I Can See Health

  Chapter 210 Removing the Ventilator

   This is too fast, right? !

  Fan Zhiping is now a black question mark face.

  Although Lu Chen's nickname is "Professor Lu", it is also academic.

   As for the clinical operation, Fan Zhiping only knew that Lu Chen would puncture the radial artery.

   But Lu Chen knew about the operation of bronchial intubation, which really calmed Fan Zhiping.

   is not to say how difficult this endotracheal intubation operation is.

   However, the division of labor in medicine is extremely fine now, and doctors in ordinary departments basically do not learn about bronchial intubation.

  Lu Chen is only a first-year graduate student. Not only can he know, but he is so proficient, which is surprising.

  Fan Zhiping took a deep look at Lu Chen.

   How many secrets does he have?

  …

   After Lu Chen was intubated, he connected the breathing bag and began to ventilate the patient at a constant speed.

   At the same time, the nurse also pushed the non-invasive ventilator over.

   With a large amount of oxygen input, the patient's blood oxygen saturation gradually increased from 80% to 90%.

   At this time, Yin Xinhua also returned to the ward.

   When she saw that the patient had been put on bronchial intubation, she was only slightly surprised, but she was not particularly surprised.

  Yin Xinhua's performance was extremely calm, which made Fan Zhiping a little puzzled.

   Is everyone used to Lu Chen's operations?

   That Lu Chen is usually a little too scary.

   "Senior sister, the patient's blood oxygen couldn't be maintained just now, so I had to plug him in first." Lu Chen said.

   "Okay, then you can cancel the consultation in the anesthesiology department." Yin Xinhua said to the nurse beside him.

   The role of the anesthesiology department is intubation.

  Since Lu Chen was intubated, they were useless.

   The nurse nodded and hurriedly called the anesthesiology department to cancel this emergency consultation.

  …

   At present, the patient's heart rate and blood pressure are normal, only consciousness has not recovered.

  All rescues follow a basic principle, and do everything possible to maintain the patient's vital signs, that is, blood pressure, heart rate, breathing, etc.

   In other words, if the patient's vital signs are stable, it means that the patient's condition has improved.

   "Let's observe it for now." Yin Xinhua said, "I talked to the patient's family and wanted them to be transferred to the CCU, but the family refused."

   Such critically ill patients who need a ventilator are generally transferred to CCU for more sophisticated treatment.

   However, due to the cost, many family members cannot afford it.

   "Senior sister, I just reviewed the patient's electrocardiogram, and there was not much change." Lu Chen said in a deep voice, "I think it may not support the diagnosis of myocardial infarction."

  Yin Xinhua heard that, she couldn't make up her mind for a while.

   "Wait for the blood test results."

  According to the patient's current symptoms and auxiliary examinations, myocardial infarction is still the first diagnosis, but it is still necessary to wait for the results of the blood troponin test.

  If troponin is elevated, there is a high probability of myocardial infarction.

  If troponin is not high, then myocardial infarction is ruled out!

   As for other diagnoses, Lu Chen, Yin Xinhua and others had no idea for a while.

  …

  At present, the patient's vital signs are maintained and there is no life-threatening condition for the time being.

  Lu Chen and others went back to the doctor's office.

  Because of the bonus from the "Clinical Thinking Skills Book" in the afternoon, after returning to the office, Lu Chen, who was open, began to sort out the entire disease process of the patient.

  From high blood pressure, headache, and later ventricular fibrillation, is there any clue in it?

  …

   After about ten minutes, the nurse walked into the office.

   "Doctor Yin, the patient is awake."

  Everyone looked happy.

   The patient's consciousness is restored, which means that everything is developing in a good direction.

   However, it is undoubtedly very uncomfortable for patients to perform endotracheal intubation in a clear state.

   "Let's go see him."

  Yin Xinhua brought Lu Chen and Fan Zhiping to the ward.

   The patient is lying on the hospital bed with half-squinted eyes.

   Beside the hospital bed, his son was sitting by the bed with a nervous expression.

   "Master, how are you feeling now?"

   The patient's lips are pale, he can't speak now, he can only blink his eyes to indicate that his condition is ok.

  The nurse took another blood pressure measurement for him.

  The blood pressure monitor shows that the blood pressure is around 130/60mmHg.

   The patient's blood pressure has returned.

  …

   "Doctor, when will my dad be released from the ventilator? I think his condition is stable."

   In the doctor's office, the patient's family asked.

  Yin Xinhua frowned: "Don't be in a hurry, wait first, we will remove the ventilator in time when the patient has an indication to go offline. If it is removed rashly, it may be life-threatening."

   "How long will it take?"

   "About two days." Yin Xinhua thought for a while.

   The patient's family members were relieved when they heard the words.

   "Okay, thank you doctor."

  The patient's family temporarily canceled their plans to withdraw the ventilator, and then left the doctor's office.

   "This son is so ruthless that he wants to take off the ventilator." Fan Zhiping shook his head slightly.

   "He's still the only child." Yin Xinhua sighed, "Sometimes raising a child can't prevent old age."

  …

   After about half an hour.

   The result of the patient's emergency blood test came out!

   "Sister Yin, the patient's troponin is negative!"

  Lu Chen immediately hit the test system and found the test result of myocardial enzyme.

   "Huh? Troponin is negative?" Yin Xinhua was startled.

   Troponin negative, which completely ruled out the possibility of myocardial infarction!

   What else would the diagnosis be?

  Yin Xinhua frowned, she had no clue.

   Fan Zhiping and Lu Chen on the side had no clue.

at this time.

  The nurse on duty ran into the office again.

   "Dr. Yin, the patient's blood pressure is high again. I just measured 198/110mmHg! Both upper limbs are symmetrical."

   Everyone looked at each other when they heard what the nurse said.

   The blood pressure has dropped to 130/70mmHg just now, but now it is 198/110mmHg.

   In less than half an hour, the blood pressure changed rapidly!

   There must be something wrong with this!

   "Use intravenous antihypertensive drugs first to lower blood pressure." Yin Xinhua said.

   "Okay." Lu Chen nodded and began to make a doctor's order.

   After the doctor's order was given, the nurse began to execute it.

  Lu Chen glanced at Yin Xinhua and Fan Zhiping, paused, then hesitated: "Senior sister, Brother Fan, do you think the patient has a pheochromocytoma?"

   The patient's blood pressure fluctuated rapidly in a wide range, and there were accompanying symptoms of headache and chest tightness.

   This has to make people suspect pheochromocytoma!

   When Fan Zhiping and Yin Xinhua heard the diagnosis, they were slightly taken aback.

Pheochromocytoma?

   This disease, simply explained, is that there is a gland above the kidneys in the human body, called the adrenal glands (the glands above the kidneys).

  If this adrenal gland grows a tumor, the tumor may secrete a lot of hormones, including epinephrine, norepinephrine and so on.

  These hormones can stimulate the sympathetic nerves in the human body, such as high blood pressure, fast heart rate, sweating, excitement, restlessness and so on.

   When will such hormones be secreted in large quantities?

   For example, when you hold a stick in your hand and there is a lion in front of you, these hormones will be secreted like crazy.

   These hormones will make you nervous and at the same time more powerful, whether it’s for running or fighting.

  If there are no special circumstances, hormones will be secreted according to the needs of the human body.

   However, if the secretion is completely unregulated by command.

   Instead, it secretes in a random way. For a while, the secretion is concentrated, and when it is exhausted, there is no secretion. The blood pressure will be like a roller coaster, with highs and lows.

   This can also damage the heart, kidneys, etc., especially may lead to arrhythmia.

   "I think 80% of them are. The patient's ventricular fibrillation and cardiac arrest may be caused by the excessive secretion of hormones by the pheochromocytoma!"

  Fan Zhiping is Lu Chen's loyal supporter.

   When Lu Chen said this diagnosis, he consciously matched all the symptoms!

   Yin Xinhua was a little silent, she kept thinking "pheochromocytoma" in her heart.

  This disease is not common in clinic, and it may take a long time to encounter one.

  The symptoms of pheochromocytoma vary widely, but the most common is the paroxysmal increase in blood pressure, which fluctuates greatly!

   To diagnose pheochromocytoma, it is necessary to complete abdominal CT or contrast-enhanced CT.

  …

   And here in Lu Chen, when he finished saying "pheochromocytoma", a prompt popped up on the system panel.

   "Congratulations, the completion of the system upgrade has increased!"

   (end of this chapter)