On the same day, 2 patients with acute myocardial infarction were rescued.
The basic condition of the 2 people is almost exactly the same, but because of the different attitudes of the family, one person is now in stable condition, and the other person is in a state of shock and dying.
Both are men, Mr. Zhang, one 49 years old, and Mr. Li, 50 years old, of similar age.
Both of them, both of whom had sudden chest pain for 1 hour, hit 120 hours, and when they arrived at the hospital, they were basically the same.
After 120 patients were admitted, they were given aspirin + tigrelor in a timely manner.
The two electrocardiograms showed that they were both acute anterior wall myocardial infarction, and the heart rate at the time of admission was about 85 beats per minute, the blood pressure was about 120/70mmHg, and the blood oxygen saturation was about 96%, that is, the vital signs were almost the same.
Both had persistent chest pain, sweating profusely, and still did not ease after arriving at the hospital.
After arriving at the hospital, doctors can give 3000u of heparin anticoagulation in time.
But what happened next determined that the fate of the two was different:
Doctors receive patients with myocardial infarction, and we will have a clinical path, that is, we will diagnose and treat them according to the regulations. This includes communication with the patient's family, as well as other rescue arrangements.
Then when the doctor communicates with the family, the words expressed are basically the same.
The doctor informed Mr. Li's wife, 50, that the patient was currently diagnosed with acute anterior wall myocardial infarction, that his condition was critical, that his heart might stop beating at any time, and that he needed to sign a critical illness notice.
Mr. Lee's wife, without hesitation, signed it immediately.
The doctor told Mr. Li's wife that at present, it is necessary to open the blood vessels as soon as possible, which can be thrombolytic or stent, but the stent is preferred.
Mr. Li's wife, without hesitation, said: Stent, I know, the blood vessel is blocked, I have to hurry up the stent, I signed.
Before the doctor could finish speaking, Mr. Li's wife took the preoperative informed consent form and signed and agreed to the operation.
Mr. Li was then sent to the catheterization room, and after 120 confirmed patients had myocardial infarction, the hospital catheterization room had made various rescue preparations, including the preparation of the catheterization room (cardiac operating room). Contrast reveals the patient's left anterior blood vessel, and the anterior descending branch opening is completely occluded.
Immediately the guide wire passes, the balloon expands, the stent is implanted, the blood vessels restore blood flow, the lumen returns to normal, and the patient is subsequently sent back to the intensive care unit for further observation.
The doctor informed Mr. Zhang's wife, 49, that the patient was diagnosed with acute anterior myocardial infarction, the condition was critical, and the heart would stop beating at any time.
Mr. Zhang's wife hesitated: Really? Usually good, how can you get a heart attack? If you take a good look at it, will the diagnosis be inaccurate? I see that Uncle Sun in our community has a heart attack, and people are fine. How do you say you're critically ill? Don't scare me.
The doctor explained again: based on the patient's symptoms of persistent chest pain, as well as changes in the electrocardiogram, the diagnosis is currently clear. This heart disease is one of the most serious and has a high mortality rate. The heart's blood vessels are blocked, and the heart can stop beating at any time. Please sign.
Mr. Zhang's wife hesitated: "Okay, let me see what you all write." I am so frightened that I can't read the words clearly.
Finally, after a few minutes, Mr. Zhang's wife finally signed the critical illness notice.
Later, when signing the surgical consent form, it was even more laborious and the old nose was strong.
Mr. Zhang's wife, at first asked about the difference between thrombolysis and stents. The doctor simply explained: stents are theoretically better and have a higher success rate.
Mr. Zhang then looked at the complications on the surgical consent form and said: This operation is so dangerous, it will also bleed, allergies, hematoma, kidney failure, arrhythmias, pericardial tamponade, cardiac arrest. So dangerous, why are we still doing surgery?
The doctor further explained: The risk of surgery is only theoretical and may occur, but the incidence is low. We have an obligation to inform and families have a right to know. These complications rarely occur, and we will also operate regularly to minimize the occurrence of complications as much as possible. Besides, at present, patients are critically ill, and the risk of acute myocardial infarction is the highest, and the purpose of our surgery is to reduce the wind of the disease, not to increase the risk. The dangers of these surgeries are negligible compared to the dangers of acute myocardial infarction itself. Because of the lack of surgery, the patient's heart will stop beating at any time.
Mr. Zhang's wife: I heard that this has made a bracket, and I can't do without medicine for a lifetime?
The doctor explained: if you have coronary heart disease, have myocardial infarction, and whether you put a stent or not, you have to take medicine all the time.
Mr. Zhang's wife: I heard that with the bracket, people can't work?
Doctors explain: put a stent in acute myocardial infarction is life-saving, if not, if the heart stops beating, let alone work, nothing can be done. The later the blood vessels are opened, the more myocardial necrosis there is, and the easier it is to have heart failure later. Without stents, the greater the risk of not being able to work in the future. It's not that you can't do the work with the scaffolding.
Mr. Zhang's wife: Well, I probably understand, you wait, I have to say a word to the old Zhang family and discuss it.
Doctor: Please hurry, we must seize the time, can not delay, delay one minute more than one minute dangerous. Aren't you a family member of a patient? Why do you still have to discuss with your family?
Mr. Zhang's wife went to the phone.
(There is a subtext here: the emperor is not in a hurry, the eunuch is in a hurry.) Although the metaphor is inappropriate, it does feel this way. ）
Mr. Li, who came in the morning, exchanged with the doctor and his family for less than 5 minutes and signed it.
Mr. Zhang, who came in the afternoon, the doctor and the family communicated for nearly 30 minutes, and the family had not yet signed.
Mr. Zhang's wife, who called for a few minutes, finally came over, signed it, and said: Let's do an angiography first, and if the blood vessels are really blocked, we will talk about it later.
In the process of communicating with his family, Mr. Zhang's heart rate is getting faster and faster, and his blood pressure is gradually lower, indicating that his condition has been worsening.
The angiography found that the opening of Mr. Zhang's left blood vessel was blocked, almost the same as Mr. Li's condition. Mr. Da Zhang opened the blood vessel late, so even if the stent was implanted, the patient already had hypotensive shock, or cardiogenic shock. Blood pressure was once below 60/30 mmHg, and with dopamine, the patient's blood pressure was maintained to 90/60 mmHg.
Mr. Zhang was sent back to the intensive care unit and has been restless, with little urine and wet and cold all over his body, which is a typical manifestation of heart failure.
Myocardial infarction is accompanied by cardiogenic shock, and the mortality rate is extremely high ...
Two patients with acute myocardial infarction, the condition is almost exactly the same, Mr. Li because of his wife's decision, the current condition has been stable. Because of his wife's hesitation, Mr. Zhang can not get rid of the danger of life at present, and it is still a question mark.
Even if you are lucky and your life is in danger, you will have chronic heart failure in the future, because she has delayed a lot of precious time, myocardial necrosis is more, and the quality of life will be greatly reduced in the future, and life expectancy will also be affected!