Chapter 126: After discussion, the seniors decided to do 1
Doctor Lin’s head was spinning as he snatched the dical record from the nurse’s hands, resenting aloud, “You never ntioned it!”
“Didn’t Doctor Zhang tell you during the handover, Doctor Lin? We asked her earlier if this patient had any relatives, and she said she would inquire, but she never updated us on the situation,” the nurse replied, refusing to take the bla.
Zhu Huicang pushed his glasses up and, upon recognizing Xie Wanying’s features, recalled their eting over three years ago: Was she the girl Cao Yong saw that looked completely dispirited?
“Is she now studying at our hospital?” Zhu Huicang asked his old classmate Ren Chongda.
“She has co for an internship in the Neurosurgery Departnt; isn’t she following Huang Zhilei?” said Ren Chongda.
“Oh,” Zhu Huicang thought to himself, wondering if soone was overjoyed because the junior sister was coming to intern in their departnt.
...
anwhile, Doctor Lin was flipping through Father Liu’s previously conducted ECG: “This, this—”
Zhu Huicang quickly leaned in to take a look and then glanced at Doctor Lin, “Your patient?”
“No, not !” Doctor Lin denied vehently, using all his strength, “She didn’t tell there was a change in his ECG, she said the ECG looked fine and the blood tests for myocardial infarction were normal.”
With such a serious issue at hand, this was a bla he could not bear!
“You call this ‘no issue’? Isn’t the ST segnt depressed?” Zhu Huicang pointed out the problem imdiately, “Isn’t this a typical sign of myocardial ischemia?”
Of course, Doctor Lin had seen it too, which is why he was desperately denying it: “Yes, yes, yes, it’s myocardial ischemia.”
“Not just myocardial ischemia, right? The patient’s chief complaint was chest pain that had vaguely started in the morning and had been painful for several hours before being admitted. It’s definitely ACS. With ACS, we must be vigilant. He should be on cardiac monitoring for at least eight hours. How long has it been since he was admitted to our ergency departnt?” Zhu Huicang asked, looking at his watch to calculate the ti.
ACS stands for acute coronary syndro.
First of all, normal cardiac enzy tests do not an that there is no myocardial infarction.
The standard diagnosis for a myocardial infarction is not just based on cardiac enzy tests. It’s confird when two out of the three indicators match—either the ECG, the cardiac enzys, or clinical symptoms.
Secondly, the ECG can also present with pseudonormal patterns.
For instance, so myocardial infarction patients might undergo an ECG during the very acute phase. At this ti, the patient is in the acute injury phase of ST-T abnormalities, before the full developnt phase, and the ECG may temporarily return to normal. Needless to say, this kind of normality is pseudo-normal.
Therefore, ECGs conducted during this period can easily lead to a misdiagnosis by the doctor, and Father Liu might well be such a case.
Experienced hospitals certainly provide guidance and requirents for clinical doctors in the diagnosis and treatnt of myocardial infarctions.
For example, at Guoxie, the protocol is that if the initial ECG appears largely normal but the patient complains about symptoms not normal and suspects ACS, as Zhu Huicang has ntioned, cardiac monitoring for over eight hours is required.
Eight hours of ECG monitoring does not an doctors can ignore the patient once the machine is connected. Such monitoring would be aningless. Doctors need to check back from ti to ti to see if there are any developnts or changes in the patient’s ECG. Such subtle changes in a patient’s condition require a doctor’s vigilance and responsibility for them to be detected. If it’s a doctor with a strong sense of responsibility, they might even perform another ECG for the patient periodically. As Xie Wanying initially argued with Doctor Jiang, the ECG monitoring uses simulated leads which are not up to the standards of an ECG machine.
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