Chapter 677: Protruding Pericardium

"Sister Jiao, I think your idea is very likely." said the young attending physician.

Pericardiocentesis is a risky clinical skill operation.

If the puncture needle accidentally penetrates a few centimeters more, it is very likely to touch the heart and pierce the heart. Even a small rupture can cause pericardial effusion.

However, Lu Chen shook his head slightly.

"I don't think this possibility is very high. Because the cardiac ultrasound before the puncture indicates a large amount of pericardial effusion, the puncture needle can draw out the fluid without inserting the needle too deep."

For a large amount of pericardial effusion, the puncture needle can drain the fluid as long as it penetrates the pericardium.

There is no need to go deep into the pericardium.

This operation can be completed by even a doctor in a county-level hospital.

Moreover, most of the current pericardiocentesis is completed under the guidance of cardiac ultrasound, and it can be seen whether it touches the heart.

"Lu Chen, what you said does make sense." Jiao Jingqiu nodded slightly. "If the puncture needle touches the heart, the heart rupture caused will probably be quite large. Will the patient still be like this?"

Everyone was talking about it.

There is still no conclusion about the cause of the patient's pericardial effusion.

"Lu Chen, what do you think?"

Jiao Jingqiu asked when she saw that Lu Chen had not made any comments.

Lu Chen has not been in the Magic City Hospital for a long time, but his clinical thinking is particularly meticulous, which is recognized by everyone.

However, Lu Chen said helplessly: "Everyone has actually talked about the causes of pericardial effusion in a whole circle, and I really can't say anything else."

There are so many causes of effusion, and everyone said one.

Basically, all of them were summarized.

"Alas." Seeing this, Jiao Jingqiu sighed slightly.

After gathering everyone's opinions, they still couldn't discuss the reason.

This makes people very melancholy!

What if the patient's pericardial effusion swells again after the drainage tube is removed, what should I do?

At this time, Lu Chen thought for a moment and said softly, "Sister Jiao, this patient has not had a cardiac ultrasound recheck since he was admitted to the hospital. Let me do a cardiac ultrasound for the patient."

"Can you do an ultrasound?" Jiao Jingqiu was stunned.

In fact, she originally wanted to recheck the patient's cardiac ultrasound.

But the patient is currently unable to move, so it is definitely inconvenient to go to the ultrasound room, so she can only do a cardiac ultrasound next to the bed.

"I know a little bit." Lu Chen nodded slightly.

His current cardiac ultrasound technology has reached an advanced level.

"Okay, then, go and try it."

There are always small ultrasound machines in the department, but not many people can use them.

After all, ultrasound requires systematic learning and training.

...

Lu Chen quickly got the portable ultrasound instrument.

A group of people followed Lu Chen to the bedside.

"In fact, ultrasound is very simple, practice makes perfect." Lu Chen took the ultrasound instrument and sat on the right side of the patient, while introducing it to everyone, "Practice on the patient a few more times, and you will be able to do it."

Cardiac ultrasound is a non-invasive examination.

Unlike invasive procedures such as coronary intervention and electrophysiology, it is simple and harmless, and it is easy to accumulate a lot of experience.

"It sounds simple, but it's hard to do!" Jiao Jingqiu shook her head. She tried to learn cardiac ultrasound, but because it was too difficult and she had no time to practice, she gave up.

Lu Chen took the cardiac ultrasound probe, applied coupling agent, and placed it on the surface of the heart skin.

"This is the short-axis section of the heart, here is the left ventricular outflow tract, the aortic arch..."

While Lu Chen examined the patient, he also explained it to everyone.

This opportunity is rare.

Ordinary ultrasound doctors do not have this leisure time to explain ultrasound to everyone.

"The liquid dark area here is pericardial effusion."

"It is easy to distinguish between effusion and normal heart tissue."

Lu Chen placed the probe at the apex of the patient's heart.

"This is the section of the apical four-chamber heart..."

Everyone heard Lu Chen's voice and felt it pause. Looking back, they saw him staring at the ultrasound screen.

"Lu Chen, what's wrong?" Jiao Jingqiu said quickly.

"Sister, look here." Lu Chen pointed to the screen, "This is the apex of the patient's heart."

Jiao Jingqiu blushed, "Even if you point it out to me, I can't understand it..."

"Sister, you don't have to understand it."

"Ah?"

"That's not what I meant." Lu Chen said quickly, "I mean there is an obvious protrusion here. Even if you can't understand the specific picture, you can still see the strong echo strip shadow of the protrusion."

"Oh, it seems to have a strong echo shadow." Jiao Jingqiu came over and took a closer look, "What is this? Normal people don't have this?"

"Definitely not!" Lu Chen said seriously, "I feel it is most likely the pericardium."

"Pericardium?" Jiao Jingqiu was stunned.

"Yes!" Lu Chen has paused the picture of the heart ultrasound and circulated it to everyone.

"The protruding pericardium... could this be..."

Suddenly, Jiao Jingqiu was startled and looked at Lu Chen beside him in surprise, "Pericardium... heart rupture?"

Lu Chen also nodded slightly, "Yes, it should be a complication after myocardial infarction - free wall rupture."

Heart rupture is divided into free wall rupture and ventricular septum perforation, but the mortality rate of free wall rupture is close to 100%.

It was the first time that Lu Chen saw someone survive a heart rupture.

"The patient has a rupture at the apex of the heart. Considering that it is caused by myocardial infarction, the local visceral pericardium gradually sealed the rupture."

Lu Chen couldn't help but sigh. Fortunately, with the help of the pericardium, he saved his life.

This man is really lucky!

Aside, Jiao Jingqiu swallowed her saliva and her right eyelid twitched.

She immediately said to the graduate student behind her: "Xiao Zhang, please ask the thoracic surgery and ultrasound departments for an emergency consultation!"

"Got it!"

The graduate student ran out in a flash.

Everyone in the ward was scared and broke out in a cold sweat.

The mortality rate of heart rupture is close to 100%, and it is actually in this ward!

"The patient must stay in bed and rest, avoid emotional excitement, and cannot get out of bed to urinate or defecate!" Jiao Jingqiu ordered, "If the stool cannot be relieved, we will prescribe laxatives!"

...

Five minutes.

All the doctors from the thoracic surgery department and the ultrasound department came.

The director of the ultrasound department came with a regular cardiac ultrasound instrument.

The portable ultrasound instrument is too small and many functions are not perfect.

Jiao Jingqiu asked the ultrasound department to do a bedside ultrasound to further confirm the diagnosis.

"Yes, the apex of the heart is the protruding pericardium!" The director of the ultrasound department had the same diagnosis as Lu Chen, "After a myocardial infarction, the myocardium is damaged and weak, and this kind of free wall rupture or ventricular septum perforation may occur!"

Confirmed that the mortality rate of heart rupture is close to 100%!

Why is the mortality rate 100%?

Once the rupture and bleeding occur, pericardial tamponade will occur in a very short time, restricting the beating of the heart.

Surgery is usually too late!

However, in this case, the patient is not suitable for hospitalization in a general ward and was transferred to the intensive care unit of the cardiology department at the first time.

...

In the doctor's office.

Jiao Jingqiu looked at Lu Chen beside him and felt like he had survived a disaster.

Fortunately, Lu Chen did an ultrasound and discovered the protruding pericardium in time.

What if the pericardium ruptures and the heart ruptures and bleeds heavily.

Then this man, it is difficult for gods to save him!

But even so, he saved his life.

The prognosis of this patient will not be very good, and the risk of severe heart failure and heart rupture is still very high.

"Congratulations, received a thank you value from Jiao Jingqiu +5!"

"Congratulations, received from..."

The system popped up a few more prompts, brushed a wave of thank you points, and the system upgrade completion rate also increased.

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