Start with an emergency physician

See all

What if the scalpel suddenly breaks?

What if the assistant has a problem?

What if the power is off?

All I can say is that if everything is normal, Zhou Yuan's operation will not fail.

He Jianyi thought for a while:"It's okay to do reperfusion therapy first. But for the heart bypass surgery, our emergency department doesn't have any bypass tools, so we have to go to the cardiovascular department to ask for them."

How can patients who usually have heart bypass surgery be given to emergency doctors... It's normal that the emergency department doesn't have the corresponding equipment.

Zhou Yuan smiled.

If he went to the cardiovascular department to borrow tools, he would definitely be criticized for stealing their jobs and would be looked down upon.

Zhou Yuan, the culprit, couldn't do this kind of work.

He glanced at He Jianyi and smiled knowingly:"Teacher, I'm busy doing perfusion therapy for Qian Wei here, otherwise...you go?"

He Jianyi's face darkened.

Sure enough...this little bastard pushed himself out!

"

I'll go , I'll go!" He Jianyi sighed.

""Thank you, teacher."

He Jianyi went to the Department of Cardiovascular Medicine, while Zhou Yuan prepared for perfusion therapy.

In the previous electrocardiogram, Qian Wei's ST segment was obviously elevated, which can be judged that Qian Wei's myocardial infarction was due to this reason.

Perfusion therapy is the most important treatment measure for acute ST-segment elevation myocardial infarction.

Opening the occluded coronary artery and restoring blood flow within 12 hours of onset can reduce the area of myocardial infarction and reduce mortality. The sooner the coronary artery is reopened, the greater the benefit to the patient.

Therefore, all patients with acute ST-segment elevation myocardial infarction must be diagnosed as soon as possible after seeing a doctor, and a reperfusion therapy strategy must be made as soon as possible.

The so-called reperfusion therapy is the use of thrombolytic drugs to , interventional therapy or surgical treatment to reopen completely occluded blood vessels and reperfuse ischemic tissues.

Since interventional therapy is not suitable for left main stem lesions and patients are very concerned about costs, Zhou Yuan chose to use thrombolytic drugs for reperfusion therapy.

This method is widely applicable, easy to implement, and cheap. The method of thrombolytic therapy is very simple. Through intravenous injection, thrombolytic drugs such as urokinase and streptokinase are given systemically or selectively.

However, thrombolytic therapy has many contraindications, such as intracranial hemorrhage, cerebrovascular injury, aortic dissection, etc.

We must wait for Qian Wei's medical history and test results to come out before we can start.

"Do another cerebral angiography. This is to prevent the occurrence of diseases.

Soon, the results came out, everything was normal. Qian Wei had no other symptoms except acute myocardial infarction, so after simple preparation and treatment, he started intravenous injection of thrombolytic drugs.

After the drug was administered, Zhou Yuanzheng, Qian Wei, who had been silent all the time, suddenly spoke.

"Dr. Zhou, can I ask you a few questions?……"

Zhou Yuan stopped and asked,"What's the problem?"

"Can you explain my illness? I have never had any heart problems. Why do I need heart surgery all of a sudden?"

Qian Wei didn't distrust the doctor, but simply didn't understand.

Zhou Yuan nodded and explained,"Your acute myocardial infarction is caused by left main trunk disease. The so-called left main trunk disease refers to the left main trunk stenosis greater than or equal to 50% in coronary angiography, and your blood vessel stenosis has reached 80%, so surgery is necessary.……"

"This is just like a traffic jam. If the road is blocked, you can use an overpass. If the blood vessels in the heart are blocked, you can also build a bridge to allow the blood flow to bypass. This is heart bypass surgery."

"To put it more precisely, it is to establish a channel between the proximal and distal ends of the stenosis of the coronary artery, so that the blood can bypass the stenosis and reach the distal end, thereby restoring the blood supply of the coronary artery."

Qian Wei thought carefully for a while, nodded after understanding, and said a little embarrassedly:"You said before that the cost of heart bypass surgery is between 40,000 and 100,000... Can you make it as cheap as possible? I don’t want to drag down the whole family because of me!"

Qian Wei said:"Why is there such a big difference, can you try to choose the cheapest one and help me do the surgery for only 40,000 yuan!"

Qian Wei worked hard for so many years to bring his family to the city, and at this juncture he just bought a house. Where can he get so much money...

Zhou Yuan hesitated for a while and explained:"There are three main reasons why the cost is so different. The first is the number of bypasses. For example, if you bypass three blood vessels, it will definitely cost more than bypassing one blood vessel."

"Second, the method of performing coronary bypass surgery. Coronary bypass surgery requires extracorporeal circulation and transfer, so the cost is higher than that of non-pump coronary bypass surgery. Of course, whether or not you need coronary bypass surgery depends on the degree of blood vessel blockage, and no one can decide."

"In addition, if the great saphenous vein is needed as a bridge for bypass surgery, the cost of obtaining the bridge vessel will also be different. If it is obtained minimally invasively under endoscopy, it will be much more expensive than obtaining it in an open area."

"Is there any difference?"Qian Wei finally heard a procedure that seemed to allow him to choose a cheaper one.

"If there is a difference, minimally invasive surgery means a small wound, which heals faster and causes less pain after surgery. It is definitely better than open surgery."

"In terms of efficacy! Will the blood vessels taken out from the open area be worse than those taken out through minimally invasive endoscopy?"

Zhou Yuan frowned:"Theoretically, no. If the technology is good, it is actually about the same."

"Doctor! Help me get it from the open area! It's okay to be a little painful!" Qian Wei gritted his teeth.

Zhou Yuan felt a little reluctant and said,"I'll try my best"

"You said there are three influencing factors. What is another factor that affects the price?"

Zhou Yuan smiled helplessly:"You probably can't change the third factor, which is the regional differences and hospital differences. Different regions and different levels of hospitals have different charging standards for bypass surgery, and different regions have different reimbursement rates for medical insurance for bypass surgery."

"Although this type of surgery is not risky, it can be very dangerous. Small hospitals won't accept it, so you'd better stay here with us." Zhou Yuan dispelled Qian Wei's idea of going to other hospitals to save money.

After a while, He Jianyi came back with a dark-faced director of the Department of Cardiology.

Obviously, the reason for the job grabbing was because of the cardiovascular department.

As soon as he saw Zhou Yuan, the director of the Department of Cardiology asked,"What kind of surgery are you going to do?"

There are many specific methods for heart bypass surgery.

For example: median chest bone bypass surgery under extracorporeal circulation; heart beating coronary artery bypass surgery; minimally invasive coronary artery bypass surgery under chest laparoscopy ; hybrid surgery for coronary artery bypass surgery; total arterial grafting for bypass surgery; left internal mammary artery bypass surgery under a small incision on the left anterior chest, etc.

As for which one to choose, it all depends on the patient's physical condition.

Zhou Yuan smiled when he heard the words of the director of the Department of Cardiology.

This is to test yourself!_To read the ununderlined version of the novel, please download Fulu Novel AP