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¡¾1536¡¿Doctors should consider all aspects when making decisions

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    The pericardium is a membranous sac, divided into fibrous layer and serous layer, and the serous layer is divided into visceral layer and parietal layer.  The visceral layer covers the surface of the heart, the parietal layer is attached to the fibrous layer, and there is a cavity in the middle called the pericardial cavity.  Under normal circumstances, the wall layer is very smooth, but now the pericardial rub sounds indicate inflammation.  Inflammation produces exudate that flows into the pericardial cavity, and the resulting fluid is called pericardial effusion.

    When the pericardial effusion increases to a certain amount, the visceral layer and the parietal layer are separated, and the friction between them disappears, the pericardial friction sound will disappear.  This is why clinical cases of large amounts of effusion with pericardial rub sound are rare and special, and this old lady should not be the case.  After auscultation, the patient's first heart sound and second heart sound were not far away.

    We are lucky that there is no large amount of effusion and the condition has not reached the level of cardiac tamponade.

    Xie Wanying put down the stethoscope and asked the patient about the location and characteristics of the pain in her chest: "Does it hurt like a knife cutting, or does it hurt like being hit by a sandbag?"

    The old lady said: "It felt like being hit in the chest by something heavy."

    It¡¯s a dull pain. Although myocardial infarction is also a dull pain, this pain may come from the pressure pain caused by pericardial effusion.  Xie Wanying analyzed and calculated in her brain based on the examination data she had obtained at this stage, and believed that the possibility of myocardial infarction in the patient was small.  The main problem is still a bit of acute heart failure.

    The flight attendant brought the oxygen mask and handed it to the nurse.  The nurse puts on the patient's oxygen mask.  The flight attendant took this time to coo in Xie Wanying's ear.

    "The captain asked, does it need to make an emergency landing to a nearby airport? If necessary, please tell us immediately. We will contact the nearby airport for landing, which also requires coordination from the airport."

    The plane does not land immediately if it wants to land.  Even a temporary emergency landing must be coordinated with the airport first. If a plane crash occurs, the aircraft will be destroyed and people will be killed.

    "How long will it take to continue flying from the Capital Airport?" Xie Wanying asked.

    "About an hour." the flight attendant replied.

    So the plane is almost over the capital.  The medical conditions in places around the capital are incomparable to those in the capital.  What¡¯s even more frightening is that everyone in the surrounding area knows that doctors from the capital often go to the capital for medical treatment. As a result, the medical technology in the surrounding areas is far inferior to that of local hospitals far away from the capital.

    "If we find a nearby airport to land temporarily, how long will it take? It will take ten or twenty minutes, right?" Xie Wanying asked again.

    "Yes." The flight attendant was mentally surprised by her quick calculation ability, as if she was more than just a doctor.

    Laymen just don¡¯t know it. Doctors often have to do calculations, whether they are physicians or surgeons.  What kind of?  The math is much older.  Making daily ward rounds, prescribing medical orders and calculating patient drug dosages are the basic skills of a clinician.  This alone involves calculation. Doctors should try their best to calculate the specific dosage of medication before the patient's changing condition. The more accurate the calculation, the better.

    Emergency physicians at the scene also need to estimate the best transportation option for the patient.

    "Can this patient's condition wait? Can he wait until he lands safely at the Capital Airport in an hour before being sent to the hospital?"  If possible, both patients and their families would definitely choose major hospitals in the capital for treatment.

    Xie Wanying needs to consider this for this patient because this patient is not a common heart disease, but a relatively rare type of hypothyroidism here.  (Remember the website address: www.hlnovel.com
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