bookpower Chapter 187
Chapter 187
At any moment, the patient's coma should rule out the possibility of hypoglycemia!
So
Lin Feng subconsciously wanted to measure the blood sugar of this patient.
There are currently several common methods for measuring blood glucose:
Fingertip blood, detect blood sugar, which is the fastest and most convenient
Venous blood, blood glucose detection
・If you are a diabetic patient who needs to monitor your blood sugar multiple times a day, you can wear "continuous glucose monitoring".
Lin Feng instructed the nurse:
"Prick his finger!"
"Okay!"
Nurse, za!
A few seconds later, the results came in!
1.4mmol/L！
"I'll go!"
The nurse exclaimed!
Lin Feng and the others took a look and were also taken aback.
Only 1.4!
So low!
Normal blood glucose values, between 2.8 and 6.0mmol/L!
And this patient turned out to be only half of the lowest normal value!
"Hurry up with intravenous bolus high sugar, 30 ml ... Not 40ml yet!! "
Lin Feng quickly ordered.
This blood sugar is too low, scary!
The so-called high sugar refers to 50% glucose injection (a tissue dehydration hyperosmolar solution), half of which is rapid intravenous injection of 20~50ml.
The general intravenous glucose solution has a concentration of 5% or 10%!
(PS: Bolus injections and intravenous drips are intravenous, but one is a syringe bolus and the other is a hanging needle)
After pushing the high sugar, Lin Feng breathed a sigh of relief.
But frowned.
"Could it be convulsions caused by hypoglycemia?"
Lin Feng looked at the patient's husband: "When did your wife eat..."
The patient's husband: "I ate in the morning, I ate several big steamed buns, I was hungry!" "
Lin Feng and the other doctors and nurses looked at each other.
The heart is uncertain.
After eating so much, you still have so low blood sugar?
Definitely problematic!
Conversely, if the patient is really coma and limb convulsions caused by hypoglycemic attacks, then pushing the diazepam needle will certainly not be effective.
So, isn't it epilepsy?
Is it hypoglycemia?
Lin Feng asked the patient's husband: "Do you think back, did the patient break out in cold sweat and his heart beat faster before he fell into a coma?" "
Many people with low blood sugar will have stomach holes, dizziness, cold sweat, rapid heartbeat, uncomfortable walking... And so on symptoms.
The reason is that when hypoglycemia occurs, the body works hard to raise blood sugar, thereby secreting some hormones that stimulate blood sugar to rise, which cause the heart to beat faster and people will break out in cold sweat.
The patient's husband recalled.
"It seems that sometimes there is, sometimes there is not..."
Then
The nurse suddenly exclaimed:
"Look, she's not twitching!"
Lin Feng and the others looked over, and sure enough, the female patient who was still twitching her limbs just now suddenly stopped twitching.
"That's right, it's hypoglycemia!!"
"It's not epilepsy, at least not this time. (Because it's useless to presume stability)"
The fog seems to be a lot clearer!
The husband was a little incredulous.
Impossible, right? We've all been on treatment for four or five years and only now tell me it's not epilepsy? Just kidding!
orn......
Lin Feng ignored her husband's complicated feelings.
"Your wife, has you ever had a history of diabetes before?"
"No, I didn't find it before!"
Lin Feng nodded.
Well, now here's the problem!
Why do patients, without a history of diabetes, suddenly develop hypoglycemia after eating breakfast?
The answer is:
Incretion!
The neurologist doctor does not understand this, but Lin Feng definitely understands!
Patients may have endocrine disorders that cause hypoglycemia!
What hormones can raise blood sugar?
There are the following:
Glucagon...
Various glucocorticoids...
Thyroxine...
And what about hormones that lower blood sugar?
There is only one!
Insulin!
Therefore, we see that those patients with high blood sugar in daily life need to take "insulin" every day!
Therefore, the female patient on the hospital bed in front of her should have a problem with insulin secretion and secrete a large amount of insulin, resulting in a rapid decrease in blood sugar!
"What causes a lot of insulin secretion?"
Lin Feng's first reaction was:
"Insulinoma!"
Here's why:
Islets: The pancreas is an irregular group of cells scattered in the pancreas, which are secreted. Three types of cells: A (or A2) cells secrete glucagon; B (or β) cells secrete insulin; There are also D cells.
Insulinoma: It is a pancreatic islet β cell tumor or β cell proliferation, which eventually causes excessive insulin secretion.
Insulinomas often present with the typical Whipple triad:
·「 Symptoms of hypoglycemia"...
·「 coma and psychoneurological symptoms"...
·「 Fasting or easy to attack after labor"...
Doesn't this correspond to the symptoms of this female patient?
Lin Feng's heart relaxed, and there was a joy in solving the puzzle in his body!
"It turned out to be an insulinoma?"
"It's really possible!"
"It's still Dr. Lin!"
Lin Feng rolled his eyes and stopped the group of medical sycophants: "I'll call and ask the CT room to see if there is a vacant seat to plug in..."
Lin Feng's popularity naturally goes without saying, most of the imaging department are female colleagues, and they have long been obsessed with Lin Feng.
As long as Lin Feng goes in person, he will definitely be able to cut the queue!
After 20 minutes,
Lin Feng pushed the patient into the imaging department, and colleagues from the neurology department followed curiously.
10 minutes later...
Abdominal CT results: The patient has a 1 cmX1 cm mass at the tail of the body of the pancreas.
Sure!
There is a tumor inside the pancreas!
Specifically, whether it is an insulinoma or not, you need to cut it and do a pathology to know.
Next, it's the surgery.
......
On the third day,
Preparations for surgery are complete.
Place of operation: Emergency operating room
Surgical protocol: minimally invasive laparoscopic body pancreaticotomy
Main knife: Lin Feng, Ichisuke Song Ziming, Wu Haoming (known as: emergency department Xiaoming)
Onlookers: The doctors of the Hepatobiliary, Spleen and Pancreatic Surgery Department heard that Lin Feng had snatched another operation, and they also came to watch and learn.
......
The operation begins,
Lin Feng is familiar with the road and uses the three-hole laparoscopic method to explore the abdomen.
Step 1,
Explore!
Lin Feng first explored whether there were metastases in the liver, hepatic portal area and mesenteric root...
Result: No metastases
Next, Lin Feng began to cut the gastrocolic ligaments to expose the pancreas, carefully observing the location and size of the tumor and the degree and extent of tumor invasion...
Results: Visual inspection of benign tumors, no spread, etc...
Lin Feng breathed a sigh of relief.
As long as it is a benign tumor, with Lin Feng's strength, the spleen can be preserved, which is good news for patients. If it is a malignant tumor, the spleen needs to be removed together.
Step 2,
Separate the spleen!
Free.
Lin Feng carefully pulled the right side of the forceps to expose the posterolateral spleen-kidney ligaments and spleen-diaphragmatic ligaments, and cut these ligaments with scissors.
Then it is free all the way, and continues to separate along the side of the large curvature of the stomach in the direction of the fundus, cut off the gastric and splenic ligaments, and ligate the short gastric blood vessels in it one by one.
Step 3,
Isolate the pancreatic body, tail!
The previous step Lin Feng has completely freed the stomach curvature and spleen.
Next, Lin Feng began to cut the posterior peritoneum of the pancreatic body, free all the way to the tail, completely separating the complete tail from other tissues.
Step 4,
Ligation cuts off the spleen artery and veins!
Lin Feng lifted the spleen and turned it up together with the pancreas body and tail, revealing the spleen artery and veins on the back side.
double ligation,
Then cut off.
Step 5,
Removal of the pancreatic body and tail!
Lin Feng measured it, and made a stitch on the upper and lower edge of the pancreas proximal to the predetermined tangent, and deeply ligated, in order to block the transverse blood vessels of the pancreas and reduce bleeding.
Then, with satinsky forceps, on a predetermined tangent line, the body tail of the pancreas is excised.
The tail of the pancreatic body (with the tumor part) is removed and taken for pathological examination.
Step 6:
Treat pancreatic stump!
Lin Feng used No. 1-0 silk thread to penetrate and suture the pancreatic canal, and then used No. 4-0 silk thread mattress to suture the pancreatic stump section.
After examining the wound and stopping the bleeding adequately,
Place the drainage tube.
Step seven,
Rinse and disinfect...
Suture the abdominal wall incision layer by layer...
End surgery!
Duration: 2 hours and 15 minutes...
This is a relatively simple operation for Lin Feng.
For those doctors who learn, Lin Feng's surgical skills are extremely skillful, and the sense of layering, rhythm, and weight is all just right.
Looking at this operation is like looking at a delicate handicraft, just looking at it, it can meet people's aesthetic needs.
It's so beautiful, this operation!
Deeply captivated!
A day later, the pathology of the tumor came out.
Sure enough, it was an insulinoma!
After a day, the patient's blood sugar and insulin levels were observed, and sure enough, they all returned to normal.
Now, everything is out of the water!
If the patient does not develop epilepsy during the next eight years of follow-up, it is certain that the islet tumor is to blame, not epilepsy.
What made Lin Feng happy was that the brain function damage caused by long-term hypoglycemia attacks did not appear in this female patient.
This is a blessing in misfortune!
However, there is still one problem that has not been solved!
"Why, in the past, the county hospital gave patients a stable dose and let the female patient's seizures stop? (Effect sometimes doesn't work)"
Lin Feng specially asked the Information Office (the department of external contact) to call the county hospital, and the medical records were quickly transferred.
After seeing the medical records, Lin Feng understood!
The first treatment record: diazepam needle 10mg intravenously + 5% glucose 250ml intravenously
The second treatment record: Valium needle 10mg intravenous push...
The 5th treatment record: diazepam injection 10mg intravenously + 5% glucose 300ml intravenously
8th Treatment Record: ...
The complete truth has come out!
The time does not work because glucose is used, so it is spiritual.
And without using glucose, it doesn't work.
The entire 4 or 5 years of treatment process is because of this 'glucose' that the real cause is masked!
"I'm awesome!"
Lin Feng laughed, and his mood was very refreshing!
Every good doctor is born with the attributes of a detective!
......
Lingnan West, a county hospital.
Internal medicine.
The attending physician, Wang Chongming, is the attending doctor of Liu Guizhen, a female patient with epilepsy.
When he learned that his patient had gone to the First Municipal Hospital in Peng City, he was stunned.
The first hospital of the city asked for medical records, and he was naturally very cooperative.
However, he also quickly called the husband of the female patient, Liu Guizhen.
"Hello!"
"Doctor Wang, hello, is there something wrong?!"
"Did you go to the First Courtyard of Peng City?"
"Yes, speaking of which, thanks to Dr. Lin Feng, it is worthy of being a divine doctor, and I found the cause of my wife."
"Found it? What's with? "
Wang Chongming has also been very troubled by this female patient.
After four or five years of treatment, this female patient has become a well-known patient in the county hospital, and basically most of the doctors associated with her have seen her.
However, in the past four or five years, I have not found the cause of epilepsy!
Many doctors have headaches!
The patient's husband rejoices: "Yes, the cause has been found!" "
Wang Chongming: "What is the reason?" "
The patient's husband: "It seems to be called pancreatic cancer ... I don't quite understand either. "
Burst~~~
Wang Chongming sprayed a mouthful of water!
Astound!
"Isn't it epilepsy? How is it a tumor? "
"Dr. Lin Feng said that it was not epilepsy, what kind of tumor, and then caused excessive insulin secretion, resulting in low blood sugar... My wife is not epileptic, but low blood sugar..."
“.................."
Wang Chongming didn't understand what excessive insulin secretion was, because he was not a doctor in that category.
But he knew that low blood sugar did cause fainting, convulsions...
He quickly went to the professional network to find information on pancreatic tumors, and finally set his eyes on "insulinoma".
After reading the relevant information, I finally understood.
"It turned out to be an insulinoma!"
"No wonder I haven't found the reason, it turns out that I got it in the wrong direction, it's not epilepsy, it's hypoglycemia!"
Combined with their own treatment using diazepam injection, sometimes without adding glucose, sometimes adding glucose, resulting in 'stability is not flexible'!
Everything is understood!
The doctor of the First Hospital of Pengshi City is really powerful!
Wang Chongming was impressed.
Wang Chongming suddenly remembered something: "Wait, did you just say that the doctor was Lin Feng?" "
The female patient's husband: "Yes, it is the famous Lin Feng, we also listen to his fame, and then hang up his number." "
Wang Chongming was surprised.
He also thought that Lin Feng became an Internet celebrity because he was momentum-creating and handsome, but he didn't expect that his strength was really strong.
Hang up the phone.
Wang Chongming told the news to other doctors.
Soon, word spread throughout the hospital.
The doctors who had seen the female patient Liu Guizhen were stunned.
"What? It turned out to be insulin cancer? Low blood sugar? "
"Not epilepsy?"
"I'll go!"
"No wonder we haven't found the reason for four or five years!"
A sigh.
......
......
Lin Feng finished his shift,
After work, get ready to go to the dining hall for dinner, and then go back to sleep.
Just as Lin Feng passed by the emergency department,
Suddenly, Director Zhou's roar was heard,
"Why are you coming to this hospital if you don't go for a test?"
Lin Feng was shocked!
He had never seen Director Zhou so angry, this was the first time.
Old Zhou, don't be angry!
Your heart can't handle it!
Then he heard Director Zhou's loud roar.
"I said, I want to send your son to CT immediately, no delay!"
Lin Feng saw that the situation was not right.
Lin Feng doesn't care about the patient's situation, but at least he must control Director Zhou's anger, otherwise the heart load is too large and dangerous!
Lin Feng quickly ran into the emergency department.
"Doctor Lin!"
Lin Feng came in, and the nurses all said hello one after another.
Lin Feng: "What's the situation?" "
Xiaoli explained: "A couple brought their children to the emergency room, faint, low blood pressure, the condition is not clear, the director wanted the parents to do CT, but the parents estimated that CT was expensive and refused to..."
Lin Feng nodded and hurried to Director Zhou's side.
"Director, calm down first, calm down..."
Lin Feng didn't care about the patient's situation, let Director Zhou calm down first.
"Lin Feng..."
Director Zhou was relieved when he saw Lin Feng coming.
"Director, you are so angry, your heart can't withstand it, I'll take over this patient..."
"Good."
Director Zhou was still very relieved about Lin Feng, and instructed Lin Feng:
"There is something wrong with this patient, you pay attention to it..."
Lin Feng nodded.
At this time, Lin Feng had time to see this family.
Middle-aged couple, probably in their 40s.
And on the hospital bed lay a junior high school student, a boy, about 14 or 15 years old, wearing the uniform of the 'Third Middle School'...
At this time, the junior high school patient was connected to the ECG monitor.
Heart rate 129 beats/min, breathing 20 beats/min, blood pressure 98/50mmHg, blood oxygen saturation 85%...
Lin Feng's heart tightened.
The heart rate is too high!
Breathe too little!
Low blood pressure!
Low blood oxygen!
"Trouble Jean..."
Lin Feng came to the patient, flashlight, and looked at the pupils.
From the pupil alone, a lot of information can be seen.
If the two pupils are not equally large, consider whether there is a lesion in the skull.
If the dilated pupils are fixed, the patient is almost dead.
Lin Feng checked his pupils,
The patient is in a coma and does not respond to light.
The pupil has a light reflex, and it is equal to the size and circle, and there is no trauma to the head, which is not estimated to be a cranial problem.
Then check elsewhere.
Touched the limbs, cool,
• Slightly pale face, estimated to have anemia
Combined with this hypotension.
Obviously, the patient is in shock!
What is shock?
I didn't see that there was trauma there, so it was difficult to judge that it was hemorrhagic shock, and there was also a possibility of infection, allergies, cardiogenesis... Wait a minute.
Further exclusion is required.
Listen to the heart and lungs, nothing is a problem.
Further down, look at the abdomen.
A touch!
I'll go!
Very drummed!
It was so tense, as if it was being held up by something!
Is it intestinal paralysis?
Flatulence?
Or a peritoneal effusion?
Lin Feng pushed and found that the whole stomach was relatively heavy to the touch, not like gas, like liquid.
It is estimated that it is a high probability of fluid accumulation!
Lin Feng had a rough judgment!
It's heavy bleeding!
Massive bleeding in the abdominal cavity!
Then leads to hemorrhagic shock!
At this time, Lin Feng also heard his father explaining:
Dad: "It's not that I don't want to do CT, but whether your CT can accurately find the problem!" "
Mom echoed: "Yes, I have long heard that the hospital is very dark, like to open all kinds of examinations, expensive to die, casually a stomachache, do some tests, hundreds and a thousand will be gone, but finally found that there is no disease." "
Lin Feng: ".................."
This kind of thing does exist in many hospitals.
However, this is actually a normal phenomenon, just like the female patient Liu Guizhen, if diabetes is not detected in the end, it is estimated that it is also a bunch of examinations, what CT, MRI are all on.
In the end, if the cause was not found, then it must be more than a thousand gone.
But this is not a problem with hospitals.
Subjectively speaking, doctors are not to earn you a thousand dollars, but to diagnose the cause.
Lin Feng stood up.
"You don't want to spend money, do you?"
"I just judged that your son should be in hemorrhagic shock, he may die at any time, you say, do you want to do this examination..."
Lin Feng's attitude was a little cold.
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ps: It's over today, no chapters, 4000 + 5700 = 9700 words
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