I Can See Health

In the third round of the provincial competition, Cheng Guowen, chairman of the Beijing Electrophysiology Society, paid great attention to this.

A total of two people from Jinghua Second Academy entered the third round.

One is Lu Chen, and the other is Lei Cui, the attending doctor in the first ward of the Department of Cardiology of Jinghua Second Hospital.

Cheng Guowen provided two free classrooms in the teaching building for the two of them as examination venues.

At 2:30 in the afternoon, Lu Chen came to Room 303 of the teaching building.

Lei Cui sat in room 304 next to Lu Chen for the exam.

…

The classroom in the teaching building is very empty, with a computer placed in the middle of the field.

Two cameras were placed around the classroom in accordance with the examination rules.

At this time, there is still half an hour before the exam starts.

Lu Chen sat at the computer, recalling all the knowledge about electrocardiograms and electrophysiology in his mind.

After studying all day yesterday and this morning, he relied on the super comprehension ability given by the electrocardiogram intermediate skill card to integrate deeper electrophysiological knowledge.

In particular, Lu Chen made a careful analysis of the past exam questions in the email Cheng Guowen sent him, including the scope, format, difficulty, etc. of the exam.

Originally, Lu Chen couldn't understand many of the real exam questions.

For example, Lu Chen only had a partial understanding of electrophysiological pacing and other aspects.

He had never had an electrophysiological surgery before, he had only watched one with Li Yao, and it was difficult for him to understand the electrophysiological principles involved.

However, with the electrocardiogram intermediate skill card, Lu Chen's understanding became stronger.

He can understand some deeper electrophysiological knowledge very thoroughly.

…

The conference room on the third floor of the teaching building of Jinghua Second Hospital.

Cheng Guowen, Li Yao, and some electrophysiology members from the Department of Cardiology were all together.

There is a huge screen in front of the meeting. Through the screen, everyone can monitor the progress and ranking of the exam in real time.

"Director Shi, you should be sure that Lei Cui will enter the top three, right?" Cheng Guowen looked at Shi Qinghua who was aside.

Shi Qinghua is the deputy director of District 1 in the heart and knows Lei Cui's learning status best.

Shi Qinghua smiled and nodded, "Lei Cui's main direction has long been electrophysiology. Her master's degree and Ph.D. are very thorough in this field. It should be no problem for her to enter the national competition."

"That's good." Cheng Guowen said, "If we can enter the national competition this time, we can take the initiative in the general election. If we can enter the top ten in the country, then this chairman has a 99% chance , will still stay in our Jinghua Second Hospital.”

Although Li Yao is the deputy chairman, she has been silent.

Lu Chen was his student and entered the third round of exams, but few people paid attention to him.

Everyone seemed to have concluded that Lu Chen couldn't possibly enter the top three.

Cheng Guowen glanced at Li Yao and wanted to say something, but swallowed it back.

…

At three o'clock in the afternoon, the exam officially begins!

Lu Chen entered the examination platform.

In the third round of the exam, there are a total of 20 questions, each worth five points, and the exam lasts two hours. After each question is completed, there will be professional personnel in the background to interpret it immediately.

There are twenty questions and two hours of exam time.

From this, we can also see how difficult this competition is!

Lu Chen clicked on the first question.

The patient was a 92-year-old male, 20 years after single-chamber pacemaker implantation (vvi), and the pacemaker (vvi) was replaced 8 years ago. He suffered from recurrent dizziness, which was obvious when changing body positions, and improved after rest. The dynamic electrocardiogram fragment is as follows. What may be the cause of the patient's dynamic electrocardiogram performance?

Sure enough, the difficulty of the third round was more than one level higher than the first two rounds!

Moreover, the content of this exam is not to diagnose the electrocardiogram, but to inquire about the reasons for such dynamic electrocardiogram!

This is not only a test of diagnosis, but also a deep-seated principle.

Fortunately, Lu Chen had seen the real exam questions from previous years, otherwise he would have been really confused.

…

Teaching building conference room.

"The exam questions this time are more difficult than those in the previous two years. Many cutting-edge electrophysiology knowledge are actually difficult to answer without training in this area."

Cheng Guowen said in a deep voice.

"Yes, this kind of question is difficult to analyze if you have not experienced electrophysiological surgery or had a pacemaker implanted yourself." Shi Qinghua nodded, "Just by imagining it, the difficulty will be increased several times."

Li Yao frowned.

What everyone means by this is very clear.

As a senior attending physician, Lei Cui has performed many electrophysiology surgeries, but Lu Chen is different. A student who doesn't even have a medical license, can he answer such a question?

The answer is obviously impossible!

…

Room 303.

Lu Chen began to analyze the fragments of the dynamic electrocardiogram.

This electrocardiogram is characterized by varying lengths of pacing intervals and baseline instability.

However, the shortest pacing interval is 1000ms (60 times/min), which is in line with the default lower limit pacing frequency setting of the pacemaker under normal circumstances. Consider that the lower limit frequency of the pacemaker is 60 times/min.

"The electrocardiogram showed disorganized electromyographic signals during the long pacing interval, and no pacing pulses appeared."

After about eight minutes of analysis, Lu Chen had the answer in his mind.

"First of all, it should be considered that the pacemaker senses the electromyographic signal and then inhibits the release of ventricular pulses. The electromyographic interference signal causes the pacing rhythm to reset, resulting in a long ventricular pause of up to 2813ms."

Lu Chen wrote down the answer, clicked to confirm, and then entered the next question.

…

Teaching building conference room.

"Well, Dr. Lei Cui answered the questions very quickly. He completed the first question and the analysis was very correct. This dynamic electrocardiogram was caused by a misperception of the pacemaker." Cheng Guowen was very satisfied with Lei Cui's performance.

Lei Cui's speed and accuracy in answering questions currently rank among the best among all ten doctors.

Shi Qinghua smiled from ear to ear.

If Lei Cui can maintain this state of answering questions, then there will definitely be no problem in getting the top three!

Except for Li Yao, few people noticed Lu Chen's answering status.

Lei Cui took five minutes for the first question, and Lu Chen took eight minutes for the first question.

Li Yao was surprised to find that although Lu Chen took a lot longer than Lei Cui, the content of his answers was very detailed.

Is this really a student new to electrophysiology?

Li Yao looked a little dazed because she knew Lu Chen's level too well.

When Lu Chen first arrived in District 8, he could only be regarded as a student with solid basic knowledge at best and knew nothing about electrophysiology.

But now, Lu Chen's knowledge reserve is even greater than that of the average attending doctor!

All this happened within these three months...

…

Lu Chen didn't know what was going on outside the court. He was now concentrating on reading the second question.

The second question is female, 84 years old.

I have been experiencing abdominal discomfort with nausea and vomiting for 4 days. The electrocardiogram showed: sinus rhythm, 3rd degree atrioventricular block, junctional escape rhythm, and acute inferior wall myocardial infarction.

Emergency coronary angiography showed complete occlusion of the proximal segment of the right coronary artery. A stent was implanted in the right coronary artery and a temporary pacemaker was implanted (parameter settings: voltage: 5.0v, sensing sensitivity: 3.0mv).

The ECG monitoring for 3 days after surgery is as follows. What is the diagnosis of the ECG monitor?

Lu Chen frowned slightly, this was another question about pacing electrophysiology.

Fortunately, he was already familiar with the scope of the exam in advance and had intensive training in pacing electrophysiology during this period, so he was now able to deal with these questions calmly.

Lu Chen clicked on the large picture of the electrocardiogram.

"The fifth heart beat in the monitoring chart is sinus capture, and ventricular pacing pulses can be seen after the escape interval."

"Monitoring charts and conventional electrocardiograms show ventricular pseudo-fusion waves and varying degrees of true fusion waves, and the pulse signals are located at different positions of the qrs."

For the second question, UU Reading www.uukanshu.net took Lu Chen seven minutes.

This time, Lei Cui took six minutes.

…

After ten questions.

In the conference room, except Li Yao, someone finally noticed Lu Chen's performance.

"Look at Lu Chen. His answer speed is not slow, right?"

Cheng Guowen looked at the exam live on the screen in surprise.

Shi Qinghua nodded: "It's pretty fast, but I don't know how he answered the first few questions..."

Although real-time rankings will appear on the screen, everyone answers questions at different speeds, and there is a certain lag.

The current real-time results only count the results of the first six questions.

7017k