109: Chapter 109 Chen Minghao's Unobjective Evaluation
When the group entered the Conference Room, quite a few people from Jiangcheng City Central Hospital were already seated.
Director Li Sen, Zhao Yaqin, Wu Fan, and Sun Ji from the Emergency Department were all there.
He Wenbin from the Cardiology Department had also arrived, along with two doctors sent by the director of the Cardiology Department.
People from the General Surgery Department, Department of Thoracic Surgery, and Ultrasound Department had also come.
President Zeng Dayang sat in the front row, and Vice President Peng Zhao sat on the other side, with two seats between them; the atmosphere was very characteristic of the Hospital.
Lu Chen sat in the back row of the Emergency Department, his white coat clean, his ID badge hanging on his chest, his expression calm.
Shen Xiaoning originally didn't have the qualifications to attend such a meeting, but today the Red Zone happened to need a Nurse to assist in preparing the consultation equipment.
She followed Meng Yan inside to help with recording and logistics, secretly standing by the wall, her eyes drifting toward Lu Chen from time to time.
Sun Ji whispered to Lu Chen, "He's here, he's here, that's Associate Chief Physician Chen Minghao."
Lu Chen took a glance.
"Hmm."
"Aren't you going to evaluate him?"
"He looks like he doesn't sleep well."
Sun Ji almost laughed out loud.
"Your angle of evaluation is very Emergency Department."
Zhao Yaqin turned her head and glared at them.
"Shut up."
Sun Ji sat up straight immediately.
After the meeting began, Section Chief He Zhongfeng gave the opening remarks.
"Distinguished experts and colleagues, today is the quarterly difficult case exchange meeting between our Jiangcheng City Central Hospital and the Provincial Peoples Hospital."
"This exchange will focus on the diagnosis and treatment of acute and critical illnesses, the management of cardiovascular emergencies, and ultrasound-guided Puncture techniques."
"I hope everyone will speak freely, learn from each other, and improve together."
Applause erupted.
President Zeng Dayang gave a brief speech.
"The Provincial Peoples Hospital has always been a benchmark for us to learn from. We are very pleased that Director Chen has personally led a team here for this exchange."
"I also hope that the young doctors in our Hospital will cherish this opportunity to listen, ask, and learn more."
Vice President Peng Zhao also spoke.
"Medical progress cannot exist without questioning, nor without standardization."
"Especially on the front lines of the Emergency Department, speed is important, but safety is even more so."
"We are discussing cases today not to praise or negate anyone, but to make our processes more standardized."
As soon as these words were spoken, many people from the Emergency Department understood what was meant.
Sun Ji muttered in a low voice.
"Here it comes, laying the groundwork first."
Lu Chen said nothing.
Associate Chief Physician Chen Minghao then gave a short report on risk control for ultrasound-guided Pericardiocentesis.
His level was indeed not bad.
From Puncture approach, positioning, distribution of pericardial effusion, needle angle, and complication prevention, to post-operative monitoring, he explained everything very clearly.
Many doctors in the Conference Room listened attentively.
Lu Chen also listened attentively.
He would not deny the other party's professional ability just because Associate Chief Physician Chen Minghao had questioned him online.
Someone who could become an Associate Chief Physician in the Cardiology Department of the Provincial Peoples Hospital was certainly no ordinary person.
After the report, the applause was even warmer than before.
Section Chief He Zhongfeng immediately said, "Director Chen's presentation was excellent, especially regarding standardized operations and risk awareness, which is very inspiring for our young doctors. Next, we will enter the typical case discussion session."
The big screen switched.
The case data for Zhou Desheng appeared on the screen.
[Patient, male, 52 years old, admitted with sudden chest tightness and shortness of breath accompanied by hypotension. Emergency ultrasound indicated massive pericardial effusion, considering acute cardiac tamponade.]
[After initial Puncture and drainage of the main cavity, vital signs improved briefly, then deteriorated again. Re-examination indicated rapid expansion of the left septated cavity, compressing the left ventricle.]
[Emergency ultrasound-guided apical Puncture and drainage performed. Post-operative vital signs stable.]
Section Chief He Zhongfeng looked at Director Li Sen.
"Director Li, this case was rescued under the leadership of your Emergency Department. Why don't we ask the operator to introduce the situation at that time first?"
Director Li Sen did not speak immediately, but looked at Lu Chen.
"Lu Chen, you tell them."
Lu Chen stood up and walked to the front.
The Conference Room suddenly became much quieter.
Associate Chief Physician Chen Minghao looked up at him.
This was his first time seeing Lu Chen offline.
He was younger than in the videos.
And calmer than he had imagined.
Lu Chen stood beside the screen, his voice not loud, but every word was very clear.
"When the patient was admitted, they were confused, had low blood pressure, jugular vein distension, and muffled heart sounds."
"Emergency bedside ultrasound indicated massive pericardial effusion, consistent with the presentation of acute cardiac tamponade."
"At that time, Director Li first performed Puncture and drainage of the main cavity. After extracting dark red fluid, blood pressure briefly recovered."
He switched to the next slide.
"Subsequently, the patient's blood pressure dropped again, heart rate increased, and blood oxygen levels dropped."
"Re-scanning revealed that the left septated cavity had expanded. After the pressure in the main cavity was relieved, the pressure in the septated cavity relatively increased, causing continuous compression on the left ventricle."
"This was also the core reason for the patient's deterioration again."
He Wenbin couldn't help but nod.
Because he was on the scene at the time, and what Lu Chen said completely matched what happened.
Lu Chen continued.
"Because the location of the septated cavity was close to the cardiac apex, the conventional subxiphoid approach could not effectively enter the target cavity, and the left parasternal approach was blocked by lung tissue, carrying a higher risk."
"Therefore, I chose the apical approach, completing the Puncture during a brief pause at the end of expiration."
"Avoiding the myocardium, lung tissue, and adhesion bands, after finally extracting the fluid, the patient's blood pressure recovered."
After he finished speaking, there was a brief silence in the Conference Room.
Director Li Sen nodded.
"The process is clear."
Section Chief He Zhongfeng looked at Associate Chief Physician Chen Minghao and said with a smile, "Director Chen, you are an expert in this field, why don't you provide some comments?"
Associate Chief Physician Chen Minghao picked up the microphone.
Everyone's eyes turned to him.
Shen Xiaoning quietly clenched her hands by the wall.
Associate Chief Physician Chen Minghao looked at the screen, his tone very steady.
"This case is indeed worthy of discussion. Judging from the results, the patient was saved; this is a fact, and I do not deny it."
Sun Ji whispered, "Oh, quite objective."
In the next second, Associate Chief Physician Chen Minghao continued, "But medicine cannot just look at results, especially with Puncture operations; succeeding once does not mean the process is completely reasonable."
Sun Ji's mouth twitched.
"I take back what I just said."
Associate Chief Physician Chen Minghao ignored the movement below.
"From the data, the patient was already experiencing circulatory instability at the time, the position of the septated cavity was special, and the risk of apical Puncture was extremely high."
"In this situation, I personally believe that priority should have been given to requesting a joint evaluation by the Cardiology Department or the Department of Thoracic Surgery, rather than having a young Resident Physician perform it directly."
Director Li Sen picked up the microphone.
"At that time, the patient's vital signs were continuously declining; there was no time to wait for a multi-department consultation."
Associate Chief Physician Chen Minghao nodded.
"I understand the urgency of the Emergency Department scenario, but the more urgent it is, the more emphasis must be placed on standardization; otherwise, it is easy to set a bad example."
Zhao Yaqin frowned.
Wu Fan's expression was also not very good.
Associate Chief Physician Chen Minghao looked at Lu Chen.
"Dr. Lu, I would like to ask, when you chose the apical approach, what was the closest distance from the needle tip to the left ventricular free wall?"
Lu Chen answered.
"According to dynamic ultrasound measurement, the closest distance was about 6 millimeters, and during the window period at the end of expiration, it could expand to about 8 millimeters."
Associate Chief Physician Chen Minghao continued to ask.
"How did you confirm that the Puncture needle did not scrape the myocardial surface?"
"The needle tip was within the ultrasound plane throughout the entire process. After entering the cavity and extracting fluid, the patient's ECG monitoring showed no new onset of ventricular arrhythmia."
"If ventricular fibrillation occurred, what was your contingency plan?"
"Immediately stop the operation, withdraw the needle to a safe position, defibrillate on-site, and have epinephrine and amiodarone on standby."
Associate Chief Physician Chen Minghao nodded.
"The answer is very complete."
Shen Xiaoning just let out a sigh of relief.
Associate Chief Physician Chen Minghao added, "But I still believe that this kind of operation is not suitable as a promotional case for young doctors, and even less suitable to be amplified by the internet."