The pericardium is a mbranous sac, divided into a fibrous layer and a serous layer, which is further divided into a visceral layer and a parietal layer. The visceral layer covers the surface of the heart, the parietal layer adheres to the fibrous layer, and there is a cavity in between called the pericardial cavity. Normally, the parietal layer is very smooth, and the presence of a pericardial friction rub indicates the onset of inflammation. Inflammation causes exudate to flow into the pericardial cavity, creating an accumulation known as pericardial effusion.
When the pericardial effusion increases to a certain amount, separating the visceral and parietal layers, they no longer rub against each other, and the pericardial friction rub disappears. This is why cases with a large amount of effusion showing pericardial friction sound are rare and special in clinical practice, which this elderly lady likely is not. This is because the patient’s first and second heart sounds were not distant upon auscultation.
The absence of large effusion ans the condition has not yet reached the stage of pericardial tamponade, which is fortunate.
Xie Wanying put down the stethoscope and asked the patient about the location and characteristics of the chest pain: "Is it like a sharp stab, or does it feel like being hit by a sandbag?"
The elderly lady said, "It’s like sothing heavy hit my chest."
It’s a dull pain. Although myocardial infarction is also dull pain, this pain may be due to pressure from the pericardial effusion. Based on the examination data currently available, Xie Wanying’s analysis suggested that the likelihood of myocardial infarction was low. The main issue seed to be a touch of acute heart failure.
The flight attendant brought over an oxygen mask to the nurse. The nurse fitted the oxygen mask onto the patient. anwhile, the flight attendant whispered into Xie Wanying’s ear.
"The captain is asking if there’s a need for an ergency landing at a nearby airport. If so, please let us know imdiately, as coordinating with the airport for a landing requires their cooperation."
A plane can’t just land imdiately whenever it wants. Even ergency landings require prior coordination with the airport; otherwise, the consequences like collisions can be catastrophic.
"How much longer to reach Capital Airport?" Xie Wanying asked.
"About an hour," the flight attendant replied.
This ant the plane was nearing Capital’s airspace. The dical conditions around the Capital are incomparable to those of Capital itself. Moreover, a concerning point is that everyone around knows Capital doctors are top-notch, leading regional dical techniques to be far behind compared to hospitals farther away from the Capital.
"If we make a temporary landing at the nearest airport, how long would it take? Would it take ten to twenty minutes?" Xie Wanying asked again.
"Yes," the flight attendant was internally amazed at her rapid calculation skills, as if she was not just a doctor.
It’s just that outsiders don’t know; doctors often have to calculate, whether they are in internal dicine or surgery. Calculate what? There are many things to calculate. Everyday ward rounds, prescribing dication, calculating patient dosage—these are basic clinical skills. This alone involves calculations, as doctors strive to anticipate changes in a patient’s condition and accurately estimate specific dication dosages, the more precise the better.
An ergency doctor on site also needs to estimate the best transport plan for the patient.
This patient’s condition—whether it can wait, whether it can wait for an hour to safely land at Capital Airport and then be sent to a hospital. If so, both the patient and family would inevitably choose Capital Hospital for treatnt first.
Xie Wanying needed to consider this because this patient did not have a common heart disease type but had a relatively rare hypothyroid heart disease here.
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