Professor Tong is also not polite, people who are used to being teachers still value this kind of teaching opportunity:

"Okay, Dean Xiao Chen asked me, an old man, to say, then let's discuss with you, we all know that myocardial infarction will cause acute ischemia in the coronary arteries, which in turn will lead to cardiac ischemia and hypoxia.

But what everyone doesn't know is that when the heart is ischemia, the autonomic nervous system of the heart will be abnormal, which may cause stimulation to the vagus ganglion in the ischemic area of the lower wall of the heart, and the phenomenon of epigastric pain will occur, which is one of the reasons.

It is also possible that acute myocardial infarction leads to persistent ischemia and hypoxia of the coronary arteries, which will cause myocardial necrosis and severe and persistent retrosternal pain in clinical practice. Because the heart is located behind the sternum, close to the xiphoid process, it is easy to mistake it for epigastric pain when the pain is severe.

Of course, the above two possibilities are just my guesses, I don't know if Dr. Lan is not satisfied, and I don't know if Dean Xiao Chen needs to add. ”

In fact, when Professor Tong was answering questions, Chen Qi remembered what happened to his grandmother in his previous life, and said with emotion:

"I myself have personally experienced a case of a gastroenterologist misdiagnosed a myocardial infarction, which is what Professor Tong said. There was an old lady who mistook it for a stomach ache because of the pain at the junction between her chest and abdomen, and ran to the hospital to see a doctor.

At that time, the guide asked the old lady to hang up the gastroenterology department, and most of the people here were gastroenterologists, and when you meet patients with pain here, the first thing that comes to mind is stomach or duodenal pain? Doesn't it seem simple?

The doctor at that time also thought so, but the doctor did not ask carefully at all, because the old lady had an underlying history of hypertension, diabetes, hyperlipidemia, coronary heart disease, and the old lady had two strokes before.

This is a typical high-risk group, but because of the gastroenterologist's self-confidence and the fact that he does not have a holistic view in his mind, he only thinks about the diseases in his system, so the doctor prescribes some stomach medicine and lets the old lady go home.

The result? The old lady saw a doctor in the morning, and died of a heart attack in the afternoon, do you think it's a pity? It can even be said that this gastroenterologist has misdiagnosed. If it is a foreign country, this medical lawsuit will definitely be lost.

Think about it, if the doctor had been more careful and more serious in his inquiry, and had given this old lady an electrocardiogram and an emergency cardiac enzyme, it was entirely possible for this old lady to detect a heart attack in advance, and she might have survived with early treatment, instead of waiting for sudden death in the afternoon.

This case is a big tragedy, and it is completely avoidable, so in the future, when you see a doctor, don't simply treat abdominal pain as what kind of enteritis or gastritis will be dismissed, and asking a few more words is a waste of time at most, but maybe you can save a life. ”

Chen Qi's example made the atmosphere in the small restaurant dull all of a sudden.

Many gastroenterologists recall that when they saw a doctor in the outpatient clinic, they met some patients who said that they had a stomachache or stomach pain, and they did just prescribe some medicine to let the family go home, and would not let the family do any ECG or cardiac enzymes.

And there are a lot of such patients, gastroenterology, after a day of outpatient clinics, more than half of the patients with abdominal pain and stomach pain, a year, ten years, the number of patients is hundreds or thousands?

How many of these patients may be myocardial infarction patients?

How many people have lost an opportunity to find out in advance, and end up dying suddenly at home or on the road?

The thought that he might lose a lot of lives in his hands made every doctor's heart feel heavy.

Chen Qi also took a deep breath, although he had been reborn in this world for 10 years, and it seemed to be very distant from his previous life, but he always inadvertently reminded him of his relatives in his previous life.

Thinking that his grandmother lost her last hope because of the doctor's misdiagnosis, I was helpless and distressed.

There was a cold scene at the banquet, which was definitely not a good thing, so Comrade Guo played a round in time:

"Ah, Professor Tong, all my colleagues from Xijing Hospital, as well as our colleagues from Yuezhong Hospital, we are now discussing academically, and we are not pursuing responsibility, there is no need to cry and mourn one by one, doesn't it seem that our Vietnamese and Chinese people are not well entertained, hehehe."

After Yi Zewen became the head of the emergency department, his emotional intelligence was slowly rising, and he hurriedly stood up at this time:

"Come on, come on, it's a rare opportunity, because our emergency department has encountered more patients with acute onset and gives us a shorter time for identification, so I would like to ask Dean Chen and Professor Tong, in addition to retrosternal pain, abdominal pain, and stomach pain, is there any other atypical pain in this myocardial infarction?"

Chen Qi also came back to his senses at this time, put the thoughts of his relatives in his previous life in his heart, and said with a smile:

"Then there are a lot of atypical pain, many of which are unimaginable, such as jaw and toothache, yes, toothache, which is the most common atypical pain in myocardial infarction.

Why? Because myocardial infarction often leads to myocardial ischemia or hypoxia, once the heart does not supply enough blood or oxygen, it will prompt the body to secrete acidic metabolites, which is called hypoxic pain.

At this time, these metabolites stimulate the sympathetic nerves of the individual very much, so that the nerves will experience severe pain, and the nerve pain will also spread to the jaw and teeth, mainly the gums.

Therefore, patients will often feel jaw or tooth pain, and once the pain is excessive, they may even faint. In the future, when you encounter the kind of patients who can't stop their toothache after using painkillers, we should attach great importance to it and let them do an electrocardiogram as soon as possible. ”

Oh~~~

Many doctors nodded their heads again and again, but what Chen Qi said was all about experience, which was not written in the book, and it was very precious.

At this time, Ma Xiaona also came to her senses and shouted: "Chen Qi, are there any other unexpected pains?" ”

Chen Qi was already smiling at this time:

"Yes, there is also a common one that is migraine. This is because when an individual has a heart attack, the blood supply to the heart is blocked.

The blood pressure of the brain is mainly supplied by the heart, and once the blood supply to the brain is insufficient, the blood vessels and nerves in the patient's head will be damaged, and the patient will have migraine due to vasospasm. ”

A young doctor from Xijing Hospital also raised his hand and said, "President Chen, is there anything else?" ”

"Also, there is a sore throat, everyone should also be careful, when a person often has a sore throat, it may also be caused by a heart attack, because the heart and throat are controlled by the same spinal nerve, and they are in the same nervous system.

If the individual has a heart attack, then the spinal nerves will also be painful. At this time, the human body will secrete a large amount of polypeptides, and once these substances spread to the vagus nerve in the pharynx, the phenomenon of sore throat will occur. ”

Everyone asked questions one by one, Chen Qi answered one by one, and the atmosphere on the scene became more and more enthusiastic.

At this time, Yang Xiuxiu, a young nurse in the emergency department, asked a sobering question:

"Dean Chen, you have just taught us all kinds of atypical myocardial infarction pain, but now there is a problem, let alone atypical, even if it is a typical myocardial infarction, the patient himself knows that it may be a myocardial infarction, but if the patient is at home or at work, how to save himself when he can't get to the hospital in time?"

As soon as this problem came out, many people slapped their thighs.

"That's right, if it's a family, go to a neighbor's house to borrow a donkey cart and drive it to the city, maybe the corpse is cold."

The person who said this was a doctor from Xijing Hospital, with the characteristics of the Great Northwest.

"No, we Vietnamese and Chinese people all take boats to see doctors, the larger ones are hand-cranked boats, and the smaller ones are canopy boats, but no matter what kind of boat you rock from home to our people's hospital, the precious rescue time is wasted."

This is said by the doctor of Yuezhong, Yuezhong is a water town, and the common people's means of transportation are mainly by boat.

"You're talking about the countryside or the countryside, even if it's in our city, how many people have to call the 120 emergency car? Patients with myocardial infarction must be sent to the hospital in a resting state, and if they come to the hospital on foot or by bicycle, they may die of seizures on the way. ”

120 ambulance is not expensive, from Chen Qi's point of view, it is really not expensive.

Because your gasoline money and car depreciation costs, the labor costs of a driver, a doctor, and a nurse, and the cost of rescue equipment and medicines on the road, it is normal to charge 10 yuan and 20 yuan for a trip.

If you are out of the township, it will be a little more expensive.

From the perspective of ordinary people, it is better to ask for 120 tens of yuan for a car, and it is better to find a few neighbors and relatives to row a small boat to the city to see a doctor.

The question is, what is an emergency department? What is an acute illness? Where are you allowed to take your time in a small boat and a donkey cart?

If the patient dies suddenly, the golden rescue time is only 5 minutes.

For example, cardiac arrest, the success rate of CPR within one minute is more than 90%, and if CPR rescue is carried out within four minutes, the chance of success of rescue is about 50%;

If CPR is started in about six minutes, the chance of success is about 10%;

If no rescue is carried out within 10 minutes, the chances of success are slim to none, close to zero.

For a disease like a heart attack, if you are taken to the hospital before sudden death, there is a certain chance of survival. If you have a heart attack at home and die suddenly on the spot, the chances of being sent to the hospital for resuscitation are slim to none, even in 2023.

In 2023, the family's heart and breathing stopped, and the family would call 120 to send it to the emergency department for final rescue no matter what, even if it was to fulfill the duties of relatives.

However, in 1989, ordinary people died suddenly at home due to heart attack, and almost no people sent patients to the hospital for emergency treatment.

One is that it is too late, and the other is that the people are poor, life and death are downbeat, and they can only blame themselves for their bad luck when they die.

This is also the main reason why in the 80s, there were few studies on coronary heart disease, or myocardial infarction, cerebral infarction or cerebral hemorrhage, and there were few specialists, and there were few treatment options and drugs to think about.

Because there is no "market".

It is rare to encounter a few myocardial infarctions a year, but your hospital has to prepare a set of myocardial infarction-related machines and medicines for this purpose, which is a waste for the hospital and is not cost-effective.

Just like the reason why some people in later generations were bitten by snakes and ran into walls everywhere after being sent to the hospital, because not every hospital has prepared antivenom, the same reason.

Why aren't hospitals ready? Because snake venom is very expensive, if no one uses it and puts it to the expiration date, the hospital will lose a lot of money, so the hospital is reluctant to spare these drugs.

This is the contradiction of an era.

From a philosophical point of view, it is the contradiction between the people's growing material needs and the backward social productive forces.

Medically speaking, it is the contradiction between the people's growing health needs and backward medical technology.

But this problem is not something that Chen Qi can solve, it depends on the top-level design, but also on the economic conditions, and everything is empty without money.

Chen Qi didn't want to answer Ma Xiaona's question, because some of the words he was about to say might be relatively advanced, and if he said too much, he would lose.

But seeing everyone's trusting eyes on him, as well as the desire for new technologies and new knowledge, Chen Qi felt that he was too ashamed not to say anything to these peers.

"Okay, since you want me to talk about it, I'll talk about it, but what I said is still in the clinical research stage, which may not be accurate, for everyone's reference, that is, how can patients with myocardial infarction help themselves at home?

When a myocardial infarction occurs, it is often the blood vessels that are occluded, and at this time, chest compressions, or epinephrine or other cardiac injections are ineffective, so some foreign experts have put forward a new concept in private, which is called 'a pack of medicine'.

What is a packet of medicine, which is often composed of three ingredients: aspirin, clopidogrel and atorvastatin; It may also be a combination of aspirin, ticagrelor, and atorvastatin. ”

Speaking of this, Chen Qi looked around the scene and found that everyone was in a state of confusion, clear with obvious stupidity.

Chen Qi knows in his heart, everyone knows about aspirin, and it is estimated that drugs such as clopidogrel, ticagrelor, atorvastatin, and rosuvastatin have not yet been invented, or have not caused domestic problems.

This is where Chen Qi worries, and it is also where his knowledge is advanced.

Now that that's all he has to say, he's out of the way.

After all, medicine is not a study of the military industry, or the study of materials science or chip science, and it will not attract the attention of the relevant state departments, and he will be arrested as a walking 500,000.

"It doesn't matter if you haven't heard of these medicines, these are all foreign, and they will cause domestic in the future, so you just need to remember this concept. For example, aspirin and ticagrelor are antiplatelet drugs, and rosuvastatin and atorvastatin are lipid-stabilizing plaque drugs.

When a heart attack occurs, immediately chew aspirin or ticagrelor, because this can be quickly absorbed by the body, to achieve rapid inhibition of platelets, dilate blood vessels, effectively relieve angina pectoris and other symptoms, which can reduce complications and prolong the treatment time. ”

Oh~~~~So magical~~~~~

Chen Qi thought that he was doing popular science, but in fact, he didn't expect that he had said a lot of things abroad, what drugs they used, but he planted an idea for the doctors in Xijing Hospital to have the opportunity to go abroad.

If he knew that he had unknowingly become a "lackey lobbyist of US imperialism", he would have been killed with a main theme, scolding free America, and how the was crushed to death by his knee and neck on the first day of the robbery.

But what Chen Qi didn't know was that the doctors of the Yuezhong People's Hospital were very calm, because they had seen some foreign dignitaries, rich people, who came to Yuezhong to see Chen Qi.

It's really good abroad, why don't people go abroad for treatment, but go to Vietnam?

This also means that the level of Dean Chen has far surpassed that of developed countries such as the United States, Japan, and Europe.

A good leader can bring the atmosphere of the whole hospital to flourish, which is the importance of choosing a leader.

(End of chapter)