The man named Huahua looked up at Wang Zhongliang at this time.

Then she looked at Lin Yi again:

"Doctor, just give me a word, can my mother's disease be cured?"

Lin Yi nodded happily:

"Yes, why not, look at the hypertrophy of the ventricular wall, if the pressure difference between the ventricle and the outflow tract is too large, the ventricular wall is too hypertrophied.

The only option is surgery to remove the hypertrophic wall.

Of course, if you can do it without surgery, it is better not to have surgery.

Because the heart is different from other organs, the entire ventricular wall is a muscle.

There's a lot of nerve conduction in there, and these nerves and muscles are connected so that the heart beats again and again.

If the hypertrophic ventricular wall is removed, it will definitely have an impact on the overall heart function.

It can cause arrhythmias, in which a part of the muscle is suddenly cut off and the heart conduction is severed.

Then the heart rate must be unstable.

Another example is acute heart failure, where part of the ventricle is cut off, and the recovery after suturing is very poor, and the heart muscle is damaged and the heart cannot beat.

That can cause heart failure throughout the heart.

But don't worry too much, the treatment can definitely be cured, but any surgery is risky.

I hope your families will be able to understand as well."

It is best to have a pressure difference of no more than 50-60 mm Hg between the outflow tract and the ventricular inflow tract.

The drug is able to hold steady.

Once the pressure difference is too large, even above 100 or 150, it is very serious.

Despite the dangerous complications, this excision had to be performed.

The family glanced at Lin Yi again, and then left the doctor's office worriedly.

An hour later, the results were in.

Differential pressure 110!!

Looking at this result, Lin Yi also had a sad face.

"Director Wang, I see that the pressure difference shown in your previous admission examination is more than 70.

This time it was 110, and I guess it must have something to do with the use of drugs such as dopamine and nitroprusside.

In this case, I recommend using verapamil and metoprolol to control the patient's myocardial contractility.

After slowing down, I'm doing a check and taking a look again."

Listening to Lin Yi's suggestion, Wang Zhongliang nodded again.

Today, Lin Yi is the boss here!

Listen to him!

In the hospital room.

Wang Zhongliang is instructing nurses to administer medication to patients.

Behind him, several young rulers who followed him couldn't help but ask:

"Director Wang, do you believe that doctor like that? In case of...... Isn't he right?"

Wang Zhongliang glanced at him and scolded:

"When I look at you, I rarely read books and rarely take the initiative to learn!

Check the symptoms of obstructive hypertrophic cardiomyopathy after work!

Write me a post in two days about the main symptoms, mock diagnosis, and treatment options for obstructive hypertrophic cardiomyopathy!"

"Huh?!"

The eyes of several people behind him widened.

No way......

We're just asking...... It doesn't mean anything else!

Two hours later.

With the right medication, the old lady's symptoms improved a lot.

The shortness of breath was significantly relieved, and the oxygen saturation index also came up.

At this time, I will arrange for a hemodynamic test.

Look at the results again, 73 mm Hg.

"Isn't that right, this one isn't that bad." Lin Yi looked at the checklist and said.

Wang Zhongliang finally showed a relaxed expression and said:

"yes, it means that the medicine is used correctly, hey...... Thank you so much for today!"

After Lin Yi returned to the consultation room, Wu Jiang was treating a pale-faced male patient.

Lin Yi hurriedly leaned over to understand the situation.

The patient is a 46-year-old male.

The chief complaint is that he has been feeling full in the upper abdomen and pantothenic acid in recent years. Especially when eating raw and cold food, it will be significantly aggravated.

Four days ago, not long after he had eaten two apples, he suddenly noticed that he had black loose stools.

Because he had a history of hemorrhoids for six years, he thought it was a recurrence of hemorrhoids, so he casually applied medicine at home to treat it, and he didn't pay much attention to it, and this situation lasted for four days.

As a result, after breakfast this morning, the patient suddenly developed symptoms such as dizziness, nausea, and hematemesis. Also, the blood is dark red and has a blood clot inside.

The amount of hematemesis is about 500, but there is no abdominal pain or diarrhea.

On the way to the hospital by taxi, the patient vomited blood twice, both dark red in color, with a blood volume of about 500, and still had blood clots.

Lin Yi was startled after measuring the patient's blood pressure.

If the patient's blood pressure drops any further, shock will occur.

Subsequently, Lin Yi immediately gave the patient colloidal solution 500, whole blood 400, pantoprazole 80, and normal saline 1000.

After the infusion of the patient, Lin Yi examined the patient and measured his blood pressure again.

Fortunately, after 10 minutes of infusion, the patient's blood pressure gradually rose to 100/60Hg.

After the physical examination, Lin Yi wrote in the medical record.

The patient is conscious, speech is clear, pale face with symptoms of anemia, pale skin all over the body, superficial lymph nodes are not palpated and swollen, the conjunctiva of the eyes is pale, and the breath sounds of both lungs are clear.

The heart rhythm was 82 beats/min, there was no murmur in the rhythm, the abdomen was soft, the middle and upper abdominal pressure was uncomfortable, the liver and spleen were not palpated under the costals, and there was no edema in both lower limbs.

The patient was then ordered with a full set of biochemical tests as well as a routine color Doppler ultrasound.

The results of routine blood test were quickly fed back, BC8.1*109//L, HGB80g/L, PLT230109//L.

Liver function, renal function, and electrolytes were normal, and hepatitis B was negative in five items, hepatitis C antibody was negative, and AIDS was negative.

Abdominal ultrasound of liver, gallbladder and spleen was generally normal.

After seeing the patient's examination results, Wu Jiang asked:

"Brother Yi, what kind of disease can you judge from the results of the examination?"

Lin Yi had received such symptoms before, and he said to Wu Jiang.

"At present, my preliminary diagnosis is that the patient has upper gastrointestinal bleeding or peptic ulcer, or ruptured constant-diameter artery under the gastric mucosa.

Acid and hemostasis are given first, as well as symptomatic fluid supplementation.

After the patient's signs are stable, the patient should be given a gastroscopy. 「

Wu Jiang nodded and said.

"Okay, just do as you say!"

He then informed nurse Zhang Shiqi to transfer the patient to the observation room.

Half an hour later, Zhang Shiqi hurried over and said:

"Brother Yi, Wu Jiang, the patient you sent over just now had his blood pressure very unstable during the infusion process, and it kept changing.

Lin Yi couldn't help asking:

"Blood pressure changes? Up or down? 「

"The patient's condition is very strange, the blood pressure has been fluctuating between 80-110/50-70Hg."

Zhang Shiqi replied,

"Although there was no nausea or vomiting during the follow-up infusion, the patient had a black stool just now."

After Lin Yi listened, he immediately said to Wu Jiang:

"The patient may not have a peptic ulcer! Let's go see!"

After speaking, Lin Yi and the others hurried to the observation room.

After a brief examination of the patient, Lin Yi found another situation, that is, the patient had mild pittable edema of both lower limbs......

In this case, Lin Yi didn't dare to be careless, so he immediately said:

"Wu Jiang, hurry up and arrange for the patient to do a gastroscopy, I suspect that the patient is esophageal and gastric varices and bleeding!"

Soon, Wu Jiang pushed the gastroscopy equipment over.

Immediately, the three of them did a gastroscopy for the patient.

The results of the examination showed that Lin Yi's judgment was not wrong.

The patient has esophageal and gastric varices with hemorrhage, chronic superficial gastritis with erosions.

After seeing the test results, Lin Yi said:

"Consider the patient's portal hypertension, esophageal and gastric variceal bleeding, and multiple gastric polyps.

We will first cut the pathology of multiple polyps and send them for testing.

Then, this case of bleeding from a ruptured esophageal and gastric varices is managed.

Immediately afterwards, Lin Yi cut all the polyps in the patient's stomach into pathology, and then sent them to Wu Jiang for examination.

The next step is how to deal with esophageal and gastric variceal bleeding.

Esophageal and gastric variceal bleeding is one of the serious and fatal complications of cirrhosis and a common cause of upper gastrointestinal bleeding.

There are many patients with liver disease in Jiangcheng, and the successful prevention and treatment of liver disease complications is also one of the key links to reduce the mortality rate and prolong the survival of patients.

In the general hospital emergency department, patients with upper gastrointestinal bleeding need to be corrected first to prevent complications such as infection.

Then, when esophagogastric variceal bleeding is confirmed, medical therapy should be the preferred first-line regimen.

For example, drugs to reduce portal venous pressure should be used in the early stage, and vasopressin and other treatment methods should be used to treat patients.

Salvage therapy can still be used after drug treatment has failed.

For example, endoscopic treatment, transjugular intrahepatic portosystemic shunt, three-lumen and two-cyst tube compression hemostasis, etc.

For this situation, Lin Yi took it as a stand, and directly picked up the instrument and began to prepare to stop the bleeding for the patient.

Again, the previous problem was encountered.

Active bleeding from the fundus without a surgical field.

However, this kind of difficulty is not difficult for Lin Yi.

He solved the problem of not having a surgical field just by changing the position and the suction tube at the front end of the gastric tube.

This small change surprised Song Borui on the side.

"Just a simple move, and the field of the technique is exposed?"

Song Borui asked in surprise.

Lin Yi smiled slightly and said:

"That's right, as long as it's familiar, it's as simple as that."

"This ........."

Song Borui was suddenly a little speechless.

As long as you are familiar with it, this sentence is easier said than done!

How can you be familiar with it without thousands of operations......

Subsequently, Lin Yi chose to use balloon compression to stop the bleeding for the patient.

Because variceal veins are located in the esophageal and gastric fundus mucosa, compression of the esophagus or stomach has a hemostatic effect.

Therefore, Lin Yi uses the most common three-cavity two-airbag tube.

He first applied liquid paraffin wax to the tip of the three-lumen tube and the outside of the balloon, and then slowly inserted it from the patient's nostrils into the stomach cavity.

Immediately after that, 200 air is injected into the gastric balloon and the pressure is maintained at 45Hg, and then the end is fixed.

After doing this, Lin Yi motioned to Song Borui to observe whether the patient was still bleeding.

After Song Borui observed, he replied.

"Brother Yi, the patient still has a small amount of bleeding in the stomach cavity.

Lin Yi nodded.

"Okay, I see."

He gently injected another 150 into the esophageal balloon, looked at the pressure gauge again, and the pressure was currently maintained at 40Hg.

This pressure is okay enough to compress the esophageal veins.

When he was done, he asked again.

What about this time? Does the patient still have bleeding in the stomach cavity? 「

Song Borui looked at the monitor again and said:

"This time it seems to be fine, no bleeding was found."

After waiting for another 3 minutes, Song Borui still found no signs of bleeding, and he hurriedly told Lin Yi.

"Brother Yi, it's really okay this time. The patient is no longer bleeding! 「

Lin Yi nodded again.

"That's fine, the bleeding finally stopped."

After saying that, he relaxed the traction and released the gas in the sac.

Then, he turned his head to Zhang Shiqi and said.

"Nurse Zhang, keep the pipeline and continue to observe for 24 hours. If there is no bleeding after 24 hours, notify me or Director Jiang, and we will extubate the patient.

During this time, the airbag is deflated every 12 hours for 30 minutes while the traction is relaxed.

And send a small amount of three-lumen tube into the stomach to relieve the pressure of the fundus cardia, and then inflate and pull to avoid erosion and necrosis of the local mucosa due to too long compression."

"Yes!"

After explaining, Lin Yi returned to the consultation room.

"Dr. Lin, the radiology department said that one of the patients I just diagnosed was unwell during the examination, please help me go over and take a look."

An attending doctor in the emergency department said as he suddenly pushed the door open.

This attending doctor Lin Yi knows, called Xu Chao.

"Okay, don't worry."

After speaking, Lin Yi hurriedly followed Xu Chao to the radiology department.

As soon as I entered the door, I saw the girl from before covering her chest with her hands, panting and shouting.

"Ahhh My chest hurts!"

Several people carried the female patient onto a stretcher and quickly returned to the emergency room in the emergency hall.

"Dr. Xu, connect the ECG monitor."

"Connected to ECG monitor."

"What is the patient's blood pressure?"

Xu Chao glanced at the ECG monitor and replied:

"The patient's blood pressure is now 95/65Hg and his heart rate is 60 beats per minute."

"Push a dobutamine."

Dobutamine, clinically used in patients with heart failure with low cardiac output and slow heart rate, is better than dopamine in improving left ventricular function.

"What is the patient's blood pressure now?"

"Blood pressure goes up a little bit."

"How much?"

"The patient's blood pressure is now 100/75Hg and his heart rate is 65 beats per minute."

Under the effect of dobutamine, the female patient's signs gradually recovered, and she no longer complained of chest pain.

"Hoo ......"

Lin Yi wiped the sweat from his forehead, let out a long breath, and then said to Lin Yi.

"After the injection of dobutamine, the patient stabilized. Transfer to the observation room for observation for 2 hours, and if the blood pressure does not continue to rise, add 1 ampoule of norepinephrine diluted with normal saline. 「

"Yes, Dr. Lin."

Xu Chao agreed.

"How are you feeling now?"

After giving the doctor's order, Lin Yi leaned over again and asked the female patient lying on the stretcher.

"Thank you, doctor. I feel much better now and don't know why my stomach has been hurting since the surgery. When I had a check-up just now, my stomach suddenly hurt. Can't you prescribe me some painkillers?"

The female patient rubbed her stomach with her hands and said with a frown.

"Reasoning and Diagnosis: Big Brother, Your Wife Is Drugged!" In order for you to see the fastest update of this book next time, please be sure to save your bookmarks!

Chapter 279: Successfully Stopping the Bleeding! Free to read.