bookpower Chapter 282
Chapter 282
When systemic muscle weakness is severe, systemic muscle weakness can occur, and even respiratory muscles can be involved, resulting in respiratory failure.
"Xiao Ai, flat car!"
"Send to the rescue room!"
Lin Feng shouted.
The next patient who wanted to come in was stunned at this moment.
And the old woman panicked, and quickly shouted: "Old man, old man, what's wrong with you?" "
soon
A few nurses quickly pushed the flat cart and ran over.
Lift the flat car together.
In the process of pushing over, Lin Feng fed the patient "pyrididimine bromide" to increase the amount of medicine!
The goal is to suppress generalized muscle weakness.
soon
Pushed the rescue room ...
Link the ECG monitor.
Within a few minutes, the data from the ECG monitor began to fall.
Decreased blood oxygen...
Increased heart rate...
Increased blood pressure...
Obviously,
Respiratory muscle weakness appeared!
That is, despite the increased amount, pyridoxidine bromide is not effective.
"Prepare gamma globulin!"
Lin Feng ordered the nurse.
Lin Feng decided to use a propyl-ball impact.
Gamma globulin is an immunoglobulin, and pulse therapy can inhibit the production of anti-AchR antibodies in patients with myasthenia gravis, thereby relieving myasthenia.
soon
Gamma globulin use...
Next
Just wait,
Wait for the results and see how the elderly will continue.
The ECG monitor has been turned on, not withdrawn, and monitors the patient's condition in real time.
......
Lin Feng was waiting,
Without idleness, he continued to return to the consultation room and see the patient.
There are many patients in the emergency department, and Lin Feng cannot look at this old patient for a long time.
Continue your visit.
Patient, male, 54 years old, symptoms are easy to be hungry, eat three bowls of rice in one meal, thin body, easy to sweat, fatigue, dizziness, often sudden tears...
"Easily hungry?"
"Cold sweat, fatigue, dizziness, it feels like low blood sugar..."
"Eating three bowls is still thin..."
Lin Feng probably thought about it.
I think it may be "hyperthyroidism". (Chapter 280 "Reduced Armor")
Hyperthyroidism, also known as big neck disease, does not necessarily mean a large neck.
"Go and check the 'Thyroid B Ultrasound', 'Jia Gong Blood Draw'..."
Lin Feng brushed the bill and asked the patient to go for examination.
Continue to see patients,
Half an hour later,
Patients suspected of "hyperthyroidism" return with B-ultrasound results.
· Ultrasound: goiter, full blood flow
Thyroid work: determine hyperthyroidism!
Lin Feng looked at the B-ultrasound results, no need for surgery, just take medicine.
Prescribe: "formamimidazole" ...
Come to an end
Press the call machine.
"Please ask patient Chen Wen to go to Clinic 3..."
Not yet started,
"Doctor Lin, it's not good, the blood oxygen saturation of that weak old man suddenly dropped to 90%!"
A nurse barged in and shouted.
90%
Lin Feng was shocked!!
This surprise is the lowest normal value!
"Sorry, I'll go save people first..."
After that, Lin Feng quickly ran out of the consultation room.
Female patient: ".............................."
soon
Lin Feng ran to the rescue room.
At this time, the rescue room was in chaos.
Nurses, interns, and doctors are like headless flies.
The alarm of the ECG monitor keeps sounding.
"Doctor Lin!"
Intern Wang Zirui was sweating profusely and quickly reported to Lin Feng.
"The patient is intubated on a ventilator to assist breathing ... A minute ago, suddenly the whole body convulsed, confused, the whole body broke out in cold sweat, the blood pressure suddenly increased to 220/120mmHg, and the oxygen saturation was reduced to 88% now..."
Lin Feng was surprised.
How did it suddenly become so serious?
With such high blood pressure, you can go into cardiac arrest or even die at any time!
"Muscle weakness crisis!"
Lin Feng suddenly thought of this word.
XXX crisis generally refers to the most severe situation that the patient has encountered.
The patient in front of him is obviously already a myasthenic crisis, which is respiratory failure and serious systemic complications caused by muscle weakness involving respiratory muscles.
Lin Feng calmed down.
Staring at the data of the ECG monitor,
Various scenarios keep flashing through my mind.
Lin Feng looked at the patient's blood gas analysis at this time to see what the patient's blood was doing now.
But
At present, it has reached a critical juncture, and the blood gas analysis results take an hour to come out, and it is simply too late.
now
All the nurses and doctors looked at Lin Feng.
Lin Feng is the needle of the sea god, as long as Lin Feng is there, everything is still stable!
At last
Lin Feng made a decision:
"Inject methylprednisolone!!"
Lin Feng decided to give methylprednisolone (hormone) shock.
As soon as Lin Feng decided, the nurse did not hesitate to start executing.
First injection!
1 minute later...
Lin Feng looked at the data, the situation was not optimistic, the effect was not enough!
"Go ahead, add half more dose!"
The second time, injection!
finally
The patient's condition also gradually recovered and blood oxygen began to rise.
"Go draw a blood and do a blood gas analysis..."
"Yes."
An hour later,
The results of blood gas analysis are available.
pH only 7.0!
(The pH of normal human blood remains relatively constant, and the range of change is between 7.35~7.45.) ）
Partial pressure of carbon dioxide: 104mmHg!
Boy!
Normal human carbon dioxide partial pressure: the highest is 47mmHg.
Obviously, this old man has severe respiratory acidosis.
That is, carbon dioxide poisoning!
Can carbon dioxide be poisoned?
Yes!
There are two scenarios of carbon dioxide poisoning:
The first type: long-term exposure to low concentrations of carbon dioxide environment
The second type: caused by sudden entry into a high concentration of carbon dioxide.
The second manifestation is cerebral hypoxia, which can cause reflex respiratory arrest and sudden death.
Lin Feng for the next two hours,
He never left the emergency room and kept the patient's vital signs stable.
Inspections are done continuously.
Then in response to indicators, symptomatic medication.
Other doctors also come to see the situation from time to time.
After 3 hours of rescue, the old man was finally rescued.
And at this time,
The old woman was already outside the door of the rescue room, and her daughter-in-law was helping, and she was simply frightened.
The son also heard the news and flew back from the provinces.
OK
With Lin Feng's efforts, after a day of continuous treatment, the patient and the elderly finally temporarily cured myasthenia gravis and recovered his health.
You can be discharged.
In the next month, he will also need to take medicine to relieve muscle weakness.
Until surgery can be started to remove the "thymoma" in the chest cavity.
......
The next day,
Lin Feng began to work the night shift.
Late at night, 1 o'clock, no patients.
Lin Feng was bored chatting with the nurses and telling jokes that belonged to the doctors.
Nurse Xiaofeng:
"I have a classmate who works at the dental hospital, and the story goes like this...
One patient had a terrible toothache and went to see the dentist he had seen before.
After sitting down, the patient said: "Doctor, I saw you last time, don't you remember?" "
The doctor said, "I don't remember. "
The patient told a lot about the last time he came and so on
The doctor just couldn't remember, confused.
The doctor was helpless: "Let's diagnose the disease first, open your mouth..."
The patient opens his mouth: "Ah~~~"
The doctor looked in and said, "Oh, it's you, I remembered."
......
"Hahaha~~~ This story can!"
"The dentist's special way of remembering ..."
"Hahaha~~~~"
The audience burst into laughter.
"I also have a joke... It's funny..." Nurse Xiao Chen laughed at this time.
Everyone quieted down and listened.
"There was a doctor who was a proctologist and asked him at a meeting why he chose such a department.
The buddy sighed and said, at that time, he was still transferring departments, and once he had dinner with several old doctors in the hospital, and then he asked which department in the hospital made more money, some said surgery, some said orthopedics.
At this time, a respected old director of the hospital said: Fart! Ophthalmology is the most profitable!
So the buddy finally chose the proctology department. "
......
"Poof~~~~~~~~"
Lin Feng and the others all laughed!
This joke has a taste!
It's hilarious!
It's all to blame that I didn't hear clearly, which led to the wrong subject!
......
suddenly
The phone at the nurse's station rang.
"Hello, this is the Harmony Emergency Department."
"What? A 3-month-old baby foaming at the mouth? Delivering? 10 minutes left? "
"Did you eat anything unhealthy? No, whole breast milk? "
"The family said they liked to shake the baby? Considered a brain injury? "
"Okay, we'll get ready right away."
The phone hangs up.
At this time, all the nurses looked at Lin Feng.
Because Lin Feng is the doctor on duty.
Lin Feng put away the smile he had just had, and his face was serious.
Start the analysis:
"3-month-old baby, foaming at the mouth, whole breast milk, that should not be poisoning, the family said to shake the baby, then it should indeed be considered that there may be "shaken baby syndrome", brain problems..."
"Xiao Chen, contact the imaging department, wake up if you sleep, and wait for the patient to do a CT!"
"Yes!"
"Xiaofeng, contact the operating room..."
"Yes."
At this moment, everyone restored the strong quality of the elite team.
Scrappy.
10 minutes later...
"Beep beep beep ~~~~~~"
The sound of an ambulance came from outside the emergency department.
Lin Feng and the others greeted outside the gate.
The doll is 3 months old, as well as parents, grandparents and 4 people, the whole family came.
soon
The baby in March was sent to the imaging department in a stroller.
Symptom:
Already stunned...
Foaming at the mouth...
On the way to the imaging department,
Lin Feng spoke quickly: "Tell me about the situation..."
。