69novels Page 388
Page 388
Shortly after Moriyama left, Dr. Yoshida was also called away, along with a resident physician.
In less than ten minutes, only Aki Tomoya remained in the department.
Just as Aki Tomoya was thinking about having to stay home to guard the house, the phone in the department suddenly rang. It was an emergency call from the cardiac surgery department, asking the on-call person to come over.
After receiving the message, Aki Tomoya took out the hospital's internal communication phone and contacted Dr. Yoshida to inform him of the situation. Then, he rushed out alone, took the elevator to the emergency room, and checked on the situation.
"I am An Yi from the Department of Cardiac Surgery. Where is the patient?"
As Aki Tomoya entered the emergency room, he immediately noticed a boy who looked about five years old, and two adults who looked anxious.
He knew the little boy; he had been a patient in their cardiac surgery department and had undergone a catheterization procedure performed by their supervising physician, Xiangyuan.
Before coming, after receiving a message from the emergency room, Aki Tomo brought the boy's medical records with him.
"The previous VSD..."
Aki Tomoya murmured as he walked up to the boy. As he took out his medical record, he noticed that the boy's left trouser leg was rolled up and his lower limb was swollen.
The boy had previously undergone a transcatheter interventional closure procedure in the cardiac surgery department for a congenital ventricular septal defect.
After the surgery, observations at the time showed that the occluder was in good position with no residual shunt, and the patient was discharged after recovery.
However, it seems a new problem has arisen: if something goes wrong with the surgery, then someone will be in trouble.
"She was discharged from the hospital just two days ago..."
Aki Tomoya murmured to himself, then asked for details.
According to the boy's parents, he was discharged from the hospital two days ago, and his left lower limb started to hurt that evening. By tonight, it was swollen, he couldn't straighten it, and he was unable to walk.
"Pain in the left lower limb, unable to straighten...significant swelling, normal arterial pulse...no significant difference in skin temperature, and no significant change in color..."
After a preliminary examination, Aki Tomoya pulled up the boy's clothes to check the location of the puncture point.
"There was no redness or pus at the puncture site..."
There was nothing wrong with the surgical site. Aki Tomoya narrowed his eyes and then had the nurse carry the boy to get checked out.
"Blood clotting and platelet counts are both within the normal range..."
Looking at the chest X-ray again, there were no obvious abnormalities.
Next, a cardiac ultrasound was performed to re-examine the location of the blockage.
"Normal, no residual shunt, and valve activity is normal..."
Aki Tomoya checked each item one by one, and had a general idea in mind. He was just waiting for the final check to confirm his thoughts.
Finally, on a bilateral arteriovenous ultrasound, he discovered an abnormality that was pretty much what he had imagined.
"thrombus?"
Aki Tomoya squeezed his fingers; it was a hypoechoic mass in the left deep femoral vein. The first word that came to his mind was thrombosis.
Just as he came up with a solution, he heard footsteps behind him.
At the same time, Dr. Yoshida, who had finished dealing with the matter, came over.
"How's it going?"
He patted Aki Tomoya on the shoulder and asked a serious question.
"I suspect it's postoperative thrombosis."
"what happened?"
Following that, Aki Tomoya explained the boy's medical records and the catheterization procedure he had previously undergone.
After a series of investigations, Aki Tomoya concluded that he had postoperative thrombosis.
Chapter 435 Quite Capable
"This is Dr. Sagara's patient, who was just discharged from the hospital a couple of days ago."
Sagara is the doctor who is currently supervising Aki Tomoya and the others; they are currently rotating through the pediatric department.
The boy in question was a former patient of Dr. Sagara, and had undergone surgery on him.
However, the surgery was not open-chest surgery, but rather a catheter-based closure procedure.
He was admitted to the hospital on July 10th and discharged on the 14th, but then a sudden situation occurred in the early morning of the 16th.
"This is his previous medical record. During the examination, it was discovered that he had a congenital heart disease, ventricular septal defect."
The medical records all state that there is tricuspid valve tissue attachment in the perimembranous region and right ventricular surface, with diffuse shunt and a more obvious left-to-right shunt at the shunt opening.
"The surgical site has recovered normally. D-dimer is 630g/L, and the four coagulation tests and platelet count are also within the normal range. The chest X-ray is normal, and after a follow-up echocardiogram, the closure position is also very good, with no residual shunt, normal valve activity, and no vegetations around it. The only exception is this small hypoechoic mass, which may be a thrombus formation."
Aki Tomoya recounted the results of his previous examinations and analyses to Yoshida Aoba.
"You're right, it's a blood clot, but this kind of complication is really rare."
Yoshida Aoba nodded, his words confirming that Aki Tomoya's judgment was correct.
"Then can we inject low molecular weight heparin sodium first? And also take oral aspirin effervescent tablets?"
After the surgery, Dr. Sagara gave similar instructions: inject low molecular weight heparin sodium twice a day, 24 hours after the operation, with a 12-hour interval, and take oral aspirin effervescent tablets to prevent thrombosis.
However, what was unexpected was that two days after the patient returned home, a blood clot still formed in the vein.
The reason why the little boy's lower limbs were swollen, he was unable to walk, and was in pain was also because of that blood clot.
"Quite capable."
Yoshida Aoba didn't object or add anything; he felt the response was sufficient. After the injection of heparin sodium and the administration of aspirin effervescent tablets, the boy was hospitalized for further observation.
After arranging a bed and taking care of her, we still couldn't let our guard down. In one night, Aki Tomo went to check on her no less than ten times.
"Aki-kun, is things going well for you?"
After spending quite some time explaining the illness to the boy's parents and arranging matters for the current key personnel, Aki Tomoya followed Yoshida Aoba back to the department.
"You've been working on it for quite a while now, is everything alright?"
As soon as Aki Tomo sat down, he heard Nishikino's question next to him.
He checked the time and realized that he had been gone for quite a while.
"Well, there shouldn't be any major problems for now. He's Dr. Sagara's patient from before, the boy who had the VSD catheter intervention surgery, do you remember him?"
Aki Tomoya couldn't say he was 100% sure.
Although Yoshida Aoba said it was fine, he still considered many possibilities.
"What happened to Dr. Sagara's patient?"
"I was discharged from the hospital two days after the surgery and developed a blood clot. I am now hospitalized. I need to report to Dr. Sagara when he arrives at the hospital this morning."
It was obvious that Nishikino still remembered that little boy.
They also studied previous VSD catheter intervention surgeries in the observation room next door.
"He was perfectly fine when he was discharged from the hospital, but now he has developed a blood clot?"
"Yes, when I saw him, I was shocked. I thought something had gone wrong with the surgery."
At that moment, Aki Tomoya couldn't help but sigh.
He was genuinely frightened when he saw the little boy.
If something goes wrong during the surgery, then things could get really serious in their department.
"In An Yi's opinion, it's not because of the surgery?"
"Well... it can't be said that there was no factor at all, but in terms of this ventricular septal defect closure surgery, it was successful. The follow-up examination showed that the closure position was correct, but complications still occurred."
It's impossible to say that it's completely unrelated to the surgery.
"Dr. Sagara performed a femoral vein puncture, and the thrombus was found in the deep femoral vein of the left lower limb. It could be due to endothelial damage at the puncture site, or it could be due to the patient's fasting before the surgery, resulting in blood concentration and a hypercoagulable state, as well as slow blood flow. Even if no problems occur in the hospital, we cannot completely guarantee that there will be no problems after discharge..."
Aki Tomoya shrugged as he spoke.
He had thought about the possible causes of thrombosis and thought it might be a good idea to discuss it with Nishikino.
Before and after discharge, doctors cannot guarantee that patients will be completely fine after leaving the hospital; it's hard to say, there are too many uncertainties.
"Dr. Sagara also gave postoperative instructions, such as injecting low molecular weight heparin sodium and taking oral aspirin, which can prevent platelet aggregation. However, the boy still developed deep vein thrombosis in the femoral vein two days after being discharged from the hospital. I guess Dr. Sagara will be very helpless when he finds out about this during the day."
This was something no one expected.
During the surgery, heparin was injected for anticoagulation, and afterwards, low molecular weight heparin sodium was injected and oral aspirin effervescent tablets were taken to prevent thrombosis.
This is why Yoshida Aoba previously said it was uncommon.
But the good news is that a blood clot still developed, so it really feels like it's impossible to prevent.
There's really nothing in this world that you can be completely certain of, especially in medicine, which is full of uncertainties.
While rigor is important, there are also countless unstable factors involved.
"Luckily it didn't fall off, otherwise it would have been a huge problem..."
Aki Tomoya smacked his lips as he spoke.
Thrombosis is uncommon with femoral vein puncture catheter intervention, but if it does form and detaches, the thrombus can travel with the bloodstream and cause a blockage.