Doctor Lin was so confused that he snatched the medical record from the nurse and complained, "You didn't tell me!"
"Didn't Doctor Zhang tell you when he was handing over the shift, Doctor Lin? We asked Doctor Zhang before if this patient had any family members, and she said she would go and ask. Later, she didn't tell us what the situation was." The nurse replied, not intending to take the blame.
Zhu Huicang held up his glasses and first recognized Xie Wanying's facial features, then recalled their encounter more than three years ago: Was she the girl who made Cao Yong lose his mind?
"Is she studying in our hospital now?" Zhu Huicang asked his old classmate Ren Chongda.
"Going for an internship in neurosurgery, isn't that following Huang Zhilei?" Ren Chongda said.
"Oh." Zhu Huicang thought: Maybe someone is so happy because the junior sister came to his department for an internship.
Doctor Lin flipped through the electrocardiogram that Liu's father had taken earlier and said, "This, this——"
Zhu Huicang leaned over to take a look, then glanced at Doctor Lin: "Who are you seeing?"
"No, it's not me!" Dr. Lin denied with all her strength, "She didn't say his electrocardiogram changed. She said the electrocardiogram looked fine, and the three blood tests for myocardial infarction were normal."
...
...
He can't take the blame for such a big thing!
"You call this nothing? Isn't the ST segment depressed?" Zhu Huicang immediately pointed out the problem. "Isn't this a typical sign of myocardial ischemia?"
Of course, Dr. Lin saw the same thing, otherwise why would he try so hard to deny it: "Yes, yes, it's myocardial ischemia."
"It's more than just myocardial ischemia, right? The patient's main complaint is chest pain, which seems to have been vague since this morning, and he had been in pain for at least several hours before being sent to the hospital. It must be ACS. If it is ACS, we must be alert. He must be kept under surveillance for at least eight hours. How long has it been since he entered the emergency department of our hospital?" Zhu Huicang asked while looking at the watch on his hand to calculate the time.
ACS stands for acute coronary syndrome.
First of all, normal myocardial enzyme test does not mean that there is no myocardial infarction.
The standard diagnosis of myocardial infarction is not based solely on myocardial enzyme tests. It can be confirmed by electrocardiogram, myocardial enzymes or clinical symptoms. Two of the three are required to meet the criteria.
Secondly, the electrocardiogram may also show pseudo-normal results.
For example, some patients with myocardial infarction may just happen to suffer from it in the hyperacute phase. When the doctor does an electrocardiogram on the patient, the patient is in the acute myocardial injury stage and the ST-T abnormality is before the full development stage, and the electrocardiogram just returns to normal. Needless to say, the normal state at this time is pseudo-normal.
Therefore, the electrocardiograms taken during this period can easily lead to doctors' misjudgment of patients. Mr. Liu may be a typical case of this.
Experienced hospitals will definitely provide guidance and requirements to clinicians in the diagnosis and treatment of myocardial infarction.
For example, the National Association stipulates that if the first electrocardiogram test is generally normal, but Mr. Liu complains of abnormality and suspects it is ACS, as Zhu Huicang said, he needs to be monitored for more than eight hours.
Eight hours of ECG monitoring does not mean that the doctor can just leave the patient alone after connecting the instrument. This kind of monitoring is meaningless. What is needed is that the doctor should come back from time to time to check if the patient's ECG has developed or changed. Such subtle changes in the patient's condition require the doctor to be vigilant and responsible enough to catch them. If the doctor is very responsible, he will even take an ECG of the patient every once in a while. Because as Xie Wanying argued with Dr. Jiang at the beginning, ECG monitoring is an analog lead and does not have the standard of an ECG machine.
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