Recently, in Beijing Jishuitan Hospital, orthopedic surgeon Sun Weitong used superb medical skills to successfully save a 40-year-old programmer.
On January 16, another busy Sunday, at about 12:00 noon, Mr. Liu, 40, came to the emergency department of Beijing Jishuitan Hospital Xinlongze Branch because of "1 day of pain in the inner side of his left upper arm". Emergency triage desk to find the orthopedic doctor Sun Weitong, Dr. Sun learned through detailed consultation, the patient is a programmer, the work pressure is larger, from 1 day ago night, there is no obvious cause of left armpit and left upper arm medial pain, there is no obvious history of trauma and chair back, crutches card pressure history, the degree of pain affects sleep, but there is no obvious chest tightness, breathing difficulties. Examination revealed tenderness in the chest wall below the left axillary fossa and the medial side of the left upper arm, no swelling and limited shoulder movement, and good movement of the distal left upper extremity.
In view of this, Dr. Sun Weitong considered that the patient's symptoms and signs did not conform to the typical orthopedic disease manifestations, in order to exclude other disciplinary diseases such as angina, Dr. Sun continued to ask about the medical history, and learned that the patient's symptoms were not the first time, and similar symptoms had appeared intermittently many times in the past 3 years, the most recent symptom was 3 months ago, and Holter was performed in the outer hospital, but no obvious abnormalities were found. Combined with the patient's occupation, medical history and signs, Dr. Sun recommended that patients go to the emergency department for electrocardiogram and other related tests to further confirm whether there is acute myocardial infarction and other acute and critical diseases.
Under the guidance of Dr. Sun, Mr. Liu entered the emergency internal medicine clinic. Physician Han Xing of the Emergency Department of Internal Medicine again asked for a detailed medical history and quickly performed an electrocardiogram for the patient, but the ECG did not clearly show acute myocardial infarction. Around 13:30, the patient was transferred to the rescue room, performed an electrocardiogram examination again, and asked Tian Zhaoxing, deputy director of the emergency department, to check on the patient. Combining the patient's symptoms and other related tests, Director Tian considered the patient to have acute inferior myocardial infarction and immediately activated the green channel for chest pain.
On the same day, Wang Jihong, deputy chief physician of the Department of Cardiology, inspected the patient, considered that the patient needed to open the coronary artery urgently, and immediately sent the patient to the catheter room for coronary angiography and related interventional treatment. Coronary angiography shows three vascular lesions in patients, two of which are very severe, with chronic occlusion of the left cyclotron branch and acute 100% occlusion of the right coronary artery. Wang Jihong, deputy director of the Department of Cardiology, immediately opened the right coronary artery, drew out a red thrombus, dilated the balloon, performed intravascular ultrasound examination to show that the blood vessels were diffuse and severely narrowed, and finally implanted two stents, and the symptoms of the patient were relieved immediately after the operation.
According to the relevant person in charge of Jishuitan Hospital, this 40-year-old patient is an IT programmer, usually tired of work, coupled with the bad habit of smoking, do not care for the body, arteriosclerosis appeared at a young age, on this basis, acute myocardial infarction occurred, thanks to the orthopedic doctor's insight of myocardial infarction, emergency department, cardiology linkage, efficient opening of chest pain green channel, otherwise the consequences will be unimaginable.
Text/Beijing Youth Daily reporter Jiang Ruojing
Editor/Peng Zhang