little."

   The patient's family is an old woman, and her son is not by her side, so she takes care of her wife alone.

  Mother-in-law's body was still strong, she came to the bed and reached out to hold the patient's palm.

   "Old man, don't move, the doctor will take your blood pressure."

   With the help of his mother-in-law, Lu Chen successfully took the patient's blood pressure.

   "Sister, the patient's blood pressure is 204/114mmHg!"

  Sun Guoguo nodded, and then immediately told the nurse, "Use 50ml of sugar with a sodium nitroprusside, pump it intravenously, and walk at a speed of 5m/h."

"receive!"

  The nurse has finished pushing the panting and furosemide, and immediately started to prepare new liquid.

   "Senior sister, can I do an electrocardiogram for the patient?" Lu Chen asked aside.

   "Okay!" Sun Guoguo nodded in relief.

   This little junior brother is quite clever, not a rookie with no clinical knowledge.

   Because some graduate students spend all their internship time on postgraduate entrance exams.

   Although he was admitted as a graduate student, he did not know anything about clinical practice.

  Book knowledge and clinical practice are separated by thousands of miles!

   What's more, he can't even do an electrocardiogram or blood pressure!

   Fortunately, Lu Chen is quite reliable, and he is very skilled in various operations.

  …

  Lu Chen quickly connected each limb lead to the chest lead.

   However, the old man was sitting on the bed, with a thin body and dry skin, and the leads of the electrocardiograph were not easy to stick to.

   "Mother-in-law, come and help, hold the three leads here firmly, don't let go."

  The old woman went to the bed again, her thin old hand pressing the lead tightly.

  On the screen of the electrocardiograph, the waveform of the electrocardiogram slowly turns on and stabilizes.

   "Okay, take a picture."

  Sun Guoguo has been paying attention to the situation here.

   When the Cardiology Department encounters a sudden disease, an electrocardiogram is extremely necessary.

   can quickly help doctors to judge the patient's condition.

   When Lu Chen heard the words, he immediately pressed the "Exit" button.

   "Buzz...buzz..."

   ECG completed.

  Sun Guoguo got the ECG drawing, glanced at it, and put it down.

   Good guy, extensive lead ST depression, severe myocardial ischemia.

   "Nurse, push another furosemide!"

   "Okay, received!"

   As soon as Sun Guoguo issued the oral doctor's order, the nurse immediately began to execute it.

   Within five minutes, Lu Chen could clearly feel that the old man on the bed was panting slowly, and his pale face regained a tinge of blood.

  Sun Guoguo and the nurses present were relieved.

   Heart failure, come and go quickly!

   "Junior Brother, do you know what kind of illness this patient just had?"

  Sun Guoguo started the daily teaching part.

  Teaching is an important part of tertiary hospitals.

  Lu Chen recalled all the symptoms and signs of the patient.

   Sitting upright, sweating profusely and short of breath.

   Wet rales could be heard and obvious in the lungs, and pitting edema of both lower extremities.

   "Acute left heart failure." Lu Chen said, "The specific cause of heart failure may be the sudden increase in blood pressure, resulting in increased load."

  Heart failure, that is, heart failure.

   Simply put, it means that the heart has no strength to beat and cannot pump blood to various organs and tissues in the body.

   This has two main consequences.

   First, various organs and tissues in the body suffer from ischemia and hypoxia, resulting in functional failure.

   Second, the blood that cannot be ejected will accumulate in the pulmonary circulation, causing acute pulmonary edema, which is often referred to as acute left heart failure in medicine.

   "Well, yes." Sun Guoguo nodded, with a hint of admiration in his eyes, "This patient is a typical acute left heart failure, so what are the treatment principles for acute left heart failure?"

   She actually wanted to see what level her young junior brother was at!

   "The general principles are cardiotonic, diuretic, and vasodilator." Lu Chen said, "Besides, there is oxygen inhalation, and morphine can be used for sedation if necessary, but be careful to avoid respiratory depression."

   "Well, not bad." Sun Guoguo smiled.

  Strengthening the heart, diuresis, and dilating blood vessels, these are the three strategies for the treatment of heart failure.

   "What does the doctor's order I just asked the nurse to execute correspond to?"

  Lu Chen recalled Sun Guoguo's oral doctor's orders for all the medicines just now.

   Furosemide, Chuanding, Sodium Nitroprusside!

   "Furosemide is a diuretic, Chuanding is an anti-asthma, and a vasodilator is sodium nitroprusside!" Lu Chen replied earnestly.

   "Then why didn't I use cardiotonic drugs?"

  Sun Guoguo said to Lu Chen with a smile.

   "Because among the three methods of cardiotonic, diuretic, and vasodilator, diuresis is the most important, followed by vasodilator. Cardiac acupuncture is only suitable for use when the first two methods do not work or the effect is relatively poor!"

   "Why is diuresis in the first place? Strong heart is the last?"

  Sun Guoguo is going to get to the bottom of it.

  Lu Chen frowned, this question seems to be difficult to explain with medical theoretical knowledge.

   Then, let’s change to another way of interpretation.

   "Actually, heart failure can be compared to a donkey walking on a muddy path with a load on its back."

   "The effect of a diuretic is to reduce the load, which is equivalent to reducing the cargo on the back of a donkey."

   "The effect of dilating blood vessels is to dilate static and dynamic blood vessels, which is equivalent to repairing a muddy path and making it easier for donkeys to walk."

   "The effect of strengthening the heart is to increase the contractility of the heart, which is equivalent to whipping the donkey with a leather whip to make the donkey run faster."

   "Comparing the three methods, we can see that the third method of strengthening the heart, although it can make the donkey run faster, may cause long-term damage to the donkey and reduce its lifespan."

   "The first diuretic method, the one that works the fastest and doesn't have many side effects!"

   After hearing Lu Chen finish, Sun Guoguo's expression was very surprised.

  Is Lu Chen really just a freshman in graduate school?

  If she took off her mask at this time, Lu Chen would definitely be able to see her opening her mouth in shock.

  Most people know "cardiac, diuretic, vasodilator", but they don't know the adaptability of each method.

  Inotropes are useful, but they are not the first choice because they may increase the mortality rate of patients in long-term hospitalization.

   "Congratulations, +1 for the thank you from Warwick!"

   Suddenly received a system prompt, which made Lu Chen look happy.

   He looked at the system panel, and the system completion became 60%.

   (end of this chapter)