bookpower Chapter 591
Chapter 591
Two possibilities!
Hyperthyroid crisis!
Hyperthyroidism, hypokalemic periodic paralysis!
"Hyperthyroid crisis" is a serious complication of poorly controlled hyperthyroidism.
The reason is that thyroid hormones enter the blood circulation in large quantities, causing high fever, sweating, irritability, nausea, vomiting, diarrhea, arrhythmia, and so on. If left untreated, patients can die at any time.
"Crisis", the word appears from time to time after various conditions and becomes a suffix.
With this suffix, it means that the condition is already serious.
The patient is only physically inadequate, has no other obvious symptoms, and is unlikely to have an overthyroid crisis.
That's the second possibility!
"Periodic paralysis of hyperthyroidism and hypokalemia",
It refers to the fact that a person with hyperthyroidism may periodically experience limb weakness or even paralysis. The cause is related to hypokalemia, and patients with hyperthyroidism are particularly prone to hypokalemia, which is key to maintaining muscle activity.
Come to think of it.
Lin Feng immediately knew what to do next!
Check blood potassium!
Together with a series of tests such as liver function electrolytes, myocardial enzymes, troponin, blood routine, and thyroid function, liver function, etc.
Then Lin Feng said to Xiao Ru: "Xiao Ru, draw blood for the patient to test the blood potassium content, and other blood draws are also done!" "
"Yes, teacher!" Xiao Ru answered immediately and stepped forward to draw blood for the patient.
Don't wait for the results to come out.
Lin Feng asked the nurse to take potassium chloride sustained-release tablets.
Prepare to give the patient oral potassium chloride first for potassium supplementation.
This is an empirical exercise.
After the patient can rule out hyperthyroid crisis, only hyperthyroid hypokalemic periodic paralysis is consistent with the patient's current symptoms, although it is not known how low the blood potassium content is, but it is impossible to make a mistake in supplementing the patient with potassium.
Nurse holding oral potassium chloride,
Mix with drinks and give them to the patient.
......
After 40 minutes,
The emergency department urged, and the laboratory department sped up.
The potassium results came in.
uploaded to the system.
Blood potassium content 1.8mmol/L
Seeing the results of this examination, Lin Feng couldn't help but be taken aback.
Normal people's blood potassium content is generally 3.50-5.50mmol/L, less than 3.50mmol/L can already be identified as hypokalemia, less than 3.00mmol/L is moderate hypokalemia, less than 2.50mmol/L is severe hypokalemia.
This is the condition of the patient now!
No wonder his limbs are weak, this is still a better situation, I am afraid that ventricular fibrillation or malignant arrhythmia will occur in the drag, resulting in cardiac arrest!
Lin Feng's brows furrowed, he didn't expect this patient to be so serious.
"Take potassium chloride and prepare for intravenous injection... I'll go talk to the family..."
Turned around and walked out.
Find a family member.
After seeing the patient's sister and brother-in-law, Lin Feng said solemnly:
"The patient is now in an urgent situation, diagnosed with severe hypokalemia, the symptom is weakness in the limbs, but it may cause malignant arrhythmia and ventricular fibrillation! We are ready to give him intravenous potassium chloride injection for rehydration! "
"What? When the patient's sister heard the four words of urgency, she began to lose her mind.
Lin Feng immediately said again: "Your brother is in a dangerous situation now, we need to inject potassium chloride into his vein, that is, use a needle to inject from the neck to find a large enough and deep enough vein to inject, so that he can quickly replenish blood potassium, do you agree?" "
"Agree, agree! Dr. Lin, you must save my brother..." My sister hurriedly said after hearing clearly.
"I'll work hard!" After speaking, Lin Feng returned to the rescue room.
I repeated what I just said to the patient.
The patient immediately agreed.
The nod is a little weak.
After obtaining the patient's consent, Lin Feng immediately began to start.
Find a vein!
Prick a needle!
In one go, it takes less than 3 minutes.
With this large vein support, the patient can quickly replenish blood potassium.
The other side.
Xiaoru took the inspection report she had done before.
In addition to thyroid hormone levels, the test takes tomorrow to come out.
Other reports came out.
Except for the extremely low blood potassium accident, there is nothing else.
It is basically determined that it is "hyperthyroidism and hypokalemic periodic paralysis"!
But this is also the most dangerous!
If this is the case, the patient's blood potassium may continue to decline later, and if it does continue to decrease, it is really precarious.
Stay in the rescue room all the time, definitely not okay.
It is better to be sent to the ICU to be safer.
Lin Feng immediately walked out.
Explain the situation to the patient's sister.
"The patient has periodic paralysis of hypokalemia caused by hyperthyroidism and has now been given potassium supplementation by intravenous infusion. However, the patient's blood potassium will continue to decrease, which may lead to cardiac arrest, which is dangerous! "
"So I recommend that when the potassium supplement is over, the patient is transferred to the ICU for close monitoring, which will be safer!"
"If there is any emergency, it is also convenient for rescue there!"
Lin Feng's explanation made the patient's sister collapse directly.
His mouth kept chanting: "My brother is still so young, he can't die!" Doctor, you need to save her! "
At the moment, she couldn't give Lin Feng an answer at all.
Lin Feng had to look at the patient's brother-in-law on the side.
Seeing Lin Feng's opinion, his brother-in-law immediately said: "Doctor Lin, just listen to you and send it to the ICU!! "
The brother-in-law also seemed to be confused by this news, but he still gave the answer.
Lin Feng immediately nodded and said, "Well, I'll contact the ICU side!" "
Suddenly~
Without waiting for Lin Feng to walk back.
Xiaoru ran out.
A look of panic.
"It's not good, the heartbeat has stopped!"
Seeing this, Lin Feng did not wait for Xiaoru to speak, and immediately ran into the rescue room.
After entering, I heard the alarm sound of ECG monitoring.
The screen shows several straight lines.
Cardiac arrest!!
There was already an intern who went up for CPR at the first time.
Lin Feng shouted: "Prepare adrenaline!" "
"Anesthesia..."
"Oxygen catheter..."
A group of nurses moved quickly.
Anesthesia is beaten.
Lin Feng picked up the prepared tracheal intubation device, and immediately inserted it into the patient, and the finger-thick tracheal tube passed through the mouth, quickly inserted into the patient's trachea, and connected to the ventilator.
Ensure the patient's respiratory oxygenation!
Subsequently, the CPR intern said that he could not hold on.
"Change me!"
Lin Feng connected and continued to press on the patient's chest.
"Doctor Lin, adrenaline!"
"Push!"
1 mg of epinephrine is injected directly.
One minute......
Two minutes......
Three minutes...
There is no response to ECG monitoring.
"Push another 1mg of adrenaline!" After Lin Feng finished speaking, he continued to press on the patient.
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