When the Doctor Uses A Hack
Chapter 1133 - 1136: Can this medicine be used?

Has the dissection ruptured?

At this thought, everyone began to break out in a cold sweat!

A portion of the ascending aorta is within the pericardium, and once it ruptures, arterial blood will quickly fill the entire pericardium, presenting as cardiac tamponade!

And this presentation is exactly the most dangerous and also the cause of the highest mortality rate!

Therefore, upon hearing Chen Cang mention pericardial tamponade, everyone, including Yu Yonggang, Li Baoshan, Xu Ziming, and others, felt a chill in their hearts!

What to do?

Even Yu Yonggang, the director of the emergency department, felt powerless in the face of such a patient at this moment!

Because even Xu Ziming, a cardiovascular surgeon, found it difficult to form a clear series of resuscitation thoughts at this time!

Sometimes, many diseases come hastily and bring with them the most severe complications and postures, like a deluge, and the patient is but a flat boat on the sea!

"Dr. Chen, should the pericardial tamponade be relieved?"

Chen Cang took a deep breath, and at this time, the echocardiograph was very unclear due to the blood filling the pericardium!

Only a lot of blood could be seen filling the pericardium.

What is the patient's condition at this moment?

Is it possible to relieve it?

Should it be relieved?

Could it trigger other risks?

No one can guarantee anymore!

Unless it is thoroughly examined!

But to examine now?

Where to go for an examination?

What examination to do?

Frankly, any examination now amounts to a death sentence!

But without a clear diagnosis, how can one make a systematic and precise judgment on the patient's condition?

How to formulate a set of effective treatment plans?

Suddenly, the patient had entered a vicious cycle!

Unclear diagnosis leads to no option to draft a plan, no plan exacerbates the condition, and the worsening condition leaves the patient with no time for other examinations and treatments.

Dissection separation?

Or dissection rupture?

Whichever it is, they are very dangerous situations.

Even, it could be a mixture of two dangerous factors.

At this thought, Chen Cang directly handed the pericardiocentesis needle to Xu Ziming.

Looking at him, he said: "Director Xu, you hold this, when I tell you to draw blood, you draw blood!"

Xu Ziming's face was solemn, and he nodded seriously!

Meanwhile, Chen Cang moved to the other side of the patient, put on the stethoscope, with one hand pressing the head of the stethoscope at different positions on the precordial region, and the other hand on the patient's wrist!

He took a deep breath, trying to calm himself down at this critical moment!

At this moment, in the room, the nurse said anxiously:

"Heart rate 60 beats per minute!"

It seemed that everyone was at a loss.

Everything happened too suddenly, and the disease progressed too quickly!

Perhaps many people do not understand why most people with Marfan syndrome do not live past their thirties, and it is because of the current situation!

The condition progresses too fast, like a tornado!

No time for rescue!

Chen Cang closed his eyes, and the people around him quickly became quiet.

They didn't dare disturb Chen Cang.

At this moment, through the pericardium, Chen Cang still heard the faint diastolic murmur accompanied by a systolic murmur in the area where the aortic valve was auscultated!

After hearing this sound, Chen Cang was overjoyed!

This was a sign with diagnostic significance!

The murmur was caused by aortic root hematoma from the dissection, which caused the aortic valve to shift, prolapse, and an annular dilation, and the ruptured intima protruded valve-like into the lumen, causing blood flow vortex.

And at this very moment, Chen Cang felt on his wrist signs of widened pulse pressure and a water-hammer pulse indicative of peripheral signs!

Thinking of this, Chen Cang was immediately elated!

The diagnosis of an ascending aortic dissection was certain.

However, there was no severe rupture of the aorta, but rather due to blood vessel damage at the location of the ascending aorta, blood had seeped through the wound into the pericardial cavity!

This caused the symptoms of cardiac tamponade.

But now, the aortic dissection hadn't completely ruptured, yet the hematoma within the dissection was very serious.

Otherwise, such a series of pathological reactions would not have occurred.

Chen Cang's mind continuously used all sorts of imaging results to simulate the patient's current thoracic conditions.

Through various diagnostic information, piece by piece, the patient's current situation was gradually ascertained.

Thinking of this, Chen Cang hurriedly said to Xu Ziming, "Pericardiocentesis!"

"Is it possible to perform the puncture?" Old Yu was somewhat worried.

Chen Cang nodded: "Yes! No problem!"

After saying this, Chen Cang turned to the nurse and continued, "Intermittent intravenous administration of propranolol and combined hypotensive treatment with nitroprusside!"

...

Chen Cang was constantly issuing various emergency medical orders.

Now was not the time to fixate on who was the director.

Because Chen Cang knew that he was the person who understood the patient's internal condition best at this moment.

It was necessary to stabilize the patient's critical symptoms and prepare for transfer to the operating room!

If surgery were to take place here, the patient's mortality rate would be over 95%.

Emergency surgery simply couldn't support such a huge, complicated and delicate operation!

In no time, everyone sprang into action.

Medical orders were continuously carried out.

Xu Ziming had long been prepared for the pericardiocentesis.

Under echocardiography, the fluid within the pericardial cavity was slowly drawn out.

One minute later, the pericardiocentesis was complete.

250 milliliters of blood was withdrawn.

And various medications began to be injected into the patient's body.

"Is it alright to lower the blood pressure like this? The patient is already experiencing some hypotension," the head of the second group, Hou, couldn't help but ask at this moment.

Indeed, was the combination of propranolol and nitroprusside too aggressive?

Everyone was somewhat concerned!

Although the patient had developed an aortic dissection, the patient was already in shock. If hypotension caused low perfusion, would the patient be able to endure the operating table?

This seemed to lead to a contradiction.

High blood pressure made it easy to induce rupture of the aortic dissection!

Low blood pressure, could the patient suffer from cerebral tissue ischemia due to low perfusion?

This was the dilemma of difficult and complicated diseases!

Every medical order needed to be carefully considered and reconsidered!

Chen Cang shook his head, immediately denying, "No, it won't happen!"

"The patient's 'low' blood pressure isn't the true blood pressure!"

At this remark, everyone around was taken aback!

Are there real and false blood pressures?

Xu Ziming's eyes suddenly lit up, he asked with curiosity, "Has the patient's hematoma within the dissection spread?"

Chen Cang nodded!

"That's right, I clearly felt widened pulse pressure and a water-hammer pulse among other peripheral signs on the radial side of the patient, and moreover, the heart sounds also showed the sudden appearance of diastolic murmur with systolic murmur at the auscultation area of the aortic valve!"

"This indicates that there's no rupture of the blood vessels, and the reason for the cardiac tamponade is due to the hematoma within the dissection at the aortic root causing displacement, prolapse of the aortic valve and annular dilation, and the inner lining ruptured presenting as valve-like protrusions into the lumen causing turbulent blood flow."

"Moreover, the patient's ascending aortic dissection indeed had blood seepage, resulting in the manifestation of cardiac tamponade."

Upon hearing Chen Cang's words, the surroundings immediately went quiet!

At this moment, it seemed everything was explained!