These words directly scratched Xie Baoshu's itch. He immediately went over Wang Zhang's diagnosis and treatment ideas from head to toe, making him nod repeatedly.
"Xiao Xie, your basic skills are very solid, and your clinical intuition is also very sharp." Wang Zhang praised: "Your Yunshi No. 1 Hospital is really full of talents."
"It's not bad." Xie Baoshu smiled in his heart and couldn't hide it on his face: "Actually, my abilities are more than that. If you give me a chance to have surgery, I guarantee that you won't be disappointed."
"Then don't worry, there will definitely be no shortage of opportunities, and it can't just be a hook - it will all depend on your performance then." Wang Zhang said with a smile.
"Director, just be at ease!" Xie Baoshu was full of confidence.
At this time, the patient came back and the test results were sent back.
The good news is that all the test results were normal.
The bad news is the patient’s symptoms.
Just after a while, his chest pain worsened again and his face turned pale.
This can't be an act. What is causing the patient so much pain?
"When did you start having chest pain?" Wang Zhang asked after thinking for a while.
"Starting from this morning, the travel schedule that was originally planned has been cancelled." The patient's friend said: "After lunch, I saw that he really couldn't hold on any longer, so I persuaded him to come to the hospital."
"Let's do another enhanced CT." Wang Zhang made the decision.
Only contrast-enhanced CT is the gold standard for determining aortic dissection, but this kind of CT requires the creation of contrast agent, and he does not want to do it on patients if it is not necessary.
But now the patient's condition has become so serious that he has to seriously consider the possibility of aortic dissection with atypical symptoms.
Xie Baoshu looked at the patient's paroxysmal pain, but he actually had other judgments in his mind.
At the Vocational Skills Improvement Center, he once encountered similar patients with similar symptoms of pain.
However, Director Wang's current approach is understandable.
Aortic dissection, the full name is aortic dissecting aneurysm. When the disease occurs, the arteries will rupture immediately, causing massive bleeding. Even if the person is rescued in the hospital, it will be very difficult. No matter how careful you are, you can't be too careful.
The effects of enhanced CT were also reported back immediately. Not aortic dissection, nor pulmonary embolism.
Wang Zhang took a deep breath of relief, and doubts followed.
The patient's pain still hasn't been relieved, and he is clutching his chest in agony - what could be the problem?
"Take another electrocardiogram." Wang Zhang said.
His orders were executed perfectly. Xie Baoshu took a look at the results and said, "Director, this is a normal electrocardiogram."
Wang Zhang took it and took a look at it without comment. Seeing that it was indeed the case, his evaluation of Xie Baoshu couldn't help but rise a few points again.
"Can you read an electrocardiogram?" he asked.
"Yes." Xie Baoshu didn't know how to be modest: "My ability to read pictures is very strong now, to tell you the truth."
"Okay." Wang Zhang said angrily: "Tell me your opinion. What other possibilities are there for this patient's chest pain?"
Xie Baoshu had been waiting for his words. Hearing this, he immediately said: "Pericarditis. I suspect it is pericarditis."
"Pericarditis?" Wang Zhang shook his head: "It's unlikely. I just auscultated the heart sounds and heard no pericardial friction sound."
"And, come here and see the results of the cardiac color ultrasound." Wang Zhang called him over: "There is no pericardial effusion or leakage at all."
Xie Baoshu had actually seen the color ultrasound results just now, but he still insisted: "In new cases, the pericardial exudate may be very small, which cannot be seen in color ultrasound and may not be audible in auscultation. "
When Wang Zhang heard this, he felt a little moved. I can't find any other reasons, so I shouldn't use medicine at will, but if I treat it in this direction, although it is relatively conservative, it is not easy to go wrong.
He thought for a while and asked the patient again: "Have you really not had any heart surgery or any trauma recently?"
"There is no trauma." The patient shook his head in pain, and suddenly remembered something, and said: "But because of a premature heart attack, I underwent radiofrequency ablation last week."
Radiofrequency ablation is an interventional technology that sends an electrode catheter into a specific part of the heart chamber through a blood vessel, releases radiofrequency current, and blocks the abnormal conduction bundle and origin of tachyarrhythmias.
The intraoperative electric current may damage normal myocardial tissue, cause pericarditis, and even cause delayed pericardial effusion.
Wang Zhang slapped his thigh: "After this operation, why didn't you tell me just now?"
The patient looked innocent: "You asked whether surgery was performed, not internal medicine?"
"You are too honest." Wang Zhang said helplessly, and then turned to look at Xie Baoshu.
The latter was secretly happy because the patient's words confirmed his judgment, but Wang Zhang saw him clearly.
"Okay, you guessed it right." Wang Zhang said: "Tell me, how to treat it?"
"The patient had radiofrequency ablation last week and developed pericardial inflammation. But it doesn't look serious at the moment. You can consider using non-steroidal anti-inflammatory drugs, such as ibuprofen, to relieve chest pain." Xie Baoshu answered clearly:
"At the same time, we should pay close attention to the changes in the effusion in the pericardial cavity, and if necessary, pericardiocentesis and surgical treatment can be used."
"Very good." Wang Zhang was extremely satisfied with his performance. He prescribed ibuprofen for the patient and arranged for him to stay in the hospital bed for observation and rest.
By the time he got off work, the patient's condition had greatly improved, and the pain in his chest was basically gone.
Xie Baoshu arranged for him to have another cardiac ultrasound and listen to the heart sounds again.
Sure enough, just as he had judged at the beginning, this time, there was a very small amount of fluid in the pericardium, and a "sand-sand-sand" friction sound appeared in the heart during auscultation.
"This is a typical pericardial friction sound." Director Wang rushed over to listen to it, and then called all the residents in the department to listen and learn. By the way, he praised Xie Baoshu in front of everyone.
"Brother Xie, tell me, we all learned together, how can you be so good?" Duoji asked Xie Baoshu quietly.
"Do you still need to ask? Brother Xie, I am a genius - of course that is impossible." Xie Baoshu said with a smile: "It is actually the result of practicing with VR glasses."
"It's not Brother Xie. I also went in and learned the pulse control and hemostasis technique. But the rest was just a hundred micro-square source energy, and it was gone without understanding anything." Duoji said regretfully.
Xie Baoshu's heart suddenly moved, and he said mysteriously: "I seem to have discovered a little secret technique that can refresh source energy. Do you want to give it a try?"
"The secret technique to gain energy?" A voice came from behind them: "What is that? Tell me!"
The two looked back and saw that the person speaking was Gan Yi, who had just entered the observation area.
Not only him, but under Wang Zhang's arrangement, the doctors who were using stethoscopes to listen for pericardial friction sounds on the patients one by one, all of them had their ears perked up, waiting intently to listen.
Xie Baoshu became inexplicably nervous: "I admit, I got a lot of source energy because of my luck. But I can't guarantee whether this method will be effective for you."
"Speak quickly and don't hide anything." Wang Zhang also turned around and said, "We will know if it works or not after we try it!"
