bookpower Chapter 430
Chapter 430
Why do patients with "acute severe pancreatitis" have low blood pressure?
That's because patients with acute severe pancreatitis lose blood volume in a short period of time and enter the third space.
Therefore, adequate fluid resuscitation should be performed at this time to prevent shock. Stabilizes hemodynamics and prevents hypoperfusion impairment in multi-organ tissues.
Lin Feng stood up abruptly.
Shouted:
"Quick, send to the rescue room!"
"For a quick infusion!"
Then he said urgently to Grandma:
"Grandma, you will be hospitalized immediately, I will arrange for the nurse to give you an infusion now, and it must be fast!"
"Huh?" The husband was shocked.
"Isn't it just a stomachache? So serious? Going to hospital? Can I go home? Grandma felt sorry for the money and said dissatisfiedly.
Lin Feng shook his head resolutely: "No, you must be hospitalized, your severe acute pancreatitis is very dangerous, and now you have a shock blood pressure, if you can't do it, there will be danger at any time, so hospitalization is the safest!" "
When the patient's grandmother's husband heard such a serious situation, he immediately decided:
"Doctor Lin, listen to your arrangement, treat it as you want!"
With the consent of the patient's family, Lin Feng began to quickly arrange nurses.
"Quick, rescue room... Wait until it's stable and then enter the ward..."
Quickly pushed Grandma and went to the rescue room.
Push into the rescue room,
The nurses began to get busy, infusions, electrocardiograms, meridian channels...
Grandma still didn't care: "Dr. Lin, you are quite scary, but I have seen more diseases... You can't scare me..."
Lin Feng stood in front of the hospital bed, staring at the ECG monitor that was beating data.
Blood pressure: 79/43mmHg
Dropped again!!
The blood oxygen saturation is only 95%.
But that's normal.
Because patients with acute severe pancreatitis are prone to respiratory insufficiency and symptoms such as pulmonary interstitial edema.
Grandma had just clearly reacted with shortness of breath.
"Give the patient an oxygen mask, positive pressure auxiliary oxygen ventilation support..."
Lin Feng said to Grandma with a solemn face: "I have always joked in front of the disease, you better seriously cooperate with the treatment." "
At this moment,
Grandma's face seemed a little wrong.
There is no such light wind as at the beginning.
A bit sluggish in reaction...
The look was a little indifferent...
Lin Feng snorted.
"It's not good, the shock reaction is out!!"
Lin Feng glanced at the meridian channel that the nurse had pierced in her right arm, and felt unsafe:
"One is not enough!"
"Add another meridian channel of the thigh, quickly..."
After 20 seconds,
Rehydration begins...
The liquid formula ordered by Lin Feng is mainly to supplement the crystalloid solution, plus the appropriate amount of protein, blood or plasma, while actively replenishing electrolytes, and also adding vasoactive drugs...
At this time, Grandma was already in a coma, and her blood pressure had dropped to 70.
The condition progresses a bit quickly.
OK
With the infusion in, plus oxygen,
Blood pressure began to rise, running to 86mmHg...
Blood oxygen is rising, back to 95%...
Lin Feng and the other nurses breathed a sigh of relief.
The condition is stable...
Then the emergency room was launched and sent to the ward.
For the next few days, the hospital needs to keep watching for Grandma's signs.
Continue to use antibiotics to prevent infection.
Use drugs to reduce pancreatic secretion and inhibit pancreatic enzyme activity
The use of magnesium sulfate can promote gastrointestinal peristalsis, reduce intra-abdominal pressure, protect gastrointestinal barrier function, reduce the displacement of bacteria and endotoxin, and also promote the absorption of peritoneal exudate;
If necessary, hemodialysis is also required.
If the condition is more severe, surgical treatment is also needed, such as:
Abdominal lavage...
Surgical treatment: necrotic tissue removal and drainage...
When Lin Feng left the ward,
Grandma woke up, feeling sorry for the coma she had just had.
And Grandma's husband took Lin Feng's hand and thanked him again and again, just now he thought that his wife was going to die, and almost scared him out of a heart attack.
......
......
Back in the consultation room, 30 minutes have passed...
The patients at the back of the queue felt so tormented.
The next patient.
Broadcast: "Please go to Wang Jian's No. 3 consultation room." "
soon
A beautiful boy in his 20s walked into the consultation room.
Thin stature.
It's a bit awkward to walk.
Covering your belly,
Pale.
When Lin Feng saw his face, he felt that it should be anemia pale.
"Doctor Lin..."
"Sit down, tell me what's going on?"
Wang Jian began to complain: "Doctor Lin, I often have diarrhea recently, and I also have a little blood in the stool and abdominal pain..."
Lin Feng: "When did it start?" How long has it been? What was the situation in the beginning? "
Wang Jian: "A year ago, I didn't know why, I suddenly had diarrhea frequently, I didn't know if this was about it... And this month, I don't know why, often abdominal pain, blood in the stool began to appear half a month ago..."
Lin Feng frowned: "Have you ever seen a doctor before?" Has it been diagnosed? What disease? "
Wang Jian said embarrassedly: "I didn't check it, I thought there was nothing wrong, it became serious this month, so I came to the hospital to see a doctor..."
Lin Feng was angry: "Why are you only here now, abdominal pain and blood in the stool are not minor problems, it's been half a month..."
Wang Jian was suddenly apprehensive: "Doctor Lin, is it serious?" "
Lin Feng glared at him: "Can it not be serious?" "
At this time, he had already begun to think in his heart:
Up to half a month, a month of abdominal pain, blood in the stool... The first reaction is rectal cancer!
Diarrhea that has been going on for more than 1 year may be rectal polyps.
The two combined,
It is supposed that the rectal polyp worsened and evolved into rectal cancer.
(PS: 80-95% of rectal cancers are polyps.) ）
(PS: Location of the rectum: upper to the colon, lower to the steel gate.) ）
Lin Feng continued to ask: "Is there a steel door lump coming out?" "
Wang Jian was surprised: "Huh?? "
Lin Feng explained: "When the steel door is touched with my hand, I feel that a piece of meat is exposed from the inside (it may be that the meat inside is out, or the meat outside is swollen). "
Wang Jian twisted: "There is..."
Lin Feng: "..........................."
Steel door mass prolapse is one of the manifestations of rectal cancer.
And wasting, apparently caused by long-term abdominal pain and diarrhea, is also one of the manifestations of rectal cancer.
Combined with the above long-term diarrhea + blood in the stool + wasting,
Comprehensive consideration: rectal cancer!!
Lin Feng did not dare to tell the young man in front of him this bad news.
If it's rectal cancer, it's an absolute nightmare! Because the rectum is short and connects the sphincter, once the rectal cancer is to be removed, the sphincter will be cut off, and the patient will not be able to control fecal excretion. (A case is written in chapter seventy.) ）
And the guy in front of him is only in his 20s, and his future life will be difficult!
"Let's go for a proctoscopy..."
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ps: The update ends today.
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