“Has she had her thyroid function tested?”
Alas. The patient's daughter was confused by Xie Wanying's sudden question.
Some epidemics do not appear to be particularly serious and life-threatening to most people, so local people will not self-check or pay special attention to them. Few people will pay attention to the reminders issued by the national health department to local medical institutions. It can only be said that it takes time for the country to cultivate the public's health awareness at this stage. Therefore, only when a small number of patients have a serious attack and go to the hospital for a checkup, will we know where the problem lies.
Hypothyroidism, commonly known as hypothyroidism, is more common in the elderly, elderly women, and iodine-deficient areas. Like heart failure, it belongs to the same syndrome. Hypothyroidism usually has an insidious onset and a long course of disease. The mild, moderate, and severe symptoms manifest in different patients. Mild patients may have no symptoms or may show muscle weakness. Severe patients may have heart failure like this old lady.
Xie Wanying said to the nurse and flight attendant: "Change her mask and give her oxygen."
Patients who are in critical condition have a higher demand for oxygen, and because of the lack of oxygen, they will unconsciously breathe through their mouths to increase their oxygen intake. Unlike nasal cannulas that only provide oxygen to the nose, masks can cover the patient's mouth and nose, providing oxygen to the mouth, which is very useful for patients who breathe through the mouth. The mask covering the patient's mouth and nose is equivalent to a closed space, where oxygen will not run around, and can provide patients with a relatively stable oxygen concentration, which is also beneficial for the patient's oxygen therapy.
The flight attendant went to get the oxygen mask. Seeing this, the nurse asked Xie Wanying, "Do you want an injection?"
Injections were not allowed. She was not a practicing physician and did not have the right to prescribe. Injections required drugs, and the medication could not be given carelessly, otherwise the law would not have a hard and fast rule on who had the right to prescribe. Unlike her cousin, she had discussed with her senior brother beforehand and could issue a medical order to be executed when necessary.
If medication doesn't work, will a bag of sugar or saline work? The patient is suffering from heart failure, not loss of body fluids. On the contrary, heart failure patients must control the amount of fluid infusion to prevent the increase in blood volume from adding more burden to the heart.
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Seeing Xie Wanying shaking her head, Lu Xin sighed and felt helpless.
In fact, for patients like this, practicing doctors would not easily use emergency medicine unless the patient is in the most critical condition. Heart disease caused by hypothyroidism is different from other heart diseases. Many heart disease drugs should be used with caution. For example, digitalis-based cardiotonic drugs commonly used in clinical practice can easily cause poisoning for such patients.
The extent of the old lady's heart disease now requires further examination.
Putting on the stethoscope, Xie Wanying performed auscultation of the patient's heart and lungs.
The apex beat is shifted to the left, and the patient is suspected of having left ventricular enlargement. The condition has reached the point where it affects the heart structure, which is a more serious condition and is not easy to reverse. In the future, he may need to go to a large hospital for major surgery.
Listening carefully, the patient could not sit down and was forced to lean forward to gasp. Xie Wanying put the stethoscope in her hand close to the patient's clothes and put it close to the patient's chest wall. From the third and fourth intercostal spaces on the left side of the sternum to the bottom of the xiphoid process, a high-frequency sound like scratching could be clearly heard, covering the heart sounds. This is the pericardial friction sound. The reason for this sound is that the pericardial fibrous layer is inflamed, and the rough pericardial wall layer and the pericardial visceral layer attached to the surface of the heart rub against each other with the heart activity.
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