Gou is practicing medicine in the clinic

Chapter 369 Both positions are difficult to hold, and the weak points cannot be replenished.
Many critically ill patients do not actually die from the original disease, but from complications.

For example, AIDS, the virus itself cannot kill us humans.But it can damage our immune system and cause immune deficiency in the body.

Without the barrier of the immune system, the human body will be very prone to various infections and its own malignant tumors.

There was an unfortunate AIDS patient who had 11 types of cancer detected in his body by the time he died.

Just one type of cancer is scary and deadly enough for the average person.

One patient developed 11 types of cancer at the same time, but no one who survived the nuclear radiation zone had so many types of cancer at the same time.

Li Jingsheng persuaded Lian Tao to give up treating this case from the beginning, and he also considered it from multiple angles.

Acute myocardial infarction is only the first complication, and it will definitely not be the last.

Although the patient has some good treatment foundations, it can be seen from his height and weight, the doctor's evaluation during the physical examination, and the current indicators that his health is in extremely poor condition.

There is an old saying that goes, "If the wall falls, the crowd will push it."

People with strong bodies are immune to all diseases and can recover quickly even if they do get sick.

But for a weak person, even a small disease can defeat him.

"Since the patient had an acute myocardial infarction after he was admitted to the hospital, I suspect that it is likely that his blood volume was insufficient, resulting in slow blood flow, which triggered the myocardial infarction. Although the condition has been controlled through timely treatment, the root cause of the disease has not been resolved. , the problem still exists.”

Li Jingsheng analyzed the patient's current situation.

He concluded that the patient had diarrhea, fever, vomiting, and coupled with discomfort, body discomfort, and poor eating, this led to insufficient blood volume.

Poor eating habits of the average patient may only result in the body becoming weaker and prolonging recovery time.

However, in such elderly patients, the blood circulation itself is not very good, and insufficient blood volume causes the blood flow to slow down, which is nothing more than adding insult to injury.

Myocardial infarction and cerebral infarction all come naturally.

"Professor Wang Weiwei also raised the issue you mentioned. Yesterday, we communicated with the family members and gave nutritional injections to address the patient's poor eating habits. The temporary effect is not bad. The key is to find out what causes the patient's vomiting and diarrhea. Otherwise, nutritional injections would not be possible all the time. The longer it is delayed, the more detrimental it will be to the patient.

To be honest, I am really anxious here.

I hope that we can help patients find the cause as soon as possible and improve their condition.

Those complications that may appear at any time are equivalent to individual villains.They are still just preparing to attack the patient, or lurking in the dark waiting for the opportunity.As long as the patient's vomiting and diarrhea problems are solved and the patient resumes eating, all the complications that are about to arise will naturally disappear without a trace. "

Lian Tao has his own treatment ideas.

And the strategic point of this idea is very high.

Chief physicians generally have the ability to see the overall situation and take a long-term view when dealing with diseases.

The patient seems to have a lot of problems, but as long as he firmly grasps the core problem and solves it, he can cut through the knot quickly.

"I very much agree with your treatment strategy. It's just that it's difficult to determine the cause of the disease. If it's quick, it can be found tonight. If it's slow, it may still hide and seek with the real cause for ten and a half months. If I couldn't find out the cause for a day or two, and I was very worried about the patient's lung infection."

Since Li Jingsheng plans to help Lian Tao treat this patient, he must first find a way to prevent potentially fatal complications.

The heart and lungs are very important.

Not to be lost.

In fact, acute myocardial infarction has occurred in the heart.

It was equivalent to almost losing one of the important positions.

Fortunately, through hard work, I have successfully defended my heart.

If an infection occurs in the lungs, the consequences will be disastrous given the patient's current condition.

Because the patient has now taken a lot of antibiotics.

In this case, the lungs are infected, and ordinary antibiotics are like a drop in the bucket and have no effect at all.

The best way is to take precautions in advance.

"Jingsheng, you only have this concern after seeing the patient's CXR results, right?"

"Yes! In the patient's chest X-ray, there are patches of exudation in the right upper lung. This indicates that infection is likely to have occurred."

"Don't worry, intravenous discharge is my strength. I have given the patient cefuroxime, ceftazidime, ciprofloxacin and other antibiotics. I am confident that the patient's infection can be controlled within half a month."

Lian Tao had a confident tone and demeanor.

"Brother Tao, we have a close relationship, and you never treat me as an outsider. I will say some things directly."

"You tell me, I'm not the kind of person with a small belly. If you have any criticisms, feel free to say them. Anyone who is willing to criticize me is my noble person."

Lian Tao said seriously.

It's true as he said. People who reach his status usually hear all kinds of praise and flattery.

There will be few criticisms of him.

Just imagine, which employee dares to criticize the leader?
Unless the employee's EQ and IQ are worrying, he will definitely not do such a stupid thing.

If you criticize leaders face to face, many leaders will accept the criticism graciously and even praise the critic.However, in fact, the idiot who criticized the leadership has been thrown into the cold palace.

Even if a broad-minded leader does not give this person a bench, he will never think of promoting this person.

Li Jingsheng and Lian Tao are friends, so they don't have such worries.

But when friends raise objections, sometimes they still need to take care of each other's face.

"Does this patient have a cough now?"

Li Jingsheng did not immediately raise objections, but asked questions first.

"Cough, what's wrong?"

"Can you cough up phlegm?"

Li Jingsheng asked again.

"I really haven't looked into this carefully. I feel like he's not coughing up phlegm very smoothly." Lian Tao's face felt slightly hot.

Busyness and short admission time for patients are not the reasons.

Being able to cough up sputum smoothly is very important for such bedridden patients.

"In my experience, the presence of patchy exudates in a patient's upper lungs often means that the patient has a problem coughing up sputum. Otherwise, as long as the phlegm can be coughed out, upper lung infection will generally not occur."

In fact, the lungs, like the organs used by women to urinate, have certain self-cleaning capabilities.

When there is foreign matter, inflammation, or infection in the lungs, it will work hard to form mucus, and then the germs and mucus will be expelled from the body through coughing.

After catching a cold, many people will develop a cough on the third day.

Experienced patients will know that this indicates that the cold will be cured soon.

Why does a runny nose or cough indicate that the cold is about to be cured?

Because coughing itself is a self-protection mechanism.

The purulent sputum coughed up contains a large amount of mucosal tissue that has been invaded by germs, as well as a large number of bacteria and viruses.

They are all stained with purulent sputum and expelled from the patient's mouth or nasal cavity.

After the bacteria and viruses are eliminated, the body will naturally recover.

"This patient is old, bedridden, and cannot cough up phlegm, which is very easy to aggravate the lung infection. It is effective to use drugs such as cefuroxime at the beginning, but the effect of the drug will become worse as time passes. In the end, the patient The lung infection is difficult to control. By that time, the patient's death will really come."

Li Jingsheng did not directly say that Lian Tao could not control the infection.

In fact, this analysis is equivalent to telling Lian Tao that the patient's lung infection is difficult to control.

As long as there are no special measures, the patient's lung infection will become more and more serious.

By then, the heart, liver, kidneys and other organs will be affected.

"You can't just ignore death, right? At least you can only know the result after you try your best."

Lian Tao's face felt hot.

Only then did he realize that the bold words he had just spoken so confidently might be a slap in the face.

It's just that he has some bookishness and refuses to give up easily.

I still want Li Jingsheng to help with treatment.

"There is absolutely no problem in trying. As long as the family and the patient are willing to cooperate, I am willing to work with you to diagnose and treat this patient. However, I still want to tell you about the possible progression of the disease. The important position of the patient's lungs has been lost. After treatment, the liver and kidneys will be affected first. Early liver-protective treatment is very necessary. It is recommended to monitor kidney function in real time. When problems arise, treat them symptomatically and make timely adjustments.

If this patient can survive a month, there is hope of survival.

If you can't survive it, even if the cause of vomiting and diarrhea is found, it will be difficult to survive the infection. "

Li Jingsheng really didn't attack Lian Tao.

These issues mentioned are all very likely to have happened.

The patient's condition will progress step by step.

Li Jingsheng now has a strong ability to predict the future direction of the patient's condition.

From the very beginning, he suggested that Lian Tao give up "torturing" this patient. Naturally, there was a reason.

Because the patient’s chance of being cured will not exceed 5%.

According to his clinical experience, this patient would develop a large number of complications within a month and eventually die after ineffective rescue.

"Can I go to the ward to see the patient now? I have read all the information and found no problems pointing to other digestive tract diseases. Judging from the existing examination data, it should be acute gastroenteritis. The only regret is that the patient does not You should delay for many days before coming to the hospital for treatment.”

After Li Jingsheng looked at it, he gave his own diagnosis.

"If it is acute gastroenteritis, why do we treat it according to the standard treatment of gastroenteritis, but it has almost no effect."

Lian Tao is also a master of gastroenterology. When treating this patient, he did feel a little confused.

"I estimate that the most likely reason is that the patient has had diarrhea and vomiting for too long, and the body has been depleted, so the treatment has no effect. There is a pharmacology in traditional Chinese medicine, which is called deficiency and not replenishment. In fact, this principle applies to patients The same applies to treating diseases of the digestive tract.”

After hearing Li Jingsheng's novel statement, Lian Tao asked doubtfully, "You mean the patient has had gastrointestinal problems for too long and cannot absorb the ingredients of the oral medicine?"

"That's just one aspect."

The medical theory mentioned by Li Jingsheng is more profound.

"But when we give medicine to patients, we also use intravenous drip and push injection. It does not pass through the digestive tract and enters the blood directly. This will not affect the absorption of the medicine due to problems in the digestive tract, right?"

Lian Tao obviously didn't agree with Li Jingsheng's point of view.

"What I mean by "deficiency is not replenished" means that the patient's body is too weak. Whether those drugs are taken or injected intravenously, the effect of the drugs may be affected by his body's weak absorption capacity, slow blood circulation, and metabolic disorders. Very bad.”

"So that's what it means, I understand! So do you have any good solutions?"

Lian Tao had a glimmer of understanding.

Three people must have my teacher.

Li Jingsheng obviously has a deeper and more thorough understanding of clinical pharmacology and medical theory than he does.

It is also more flexible in use.

You can draw inferences from one instance and gain a comprehensive understanding.

"It's not a good method, but there are still some common methods. It can strengthen the patient's parenteral and enteral nutrition. If nothing else, at least the complications such as low potassium and low sodium that the patient is experiencing can be quickly corrected. "

At this moment, although Li Jingsheng was talking eloquently, his prescription and medical skills had not yet improved.

A bit of a drag.

(End of this chapter)