Chapter 126: After discussion, the seniors decided to do 1
Doctor Lin’s head was spinning as he snatched the medical record from the nurse’s hands, resenting aloud, “You never mentioned it!”
“Didn’t Doctor Zhang tell you during the handover, Doctor Lin? We asked her earlier if this patient had any relatives, and she said she would inquire, but she never updated us on the situation,” the nurse replied, refusing to take the blame.
Zhu Huicang pushed his glasses up and, upon recognizing Xie Wanying’s features, recalled their meeting over three years ago: Was she the girl Cao Yong saw that looked completely dispirited?
“Is she now studying at our hospital?” Zhu Huicang asked his old classmate Ren Chongda.
“She has come for an internship in the Neurosurgery Department; isn’t she following Huang Zhilei?” said Ren Chongda.
“Oh,” Zhu Huicang thought to himself, wondering if someone was overjoyed because the junior sister was coming to intern in their department.
Meanwhile, Doctor Lin was flipping through Father Liu’s previously conducted ECG: “This, this—”
Zhu Huicang quickly leaned in to take a look and then glanced at Doctor Lin, “Your patient?”
“No, not me!” Doctor Lin denied vehemently, using all his strength, “She didn’t tell me there was a change in his ECG, she said the ECG looked fine and the blood tests for myocardial infarction were normal.”
With such a serious issue at hand, this was a blame he could not bear!
“You call this ‘no issue’? Isn’t the ST segment depressed?” Zhu Huicang pointed out the problem immediately, “Isn’t this a typical sign of myocardial ischemia?”
Of course, Doctor Lin had seen it too, which is why he was desperately denying it: “Yes, yes, yes, it’s myocardial ischemia.”
“Not just myocardial ischemia, right? The patient’s chief complaint was chest pain that had vaguely started in the morning and had been painful for several hours before being admitted. It’s definitely ACS. With ACS, we must be vigilant. He should be on cardiac monitoring for at least eight hours. How long has it been since he was admitted to our emergency department?” Zhu Huicang asked, looking at his watch to calculate the time.
ACS stands for acute coronary syndrome.
First of all, normal cardiac enzyme tests do not mean that there is no myocardial infarction.
The standard diagnosis for a myocardial infarction is not just based on cardiac enzyme tests. It’s confirmed when two out of the three indicators match—either the ECG, the cardiac enzymes, or clinical symptoms.
Secondly, the ECG can also present with pseudonormal patterns.
For instance, some myocardial infarction patients might undergo an ECG during the very acute phase. At this time, the patient is in the acute injury phase of ST-T abnormalities, before the full development phase, and the ECG may temporarily return to normal. Needless to say, this kind of normality is pseudo-normal.
Therefore, ECGs conducted during this period can easily lead to a misdiagnosis by the doctor, and Father Liu might well be such a case.
Experienced hospitals certainly provide guidance and requirements for clinical doctors in the diagnosis and treatment of myocardial infarctions.
For example, at Guoxie, the protocol is that if the initial ECG appears largely normal but the patient complains about symptoms not normal and suspects ACS, as Zhu Huicang has mentioned, cardiac monitoring for over eight hours is required.
Eight hours of ECG monitoring does not mean doctors can ignore the patient once the machine is connected. Such monitoring would be meaningless. Doctors need to check back from time to time to see if there are any developments or changes in the patient’s ECG. Such subtle changes in a patient’s condition require a doctor’s vigilance and responsibility for them to be detected. If it’s a doctor with a strong sense of responsibility, they might even perform another ECG for the patient periodically. As Xie Wanying initially argued with Doctor Jiang, the ECG monitoring uses simulated leads which are not up to the standards of an ECG machine.