latelenovela Chapter 638
Chapter 638
Admission to the hospital,
In the emergency department ward, testing is continuous.
The next question is, do you want surgery?!
Indications for surgery: If the patient's pancreatitis is caused by gallbladder bile duct stones and there is obstruction, surgery is necessary to solve the problem.
No surgical indications: not caused by gallstones, it is only inflammation, this condition can be conservatively treated.
Surgical resection does not mean that it can be cut off casually, even if a certain section of the pancreas is necrosis, it cannot be cut off casually, because it is easy to cause a series of complications.
"Shouldn't you really have surgery?"
At this time, the patient looked regretful.
Don't overeat if you already know!
"Don't be nervous, your vital signs are still stable at present, and there are no indications for surgery for the time being." Lin Feng said.
The patient breathed a sigh of relief.
But Lin Feng added:
"You can't let your guard down too much, the cause of acute pancreatitis is very complex, the course of the disease is also very complicated, don't underestimate this disease..."
The patient tensed up.
I was a little unstable by Lin Feng.
Lin Feng chuckled, the patient is a young man, if not more serious, it is estimated that he will let himself go again.
It didn't take long for the patient's girlfriend to arrive at the hospital.
It was also after hearing the bad news that he came in a hurry.
Lin Feng: "Make a gastric tube first and pull out the contents ... By the way, from now on, you can't eat, you have to fast. "
Patient's girlfriend: "Huh? Why? "
The patient is distressed: "Is it okay not to insert a gastric tube?" "
The thought of inserting a gastric tube into my nose and throat makes me feel hairy.
Lin Feng said seriously: "The current diagnosis is pancreatic inflammation, so the fastest way is to empty that stomach, reduce food, stomach acid to stimulate the pancreas, and at the same time less food, the pancreas can secrete less decomposition enzymes, so that it can rest..."
Got it.
The patient and his girlfriend nodded one after another.
"Follow Dr. Lin's orders."
The patient struggled with a face.
For life, the gastric tube is inserted.
Soon, Lin Feng operated the gastric tube (a small plastic hose) inserted from the nostril, down the throat, all the way to the stomach...
First, pull out the contents of the stomach.
Then use some glucose, salt water to flush in, but also use some drugs to inhibit pancreatic fluid secretion, analgesia, relieve gastrointestinal spasms and relieve pain, etc.
......
After doing this,
The next step is ongoing treatment.
Lin Feng left the ward, returned to the consultation room, and continued to receive patients.
Until noon, Lin Feng went to the ward to check the patient's physical condition.
Abdominal pain relief...
Reduced vomiting ...
But
Good things take a long time, just when Lin Feng was in the lounge, talking with other doctors and nurses,
The condition has progressed!
"Doctor Lin, it's not good, the heart rate of that patient with acute pancreatitis has accelerated, and his blood pressure is dropping!!"
The patrol nurse ran quickly, pushed open the door of the duty room, and said breathlessly.
When Lin Feng heard this, his face was shocked.
"Oops!"
"It may have progressed to severe acute pancreatitis!"
Lin Feng quickly left the duty room and rushed to the ward.
Rushed to the bed in the ward,
Look at the ECG monitor.
Heart rate: 150...
Blood pressure: 88/40mmHg...
Blood oxygen: 94...
Blood pressure is so low!!
Blood pressure is also so high!!
The sweaty tube bed doctor saw Lin Feng, like Meng Dahe.
"Dr. Lin, I gave him fluids and wanted to raise his blood pressure, but the effect was very poor..."
Lin Feng nodded.
Why do patients have low blood pressure?
Either pancreatitis has progressed and caused shock itself!
Either there is a possibility of intra-abdominal bleeding, resulting in hemorrhagic shock!
Severe!
Didn't run!
"How are you doing now?"
Lin Feng asked the patient.
The patient was also terrified at this time.
"I feel a little stuffy in my chest, my heart is flustered, and my stomach hurts even more..."
The girlfriend was panicking on the side, but did not dare to come over and disturb Lin Feng.
If another respiratory failure occurs by then, it will be tricky.
"Call the ICU and ask if there are any beds..."
Lin Feng instructed the nurse.
Because the patient's situation is now very complicated, with the equipment of the emergency department, I am afraid it is a little difficult...
Then I told the patient and girlfriend:
"In this case, you may have to go to the ICU, if there is a bed, you can transfer it... But the cost over there is relatively high, thousands of dollars a day, ten thousand small a day, you can discuss, whether you want to go..."
"Go, definitely go!"
"Go!"
The two said they were going.
Nonsense
The life is gone, where dare not go.
Then consider the issue of stabilizing blood pressure.
As mentioned earlier, there are two possibilities:
Pancreatitis itself causes shock...
Bleeding causes shock...
Now, it is necessary to judge, which one it is!
Very simple!
Do a "blood routine"!
If there is bleeding, the hemoglobin and red blood cells will definitely fall off!
blood draw,
Then expedited.
After 10 minutes, the results came in.
Hemoglobin - 113g/L (normal value: 120~165g/L)
Although a little less than normal,
However, it is only a little lower.
This is clearly not hemorrhagic shock caused by bleeding.
It is the low blood pressure caused by pancreatitis itself.
(Why is it a little lower, it should be constant hydration, resulting in a decrease in hemoglobin content.) ）
Clearly, pancreatitis worsens, inflammation spreads, spreads elsewhere, causes small blood vessels to dilate or other more complex mechanisms caused by hypotension.
At this time, there is no need to replenish plasma, platelets, etc...
Instead, it is necessary to replenish a large amount of salt and sugar liquid, while strengthening the fight against infection and suppressing inflammation.
At this point,
On the ECG monitor, the patient's temperature is displayed at 39.7 degrees.
Inflammation.
Lin Feng began to order, a series of anti-inflammatory drugs, from the gastric tube, intravenous injection, infusion.
Lin Feng began to think about the next question:
"Chest tightness"!
Why do you get chest tightness?
Chest tightness is generally a lung problem.
Chest pain can be a problem with the heart.
Chest tightness, possibly pancreatitis, inflammation has spread to the lungs.
Causes some degree of respiratory failure.
"Let's get the ventilator ready first..."
Lin Feng said.
Once the lung function is too poor, a ventilator should be used to reduce the burden of lung breathing as much as possible.
Next
The breathing was really wrong, and the blood oxygen was dropping.
Hurry up and get on the ventilator first...
After half an hour...
The patient was lucky.
With the input of anti-inflammatory drugs, the addition of a ventilator, the condition began to improve.
Blood pressure rises...
Blood oxygen also raised from 92, raised up to 96...
The situation seems to be moving in a better direction.
However, in any case, he is already severely ill with acute pancreatitis and must be sent to the ICU.
After his condition was stabilized, at 18 p.m., he was taken to the ICU.
......
The next day, when Lin Feng was on the day shift.
The ICU is calling!
The patient's condition has recurred again!!
。。