Chest pain, accompanied by rapid heartbeat, panting, cold sweat all over the body... Recently, Mr. Zhang of Ciheng County, Guizhou Province, had a dangerous scene. Mr. Zhang, who was in pain, immediately rushed to the emergency department of Chengheng County People's Hospital, and through the doctor's diagnosis, it was determined that he was an acute st-segment elevation myocardial infarction, and his condition might deteriorate at any time, and he must rebuild his blood flow as soon as possible to preserve more myocardium, otherwise it will be life-threatening.
Under the guidance of Li Deqing and Hu Liangqiao, medical experts from Ciheng County, Huicheng District, the emergency department of Ciheng County People's Hospital worked closely with the Department of Cardiovascular Medicine to successfully pull Mr. Zhang back from the "ghost gate" through thrombolytic treatment. It is understood that since the Huicheng District Medical Team rushed to help the Chengheng County People's Hospital, it has continuously discovered technical weaknesses, strived to improve the local medical level, and truly achieved the transformation of technical assistance from "blood transfusion" to "hematopoiesis".
The condition is dangerous, and sudden acute myocardial infarction
Two months ago, Mr. Zhang conducted a coronary cta examination in Guiyang City, which showed about 30% stenosis of two blood vessels. What Mr. Zhang did not expect was that this buried hidden dangers for him in the future. Recently, Mr. Zhang, who works as usual, suddenly felt pain in his chest at about 12 noon, which was only a feeling of pressure at first, and then quickly aggravated, accompanied by symptoms such as rapid heartbeat, panting, and cold sweat all over the body.
Half an hour later, Mr. Zhang arrived at the emergency department. Su Gen, a doctor in the emergency department of the hospital, immediately examined his electrocardiogram and the preliminary diagnosis was myocardial infarction, so he immediately contacted Dr. Li Deqing.
"It is an acute st-segment elevation myocardial infarction, chest pain symptoms have exceeded half an hour, the ECG is obviously dynamic evolution, for acute inferior and posterior wall myocardial infarction, the condition is very critical, must immediately start thrombolysis." After Hu Liangqiao, a cardiovascular physician, rushed to the scene to assist in rescue, he found that the situation was very critical.
Acute st-segment elevation myocardial infarction requires pci treatment (i.e., "coronary interventional surgery"), but limited to factors such as traffic, the best treatment option in Chengheng County is to transport to a higher hospital for pci treatment as soon as possible after thrombolysis.
"Blood circulation must be rebuilt as quickly as possible to preserve more heart muscle, otherwise it will be life-threatening." Dr. Li Deqing explained the condition to the patient and informed Mr. Zhang that the biggest risk is cerebral hemorrhage, but with the use of specific thrombolytic drugs, the risk of bleeding will be relatively reduced, and it is necessary to decide whether to carry out drug thrombolysis as soon as possible.
Because his family was not around, only accompanied by colleagues, Mr. Zhang was still hesitating. At this moment, Mr. Zhang's chest pain worsened, his face was pale, and his whole body was in a cold sweat.
The danger was overcome, and the heart function was not affected
"Shake the bed high, pump nitroglycerin into the vein, quickly control blood pressure!" Dr. Hu Liangqiao methodically directed the rescue, the blood pressure gradually stabilized, the patient felt chest pain slightly reduced, "blood pressure control is stable, began intravenous unfractionated heparinization." "All the doctors and nurses at the scene are working in a tense and orderly manner to cooperate with the rescue.
Treatment is imminent. At the same time of rescue, Li Deqing and Hu Liangqiao continued to patiently explain to the patient. Finally, Mr. Zhang made a decision and signed his own consent to receive thrombolytic treatment.
"You try to relax as much as possible, and tell us in time if you are uncomfortable." While comforting the patient, the doctor keeps an eye on the ECG monitoring and carefully observes the patient's reaction, and the whole thrombolysis process is relatively smooth.
More than 10 minutes after the start of thrombolysis, the patient felt that the chest pain was significantly relieved, and the thrombolysis was quickly effective; after half an hour, the ECG monitoring suggested that the st segment gradually decreased; after 1 hour, the ELECTROCARD prompted the st segment to drop by 50% compared with before thrombolysis, the atrial fibrillation turned into sinus rhythm, and the heart rate was between 100-120 beats / min... Soon, Mr. Zhang's condition stabilized.
Subsequently, the People's Hospital of Ciheng County immediately contacted the emergency department of Qianxian Prefecture People's Hospital, dispatched 120 ambulances, and escorted Mr. Zhang to Qianxian Prefecture People's Hospital in a race against time, initiated emergency coronary angiography and implanted a stent.
Happily, Mr. Zhang's ecliptic wall movement of the heart ultrasound segment is not obvious, and the pump function is not affected. It is precisely because of the timely thrombolytic therapy that the subsequent coronary angiography and stent implantation have bought time. "In the future, when I return to Chengheng County, I will definitely find Dr. Li and Dr. Hu for follow-up consultation." Mr. Zhang said.
Technical support, from "blood transfusion" to "hematopoiesis"
It is understood that Chengheng County is the first county in Buyi, China, and its unique geographical environment has led to inconvenient transportation, and the lack of medical knowledge of ethnic minorities about chest pain has increased the difficulty of myocardial infarction treatment in Chengheng County.
Since the Huicheng District Medical Team rushed to the Zhiheng County People's Hospital, Li Deqing and Hu Liangqiao have successively produced a thrombolysis screening form, informed consent and a correct and standardized thrombolytic flow chart for st-section elevated myocardial infarction, and formulated a cardiovascular disease business learning training plan, a teaching round system, a first-aid operation skills assessment system, and an intern teaching system.
At the same time, through the combination of theoretical teaching and practical ability operation, the local young doctors deepen the identification of patients with acute and critical chest pain, familiarize themselves with the treatment process of chest pain, master the thrombolytic indications and specific thrombolysis processes of acute st-segment elevation myocardial infarction, give full play to the role of "passing on help", promote the rapid growth of young grass-roots medical personnel, and establish a medical team that "cannot be taken away".
In addition to the hand-to-hand teaching to promote the development of the emergency department and cardiovascular medicine department of Chengheng County People's Hospital, Li Deqing and Hu Liangqiao, medical experts in Huicheng District, will also assist Chengheng County People's Hospital to create a chest pain center (grassroots version), continue to cooperate with the hospital to vigorously carry out the construction of chest pain center, and promote the Chengheng County People's Hospital to successfully pass the chest pain center assessment.
The Huicheng District Medical Team strives to improve the local medical level, establish a good reputation among the local people, and better serve the local people. Let the local people believe in medical personnel, rest assured that they can diagnose and treat at the doorstep of their homes, and truly achieve the transformation of technical assistance from "blood transfusion" to "hematopoiesis".
[Reporter] Lu Hui
[Correspondent] Shi Jing, Li Deqing, Hu Liangqiao
【Author】 Lu Hui
【Source】 Southern Press Media Group South + client
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