bookpower Chapter 719
Chapter 719
The next day.
Lin Feng did not wait for the results of the bacterial culture room, so he called first.
Ask what bacteria the pus sent yesterday was cultured to.
The other party replied: "It seems to have seen gram-negative bacilli." "
Lin Feng immediately asked, "How about continuing a little?" Like what bacteria! "
The opposite side paused for a moment, as if thinking.
After a while, he replied: "It's very similar to Klebsiella pneumoniae." "
"Okay, thanks!" Immediately, Lin Feng hung up the phone.
This answer made him very satisfied.
The truth has finally come out!
This will recall that the patient had diabetes at the beginning, but he did not go to the physical examination or see a doctor, and he never found it, so the glycated hemoglobin was very high and the blood sugar was also high.
Under this premise, the patient's immunity must have declined, resulting in a weakening of the ability to resist bacteria.
At that time, bacteria in the intestine (Klebsiella pneumoniae) take advantage of the deficiency and reverse flow into the biliary tract or liver, causing infection and liver abscess.
The bacteria then enter the bloodstream and spread to the lungs, causing a lung abscess.
This causes the patient to have symptoms of serious infections such as fever, fast heart rate, and rapid breathing.
It is also because of this infection that induces diabetic ketoacidosis, the two diseases are intertwined, affect each other, if the liver abscess is not controlled, it is difficult to control diabetic ketoacidosis.
After the results of the cultivation came out.
The treatment of patients has also become more precise.
After direct use of strong antibiotics, insulin, large rehydration fluid expansion and other comprehensive treatment, the patient also survived.
After 5 days, he was released from the ventilator and the patient woke up smoothly.
After 7 days, the patient was transferred out of the ICU and admitted to the general ward for continued treatment.
By this time, vital signs have stabilized and the infection has been controlled.
The patient's children saw that their mother was completely out of danger, and they shed tears with excitement, and their throats trembled to thank Lin Feng.
Afterwards, Lin Feng returned to the consultation room.
The ass is not yet hot.
He was called to the rescue room again.
The patient is now lying on the hospital bed.
As soon as he walked to the ward, the doctor immediately said to Lin Feng: "The patient has coronary heart disease, usually chest pain will be relieved by taking nitroglycerin under the tongue, but today there is no effect, it is very painful, and I can't breathe." "
"How long has it been pain?" Lin Feng asked.
"It's been almost 30 minutes." This time it was the patient's family who answered.
Lin Feng immediately looked at the patient and asked softly, "Is it like a stone pressing against your chest, and you can't breathe in pain?" "
"Yes, yes, yes! That's how it feels. The patient endured the pain and replied with a frown, sweat oozing from his forehead and his hands over his chest, looking really painful.
I looked at the examination done after the patient arrived.
Blood pressure 160/90mmHg
The situation is fine, the blood pressure is not low.
Nitroglycerin is not casual, if you want to take it sublingually, you must measure your blood pressure, if the blood pressure is lower than 100mmHg, then you can not use nitroglycerin, otherwise blood pressure may collapse directly.
This medicine was previously an ingredient in explosives, very fierce, can lower blood pressure, but must not be used when blood pressure is low.
Lin Feng nodded, like a doctor on the side, asked, "Did the electrocardiogram pull out?" "
"The ST segment of leads II, III, and aVF moved down by 0.05mV, and the ST segment also shifted down due to the T wave of leads V4-V6." Dr. Gui Pei hurriedly said, and then hurriedly said: "The patient's left forearm still has a pulling pain. "
"Dr. Lin, is this typical radiant pain in the patient?"
The patient is relatively obese, previously diagnosed with coronary heart disease and hypertension, and now has obvious chest pain, reflex pain, and ECG performance, indicating that the possibility of acute coronary syndrome is quite high.
The patient has not had coronary angiography and coronary CTA, and it is not certain that it must be coronary heart disease.
However, the clinical response of the patient is very similar.
Lin Feng felt that he needed to prepare first and opened an intravenous channel for the patient.
Draw blood from the patient and do routine examinations first, especially myocardial enzymes and troponin.
Troponin can be done directly here, and the results come out very quickly, showing that they are very normal and not significantly elevated.
"Teacher, can't you diagnose myocardial infarction yet?" The doctor on the side said.
Hearing this, Lin Feng immediately said: "The three elements of diagnosing myocardial infarction, one is typical chest pain, the other is electrocardiogram performance, and the third is the increase of troponin and myocardial enzymes, which means myocardial infarction and myocardial cell rupture." "
"Now the patient's troponin is still normal!"
"However, troponin and cardiac enzymes take time to rise. The fastest troponin also takes 30 minutes to 1 hour to rise, while troponin takes at least 2-3 hours to rise. "
"The patient now has chest pain for less than 1 hour, troponin is normal as expected, but dynamic review is required!"
Gui Pei nodded, what Lin Feng said was the basics.
After saying this.
Lin Feng contacted the intervention department directly.
Although it is not certain that the patient has a myocardial infarction, results will be available soon.
If the diagnosis is confirmed, it is necessary to be immediately sent to the interventional department for coronary intervention to open the coronary artery blocked by the thrombus.
Contact the interventional department, but also say hello in advance, leave a fast green channel, convenient for timely treatment of patients.
If you delay time and cause the patient's heart to stop, that's a big problem!
Normally, angina can be relieved by taking nitroglycerin, and if it cannot be relieved, most of them are myocardial infarction.
After contacting the interventional department, Lin Feng began to examine the patient.
The main reason is that the patient is relatively obese, has a history of hypertension, and was previously diagnosed with coronary heart disease, and this time the chest pain continues to not be relieved.
Routine anticoagulation, antiplatelet post-emergency PCI is normally recommended.
But he is not at ease!
Patients with aortic dissection and acute pulmonary embolism should also be excluded.
In case the patient is aortic dissection, once the anticoagulant and antiplatelet drugs are used, it will be bad, maybe it will cause bleeding, and the patient will be gone!
Immediately, Lin Feng proposed to do chest CTA for the patient first, thoroughly check for aortic dissection and acute pulmonary embolism, and then go for coronary interventional treatment.
For Lin Feng's arrangement, basically no one will object.
At this time, the doctor on the side asked Lin Feng in a worried voice: "Doctor Lin, the patient is very likely to have acute myocardial infarction at present, if the time to open the blood vessel is delayed, will it cause more harm to the patient!" "
Lin Feng naturally thought of this question, and then said softly: "That's right, so I need to prepare at the same time!" After the CTA results come out, if the diagnosis is confirmed, it will be immediately sent to the interventional department and start coronary interventional treatment! "
With the good relationship between Lin Feng and the Intervention Section, the Intervention Section must agree.
。。。