Chapter 481: Chapter 277: Shining at Yanjing University People’s Hospital (Part 2)

"The in-transit physical exam showed the patient’s blood pressure peaked at 160/110 mmHg. She hasn’t been taking her medication regularly, so her blood pressure control is unknown..."

"The family also stated the patient has a six-year history of hepatitis B and a three-year history of hypertension..."

While Zhang Yuanyuan was briefing them on the patient’s condition, they had already started drawing blood for a CBC and amylase test.

As the doctors were discussing the case, the patient’s condition suddenly worsened. She fainted and lost consciousness.

Zhang Yuanyuan rushed forward and called out to her, but there was no response.

The patient’s daughter began to cry out from the side.

"Doctor, doctor, what’s happening to my mom? Please, you have to save her."

The daughter was frantic and heartbroken.

Zhang Yuanyuan and Jiang Ming immediately began emergency treatment, starting an IV line, administering oxygen, suctioning phlegm, and hooking her up to an ECG monitor...

"Continue chest compressions..."

While Zhang Yuanyuan was in the trauma bay assisting with CPR and other emergency measures, Director Chen, the head of the Emergency Department, arrived.

Director Sun from the Gastroenterology Department also came for the consultation.

Jiang Ming joined the consultation, bringing Wu Ting with him.

By the time the consultation began, the patient’s physical exam results were already dire:

Blood pressure: 60/30; pulse: 30 beats/min; respirations: 4 breaths/min; cyanotic lips...

At the same time, the patient’s ECG results were delivered.

Director Chen picked them up and read them. The ECG showed:

"Sinus rhythm, ST-T segment changes, cardiac enzyme panel: no abnormalities noted..."

Based on the patient’s current exam findings and past medical history, the two directors’ preliminary diagnoses were:

1. Caused by chronic gastritis.

2. Caused by hypertensive disease.

Director Sun from Gastroenterology analyzed the case carefully, but he couldn’t find a gastrointestinal cause for such a critical situation.

’Sustained hypertension, retrosternal discomfort, gastrointestinal reactions...’

Director Chen looked again at the patient’s condition, still uncertain.

"Jiang Ming, go get your Director Liu. See if this could be a myocardial infarction..."

Jiang Ming immediately went to find him.

A short while later, Director Liu rushed into the consultation room.

Meanwhile, in the trauma bay, the patient’s condition had still not improved.

Director Chen had no choice but to first administer the "cardiac triad"—atropine, lidocaine, and epinephrine... At the same time, he informed the family and issued a critical condition notice.

If they couldn’t find the specific cause of her illness soon, the patient would most likely die right there.

Outside the trauma bay, upon receiving the critical condition notice, the patient’s family member almost lost her footing. She squatted on the floor, leaning against the wall, tears streaming down her face.

She never expected her mother’s condition to turn so suddenly. This kind of abdominal pain had happened often before, and it would usually pass after taking some stomach medicine. She hadn’t paid it much mind.

She was always busy with work and kept thinking she’d take her mother for a proper check-up when she had time. Who knew that before she got the chance, her mother would suddenly collapse?

「Inside the consultation room.」

Director Liu, the head of the Emergency Cardiology Group, looked at the patient’s atypical clinical signs and symptoms, feeling indecisive.

’There are two possibilities right now. One is that the patient is having a myocardial infarction, which would require antiplatelet drugs to inhibit platelet and coagulation factor activity and prevent thrombosis...’

’The other possibility is a pulmonary embolism...’

’But these two different conditions require completely different treatment plans.’

As silence fell over the consultation room, with no clear answer in sight...

A new voice spoke up: "Could it be an acute aortic dissection aneurysm?!"

The so-called dissecting aortic aneurysm occurs when there is a small tear in the intima and media of the aorta.

When blood flows from a tear in the aortic intima into the aortic media, it separates the layers of the media. This separation then expands along the long axis of the aorta, splitting it into two channels. The resulting intramural hematoma compresses the separated layers, causing the outer aortic wall to bulge out and the inner wall to bulge in. This narrows the aortic lumen and forms a dissecting aneurysm!

Acute aortic dissection has a high rate of misdiagnosis and mortality.

If not treated in time, the mortality rate is extremely high.

Hearing Wu Ting’s words, the directors looked at this unfamiliar young man with some surprise.

"This is my colleague from Fan City, Wu Ting."

Jiang Ming gave a brief introduction. The situation was too urgent to go into detail about Wu Ting’s diagnostic abilities. Besides, Wu Ting was so young that the directors probably wouldn’t have been convinced anyway.

So, Jiang Ming cut straight to asking for the basis of the diagnosis, letting the facts speak for themselves.

"Wu Ting, what’s your reasoning?"

"Aortic dissection causes intense pain. When blood enters the layers of the vessel wall, it causes a sharp, tearing pain in the patient’s chest and back... But this patient clearly doesn’t have such typical clinical signs and symptoms. She was admitted for gastrointestinal issues..."

Jiang Ming voiced his doubt, which was also the reason the other directors hadn’t considered an aortic dissection.

Among the many dangerous conditions seen in the ER, aortic dissection was undoubtedly one that made emergency physicians feel like they were walking on thin ice.

The disease has an extremely high mortality rate, and its symptoms are highly similar to those of myocardial infarction, pulmonary embolism, and other conditions, making it very deceptive.

If it really was an aortic dissection and it was misdiagnosed as a myocardial infarction, treating it with dual antiplatelet therapy would have unimaginable consequences. It would cause the already dangerous condition to progress even faster, accelerating death!

At this moment, Directors Liu, Sun, and Chen didn’t dare to rashly dismiss Wu Ting’s suggestion, even though the doctor looked very young and was a complete stranger.

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