MTL - I Can See Health-Chapter 51 Heart Stent Price Reduction

  Chapter 51 Heart Stent Price Reduction

   Click the Receive button.

   A red box popped up on the central interface of the computer.

   Laboratory critical value reminder!

  Department: The Eighth Ward of Cardiovascular Medicine

   Name: Zhang Guangming

  Bed size: 20 beds

  Age: 31

  Critical value: cardiac troponin I (fluorescence method) 5.4ng/ml (normal value 0-1ng/ml).

   Seeing the critical value of the test, Lu Chen's heart sank. Troponin increased five times. This young guy has a heart attack?

  The current international diagnostic criteria for acute myocardial infarction follow the "1+1 model".

   The first 1 is a typical dynamic change of the marker, that is, an increase in troponin.

The second 1 is any one of the four criteria. The four criteria refer to: 1. symptoms of chest pain and chest tightness, 2. pathological Q waves on the ECG, 3. ST segment elevation or depression on the ECG, 4. Imaging examination showed abnormal myocardial movement.

   And this 20-bed patient just met the 1+1 diagnostic criteria!

   "Senior Sister Guoguo, the 20 beds just received, the troponin has increased!"

  Lu Chen shouted to Sun Guoguo who was beside him.

  Sun Guoguo was reviewing the discharge medical records. Hearing Lu Chen's words, he was also shocked. He quickly put down the medical records in his hand and hurriedly sat in front of the computer.

  Open the test sheet of the system, cardiac troponin I (fluorescence method) 5.4ng/ml!

   Just now she was talking about coronary spasm caused by smoking

   Now it's really a slap in the face!

   "Myocardial infarction!" Sun Guoguo immediately picked up the stethoscope and stood up, "Junior brother, push the ECG machine and review the patient's ECG. I'll go and communicate with the patient's family about the condition!"

   "Okay." Lu Chen nodded and started to act separately.

  …

  Patients who are suspected of myocardial infarction must check the ECG frequently, preferably every half an hour to an hour.

   ECG is a simple, non-invasive and inexpensive examination, and can understand the changes of myocardial ischemia in patients at the first time.

   pushed the electrocardiograph to bed 20.

   As soon as Lu Chen walked into the ward, he saw a middle-aged uncle of about fifty years old standing beside the bed. He should be the patient's family.

  The middle-aged uncle has a thin body and dark skin. He may be a person who has been working in the sun for a long time.

  Lu Chen looked at the young male patient lying on the bed.

   The color on his head has changed from yellow to red!

  Lu Chen pushed the ECG forward and immediately reviewed the ECG for the patient.

  The electrocardiogram showed that the ST segment in leads V1~V3 of the chest was about 0.2mv higher than before.

  Sun Guoguo finished auscultating the patient again. He looked at the electrocardiogram of the reexamination and frowned: "Basically, acute myocardial infarction has been diagnosed."

   "Doctor Sun, you said my son had acute myocardial infarction?"

   The middle-aged uncle had a sullen face, his hands behind his back, and his eyes were erratic.

   "Well, judging from the current tests, electrocardiogram and symptoms, there is a high probability of acute myocardial infarction."

   "We need to contact the immediate interventional coronary angiography to assess the condition of the heart vessels, and if necessary, coronary stents may be implanted!"

  Sun Guoguo's face was serious, and there was a hint of doubt in his tone.

"Interventional surgery? Dr. Sun, I still understand this disease, because a relative in my family had a myocardial infarction and a stent was placed." The middle-aged uncle said solemnly, "But at that time, my relative had severe chest pain, and I My son doesn't feel any discomfort now, how could it be a heart attack? Could it be a mistake?"

  The male patient lying on the bed also said loudly: "Yes, I don't have any symptoms now, and I don't feel any pain at all. It's no different from a normal person. You just checked the blood once, will it be wrong?"

  Sun Guoguo patiently said slowly: "Each patient's condition is different and can change at any time, and the patient has already experienced chest pain symptoms when exercising in the morning, which indicates a high probability of myocardial infarction."

  The middle-aged uncle was silent for a long time before speaking.

   "Doctor Sun, to tell you the truth, my relative died the next year after the stent was placed. Now I don't know whether it was because of his own disease or because of the stent."

  Sun Guoguo frowned

   Patients or their family members who can say such things are generally difficult to deal with.

   I had a distrustful attitude towards the hospital from the beginning, and when it comes to various treatments in the future, there may be more disputes.

"Whether to do coronary angiography, or not to put stents, it's up to you to decide, our doctor just gives our advice." Sun Guoguo said, "If you are in the cardiology department of our hospital, you need to have a coronary immediately. Pulse angiography!"

   "Can't it be treated conservatively?"

   The middle-aged uncle wondered.

  Sun Guoguo shook his head, "At present, the patient is in the time window for interventional surgery, and emergency coronary angiography interventional surgery is the best treatment at present!"

   As soon as the voice fell, the young patient on the bed immediately said: "Dad, I don't have surgery, I don't have any problems now, I won't put the stent! If the stent is placed, won't I be useless for the rest of my life?"

   "I'm not married yet, if other women knew I had a stent, would I still be able to find a wife?!"

   The middle-aged uncle frowned, "Dr. Sun, let's do this, I have a friend who is engaged in medicine. I'll call him first and ask him, and then give you an answer."

  Sun Guoguo nodded: "Yes, whether you want to have surgery or not, make a decision as soon as possible. We will give you ten minutes at most. If you do, we will arrange it immediately. If you don't do it, sign and take the risk, that's all."

   The middle-aged uncle replied softly, and then walked out of the ward with his mobile phone in his pocket.

   "Junior brother, change the nursing level of this patient to first-level nursing, let the nurse use the ECG monitor, and then report it in critical condition, and give the patient's family a critical illness notice."

   Walking out of the ward, Sun Guoguo instructed.

   "Okay." Lu Chen nodded.

   He looked around and found the middle-aged uncle standing in the corner of the corridor, holding a mobile phone and talking to someone.

   For this kind of patient, Lu Chen didn't say much.

  Sometimes, the advice of the doctor in charge may not be as useful as the words of a stranger.

  …

   Back to the doctor's office.

  Lu Chen began to revise the doctor's order for 20 beds.

"Senior brother, this patient's vital signs are stable, why do you want to change the level of secondary care to primary care?" Yao Jie suddenly stepped forward and looked at Lu Chen suspiciously, "And the 19-bed old man is this year's 69 years old, also has acute myocardial infarction, and still has a stent in our hospital, why is he in secondary care?"

  First-level nursing care is mainly suitable for those who are seriously ill, critically ill, and have extreme heart, liver, and kidney function failure, who need strict bed rest, and who cannot take care of themselves.

  Secondary care, mainly for patients with severe illness, disappearance of acute symptoms, and stable condition after major surgery.

   Simply put, patients in primary care are generally more critically ill!

  Secondary care is the second, and tertiary care is the lightest.

   The current 20-bed patients, heart rate, blood pressure, respiration, pulse and other vital signs are all normal.

  Lu Chen smiled and explained while revising the doctor's order.

   "Junior sister, don't think that the 20-bed patient is young, and now his condition is stable, you think he has no major problems."

   "As long as it is a patient with myocardial infarction, as long as it is in the acute phase, his heart is in a very fragile state, and there is a risk of heart rupture or even sudden death at any time."

   "So you have to remember that any patient with acute myocardial infarction, in the acute phase, needs to issue a critical illness notice."

   "Although the 19-bed patient also had acute myocardial infarction and two stents were placed, he has passed the acute risk period, so the level of care has been downgraded from primary care to secondary care!"

   Yao Jie nodded, his eyes seemed to understand.

  …

   about ten minutes later.

  The middle-aged uncle walked into the doctor's office.

   "Doctor Sun, I've thought about it."

  Sun Guoguo put down the medical records in his hand and looked at the middle-aged uncle in front of him.

"I heard from a friend that in a few months, the price of cardiac stents will be reduced! Now the stents of six or seven thousand, or even tens of thousands of dollars, may drop to four or five hundred or even lower in the future. My thoughts Well, I will treat him conservatively now, and when the price of the stent is reduced, I will bring him over for angiographic interventional surgery."

   "Because if you have an operation now, if you have to put a stent, it will be a big loss!"

  Sun Guoguo frowned and asked suspiciously, "Did that doctor friend of yours suggested that you do interventional surgery in the future?"

  The middle-aged uncle waved his hand, "No, I just asked about the price of the stent, and he told me about the price reduction of the stent. He didn't tell me when the surgery would be performed."

  Sun Guoguo's expression softened a little. She thought that some doctors had violated the principles of treatment in order to save money.

"Uncle, things need to be prioritized. The price of cardiac stents will indeed drop, but your son is in a hurry. Immediate interventional surgery can achieve the best results." Sun Guoguo said, "If you wait for the price of cardiac stents to drop, you might have to wait. For several months, what if your son gets sick again during this period?"

  The young uncle smiled and said, "Oh, the price reduction of this heart stent is a matter of next month, and we can't wait too long."

   "Dr. Sun, don't worry, the price of the heart stent will drop, I will definitely come back to you to do it!"

  Sun Guoguo frowned, since the persuasion was invalid, he had no choice but to give up, and turned around and said to Lu Chen.

   "Junior brother, print out a copy of the communication record of refusing interventional surgery."

"it is good."

   When Lu Chen heard the decision made by the middle-aged uncle, he had already printed out the communication record of "refusing interventional surgery".

   "Uncle, just sign your name on this last line." Lu Chen pointed to the blank space at the end of the communication record, "After signing your name, write it again. If you refuse surgery, you will be responsible for the consequences."

  The middle-aged uncle was quite cheerful, signed his name without hesitation, and then wrote the eight characters "Refuse to operate at your own risk".

   "Then I will trouble Dr. Sun to take care of it these few days." The middle-aged uncle said, "We will be discharged from the hospital when the condition is stable. After a while, the price of cardiac stents will drop, and we will come back for surgery."

   Looking at the back of the middle-aged uncle leaving, Sun Guoguo was also helpless.

   It can be seen that this middle-aged uncle did not want to have surgery, but chose to suspend it for economic reasons.

   (end of this chapter)