On March 27, large snowflakes floated in the sky of Deqin County, Diqing Tibetan Autonomous Prefecture, Yunnan Province, which sits at an altitude of 3,400 meters. Chen Taibo, deputy chief physician of the Department of Cardiology, PUMCH, was scheduled to have a meeting to discuss free consultations, teaching of ward rounds and healthcare lectures with the Vice President and other personnel of the Deqin County Hospital. Hardly had he stepped into the conference room when the Vice President got a call and learned that a patient with acute chest pain was brought into the hospital by ambulance. “The case is severe, we would appreciate your guidance,” the Vice President addressed Dr. Chen Taibo eagerly, who rushed to the patient’s bedside without taking the time to put on his white coat.
The patient was a 49-year-old male. The chief complaint of the patient was chest pain for 3.5 hours, and he still had pharyngeal pain symptoms. His heart rate was 55-60 beats/min, and blood pressure 95/65 mmHg. ECG showed complete atrioventricularheart block and straight upsloping elevation of the inferior wall ST segmentsegments elevation in inferior leads; . the chief complaint of the patient was chest pain for 3-4 hours, and he still had pharyngeal pain symptoms. Local medical staff administered morphine analgesia and antiplatelet agents. Having learned all that in haste, Dr. Chen Taibo ordered another 18-lead ECG for the patient, which showed a more pronounced straight upsloping elevation of the inferior wall ST segment-elevation as well as ST-segment elevation in right leads and posterior leads. Dr. Chen Taibo judged that the diagnosis of acute myocardial infarction was unequivocal, and the patient was within the time window for vascular recanalizationreperfusion treatment.
▲Dr. Chen Taibo was giving instructions on emergency aid of the patient with myocardial infarction
However, the Deqin County People’s Hospital was not equipped for coronary intervention and the patient needed to be transferred to a hospital 4 hours away. Dr. Chen immediately administered intravenous thrombolytics to the patient and made preparations for the transfer. While waiting for the infusion of thrombolytics to finish, Dr. Chen took advantage of the time for bedside teaching. Taking the patient as an example, he walked the medical personnel through the diagnosis and treatment process of acute myocardial infarction in primary hospitals, emphasizing “time is myocardium”.; Hhe also shared the ECG details to attend to for diagnosis and summarized the key points of pre-hospital emergency treatment for acute myocardial infarction.
When the thrombolytics infusion was over, the patient’s symptoms were relieved significantly, with the heart block mitigated, the blood pressure rebounding to 120/70mmHg, and the atrioventricular block mitigated and ST-segment elevation loweredresolution. Just then the ambulance and the personnel were already in place for the transfer. Dr. Chen Taibo then informed the medical staff in detail about the identification of possible complications after thrombolysis and the key points for handling the complications. The patient’s family were very grateful to the PUMCH expert providing timely aid: “You saved the day for us!”
▲Group picture of the expert taskforce assembled by the Ministry of Human Resources and Social Security. PUMCH members: Deng Chengyan (third from right in the second row), Chen Taibo (first from right in the second row) and Mao Chenhui (third from left in the second row)
The Ministry of Human Resources and Social Security of China assembled an expert taskforce for the program of cultivating professional and technical talents for ethnic minorities in autonomous prefectures and counties inhabited by the Tibetan people. PUMCH sent three experts to join the expert taskforce, namely Dr. Deng Chengyan, chief physician of the Gynecological Endocrinology and Reproduction Center, Dr. Chen Taibo, deputy chief physician of the Department of Cardiology, and Dr. Mao Chenhui, deputy chief physician of the Department of Neurology. During March 26 and 31, they carried out activities such as free consultation, teaching of ward rounds and healthcare-related lectures in the People’s Hospital of Diqing Tibetan Autonomous Prefecture, the Tibetan Medicine Hospital of Diqing Prefecture and Shangri-La Maternal and Child Health Hospital.
Written by the PUMCH experts in Diqing, Yunnan
Pictures courtesy of the PUMCH experts in Diqing, Yunnan
Edited by Fu Tanpin, Xiao Xiong and Wang Yao
Translated by Liu Haiyan