I Can See Health

   Chapter 48 Digitalis poisoning?

  Close the website and close the computer.

  Lu Chen began to read books on ECG interpretation.

   He still has no clue about the abnormal ECG of the 12-bed patient this morning.

   Do you really have to wait until tomorrow morning for Sun Guoguo to answer?

  Lu Chen was a little unwilling.

   "Lu Chen, let's eat chicken together, four are missing, can you come?"

   Now the battle royale game is very good, and the other three people in the bedroom are playing games with their mobile phones.

  Lu Chen smiled and shook his head, "No, just play, I'm not very good at it."

   "Hey, that's fine."

   Several roommates were having a good time, while Lu Chen kept flipping through the ECG manual.

   Start reviewing from the principle of electrocardiogram, check the specific meaning of each waveform change, and then find various examples to interpret...

   At eleven o’clock at night, the moon and stars are thin.

   The night was already deep.

   The lights in the bedroom were turned off, and only the lamp in front of Lu Chen's desk was on.

   The halo of the desk lamp shone on Lu Chen's face.

   He slowly began to have a clue about this abnormal electrocardiogram of the 12-bed.

   ECG features of the 12-bed patient: sinus bradycardia, premature atrial beats, and ST-segment downslope depression, T wave flattening, and QT interval shortening, with a measured value of 280 ms.

   Isn't this a "fishhook-like" change?

   Lu Chen's eyes lit up, but then he showed doubts.

   ECG "fishhook-like" changes are usually caused by overdose of "digitalis" drugs, resulting in the digitalis effect caused by poisoning.

   But according to the patient's own description, she is not taking any medicine at all.

   Not to mention the "Digitalis" cardiotonic drugs!

   This drug is only used by patients with heart disease and heart failure.

   Now the patient's probable cause has been identified, but another dilemma has arisen.

   Time passes by every minute and every second.

   After all, Lu Chen couldn't resist the drowsiness and fell asleep slowly.

  …

   was speechless all night.

   The next day.

  Lu Chen came to the department at seven o'clock to measure the blood pressure of the four patients under his supervision.

  The mental state of the 10-bed old man is much better than the previous day.

   He lay flat on the bed, breathing smoothly, without the slightest irritability, and even took the initiative to say hello to Lu Chen.

   "Doctor Lu, are you coming for rounds so early?"

   "It's getting late. Dad, did you cough up red phlegm last night?"

  The old man shook his head, "No, the cough is white sticky phlegm."

  Lu Chen nodded, then took the mercury sphygmomanometer and took his blood pressure.

   Blood pressure is around 140/80mmHg, which has dropped a little compared to yesterday morning.

   After measuring the blood pressure, it is to auscultate the lungs.

  Auscultation of the lungs is mainly to determine whether the dry and wet rales in the lungs have decreased.

  Especially for patients with heart failure and pulmonary infection, it is extremely important to auscultate the changes of rales in the lungs!

   Wet rales can still be heard in both lungs of the 10-bed old man, but compared to yesterday, it has been reduced a lot!

   This shows that the condition of the elderly is gradually improving.

  …

   And the aunt with 12 beds walked in the corridor early in the morning.

   Seeing Lu Chen coming, he pulled him to ask questions again.

   "Doctor Lu, how is my illness now?"

   It is also very strange to say that she has always been alone, and Lu Chen has never met her family.

   "Auntie, don't worry." Lu Chen said, "We will make a decision when our superior doctor checked the room this morning."

  Lu Chen asked the 12 patients again whether they were taking "digitalis" drugs.

  The 12-bed patient is still in denial.

   "Doctor Lu, I was not sick before, why am I taking medicine!"

  Looking at her appearance, Lu Chen should not have lied.

   That's a little weird!

   There is no way to ingest "Digitalis" at all!

   The patients in the other two beds are in stable condition and have not received special treatment.

  …

   7:30 AM.

   The rest of the group came, including two interns.

   "Junior Brother, do you see what that electrocardiogram is?"

  Sun Guoguo walked into the doctor's office and said to Lu Chen with a smile.

   "Senior sister, is this a fishhook-like change?" Lu Chen answered tentatively.

  Sun Guoguo nodded in relief.

   "Yes, the ECG of this 12-bed patient is a typical fishhook-like change! That is the effect of digitalis overdose!"

   "Senior sister, but this patient denies taking any drugs!" Lu Chen wondered.

   For patients with digitalis poisoning, it is very important that long-term oral administration of these drugs will cause an accumulated toxicity, and the use of small doses is not toxic.

  If it is really considered to be "digitalis" poisoning, then the patient will definitely ingest "digitalis" through the gastrointestinal tract.

   But now it seems that this possibility does not seem to hold.

"So this is where I am puzzled." Sun Guoguo pondered, "But what we need to do now is to improve the determination of serum digitalis, determine whether there is a possibility of digitalis poisoning, and then treat it, and finally look for it. Cause!"

  When you don’t know the cause, the most important thing is to treat the symptoms, stabilize the patient’s state, and then slowly find the cause.

   Others in the same group were also attracted by the discussion between Lu Chen and Sun Guoguo, and several people picked up the ECG of the 12-bed patient to watch.

  …

Eight in the morning.

   After the shift is over, Li Yao still hasn't come to the department today.

  Sun Guoguo led the crowd to start rounds.

   Came to bed number 10.

  The old woman took out a small bamboo basket from the bedside table in the ward, and in the basket were a dozen eggs.

   The egg looks very big, and there is a little dirt on it.

   "Doctor Sun, this is sent to you by my fellow villagers."

  The old woman tremblingly carried the bamboo basket, with one hand covering the bottom, tightly protecting the bamboo basket.

   "No, thank you mother-in-law." Sun Guoguo quickly refused, waved her hand and said, "Take it back and eat it yourself."

   "Doctor Sun, don't think that this egg looks bad, it's our own egg." The old woman handed the bamboo basket to Sun Guoguo's hand, "The egg is very nutritious!"

  Sun Guoguo saw that the rejection was fruitless, so he had to accept the bamboo basket and hand it to Lu Chen.

   "Junior brother, you can take it back to the department first. Anyone in the group can get it if they want."

  Clinically, the patient's red envelope is absolutely not accepted!

   But some of the local products and fruits brought by some patients cannot be refused, and a small portion can be accepted as appropriate.

   "Mother-in-law, Daddy's condition is stable now, but you can't give him so much water in the future." Sun Guoguo pointed to the 500ML water bottle on the bedside table.

  Patients with heart failure must strictly control the intake of water.

  Many patients drink too much water, which increases the load on the heart and induces heart failure.

   "Thank you, Dr. Sun, when will we be discharged from the hospital?" the old woman asked.

   "Not yet, maybe another four or five days." Sun Guoguo pondered for a moment.

   (end of this chapter)