mtl008 Chapter 571
Chapter 571
Pneumothorax, in layman's terms, is a lung rupture!
When one of the lungs is broken, then the gas in the alveoli will enter the chest cavity, and the air will in turn compress the lungs after entering the chest cavity, causing breathing difficulties!
A moment later, Lin Feng went to the stethoscope.
The patient has symmetrical bipulmonary sounds. (If there is a pneumothorax, it must be asymmetric.) Unless there is a very small probability that there is a pneumothorax on both sides, and the size of the pneumothorax is the same. ）
Combined with the emergency chest x-ray taken just now, there was no pneumothorax phenomenon on the chest radiograph, and he had ruled out the possibility of pneumothorax.
Excluded: Pneumothorax
And then
Electrocardiogram, myocardial enzymes, troponin, etc. have been checked, and no manifestations of myocardial infarction have been found.
Exclusion of myocardial infarction...
"Teacher, the blood draw results are out..."
At this time,
Xiaoru kept brushing the computer system, and finally brushed out the patient's blood drawing information.
Blood test results: the infection index is very high, and it can be determined that it is severe pneumonia caused by infection.
So far.
The patient was identified because - severe pneumonia.
But what exactly is pneumonia?
At this time, a ward nurse ran in and said to Lin Feng: "Doctor Lin, the arterial blood gas results are out, showing severe hypoxia, and the partial pressure of oxygen is very low!" "
Lin Feng glanced at the patient's blood oxygen, and unknowingly dropped to 94%!
"Turn the oxygen flow to the maximum!" Lin Feng immediately ordered.
At this time, non-invasive ventilation may not be possible.
Need a ventilator up.
Immediately said to Xiao Ru: "Xiao Ru, go and push the cannula box, push the ventilator over, get on the ventilator!" "
"Yes, teacher!" Xiao Ru hurriedly trotted for a while.
The patient obviously had lung problems.
Dyspnea!
Non-invasive ventilation is no longer sufficient to replenish the patient's oxygen, and a ventilator must be obtained.
If the ventilator is not enough, I am afraid that you will need to go to ECMO.
Don't mention transferring to ICU quickly!
That's all!
Now the patient's situation is very dangerous, if there is a problem on the way to the transfer, no one can bear this responsibility!
After a while, Xiao Ru pushed the ventilator in.
Send the endotracheal intubation to Lin Feng's hands.
"Your current situation is very urgent, the lung lesion is very serious, if you want to treat the disease, you must do endotracheal intubation and connect to the ventilator! Do you understand? Lin Feng said to the patient before moving.
Although the patient's condition did not improve, he was still conscious, and he nodded vigorously.
Represents the meaning of his consent!
"Have the families arrived?"
"Doctor Lin, the family has already been contacted, but it will take half a day to arrive!"
"So long! What did the family say? "
"Dr. Lin, the family's attitude is very positive and very cooperative with the rescue work!"
"That'll do! Prepare for endotracheal intubation insertion and access to a ventilator! "
"Dr. Lin! That being said, there is no evidence, what if something happens? "
"Human life is at stake! Save people first, I will bear what to do... However, tell the director and report to the medical office! "
"Yes!"
Lin Feng began to prepare.
The nurse on the side gave the patient 5mg of midazolam to calm down.
The patient must be sedated, otherwise it is difficult to insert the endotracheal tube smoothly.
Just then...
The patient's eyes suddenly bulged!
The upper body struggles violently.
Lin Feng was shocked!
The other doctors and nurses were shocked!
"What happened?"
At this time, they did not dare to press it, for fear of hurting the patient.
Suddenly!
Burst~~~~~~
The patient jerked his mouth open...
Sprayed blood!!
The front sector is at a 30-degree angle, three or four meters in diameter, and it sprays out!!
The air is filled with blood mist!!
Many people in Lin Feng were recruited, and there were blood spots everywhere on their bodies.
"Shouldn't he have Ez?"
"Tuberculosis?"
"Infectious diseases..."
At this moment, the doctors and nurses were panicked!
Lin Feng was also shocked at this time!!
So much blood!!
What's going on?
At this moment, Lin Feng suddenly had a flash of light!
"Vozh!!"
"Another similar patient!!"
Lin Feng thought of the rescue half a month ago.
It is also because the patient has a large amount of blood in his throat.
"What's going on with that patient?"
Lin Feng quickly intubated.
Insert the airway...
Suction suction ...
Suction sucks ~~~~~~
Constantly rattling, blood flows out of the suction tube.
He already thinks about the last patient.
Tuberculosis - > pulmonary hemorrhage - > heavy bleeding - > itching problems ... Didi ~~~~~~
The patient who pushed the sedative had fallen asleep, but his breathing was still relatively rapid, and the patient's oxygen saturation was reduced on ECG monitoring.
Dropped to 83%!!
It means that the blood causes suffocation and lack of oxygen.
Lin Feng knew that the time was urgent!
Get on the ventilator!!
He took matters into his own hands,
Brush brush brush ~~~
rapid intubation,
It's embarrassing...
After almost 3 minutes, it was successfully inserted, and then the ventilator injected oxygen at a fast frequency and high flow.
What made Lin Feng's heart relieved was that
This patient is much better than the previous patient, there is no cardiac arrest, no ventricular fibrillation.
After oxygenation,
Blood oxygen saturation keeps rising.
Now, it's time to look for the cause.
"ECG machine, pull him an ECG right away..."
soon
The first segment of the ECG came out.
Electrocardiogram: Confirm heart failure!
I'll go!
It turned out to be really heart failure!
But!
Why do I have heart failure?
Why was there no prompt when I did an electrocardiogram earlier?
Is the disease progressing so fast?
"Right away, diuretic !!"
Lin Feng shouted.
Although the cause cannot be found at present, it is definitely heart failure.
Why heart failure is unknown, but anti-heart failure treatment is definitely needed.
At this point,
Diuretics are ready.
Central vein, direct injection!
So that it can quickly enter the whole body!
The first key to heart failure is - diuresis!
With diuretic drugs, water and sodium retention are reduced and the preload of the heart is reduced.
First diuretic, then others, this is the principle of treatment!
Then apply inotropic drugs to enhance the contractility of the heart muscle!
Then use vasodilator drugs to reduce the afterload of the heart!
Lin Feng kept ordering...
The nurses move quickly and methodically...
(ps: the doctor is responsible for the program, the nurse is responsible for the implementation, so the nurse also has a lot of power, do not underestimate the status of the nurse, think that the nurse is a miscellaneous, the old nurse trains the new doctor, it is a common thing, the nurse can even scold the regulation to the point of blood)
A series of combo punches down...
The patient's condition was gradually brought under control.
Lin Feng breathed a sigh of relief.
It was as if everyone had experienced a great war.
So next,
It is to find the cause of heart failure.
"Explosive myocarditis?"
Such a fast speed, it may be explosive myocarditis.
"Send to ICU..."
The patient's situation may not be able to withstand in the emergency department.
......
An hour later,
Lin Feng returned from the ICU.
The patient was finally confirmed to be explosive myocarditis, which caused heart failure, resulting in pulmonary edema...
But the patient's condition sore throat, what is the cause, is not known for the time being.
......
......
Start cheering tomorrow!
Back to the consultation room,
Continue to diagnose other patients...
.