bookpower Chapter 637
Chapter 637
Lin Feng saw the patient's appearance, plus he had a history of overeating before.
If it is acute gastroenteritis, it is good to say that the treatment is not so complicated.
If it is mild pancreatitis, it is good to say that it generally cannot die.
If it is severe pancreatitis, the mortality rate is still very high.
Rumble ~~~~
The flat car ran at speed.
soon
I took the patient and went into the rescue room.
Lie flat.
An abdominal examination was done.
As soon as you open your stomach,
It can be clearly seen that the patient's belly is very bloated, the very obvious kind.
Lin Feng's hand touched the patient's abdomen.
Not strong yet.
"Ah~~~~~Pain~~~"
The patient screamed directly.
"Bear with me..."
"I'm going to give you all the presses..."
Lin Feng shouted.
Pressed other parts.
"Aaaaa
Screams rang out in the rescue room.
Lin Feng finally had a preliminary understanding of the condition.
Patient's condition:
Pain throughout the abdomen
The upper abdomen is most pronounced slightly to the left.
This tenderness is evident, as is the rebound pain.
Then auscultation.
Weakened bowel sounds may be related to the patient's flatulence.
"How much did you eat that day?"
"A lot, about eight or nine beers, and then a lot of roasts..." the patient huffed and huffed, carrying the pain.
At this point,
The nurse had already connected to the ECG monitor.
Lin Feng glanced at it, and his heart rate was a little higher, but it was normal for his heart rate to be high under severe pain. There is nothing wrong with other blood pressure.
"Give him an electrocardiogram..."
Although Lin Feng thinks that it is acute gastroenteritis and acute pancreatitis, he still needs to use electrocardiogram to exclude myocardial infarction, abdominal aortic dissection and so on.
A dozen electrocardiograms can be checked.
soon
The electrocardiogram pushed over.
Connect.
Click~~~~~~
ECG drawing: no abnormality in the display...
"Let's draw blood, do blood routine, liver and kidney work, all have to do... Also check amylase..."
"Amylase" - the pancreas is deep in the left side of the human abdomen, usually secreting some amylase, lipase into the intestine to help digest food, but if there is a trigger for overeating, the pancreas will secrete too much amylase, lipase out, pancreatic duct pressure increases, may block the small pancreatic duct, causing these enzymes to digest the pancreas itself, causing inflammation.
This is why overeating triggers pancreatitis!
"Yes!"
The nurse was already ready, and then began to issue the bill, and Lin Feng signed.
Draw blood quickly.
"Hang him some glucose and salt water..."
Rehydration.
Purpose: In case it is really severe pancreatitis, then there must be pancreatic necrosis, and shock may appear dead at any time, so Lin Feng is still extremely vigilant. Ask the nurse to quickly open the intravenous channel for the patient and replenish some fluids.
Anyway, if it's okay, it doesn't matter much to the body if you make up more.
Hang up the potion and give it intravenously.
"Go, go to the CT room..."
Lin Feng shouted.
Pushed the flat car, out of the rescue room, straight to the CT side.
Now the key is to do a CT to see what is going on in the pancreas.
Because it is more urgent, and CT is the most accurate.
Also, why is pancreatitis preferred over gastroenteritis?
Because pancreatitis is more dangerous.
Not far away,
Jiang Yue, who was on duty, happened to pass by and saw Lin Feng rescuing.
She asked the doctor next to her curiously: "Don't you need to call other doctors to consult?" "
Doctor Gui Pei smiled and said, "Dr. Lin understands everything, so there is no need to consult with other doctors..."
......
on the road
Xiaoru asked curiously:
"Teacher, is this situation considered intestinal obstruction? The bowel sounds are so weak... For example, eating too much, holding on, and then intestinal obstruction. "
Lin Feng nodded: "There is this possibility..."
Turn to the patient and ask, "Have you had any surgeries before?" abdomen..."
The patient shakes his head; "No, I was in good health before, I didn't have surgery."
Lin Feng: "Have you ever farted, these two days?" "
The patient nodded: "Yes!" "
Lin Feng nodded, and then said to Xiaoru: "Intestinal obstruction generally has causes, such as postoperative intestinal adhesions, but the patient has not had surgery before, which is unlikely." Another point is that he fart, which can basically rule out intestinal obstruction. Of course, many diseases have atypical symptoms, and it is also possible to be intestinal obstruction, but it is not critical, and it can be seen by waiting for CT, so it is still necessary to check whether it is severe acute pancreatitis first! "
Another Guipei asked curiously:
"Dr. Lin, is it possible that the intestine is perforated? I have also seen cases of gastrointestinal perforation after drinking a lot of alcohol before, exactly the same as this, severe abdominal pain and vomiting. "
"It's hard to say, it's possible." Lin Feng said.
"However, but the intestinal perforation generally has a plate-like abdomen, the stomach is hard as an iron plate, because there are signs of acute peritonitis, although this patient has tenderness and rebound pain in the abdomen, but the stomach is not too hard, it doesn't look like it." Of course, it cannot be ruled out... Wait and look at the CT, and everything will be understood. "
Behind him, Douyin's assistant held a live broadcast device and followed all the way.
Because of the rescue in the live broadcast room, the audience suddenly increased a lot, rising to 10 million, which was a lot lively.
"Learned, learned!"
"There are really many things in medicine, but they all have logical lines, and it is not difficult..."
"Upstairs is too small to see a doctor, although medicine has logic, but the information is as vast as the sea, and every year the world's papers alone can fill a study..."
"Dr. Lin is awesome, he understands everything!"
"It seems that there is nothing that Dr. Lin will not do!"
“6666~~~~~"
soon
The patient was admitted to CT.
The results came out quickly.
· CT results: The edema around the pancreas was obvious, the boundaries became blurred, and the pancreatic fluid exuded.
OK: Acute pancreatitis!!
Stomach, nothing big ... Exclusion of acute gastroenteritis...
Exclusion of intestinal obstruction...
Leave the CT room,
All the way back to the emergency department.
Not long after the placement, the blood draw over there came out.
Pancreas, amylase levels up to 800U!
Normal human amylase does not exceed 150.
Intestinal perforation, obstruction, etc. can also have amylase elevation, but rarely exceed 500.
So
It can be determined that it is "acute pancreatitis"!
In addition, there is another corroboration.
·「 Blood sugar in the blood routine increased significantly by 3 times.
Obviously,
It is because there is a problem with the pancreas, resulting in a decrease in insulin secretion, which further leads to the inability to break down blood sugar, so the blood sugar content is significantly increased.
presently
Acute pancreatitis has been identified.
But it has not yet been determined whether it is severe or mild.
Moreover, the patient's stomach tenderness is obvious, indicating that the inflammation is severe.
It may continue to worsen at any time, and shock, respiratory failure, kidney failure and other conditions may occur.
This kind of patient, the probability of death is not small!
Since it is determined that it is "acute pancreatitis", the next step is to consider the treatment problem.
How is it treated?
Admission first...
Then consider whether to operate, whether to push the ICU, what kind of treatment should be made...
。