I really don't want to be a doctor

Chapter 166 Aortic Dissection

The blood pressure on both sides is only a reference value. It does not mean that if the blood pressure on both sides is not much different, aortic dissection can be completely ruled out.

Jing Xiaoran did not respond to Li Wenlin, searching for other missing evidence in his mind.

By this time the bedside nurse had finished taking blood.

According to Teacher Cao, as long as the nurse finishes collecting blood, she should immediately complete the cath lab.

"Junior brother, the patient did not take the first dose of anticoagulant in the 120 ambulance." Li Wenlin said, "I will ask Teacher Cao to see if the first dose is needed."

"Okay." Jing Xiaoran nodded.

Patients with acute myocardial infarction need to chew the first dose of anticoagulant before interventional surgery, which can increase the efficacy of interventional surgery.

There are two conventional first doses, 300mg of aspirin and 600mg of clopidogrel.

However, according to the current situation, even if the patient has aortic dissection, once these two anticoagulant drugs are taken, the patient's bleeding will definitely be aggravated.

"By the way! How did I forget this."

Jing Xiaoran suddenly thought of an instrument, that is a portable ultrasound machine.

Ultrasound can remove ethmoid aortic dissection.

In the ultrasound performance of aortic dissection, it can be seen that the intima of the aorta has the formation of intima and the appearance of true and false lumens.

However, ultrasound can only see the initial section of the aorta. If the tear of the dissection is below the initial section, it cannot be observed by ultrasound.

At this time, Li Wenlin had already returned from the ward.

"Mr. Cao said that there is still an emergency intervention patient waiting in the cath lab, let us wait a little while before pushing the patient over."

The Cardiology Department of Fancheng Central Hospital is responsible for most of the emergency patients with cardiology diseases in the urban area. In many cases, the interventional operating rooms in the catheterization room are not enough.

"Is the first dose given?" The bedside nurse asked.

"Yes." Li Wenlin said, "Sister nurse, give the patient 300mg of aspirin and 600mg of clopidogrel."

Both aspirin and clopidogrel are pills, but they should not be swallowed whole, but need to be chewed.

Chewing is to chew the tablet into pieces, which can quickly and fully exert the medicinal effect.

The bedside nurse was going to the central nurse station to get oral medicine.

"Sister Nurse." Jing Xiaoran suddenly shouted, "You should do something else, I'll help you get it."

"Do you know where it is?" the bedside nurse asked.

"Of course I know." Jing Xiaoran smiled, "I've been in the intensive care unit for almost two months."

"Thank you." The bedside nurse smiled, "I can just write this patient's admission nursing record."

Jing Xiaoran went to the central nurse's station to get the anticoagulant medicine, and also brought a portable ultrasound machine by the way.

Back in the ward, Li Wenlin saw the ultrasound machine in Jing Xiaoran's hand at a glance.

"Junior brother, you are..."

"I want to take a look at the patient's heart condition first." Jing Xiaoran said seriously, "If there is no problem, then give the patient the first dose of anticoagulant."

Although all the current clinical evidence points to acute myocardial infarction, Jing Xiaoran still wants to use ultrasound to rule it out.

Moreover, ultrasonography is not time-consuming, and the initial screening can be performed in a few minutes.

"Okay." Li Wenlin said, "Just give the patient the anticoagulant before pushing it into the cath lab."

Jing Xiaoran nodded, then turned on the ultrasound machine and began to examine the patient.

Li Wenlin watched Jing Xiaoran curiously and began to operate.

Ultrasound is a novelty for many medical students.

It's not that they haven't seen ultrasound, but it's not easy to learn how to operate and read it.

Li Wenlin has been in the intensive care unit of the Cardiology Department for so long, and she has not yet learned how to use ultrasound. You can see how difficult it is to learn ultrasound.

Jing Xiaoran chose the ultrasound section of the long axis of the left ventricle.

In this view, the left ventricular outflow tract, aortic root, and right ventricle can be seen, and the width of these three structures is the same in the long-axis view of the left ventricle.

If the inner diameter of the aorta is widened, it is easy to distinguish it on this view.

Place the ultrasound probe on the long axis view of the left ventricle next to the sternum, and within a dozen seconds, a clear picture will appear on the ultrasound window.

"How is it?" Li Wenlin asked, "Can you see the inner film?"

If a stripped intimal sheet can be observed on the aorta on ultrasound, the diagnosis of aortic dissection can basically be confirmed.

"There is no intima." Jing Xiaoran shook his head, "However, I think the inner diameter of the aortic root is obviously wider than the left ventricular outflow tract and right ventricle."

Looking at the black and white ultrasound screen, Li Wenlin really couldn't figure out how to identify it.

"What does that mean? Aortic dissection?"

"A widened inner diameter certainly cannot diagnose aortic dissection." Jing Xiaoran said, "It can only mean that the aortic root is widened."

In aortic dissection, the inner diameter of the aorta does increase.However, there are other diseases that can also cause aortic enlargement, the most common being high blood pressure.

At this time, Teacher Cao suddenly ran into the ward.

"Xiao Li, have you given the patient the first dose of anticoagulant?"

"No, not yet..."

Li Wenlin saw Teacher Cao who was out of breath, with a look of doubt on her face.

"Great!"

Teacher Cao patted his chest to calm himself down.

"Did something happen?"

Li Wenlin asked.

"Don't give the patient first anticoagulant drugs." Teacher Cao said, "Just now Zhu Zhu and I found some problems with the patient's chest CT. It is likely to be aortic dissection."

The expression on Li Wenlin's face did not change, she just glanced at Jing Xiaoran, "Mr. Cao, Junior Brother Jing also said just now that the patient may have aortic dissection."

Teacher Cao was taken aback for a moment. He saw the portable ultrasound machine in Jing Xiaoran's hand, and asked, "What's abnormal about the patient's heart ultrasound?"

"The inner diameter of the aorta has widened." Jing Xiaoran said.

The bedside nurse also looked at Jing Xiaoran in surprise, she heard the conversation between Jing Xiaoran and Li Wenlin just now, it was this boy who suggested not to take the first dose of anticoagulant.

"Xiao Jing, have you seen the patient's chest CT?" Teacher Cao asked curiously, "How did you judge that the patient had a dissection?"

"I haven't seen the patient's chest CT yet." Jing Xiaoran shook his head, "I just feel that his medical history is a bit strange, so I thought that the possibility of aortic dissection should be ruled out."

Teacher Cao laughed immediately, "Xiao Jing, your intuition is really accurate."

"But Mr. Cao, if I remember correctly, the CT report brought by the patient is an ordinary 16-slice CT?" Li Wenlin asked suddenly, "Aortic dissection can only be diagnosed with enhanced CT. Can ordinary CT also be diagnosed? ?”

Aortic dissection is due to long-term high blood pressure and unhealthy blood vessels, resulting in rupture of the aortic intima and media, and blood enters between the intima and media, forming a true and false cavity.

Therefore, on CT, the main manifestations of aortic dissection are obvious true and false lumens, with the true lumen being small and the false lumen being large.

However, if you want to observe the true and false chambers, you need to do enhanced CT and inject contrast agent into the blood vessels.

On the enhanced CT of aortic dissection, obvious contrast agent can be seen in the false lumen, showing transparency.In addition, dark red density shadows can be seen around the aortic wall, which is the performance of aortic intramural hematoma.In addition, breaches in the media and intima can be seen.

However, generally speaking, the ordinary 16-slice CT or 64-slice CT of the chest, without contrast agent, cannot observe the true and false chambers.

(End of this chapter)