95: Chapter 95 850 ml of pericardial effusion!
9:50.
A commotion erupted at the entrance of the Emergency Department.
Lu Chen walked to the entrance of the Red Zone and took a look.
Good grief.
A massive crowd of people had swarmed into the hallway.
At the front was an emergency gurney, on which lay a Middle-aged man. His face was ashen, his lips were purple, and his breathing was rapid; he was clearly in great distress.
At least fifteen or sixteen people followed behind the gurney.
A woman in her forties walked at the very front. She was dressed in designer clothes, and her hair was styled meticulously, but her expression had completely crumbled, and her eyes were red.
Behind her were several Middle-aged Men in suits, likely people from his company or friends.
Further back were several young people carrying various bags, though it was unclear what they contained.
The most exaggerated part was that among this group were two people in white coats; judging by their attire, they were likely doctors from a private clinic or private Hospital who had tagged along.
Zhao Yaqin, standing next to Lu Chen, watched this scene and whispered.
"See that? What did I tell you?"
Director Li Sen had already walked out of his office and was standing at the entrance of the Red Zone.
His expression was calm, and his tone was steady but carried an unquestionable weight.
"Who is the family member?"
The woman in designer clothes immediately rushed forward.
"I am! I am his wife!"
"Director Li, I beg you, please save my husband."
"He hasn't been able to catch his breath since this morning, and his complexion has been getting worse and worse. Our family doctor said it might be some kind of pericardial effusion!"
Her voice was trembling as she spoke.
The crowd behind her surged forward as well.
"Director Li, please, you must save Old Zhou!"
"Director, money is no object. Whatever medicine or equipment you need, we will pay for it!"
"Does he need to be transferred? Should we contact the provincial Hospital?"
Everyone was talking at once.
Director Li Sen raised a hand.
"Quiet first."
Everyone's voices stopped instantly.
This was the aura of a veteran director who had worked in the Emergency Department for over twenty years.
"The patient will enter the Resuscitation Room first. I need to perform a comprehensive examination and assessment. Before I provide a definitive conclusion, all family members must wait in the waiting area outside. Only one person may come in to sign."
The woman nodded repeatedly.
"Okay, okay, okay, I'll go in, I'll sign."
"As for the rest of you, don't block the hallway; it affects the passage of other patients."
The people behind looked at each other, and eventually, they slowly dispersed.
But the two private doctors who had followed didn't move.
One of them, in his early forties and wearing glasses, took the initiative to step forward.
"Director Li, hello. I am the specially appointed health doctor for Desheng Group."
"My surname is Fang. On the way here, I already performed a preliminary examination on President Zhou."
"His heart rate is fast, blood pressure is low, and jugular vein distension is obvious. I highly suspect acute cardiac tamponade."
Director Li Sen glanced at him.
"Did you perform an ultrasound?"
"Conditions in the car were limited, so I didn't."
"You made a judgment of cardiac tamponade without an ultrasound?"
Dr. Fang was choked up.
"I made a comprehensive judgment based on his physical signs..."
"Physical signs can indicate a direction, but they cannot replace imaging evidence. I shouldn't need to teach you that, right?"
Dr. Fang's face flushed slightly.
"Yes, Director Li is right."
"All right, wait outside. I will notify you once I've finished the examination."
Dr. Fang opened his mouth, but ultimately didn't say anything else and retreated to the back.
The gurney was pushed into the Red Zone Resuscitation Room.
Lu Chen and Shen Xiaoning were already waiting inside.
The moment the patient was transferred to the resuscitation bed, Lu Chen's gaze landed on him.
[Eye of Truth] automatically activated.
That familiar holographic projection unfolded in his field of vision.
The patient's heart area was flashing with a blinding red light.
[Eye of Truth scan complete]
[Patient Information: Male, 52 years old]
[Chief Complaint: Chest tightness and shortness of breath for three days, worsened for half a day]
[Eye of Truth Diagnosis: Massive pericardial effusion (approx. 850ml), acute cardiac tamponade (progressive stage), pericardial fluid is partially loculated, string-like adhesion bands exist between the left pericardial parietal and visceral layers, right ventricular diastolic function is severely limited]
[Risk Level: S-Class (Extremely High Risk)]
[Current Symptoms: Orthopnea, jugular vein distension, heart rate 126 bpm, blood pressure 82/55 mmHg, oxygen saturation 91%, pulsus paradoxus positive]
[Recommendation: Perform ultrasound-guided Pericardiocentesis immediately. Note the presence of loculated adhesions within the pericardial cavity; the conventional subxiphoid approach may not achieve complete drainage. Need to select the optimal Puncture window based on real-time ultrasound localization.]
[Warning: Adhesion bands within the pericardial cavity are distributed irregularly. Improper selection of the Puncture path may lead to myocardial injury or Puncture failure. It is recommended to use multi-angle ultrasound exploration to identify a non-adherent channel before performing the Puncture.]
Lu Chen's pupils contracted slightly.
S-Class.
850 milliliters of pericardial effusion.
And there were adhesions in the pericardial cavity.
This meant that the effusion was not evenly distributed; there was more in some places and less in others, and the adhesion bands had separated the effusion into several compartments.
The conventional subxiphoid Puncture path might not be successful in one go.
The difficulty of this patient was much higher than he had anticipated.
But he did not speak.
Director Li Sen was currently standing in front of the Hospital bed, quickly performing a physical examination.
Jugular vein distension, distant heart sounds, hypotension, rapid heart rate.
The standard cardiac tamponade triad.
"Is the ECG monitor hooked up?" Director Li Sen asked.
"It is." Shen Xiaoning's voice was crisp and efficient.
The numbers on the monitor jumped out.
Heart rate 126, blood pressure 82/55, oxygen saturation 91%.
Director Li Sen frowned.
"Blood pressure is low, heart rate is compensatorily increased, and oxygen saturation doesn't look good. Give him oxygen via mask first, 6 liters."
"Okay."
Shen Xiaoning quickly adjusted the oxygen flow and placed the mask on the patient's face.
Lu Chen had already pushed the portable ultrasound device to the bedside.
"Director Li, the ultrasound is ready."
"You perform the examination, I'll watch the screen."
Lu Chen picked up the ultrasound probe and placed it on the left sternal border of the patient.
He adjusted the angle and depth of the probe.
The image on the screen became clear instantly.
Even without the Eye of Truth, it could be seen very clearly on the ultrasound screen.
There was a large anechoic area around the heart.
That was the effusion.
A massive amount of effusion.
The heart was being compressed by the fluid to the point where it could barely expand normally, and the right ventricular wall showed obvious collapse during every diastole.
"The amount is not small." Director Li Sen looked at the screen, his expression turning serious.
"Conservatively estimated at over eight hundred," Lu Chen said.
"How did you judge that?"
"The maximum diameter of the anechoic area exceeds two centimeters, surrounding the entire heart, and the anechoic area at the posterior wall is deeper."
Director Li Sen glanced at him, said nothing, but there was a hint of surprise in his eyes.
This judgment required considerable experience in reading ultrasound images.
"Switch to the subxiphoid view and take a look."
Lu Chen moved the probe to below the xiphoid process.
The image switched.
The subxiphoid four-chamber view appeared.
There was indeed a lot of effusion, but Lu Chen noticed a detail.
In the front of the pericardial cavity, there were several fine, strong echo lines.
Those were adhesion bands.
He had already seen this information in the Eye of Truth diagnosis, and now the ultrasound image confirmed it.
"Director Li, there are adhesions in this subxiphoid area."
Director Li Sen leaned closer to the screen.
"Are you referring to these few strong echoes?"
"Yes, these are string-like adhesions between the pericardial parietal and visceral layers. If we insert the needle from the subxiphoid area, we might encounter these adhesion bands along the Puncture path."
Director Li Sen's brow furrowed even deeper.
The difficulty of a Pericardiocentesis with adhesions would rise sharply.
Once the needle tip touches an adhesion band, it might change the direction of the needle, leading to myocardial perforation.
"Explore other views again to see if there is a better Puncture window."
"Okay."