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Click the Receive button.

A red box popped up in the central interface of the computer.

Laboratory critical value reminder!

Department: Cardiovascular Medicine Ward 8

Name: Zhang Guangming

Bed number: 20 beds

Age: 31 years old

Critical value: cardiac troponin I (fluorescence method) 5.4ng/ml (normal value 0-1 ng/ml).

Lu Chen's heart sank when he saw the critical value of the test. The troponin level increased five times. Did this young man have a heart attack?

The current international diagnostic standards for acute myocardial infarction follow the “1+1 model”.

The first 1 is a typical dynamic change in markers, that is, an increase in troponin.

The second 1 is any one of the four standards. The four standards refer to: 1. Symptoms of chest pain and chest tightness, 2. Pathological Q waves in the electrocardiogram, 3. Elevation or depression of the ST segment in the electrocardiogram, 4. Imaging examination shows abnormal myocardial movement.

And this 20-bed patient just meets the 1+1 diagnostic criteria!

"Senior Sister Guoguo, the troponin of the 20th bed we just took in has increased!"

Lu Chen shouted to Sun Guoguo on the side.

Sun Guoguo was reviewing the discharge medical records. When she heard Lu Chen's words, she was shocked. She quickly put down the medical records in her hands and sat in front of the computer.

Open the system's test sheet, cardiac troponin I (fluorescence method) 5.4ng/ml!

Just now she was saying that it might be coronary spasm caused by smoking.

Now it’s really a slap in the face!

"Myocardial infarction!" Sun Guoguo immediately picked up the stethoscope and stood up, "Junior brother, you go to turn on the electrocardiogram machine and review the patient's electrocardiogram. I will communicate with the patient's family about the condition!"

"Okay." Lu Chen nodded and started to split up.

…

Patients suspected of having a myocardial infarction must have their electrocardiogram checked frequently, preferably every half an hour to an hour.

Electrocardiogram is a simple, non-invasive and cheap examination, and can detect the changes of myocardial ischemia in patients at the first time.

Pushing the electrocardiograph machine to bed 20.

As soon as Lu Chen walked into the ward, he saw a middle-aged uncle about fifty years old standing next to the bed. He should be a family member of the patient.

The middle-aged uncle is thin and has dark skin. He may be someone who has been exposed to the sun for a long time.

Lu Chen looked at the young male patient lying on the bed.

The color on his head has changed from yellow to red!

Lu Chen pushed the electrocardiogram forward and immediately reviewed the patient's electrocardiogram.

The electrocardiogram showed that the ST segment in leads V1~V3 on the chest was elevated by about 0.2mv than before.

After Sun Guoguo auscultated the patient again, he looked at the electrocardiogram and frowned: "Basically, acute myocardial infarction has been diagnosed."

"Dr. Sun, you said my son had acute myocardial infarction?"

The middle-aged uncle had a sullen face, his hands behind his back, and his eyes were wandering.

"Well, judging from the current laboratory tests, electrocardiogram and symptoms, it is most likely acute myocardial infarction."

"We need to contact you for immediate coronary angiography intervention to evaluate the condition of your heart and blood vessels. If necessary, you may need to implant a coronary stent!"

Sun Guoguo's face was serious, with a hint of doubt in his tone.

"Interventional surgery? Dr. Sun, I know a lot about this disease, because a relative of mine had a myocardial infarction and had a stent inserted." The middle-aged uncle said solemnly, "But at that time, my relative had severe chest pain. My son doesn't feel any discomfort now, so how could it be a heart attack? Could it be a mistake?"

The male patient lying on the bed also said loudly: "Yes, I don't have any symptoms now. I don't have any pain at all. I am no different from a normal person. You just did a blood test. Are you sure it's inaccurate?"

Sun Guoguo patiently said slowly: "Each patient's condition is different and can change at any time. Moreover, the patient has already had chest pain symptoms during morning activities, which indicates that the probability of myocardial infarction is high."

The middle-aged uncle was silent for a long time before saying.

"Dr. Sun, to tell you the truth, my relative died the next year after the stent was inserted. Now I don't know whether it was due to his own disease or the reason for the stent."

Sun Guoguo frowned

It is generally difficult to deal with patients or patients' family members who can say such things.

If you have an attitude of distrust towards the hospital from the beginning, it may cause more disputes when it comes to various treatments in the future.

"It's up to you to decide whether to do coronary angiography and whether to insert a stent. Our doctors are just giving our suggestions." Sun Guoguo said, "If you are in the cardiology department of our hospital, you need to have a coronary immediately. Pulsography!”

"Can't it be treated conservatively?"

The middle-aged uncle said doubtfully.

Sun Guoguo shook his head, "Currently, the patient is within the time window for interventional surgery. Emergency coronary angiography interventional surgery is currently the best treatment method!"

As soon as he finished speaking, the young patient on the bed immediately said: "Dad, if I don't do surgery, I don't have anything wrong with me now. I won't put in a stent! If I put in a stent, won't I be disabled for the rest of my life?"

"I'm not married yet. If other women know that I have a stent, will I still be able to find a wife?!"

The middle-aged uncle frowned and said, "Dr. Sun, let's do this. I have a friend who is engaged in medicine. I will call him first and ask him before I give you an answer."

Sun Guoguo nodded: "Yes, whether you want to have surgery or not, make a decision as soon as possible. We will give you ten minutes at most. If you do, we will arrange it immediately. If you don't, just sign and bear the risk. That's fine."

The middle-aged uncle responded softly, then walked out of the ward with his cell phone in his pocket.

"Junior brother, change this patient's level of care to first-level care, ask the nurse to use the ECG monitor, then notify the patient of critical illness and issue a critical illness notification to the patient's family."

Sun Guoguo ordered after walking out of the ward.

"Okay." Lu Chen nodded.

He looked around and found a middle-aged man standing in the corner of the corridor, talking to someone on his cell phone.

Lu Chen couldn't say much to this kind of patient.

Sometimes, the advice of the doctor in charge may not be as useful as the words of a stranger.

…

Back to the doctor's office.

Lu Chen began to revise the medical orders for 20 beds.

"Brother, this patient's vital signs are stable, why do we need to change the level of secondary care to primary care?" Yao Jie suddenly stepped forward and looked at Lu Chen doubtfully, "And the 19-bed elderly person is this year. He was 69 years old and had an acute myocardial infarction, and a stent was placed in our hospital. Why is he in secondary care?"

First-level care is mainly suitable for those who are seriously ill, critically ill, and have extreme heart, liver, and kidney failure, who require strict bed rest and cannot take care of themselves.

Secondary care is mainly suitable for patients who are seriously ill, whose acute symptoms have disappeared, and whose condition is stable after major surgery.

To put it simply, patients in first-level care are generally in more critical condition!

Secondary care is the next best, and tertiary care is the lightest.

Currently, the vital signs of the 20-bed patients are normal such as heart rate, blood pressure, respiration, and pulse.

Lu Chen smiled and explained while revising the doctor's orders.

"Junior sister, don't think that the patient in bed 20 has no big problem just because he is young and his condition is stable now."

"As long as a patient with myocardial infarction is in the acute stage, his heart is in a very fragile state, and there is a risk of heart rupture or even sudden death at any time."

"So you have to remember that any patient with acute myocardial infarction needs to be issued a critical illness notification in the acute stage."

"Although the patient in bed 19 also suffered from acute myocardial infarction and had two stents placed, he has passed the acute crisis period, so the level of care has been downgraded from primary care to secondary care!"

Yao Jie nodded, her eyes half understanding.

…

About ten minutes later.

The middle-aged uncle walked into the doctor's office.

"Dr. Sun, I've thought about it."

Sun Guoguo put down the medical records in her hands and looked at the middle-aged uncle in front of her.

"I heard a friend say that in a few months, the price of heart stents will be reduced! The price of stents that cost six thousand, seven thousand, or even tens of thousands of yuan now may drop to four hundred, five hundred, or even lower in the future. My thoughts Well, I will treat him conservatively now, and when the price of stents drops, I will take him over for angiographic interventional surgery."

"Because if you do surgery now, it will be a big loss if you have to put in a stent!"

Sun Guoguo frowned and asked in confusion: "Did your doctor friend suggest you do interventional surgery in the future?"

The middle-aged uncle waved his hand, "No, I asked about the price of the stent, and he told me that the price of the stent was going to be reduced. He didn't tell me when he would have the surgery. UU Reading www.uukanshu.net "

Sun Guoguo's expression softened a little. She thought that some doctors actually violated the treatment principles in order to save money.

"Uncle, you have to prioritize things. The price of heart stents will indeed drop, but your son's condition is more serious. You can achieve the best results by performing interventional surgery immediately." Sun Guoguo said, "If you wait until the price of heart stents drops, you may have to wait. It's been several months. What if your son gets sick again during this period?"

But the young uncle smiled and said: "Oh, the price reduction of this heart stent will happen next month, I can't wait too long."

"Dr. Sun, don't worry. When the price of cardiac stents drops, I will definitely come back to you to do it!"

Sun Guoguo frowned. Since the persuasion was ineffective, she had no choice but to give up and turned around and said to Lu Chen.

"Junior brother, print out a communication record of your refusal to undergo interventional surgery."

"good."

When Lu Chen heard the middle-aged uncle's decision, he had already printed out the communication record of "rejection of interventional surgery".

"Uncle, just sign your name on the last line." Lu Chen pointed to the blank space at the end of the communication record, "After you sign your name, write again that you refuse the surgery at your own risk."

The middle-aged uncle was very cheerful and signed his name without hesitation, and then wrote "Refuse the surgery at your own risk".

"Then please ask Dr. Sun to take care of him in the past few days." The middle-aged uncle said, "We will be discharged from the hospital when the condition stabilizes. After a while, the price of cardiac stents will be reduced, and we will come back for surgery."

Watching the middle-aged uncle leave, Sun Guoguo felt helpless.

It can be seen that this middle-aged uncle did not want to have surgery, but chose to postpone it due to financial reasons.