I Can See Health

   Chapter 880 Lu Chen, who can't be the chief knife

   At this moment, the resident doctor just rushed over again.

   "Director Tian, ​​Professor Shi, the emergency laboratory department called just now, this patient is in critical condition!"

  Shi Langqin was taken aback for a moment, then immediately found a computer.

   Open the inspection system.

   The patient's test indicators immediately jumped out.

   "Brain natriuretic peptide (BNP)>35000pg/ml, urea 28mmol/L, serum creatinine 175.0μmol/L, serum potassium 6.55mmol/L."

   "Aspartate aminotransferase 2373IU/L, alanine aminotransferase 1788IU/L, total bilirubin 131.7μmol/L and direct bilirubin 90.4μmol/L."

   "Arterial blood gas tips: pH 7.288, partial pressure of carbon dioxide 53mmHg, partial pressure of oxygen 67mmHg (mask oxygen 6L/min), alkali remaining -6.96mmol/L."

   "Myocardial markers: myoglobin 152.30ng/ml, troponin 125.0ng/ml."

   Serum potassium, liver function, blood gas analysis, and troponin are all critical values!

   When everyone saw this test indicator, their eyelids couldn't help but jump.

  Lu Chen's face was solemn. In his sight, the patient's health was rapidly dropping!

   "In this case, we need dialysis first!" Director Tian couldn't help saying.

   All organs are basically in a state of failure, and the cause is cardiogenic shock, resulting in insufficient blood supply to each organ.

"This kind of cardiogenic shock cannot tolerate dialysis at all!" Shi Langqin immediately denied Director Tian's idea, "If the cause of cardiogenic shock is not resolved as soon as possible, any other operation will be superfluous. The effect is also very poor!"

   "Professor Shi, you mean... emergency surgery?!"

   Director Tian's eyes widened.

   For this kind of patient to do emergency surgery, they basically put themselves on the fire!

   A patient who survives the ninth death, and the operation is the ninth death.

   When these two meet, what are the chances of success in the end?

   "What is the willingness of the patient's family to receive treatment?" Shi Langqin continued.

   "I have already communicated with the family members." Director Tian whispered, "The family members are very active in treatment, and the money is not bad. The only requirement is to let the patient live for an extra month."

   "Live another month?" Shi Langqin frowned, "Why is there such a need?"

   Director Tian said: "His family has a grandson who will get married next month, and he wants to let him go after that."

  Shi Langqin was silent for a while, he looked at Lu Chen next to him.

  Lu Chen had put on a white coat at this time and performed a physical examination on the patient in person.

   for a long time.

   He put down the stethoscope in his hand.

   "Director Lu, how are you?" Shi Langqin said quickly.

   What he asked was, of course, the patient's condition and the chance of surgery.

"Surgery can be done, but the risk is extremely high!" Lu Chen said solemnly, "Be sure to discuss clearly with the patient's family, now that a dead horse is a living horse doctor, if you can save it, let alone a month, two months or even half a year. There is a survival period. However, if it is not rescued, it will be explained here tonight!"

   "Director Lu, if you say you can perform surgery, that's fine." Shi Langqin nodded, "Are you going to be the chief surgeon of this surgery?"

  Lu Chen smiled and shook his head: "I have resigned from Mayo now, and I don't have any position in the country. Although I have a doctor's license, it is illegal to practice medicine in places outside the scope of the license!"

   "Then...this operation..." Shi Langqin immediately backed off.

   The source of all his confidence was Lu Chen.

   Now considering Lu Chen's identity, it would be troublesome!

   "Although I can't be on stage, I can guide."

   Just as Shi Langqin frowned, Lu Chen suddenly said again.

   "This operation is not difficult. The key is that you don't know the shape of the valve before the operation. There are many unknown factors. As long as this problem is solved, the operation will be simple."

   "That's fine!" Shi Langqin's eyes lit up, "Can you do an esophageal ultrasound?"

   "Yes!" Lu Chen nodded.

  Lu Chen is right, most patients have similar vascular conditions.

   This patient is complicated mainly because there are too many underlying diseases and his physical condition is too poor to tolerate surgery.

   As for the difficulty of the operation itself, the main reason is that the patient's valve condition is unknown.

   Generally speaking, before TAVR surgery, a detailed examination of the patient's valve, such as CT examination, is required.

   After a comprehensive analysis of the valve shape, leaflet, calcification, etc., a detailed surgical plan is specified.

   But now this patient, I am afraid it is too late to do CT.

   Now the only way, that is to do a transesophageal echocardiogram!

   Excellent surgeons can judge the status of the valve through esophageal ultrasound.

   During the operation, the esophagus ultrasound can be performed at the same time, and the general condition of the patient's valve can be clearly seen.

  Shi Langqin heard the words, turned around and immediately said to Director Tian: "Director Tian, ​​please communicate with the patient again, just as Director Lu said just now, a dead horse is a living horse doctor!"

   "This..." Director Tian glanced at Lu Chen, a trace of doubt flashed in his eyes, who is this person?

   So young, only in his early thirties?

  Why does Professor Shi Langqin listen to him like this?

   Director Tian came to Guanghai from the north recently, and he didn't know much about Lu Chen.

   Even if he heard Lu Chen's name, he never really saw it.

   "Come on, don't waste time!" Shi Langqin urged.

   "Oh, well, I'll go now."

   Seeing what Shi Langqin had ordered, Director Tian had put away his doubts and went to the doctor-patient communication room to communicate with the patient's family.

  …

five minutes later.

   Director Tian ran all the way and returned to the CCU ward.

   "Mr. Shi, the patient's family bears the risk and agrees to the operation!"

  Shi Langqin was refreshed and immediately stood up and said, "Okay, notify the catheterization lab and prepare for surgery!"

  The crowd immediately began to get busy.

  A doctor is contacting the catheterization lab, and a doctor is preparing the patient for transfer.

   Everyone split up and moved quickly.

   The patient entered the operating room under the support of high-dose vasoactive drugs and IABP.

   HR109 times/min, BP80/40mmHg, SpO2 (50% oxygen concentration) 92%.

   The first step in today’s surgery is not to perform a puncture, but to perform an esophageal echocardiogram.

   Simply put, the ultrasound probe is inserted deep into the esophagus and stopped at the level of the heart.

   Ultrasound through the esophagus can see the patient's heart more clearly.

   Including the state of the valve, whether there is a thrombus in the atrium, etc.

   "Director Lu, can we start?" Shi Langqin, as the chief surgeon, looked at Lu Chen beside him.

   "Yes." Lu Chen nodded slightly.

  Although I can't be the main surgeon today, this transesophageal echocardiography is the focus of this operation.

   The degree of difficulty and importance is no less than the valve delivery process of the entire operation.

  …

   General anesthesia was successfully induced.

Place the TEE probe after    induction.

  Lu Chen began to manipulate the esophageal ultrasound and enter the patient's body.

   Arrived at the position of the heart, an image appeared on the ultrasound screen immediately.

  Lu Chen recorded the image content while performing the operation.

   "The aorta is widened, the ascending aorta is obvious, the aortic valve is bicuspid deformity, the valve leaflets are obviously thickened and calcified, and the opening is obviously limited."

   "The aortic valve area (Ava) was 0.5 cm2, the peak aortic valve velocity (AV) was 12.33 m/s, and the left ventricular ejection fraction (LVEF) was significantly reduced by 27.7%."

   (end of this chapter)