Is the interlayer broken?


    Thinking of this, everyone began to exude a cold sweat!


    Part of the ascending aorta is in the pericardium. Once it breaks here, the arterial blood will soon fill the whole pericardium, forming a pericardial pressure plug on the heart!


    This performance is precisely the most dangerous and also the cause of the highest mortality!


    Therefore, after hearing Chen Cang say that pericardial tamponade, no matter Yu Yonggang, Li Baoshan, Xu Ziming and others, their hearts can''t help but feel cold!


    What should I do?


    Even Yu Yonggang, director of the emergency department, is powerless in the face of such a patient!


    Because even Xu Ziming of cardiac surgery, it is difficult to form a series of clear rescue ideas at this time!


    Sometimes, many diseases come in a hurry and roll in with the most serious complications and posture, just like a torrential flood, and the patient is just a boat on the sea!


    "Dr. Chen, do you want to relieve the pericardial tamponade?"


    Chen Cang took a deep breath. At this time, because the pericardium was full of blood, he couldn''t see a lot clearly!


    You can only see a lot of blood filling the pericardium.


    What is the patient''s state at this time?


    Can it be lifted?


    Should it be lifted?


    Will it induce other risks?


    No one can guarantee!


    Unless you check it clearly!


    But check now?


    Where to check?


    What check?


    To tell the truth, any examination now is tantamount to a death!


    However, without a clear diagnosis, how can we make a systematic and accurate judgment on the patient''s condition?


    How can we formulate a set of effective treatment plans?


    For a time, the patient has entered a dead cycle!


    The unclear diagnosis leads to the inability to formulate the plan, and the inability to formulate the plan leads to the continued deterioration of the condition, which makes the patient have no time to do other examinations and treatment.


    Interlayer separation?


    Or interlayer rupture?


    Whatever it is, it is a very dangerous thing.


    Even, there may be a multi risk factor mixed with two.


    Thinking of this, Chen Cang directly handed Xu Ziming the pericardial puncture needle.


    Staring at him, he said, "director Xu, take it. If I ask you to draw blood, you will draw blood!"


    Xu Ziming looks dignified and nods seriously!


    Chen Cang went directly around the other side of the patient and put on the stethoscope. With one hand, he pressed the head of the stethoscope at different positions in the precordial area, and with the other hand, he put it on the patient''s wrist!


    He took a deep breath to calm himself down at such a critical juncture!


    At this time, in the room, the nurse said nervously:


    "60 beats per minute!"


    It seems that everyone is at a loss.


    Things are too sudden, and the disease is developing too fast!


    Maybe many people don''t understand why most Marfan syndrome can''t live in their thirties, because it''s like this now!


    The disease develops too fast, just like a tornado!


    There''s no time to rescue!


    Chen Cang closed his eyes and the people around him quickly quieted down.


    Dare not disturb Chen Cang.


    At this moment, Chen Cang still heard a faint aortic valve auscultation area across the pericardium. There was a sudden diastolic murmur with systolic murmur!


    Hearing this sound, Chen Cang was immediately happy!


    This is a sign of diagnostic significance!


    Murmur is caused by aortic valve displacement, prolapse and annular expansion caused by aortic root dissection hematoma. After intimal rupture, it protrudes into the lumen in a valve shape, causing blood flow vortex.


    At this time, Chen Cang felt the peripheral signs such as widening pulse pressure and edema pulse on his wrist!


    Chen Cang was delighted at the thought of this!


    Ascending aortic dissection is positive.


    However, there was no serious rupture of aortic vessels, but because of vascular injury in the ascending aorta, resulting in blood seeping into the pericardial cavity through the wound!


    Developed symptoms of pericardial tamponade.


    However, the aortic dissection is not completely ruptured, but the dissection hematoma is very serious.


    Otherwise, it is impossible to produce such a series of pathological reactions.


    The four-dimensional image of Chen Cang''s mind constantly simulates the situation in the patient''s chest through various image results.


    Through various diagnostic information, the patient''s situation at this time is gradually felt bit by bit.


    Thinking of this, Chen Cang quickly said to Xu Ziming, "puncture!"


    "Can I wear it?" Lao Yu was worried.


    Chen Cang nodded: "yes! No problem!"


    After that, Chen Cang turned to the nurse and continued: "intermittent intravenous administration of propranolol and intravenous hypotension of sodium nitroprusside!"


    ……


    Chen Cang continuously issued various temporary rescue orders.


    This is not the time to worry about who is the director.


    Because Chen Cang knows that now he is the one who knows the patient''s internal situation best.


    The patient''s critical symptoms must be stabilized at this time and be ready to be sent to the operating room!


    If surgery is performed here, the patient mortality rate is as high as more than 95%.


    Emergency surgery is not enough to support such a huge, cumbersome and precise operation!


    For a time, everyone began to mobilize.


    Medical orders are constantly executed.


    Xu Ziming has long been ready for puncture.


    Under echocardiography, the fluid in the pericardial cavity was slowly extracted.


    One minute later, the puncture was completed.


    250 ml of blood was extracted.


    And various drugs began to be injected into patients.


    "Can you reduce blood pressure like this? The patient has some hypotension?" at this time, group leader Hou of the second group couldn''t help asking.


    Indeed, is propranolol combined with sodium nitroprusside too powerful?


    Everyone is worried!


    Although the patient has aortic dissection, the patient has been in shock. If hypotension causes hypoperfusion, can you insist on getting off the operating table?


    This seems to have entered a contradiction point again.


    Hypertension, easy to induce aortic dissection rupture!


    Hypotension, will the patient cause cerebral ischemia and hypoxia due to hypoperfusion?


    This is a difficult disease!


    Every doctor''s order needs to be considered!


    Chen Cang shook his head and immediately denied: "no!"


    "The patient''s low blood pressure is not real blood pressure!"


    As soon as this remark came out, everyone around was stunned!


    Blood pressure and true blood pressure and false blood pressure?


    Xu Ziming suddenly brightened his eyes. He asked suspiciously, "is the patient with dissection hematoma spreading?"


    Chen Cang nodded!


    "Yes, I just clearly felt the peripheral signs such as widening pulse pressure and edema pulse on the radial side of the patient. Moreover, the heart sound also showed that there was a sudden diastolic murmur with systolic murmur in the auscultation area of aortic valve!"


    "This shows that the patient has no rupture of blood vessels, and the reason for pericardial tamponade is that the aortic valve displacement, prolapse and valve ring expansion caused by aortic root dissection hematoma. After intimal rupture, it protrudes into the lumen in a valve shape, causing blood flow vortex."


    "Moreover, the patient''s ascending aortic dissection does have blood exudation, resulting in this manifestation of cardiac tamponade."


    Hearing Chen Cang''s words, the surroundings became quiet!


    At this moment, it seems that the explanation makes sense!