MTL - Emergency Doctor Mercenary Road-Chapter 2 The maddening heart
Chapter 2 The heart that is surging
On April 26, 2009, a mirror parallel universe of Earth.
M 7:30 am in Carson City, Nevada.
This inland city is slowly waking up, with a little bit of hustle and bustle in the tranquility.
Casey Street in the center of the city, the number of cars gradually increased, and the vehicles from various branch roads slowly merged into the traffic flow on the main road, and flowed meanderingly.
A Chinese-American youth in sportswear is running slowly from east to west along the sidewalk of Casey Street. The sparse pedestrians in the morning were overtaken by him from time to time.
His name is Lu Fei and he is a prospective doctor. Today is the last day of his one-year internship at St. Cathy's Hospital.
After two rounds of STEP examinations, he has already obtained the professional qualification of a physician. The hard days of being an intern who go to work at 5 in the morning and leave work at 7 in the afternoon have finally come to an end.
Lu Fei is not a native of this world.
Seven years ago, his soul consciousness came through, and he "settled" on a thin sixteen-year-old boy named Lu Fei in Chinese and Jack in English. At first, he suspected that he was schizophrenic and had hallucinations. After a few days, after confirming that the soul transmigration was unmistakable, Lu Fei was very happy, not to mention that he couldn't figure out how to find life and death.
In the last life, his parents had him in their 50s, and he was a standard old-timer.
Lu Fei went to the hospital for his first year of practice, his father was afflicted with geriatric disease and could not stand Xianyou. The mother, who was already middle-aged and gave birth to a frail and sickly child, was hit by this and passed away half a year later.
Lu Fei has been depressed for a long time, but the massive study tasks and tiring internship have made his grief slowly pass.
The work in the emergency department of Southern Hospital is heavy and uninteresting.
Forget about poetry and the distance, a moment of relaxation and tranquility is rare, the daily routine of a single dog in the emergency department is enough, and the comfort of a girlfriend is impossible, how can there be such spare money and time.
A short life can be summed up in heartbreak, money worries, and tiredness like a dog.
And Lu Fei, who has traveled to this world, is much happier, with a relaxed family, a harmonious family, and a surplus of wealth.
Lu Fei jogs to the intersection of Casey Street and Martin Street, turn right for 100 meters, and you will reach St. Casey Hospital.
When he was about to run to the intersection, he saw on the bench on the right, a well-dressed middle-aged man with a flushed face. , the body posture is very strange.
Lu Fei kept his pace and passed the intersection in a blink of an eye.
Because of professional sensitivity, I always felt that something was not right, so I turned around and ran back, slowing down to the middle-aged man.
lowered his head and asked, "Sir, what's wrong with you, do you need any help?"
"Call me Carl, my left chest hurts so badly, I'm going to the hospital, I can't walk, help me." The middle-aged man said intermittently.
Lu Fei asked: "Mr. Carl, I'm the emergency doctor at St. Kathy's Hospital, Jack, tell me what's wrong with you? Can I check it for you?"
Carl rejoiced: "Okay, I came to Carson on a business trip two days ago. I drank some wine during breakfast at the hotel at 7:00 in the morning. As soon as I went out, my chest was so painful that I vomited up my breakfast, so I wanted to come to the hospital to see a doctor. , I really can't stand it here."
Lu Fei put his face on Carl's chest, and while listening to the sound of his heart, he asked, "Do you have the habit of drinking in the morning?"
"The business trip has been smooth and smooth these two days, so I drank half a bottle of whisky in the morning." Carl replied incoherently.
"Understood, I'll carry you to the hospital, it's only a few steps away, and it's too late to call an ambulance." While speaking, Lu Fei squatted down and carried him on his back, and walked quickly to the hospital.
Lu Fei heard his heartbeat like a blower, and knew that he was in big trouble. He initially judged that it was an acute myocardial infarction. In this case, people say it's gone.
Lu Fei walked faster and faster with Carl on his back. After a few steps, he simply ran up and said loudly:
"Mr. Carl, where is your home? How many people are there, and how many pigs are you raising?"
"How many pigs? Strange question, my family lives in woo woo, woo woo." Carl squeaked on his back, a little unconscious.
"Hi, brother, don't sleep, get up, let's have a drink together. As the saying goes, if you get up early for a glass of wine, your friendship will last."
Lu Fei was talking nonsense, but he didn't dare to stop for a moment. If he arrived at the hospital, he could still be rescued. If he was a little slower, he might have died on his back. If people really died on him, it would be blood mold.
"Hey, I saw that I was washing my hands in a golden basin in the emergency department and retiring from the world. Hey, there is a big event this morning, and the people in this country are not kind? What kind of trouble do I have?"
Lu Fei worked up all his strength and ran to the hospital. Fortunately, he arrived at the emergency door after a few dozen steps.
He kept walking and shouted at the security guard at the door: "Uncle Eddie, I'm Jack from the emergency department. I'm pushing a stretcher. The patient on my back is dying."
Eddie, the security guard at the door, quickly pushed the stretcher cart over. The two quickly carried the patient into the car and pushed them to the emergency room. "
Emergency room nurse Mia was standing at the gate. Seeing the situation, she hurried over and asked, "What's the matter, Doctor Lu?"
Lu Fei said loudly: "I picked up a dying person on the road. I'm under the doctor's order now. You and I will rescue you together. Male, about 40 years old, preliminary diagnosis of physical examination, acute myocardial infarction, and ECG monitoring will be performed as soon as possible. ."
The patient was in a coma at this time, and the carotid artery could not be felt. He jumped on the stretcher and began to perform chest compressions. He said loudly, "Nurse on duty, call the director of the emergency department, Mr. Anderson, and ask him to come quickly. The patient is dying."
The stretcher cart was pushed to the emergency room, and nurse Mia said urgently: "Cable 3."
Mia and the security uncle pushed the stretcher cart into the No. 3 compartment, Mia pulled the stretcher cart to the side of the hospital bed, and said loudly:
"Dr. Jack come down, everyone and I will carry the patient to the hospital bed. I will be on ECG monitoring." Lu Fei got off the stretcher bed, and together with Uncle Eddie carried the patient to the emergency bed, and shouted loudly:
"Someone to help, emergency rescue."
As soon as he finished speaking, a plump young female doctor ran in.
Lu Fei looked up at her and said loudly: "Acute myocardial infarction, Olive helps, prepare for tracheal intubation, ventilator to assist breathing, prepare for defibrillation." After saying that, he picked up the defibrillator beside him and stared at it. On the ECG monitor, Mia just received the ECG monitor, and the ECG monitor screamed, showing severe ventricular fibrillation.
"I'm about to defibrillate, leave my hands, 200 joules two-way asynchronous defibrillation." After Lu Fei finished speaking, the defibrillator pressed on the patient's chest.
"Boom", the patient on the bed jumped up stiffly and fell heavily.
"Come again, everyone be careful."
"Boom", Lu Fei defibrillated a second time.
"Mia, one unit of epinephrine, 50 mg of lidocaine, Olive intubation, and high-concentration oxygen." Lu Fei placed the doctor's order while holding the defibrillator, staring at the ECG monitor. device.
"It's here again, the heart trembles again, Mia and Olive leave their hands, the third defibrillation with 200 joules," Lu Fei shouted.
"Boom", another shock to defibrillate.
Mia, Olive and other patients fell, and immediately rushed up to operate. A minute later, Mia said loudly: "The venous channel has been opened, and the adrenaline and lidocaine have been pushed out."
Olive also said at this time: "The endotracheal intubation has been completed, the ventilator has been connected, and the oxygen supply has begun."
Before everyone could continue to move, the ECG monitor started beeping again, and the red warning light flashed desperately. Lu Fei performed defibrillation again, "Boom", and when the patient fell, Lu Fei shouted to Mia: "The maximum dose of dopamine is calculated based on the body weight of 80 kg, and sodium bicarbonate is intravenously infused."
The patient's condition is extremely critical. He has ventricular fibrillation every one to two minutes, ventricular fibrillation, defibrillation, and repeated.
No one speaks in the emergency room, and everyone has complicated expressions on their faces. They are afraid that the patient will die immediately, and expect a miracle to happen. If the patient cannot be rescued, the doctors involved in the rescue will be depressed for a long time.
After the 11th defibrillation, the patient was finally briefly converted to sinus rhythm again. Lu Fei knew that the symptoms could not be cured, so he had to quickly find out the patient's heart condition, and shouted loudly, "Olive hurry up and take an electrocardiogram to see the state of the heart."
Oliver repeatedly agreed, turned her head and dragged the mobile ECG machine over, tore off the clothes on the patient's chest, and took the time to start the patch. Connect the electrodes. An electrocardiogram showed sinus tachycardia, complete right bundle branch block, and acute extensive anterior with high lateral myocardial infarction.
In layman's terms, a large blood vessel in the heart has been completely blocked (blocked).
Before Lu Fei could think about it, the patient started ventricular fibrillation again, so he had to continue defibrillation with gritted teeth.
20 minutes, 7 times of intermittent defibrillation, the patient resumed sinus rhythm briefly after the 8th defibrillation. Lu Fei shouted to Olive: "You take over, I'll get the thrombolytic."
At this time, the director of the emergency department, Anderson, came in and asked while wearing gloves, "Jack, what's the condition of the patient now."
Lu Fei reported the situation in a few words.
Anderson pondered for a while and asked, "Jack, what do you think should be treated next?"
"Dr. Anderson, the patient's condition is too serious, the heart rhythm is extremely unstable, ventricular fibrillation occurs once within 1-2 minutes, and the patient cannot be moved at all, and the interventional embolization treatment cannot be carried out immediately. I suggest performing it in the emergency room on the spot. intravenous thrombolysis."
"What about the dose?" Anderson asked calmly.
"I recommend intravenous thrombolysis to inject 15 mg of alteplase for injection, followed by 50 mg of continuous intravenous infusion for 30 minutes, and the remaining 35 mg of continuous intravenous infusion for 60 minutes. The total intravenous thrombolysis is 90 minutes." Lu Feifei quickly road.
"Just do it, Olive and Mia do it." Anderson ordered decisively.
After one minute, the intravenous channel was opened, the injection of the thrombolytic alteplase for injection was completed, and the intravenous drip started. Before everyone could breathe a sigh of relief, the patient began to convulse again, and the warning sound of Didi Didi sounded rapidly.
is like the howl of the **** of death.
Okay, let's continue the "Electric Man", and everyone rushed to the rescue again.
Lu Fei took time to look up at the wall clock in the emergency room. It was 8:50, and the rescue was less than an hour away. This hour was too long, and every minute of fighting against the **** of death was so hard.
The patient still had frequent ventricular tachycardia and ventricular fibrillation during the thrombolysis process. Lu Fei and Olive took turns to defibrillate, and continued to be given antiarrhythmic treatment and drugs.
After defibrillation 43 times, the heart rhythm finally changed to sinus rhythm after the last defibrillation at 10:04. After waiting for 5 minutes, the patient no longer had ventricular fibrillation, and the atmosphere instantly relaxed.
After another 10 minutes or so, the intravenous thrombolysis was over.
"It should be rescued. Let's observe it for a while. If it's all right, we will look at the follow-up treatment and recovery after entering the ICU. Jack, you did a great job today, and you can write a paper on the rescue process." Anderson smiled. .
"I'm a professional in first aid." Lu Fei was in a good mood and became brazen.
Patient Carl gradually regained consciousness, turned his head slowly, and focused his eyes on Lu Fei's face.
Lu Fei saw that he wanted to talk, and took off the ventilator on his face. Carl said hoarsely, "Thank you for saving me and keeping my son from losing his father."
"Everyone saved you, you will be fine."
Director Anderson also smiled and said at this time: "Mia, check the electrocardiogram again to see the situation."
Mia connected to the electrocardiogram, and the doctors observed it carefully. The electrocardiogram showed that the elevated ST segment fell back >50%, and the myocardial enzyme spectrum: the high peaks of CK and CK-MB moved forward within 6 hours after the onset of the disease, indicating that the blocked coronary artery is re-opened. Pass, successful thrombolysis!
After observing the patient for half an hour, there was no ventricular fibrillation during the period. At this time, Anderson said: "Send it to the ICU. It is recommended to give symptomatic treatment of anticoagulation, antiplatelet aggregation, plaque stabilization, coronary expansion, and improvement of cardiac function. Everything is ok, in the evening. It is estimated that the tracheal intubation can be removed and the vasoactive drugs can be stopped, and coronary angiography will be performed tomorrow, followed by follow-up intervention or thrombolysis."
"Today we rescued the patient and defibrillated a total of 96 times, which should have broken our emergency room record." Mia looked at the numbers on the machine and said in surprise.
Anderson nodded again with satisfaction: "Very good, Olive, send this lucky gentleman to the ICU, Mia will follow him to assist with the admission procedures, and let our hero Dr. Jack rest for a while, after all, this is his internship. It's the last day."
Olive smiled and said, "As you wish."
Soon Olive and others carried the patient Carl onto the stretcher cart and pushed him to the ICU of the hospital.
Karl on the hospital bed slowly stretched out his right hand into the air, bent his four fingers inwards, raised his thumb straight up, and made a classic Terminator like gesture towards the direction of Lufei.
The hospital bed was slowly pushed away, and his hands were not put down for a long time.
(end of this chapter)
