The pericardium is a membranous sac, which is divided into a fibrous layer and a serous layer. The serous layer is further divided into a visceral layer and a parietal layer. The visceral layer covers the surface of the heart, and the parietal layer is attached to the fibrous layer. There is a cavity in the middle called the pericardial cavity. Under normal circumstances, the parietal layer is very smooth. Now the pericardial friction sound indicates inflammation. Inflammation will produce exudate, which flows into the pericardial cavity. The resulting effusion is called pericardial effusion.
When the pericardial effusion increases to a certain amount, the visceral layer and the parietal layer are separated, and the friction between them is gone, the pericardial friction sound will disappear. This is why it is rare and special for clinical cases with large amounts of effusion to have pericardial friction sound. This old lady should not be one of them. Because after auscultation, the patient's first and second heart sounds are not far away.
Fortunately, there is no large amount of fluid accumulation and the condition has not yet reached the level of pericardial tamponade.
Xie Wanying put down the stethoscope and asked the patient about the location and characteristics of the pain in her heart: "Does it feel like a knife cutting you, or like being hit by a sandbag?"
The old lady said, "It's like being hit in the chest by something heavy."
It was a dull pain. Although myocardial infarction is also a dull pain, this pain may come from the pressure pain caused by pericardial effusion. Xie Wanying analyzed and calculated the examination data at this stage and believed that the possibility of myocardial infarction in the patient was small. The main problem was still a bit of acute heart failure.
The flight attendant brought the oxygen mask and handed it to the nurse. The nurse put the oxygen mask on the patient. The flight attendant took this opportunity to whisper something in Xie Wanying's ear.
"The captain asked if we needed to make an emergency landing at a nearby airport. If so, please tell us immediately. We will contact a nearby airport for landing and the airport will also need coordination."
A plane cannot land immediately if it wants to. Even if it is an emergency landing, it must be coordinated with the airport first. If a collision occurs, the consequences will be the destruction of the plane and the death of people.
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"How long will it take to fly to the Capital Airport?" Xie Wanying asked.
"About an hour," the flight attendant replied.
The plane is about to fly over the capital. The medical conditions in the areas around the capital are incomparable to those in the capital. What is even more frightening is that the people in the surrounding areas all know that the doctors in the capital are always rushing to the capital for treatment, which results in the medical technology in the surrounding areas being worse than that in the capital, and some are even worse than those in local hospitals far away from the capital.
"If we find a nearby airport for a temporary landing, how long will it take? Will it take about ten to twenty minutes?" Xie Wanying asked again.
"Yes." The flight attendant was surprised at her quick calculation ability, as if she was more than just a doctor.
Laymen just don't know it, but doctors often have to do math, whether they are internists or surgeons. What do they do? There are many things to do. Calculating the dosage of patients' medicines during daily rounds and prescribing orders is a basic skill for clinical doctors. This alone involves calculations, and doctors should try to calculate the specific dosage of medicines ahead of the patient's condition as much as possible. The more accurate the calculation, the better.
The emergency physician also needs to estimate the best transportation plan for the patient.
Can this patient's condition wait, can it wait until he lands safely at the Capital Airport an hour later before being sent to the hospital? If it can, both the patient and his family will definitely choose the Capital Hospital for treatment.
Xie Wanying needs to take this into consideration for this patient because this patient does not have a common type of heart disease, but rather a relatively rare type of hypothyroidism heart disease.
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