This doctor has a system

Chapter 415 480. Give him potassium chloride

"But being fat is even worse. It will make people feel scared." The patient said softly.

"How could it be possible?" Zou Yunxiang said with a smile, "How do you say that, good-looking skins are all the same, but there are more than 200 interesting souls. Just in case, pick one."

"I still like girls with a sense of strength." He was referring to the breasts and buttocks, not counting the flesh in other places.

"It doesn't matter if you are fat, we can work out together."

"When you are tired from working out, let's take a shower together and then..."

"Take a bath together?" The patient looked at his charming peach blossom eyes and turned red.

"Of course it's my girlfriend." Zou Yun frowned and said, "You can't do this, you're too thin."

"I can also eat fat. I have this foundation before." The patient said with courage.

"Are you okay?" Zou Yun said doubtfully, "I heard that you will vomit if you eat more."

"Mr. Hu is in the office." Several people stood up quickly, "Hello, boss!"

"I'm not confused, my brain works very well." The uncle replied with a smile on his face.

The results have been given to them, so the verification process should be simpler.

So, you can wait as long as you want, keep your professionalism here.

"His ears don't work well." A family member on the side said to Gao Feng, "The main problem is chest tightness when moving."

"Of course." Zou Yun said. This was really what he said. After all, he had already received a deposit of 10 yuan, and his family had promised to pay 8 yuan a month. If his condition improved, he would get a big red envelope.

Gao Feng watched him go through the steps of chimerization, and the final result was naturally a failure.

"Then let me do it." Hu Jiaran stepped forward consciously. Although the others had higher academic qualifications than him, no one could surpass him in terms of practical ability.

Now the patient's mother is a little anxious again. She is gaining weight a little fast.

"The order is wrong, and the temperature control is not done properly." He thought for a moment before taking out a piece of paper, "Just follow the instructions above."

"You can have someone do it again and I'll take a look." Gao Feng signaled.

In the afternoon of that day, the patient drank an extra bowl of white porridge and ate an egg without any obvious nausea symptoms.

But it seemed that he had come here like this before, so he could only nod his head.

The patient's condition improved at a speed visible to the naked eye. Soon her weight reached 100 pounds, and her face looked fat.

"I can do it." The patient said quickly, "I'll take my time and I'll definitely gain weight."

"We need to revise the script." The family members urgently communicated with Zou Yun, "hurt her! You have to hurt her tomorrow."

Hu Jiaran only felt his head hurt. He knew little about this. How could he remind everyone? Isn't this embarrassing?

"Can you explain the principle to everyone, such as why this temperature is required?" Hu Jiaran said.

"You are married to the right person. If you cough, she will think you have a cold."

"Where's Hu Jiaran?" Li Youliang asked.

Looking at his expression, Gao Feng felt that he must have been swinging a lot.

"It would be great if you can see the effect." Gao Feng said with a smile.

Gao Feng took a whole day to go there. When he came to the laboratory, he heard several people talking about family affairs.

"If you marry the wrong person, she will think you are hanging on a swing if you hang yourself."

"Ah?" Zou Yun was a little regretful, this meant that his work was over.

"This woman is the same, she's all motivated by sex." Li Youliang said, "Look, during the ward rounds, she said she was boring, but now she's chatting on WeChat with her finger pointing."

"It's still up to everyone to delve into it on their own." Gao Feng said, "Don't take things out all at once, remind them slowly."

Seeing Hu Jiaran's operation, he was too lazy to teach him. This was better than what he did.

In fact, Gao Feng is not entirely afraid of trouble. There are many things he hasn't figured out yet. People's energy is always limited, and it doesn't matter if they are always depressed.

"Scumbag!"

"Hello to you too." Gao Feng nodded in response.

"Let me tell you, you must find the right person to get married." An older employee said with emotion, "Marrying a wife is a matter of marriage."

"Waiting for you." He gave the patient a big hug, and the latter's face turned red to his ears.

Zou Yun got a big slap on his face and successfully transformed from a sweet guy to a scumbag.
-
Hu Jiaran has been busy recently, and has encountered difficulties with CAR-T therapeutic drugs for multiple myeloma.

"Really? In fact, I felt very attracted to you the first time I saw you." Zou Yun said happily, "I found that you are a very kind girl with a tall figure. I fell in love with you at the first sight. "

It's better to write things down and let these people study them.

"Can you really wait for me?" the patient asked shyly.

"Old man, what's wrong with you?"

So the next day, the patient accidentally saw Zou Yun cuddling with a beautiful girl on the street, behaving intimately and even making waves.

"It's impossible to embed it." Hu Jiaran led him to the laboratory. It has to be said that the place here is many times bigger than when he was at Z University. It took several minutes to walk to the destination.

"How about you come over and take a look?" He called Gao Feng.

"My ears are fine." The uncle heard these words very clearly.

"Then let me say something and you repeat it." Bu Zhengyang said.

"brother."

"Victory." The uncle said.

"Specialty."

"Classroom." Uncle

"Firefighting."

"Fruit." Uncle

"speed."

"Interaction." The uncle said confidently.

"You can take him to the otolaryngology department for another check-up later." Bu Zhengyang said to his family members, "See if he can get a hearing aid or something."

Everyone can see that the uncle has some hearing, but obviously not very much.

This old man is 94 years old this year. This time he was admitted to the hospital with complaints of chest tightness after two weeks of activity. He had taken a chest X-ray in the community before. The report said that there were multiple shadows in both lungs. It was recommended that a chest CT examination be performed, but none were seen. Film.

"It's best to take another chest CT." During auscultation, Gao Feng found that obvious wet and dry rales could be heard in the old man's lungs, and his heart rate was not very regular.

"Okay." The family members were still very positive, "We will go together when the others come over."

"Are you the old man's son?" Bu Zhengyang asked, "You still look quite young, are you almost 60 this year?" "I am his grandson." The male family member was a little speechless, "I am only in my early 40s."

"Then you look quite anxious." Bu Zhengyang said with a smile.

In the afternoon, the patient's chest CT results came out. Gao Feng couldn't help but frowned after taking a look at it. Bu Zhengyang also looked unhappy.

"Doctor, is the problem serious?" the patient's grandson asked.

"Well, how should I put it?" Bu Zhengyang, who was in charge of the bed, hesitated, "One bad news and one good news."

"Please tell me the good news first." The male family member said.

"The good news is that you no longer need to go to the otolaryngology department to get hearing aids."

"Where's the bad news?"

"It's most likely a tumor, late stage." Gao Feng pointed out to him, "Look, this piece is 4 centimeters in diameter. It's divided, has pleural traction, and is divided into lobes. These are the characteristics of malignancy."

"These pieces on the liver should also have been transferred."

"This is really true." The family members sighed.

"At this age, palliative care is still recommended." Gao Feng said to him, "If I really want to be more proactive, I can do a puncture to see what type it is."

"If you have a genetic mutation, you can take targeted drugs."

If not, at this age, I don’t know if I can withstand chemotherapy.

After discussion, the family members decided to be more proactive. After all, the patient can now walk and eat, so they cannot emotionally accept doing nothing.

Since the mass was located relatively peripherally, Gao Feng decided to perform a lung puncture examination on the patient.

The overall process was very smooth, and the result was no fluke. The pathology showed that it was squamous cell carcinoma of the lung. A genetic test was done, which showed EML4-ALK fusion.

"Oh, the old man is quite lucky." Bu Zhengyang said with a smile, "This is a diamond mutation."

ALK fusion mutation is one of the common driver gene mutations in non-small cell lung cancer. Compared with other targets and drugs, patients with ALK gene mutations can obtain better efficacy and longer survival by using corresponding targeted drugs. Known as the "diamond mutation".

However, the occurrence rate of ALK fusion mutations is only about 5%-7%, so those who are ALK-positive are the lucky ones.

"How can you be so lucky even if you have this disease?" The patient's grandson smiled bitterly.

"It's a blessing in misfortune." Gao Feng said.

However, most drugs targeting ALK fusion mutations are relatively expensive, but this is not a problem for patients.

He got married early and did a good job in branching out when he was young. Bu Zhengyang learned that the old man had a total of 8 children and 14 grandchildren, all of whom were adults.

The family members held a mobilization meeting, and soon more than 10 yuan in hospitalization expenses were added to their accounts.

The saying that there is strength in numbers was clearly stated, and the old man in the bed next door had an envious look on his face.

"I'm from a public institution." He said angrily, "God damn it! I was not allowed to live at that time."

He only has a daughter who is currently abroad and is in contact with her by phone every day. There were always a group of family members surrounding her bed, holding a bunch of children, and he burst into tears when he saw them.
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"Director Gao, are you in the hospital?" The caller was the doctor in the intensive care unit. Gao Feng remembered him. He was in charge of Jiao Chengxi who was poisoned last time.

"Here he is." Gao Feng replied.

"We admitted a patient with a serum potassium of 1.0."

"What?" After hearing this, Gao Feng quickly ran to the intensive care unit at full speed.

Last time it was 0.9, this time it was 1.0. Wang Zhimin, who was on duty, felt quite unfortunate.

The patient, male, 31 years old, was admitted to the Provincial Medical Intensive Care Unit by the 1 bus with chief complaint of general weakness for one hour.

One hour ago, the patient developed weakness in his limbs, accompanied by chest tightness and shortness of breath, nausea, and vomiting dozens of times, all of which were stomach contents and bile. There was no headache, dizziness, chest pain, abdominal pain, or twitching of the limbs, so he called 1 to come to our hospital.

"The family members said that the patient was in good health and drank a lot of alcohol one day ago, accompanied by multiple violent vomitings. The vomitus was stomach contents." Wang Zhiminhui reported, "There was no hematemesis and he denied a history of drug allergy."

“体格检查:体温:37℃心率:121次/分呼吸:20次/分血压:90/60mmHg;{SPO2:95%。

The patient is conscious, poor in energy, and restless. There was no tremor in the eyeballs on both sides, and the pupils on both sides were large and round, about 3 mm in diameter, and sensitive to light reflection. The lungs were clear to percussion, the breath sounds to the lungs were clear to auscultation, and no wet or dry rales were heard. The heart rate was 121 beats/min, regular, and the heart sounds were normal, with no pathological murmur heard.

The abdomen was soft, with no tenderness in the entire abdomen, and bowel sounds were about 4 times/min. The muscle strength of the limbs was grade 1, and the Pap sign was negative. "

Wang Zhimin said so much in one breath, Gao Feng felt that his basic skills were quite solid.

"As soon as the results came out, the potassium was pumped."

"The blood potassium is too low, so I just wanted to call you over and take a look."

Such low blood potassium will cause metabolic dysfunction of myocardial cells and lead to a sharp decline in myocardial contractile function. The consequence is that sudden accidents are prone to occur, such as cardiac arrest.

Gao Feng was still looking at the test results when a nurse howled.

"Someone, come quickly! Bed 17's breathing and heartbeat have stopped!"

"Damn it!" Wang Zhimin rushed over quickly. What he thought came to him was that the patient in bed 17 was suffering from hypokalemia.

"Life hangs by a thread: Ma Jiahao's life has entered a countdown, and his great-grandmother is already on the way. Please do something immediately to save his life. You can get 20 skill points by completing the task."

In fact, Gao Feng was not very fond of this patient. The medical record stated that he had a long history of drinking and had been hospitalized in the emergency department many times for acute alcohol poisoning.

Pure wine.

Besides, since the patient's great-grandmother is already on her way here, it doesn't seem appropriate for the elderly person to make the trip in vain.

It's a bit disrespectful to the elderly.

But when he came to the bedside and saw the patient's young face, he couldn't help but sigh.

Compression, intubation, epinephrine, the process was very smooth. After all, this is an intensive care unit. They are very professional in doing this, and Gao Feng couldn't find any major faults.

But several cycles have passed, and the patient's heartbeat and breathing have not recovered.

"Get on ECMO." Gao Feng said. If you really want to save the patient's life in this situation, cardiopulmonary resuscitation with ECMO support is the best solution.

But this patient was really lucky. If his heart had stopped outside, he would have died. Now that Gao Feng is at the scene and ECMO is still available in the department, we can only say that his life should not be cut off.

The process of putting on ECMO was very smooth. Wang Zhimin had never seen such a quick operation. The nurse who helped me obviously couldn't keep up with the rhythm and was in a hurry.

Cardiopulmonary resuscitation with ECMO support continued, and the patient finally recovered his spontaneous heart rate after about 30 minutes.

But before everyone could breathe a sigh of relief, ventricular fibrillation started again.

Wang Zhimin quickly raised the defibrillator. Subsequently, the patient suffered from repeated ventricular fibrillation, and the defibrillator was running at full capacity today.

"Serum potassium 1.0mmol/L." The nurse reported the results of the blood gas analysis.

"Give him a bottle of potassium chloride." Gao Feng signaled.

"Huh?" The nurse suspected that she heard wrongly, "Just push it?"

"Yes, the blood potassium is too low, that's why the patient has repeated ventricular fibrillation." Gao Feng said, "After pushing the next gastric tube, I will feed a few more tubes through the nose."

This is ridiculous, the nurse thought to herself. This is the first time that my mother has been asked by a doctor to give intravenous potassium chloride to a patient in so many years of working.

(End of this chapter)