White armor

Chapter 334: Can fat emulsion also cure allergies?

"Not bad." Luo Hao smiled slightly, "Qingqing, we can just find someone."

Chen Yong's mouth curled up.

After the 912 incident, Luo Hao might no longer have the face to talk about our Union Medical College Hospital, which really makes people feel happy.

"Isn't this the most convenient way to find you? Otherwise I have to find my dad."

"Okay, I'll go there." Luo Hao smiled and hung up the phone.

"Okay, let's go after we've finished eating." Luo Hao said, "Old Bai, you've worked hard this time, and I'll have to work hard on you in the future."

Seeing Baidi Cheng turned into a beast of burden, Luo Hao felt a little strange.

"It's okay." Bai Dicheng replied.

"I'll go with you." Chen Yong paid the bill and followed Luo Hao.

"You're not going to accompany me?"

"It's inconvenient." Chen Yong was a little embarrassed.

Luo Hao chuckled. Chen Yong had indeed changed. He just didn't know what ability Old Liu had to be able to subdue Chen Yong.

But these things are not easy to ask, as there is always someone better than you in this world.

Lao Liu is the brine and Chen Yong is the tofu.

"Chen Yong, why do you insist on raising poisonous insects? It's disgusting just looking at them." Luo Hao asked the doubts in his heart while waiting for the online taxi.

"Gu King, that's Gu King! What kind of Gu insect is that? You look so uneducated. Fang Xiao, Chen Yan and Boss Chai, how can they be the same?"

"Okay, okay, King Gu."

Although Luo Hao felt that Chen Yong's analogy was unreasonable, he still agreed.

"The Gu King eats all kinds of insects, as written in the book. I'm thinking if I encounter a patient with parasites in the future, can I try a different treatment method?"

Luo Hao was stunned. This idea was a bit far-fetched and totally impractical.

A patient with hydatid disease was sent to the hospital. Chen Yong took out the Gu King, and the hydatid worms crawled out through his mouth and nose.

That scene is too weird.

No, hydatid cysts grow in the liver parenchyma, so how they can enter the digestive tract is a big problem.

bile duct?

Hepatic duct?

Luo Hao began to think about it.

"Hey, that makes sense!" Chen Yong thought Luo Hao was questioning him, so he argued.

"It's quite interesting. What's the principle?" Luo Hao asked.

"You just gave the example of a mouse infested with parasites having its mind affected. Is it reasonable for a mouse to attack a cat?"

"Too."

"Luo Hao, what kind of parasite is so fierce?" Chen Yong asked.

"Toxoplasma gondii can permanently change the brain tissue structure of mice." Luo Hao finished speaking, and added, "This is what a research team from the University of California, Berkeley published in the American journal Plos One. They have done many similar studies."

"You've got enough of always mentioning America."

Luo Hao said seriously, "Learn advanced experience and catch up as soon as possible, otherwise it will just be a troll on the Internet. Which one do you think is more appropriate?"

Chen Yong thought about it and decided not to argue with Luo Hao.

"And their research is so thorough, it's not just for the purpose of curing diseases."

"What else?"

"Poisoning. Gaza's water sources are infected with hepatitis A virus, polio virus, etc. Isn't the coronavirus a few years ago an example?"

Chen Yong nodded, agreeing with it deeply.

"Tell me in detail what happened to you in Nanyang."

"Why, do you want to raise a Gu King?" Chen Yong was eager to try.

"No, if my speculation is reasonable, then the way the Gu King has been raised since ancient times is wrong. There is no need to burn thousands of miles of barren land and use the blood of so many people to feed it. An Ecmo and some nutrient solution are enough."

"!!!"

"We also need to study the blood composition before and after absorption. Upgrading by just soaking? That doesn't conform to the physical rules of this world."

"also……"

Luo Hao told Chen Yong what he was thinking, and Chen Yong was dumbfounded.

He even felt that Luo Hao really wanted to raise the Gu King and then throw him to Baltimore.

This bastard Luo Hao really holds a grudge, really.

After getting in the car, Luo Hao was more careful about what he said, talking about theoretical things so as not to let his brother from the capital interrupt him.

There was a traffic jam in the capital late at night. Although it was not a deadlock and traffic was still moving, it was not smooth at all.

It took more than half an hour to arrive at Concord Hospital.

Before getting off the bus, Chen Yong put on a mask.

The weather was still a bit hot and humid, and there was sweat on Chen Yong's forehead and temples.

"You must be suffering a lot." Luo Hao looked at Chen Yong with a smile and asked jokingly.

"It's okay, otherwise it would be even more painful."

No matter how Luo Hao listened, he felt that Chen Yong's tone carried the flavor of what he was saying - the flavor of my Union Medical College Hospital.

But it's just a suspicion, there's no evidence.

Ye Qingqing was not at the door. Luo Hao called her, but Ye Qingqing didn't answer.

This kid, really.

Although Luo Hao complained a few words in his heart, he still had a smile on his face.

As I entered the emergency department, a cold air hit me in the face.

Although he knew that this was probably the cold air from the central air-conditioning, Luo Hao had another idea in his mind.

He has been to the emergency departments of many hospitals, and no matter which direction they are in, the emergency departments always have a chilly atmosphere.

Perhaps it’s because there are too many dead people here and the yin energy is quite heavy.

Moreover, the background of many urban legends is the emergency department, and Luo Hao doesn’t know whether they have any scientific basis.

The emergency department corridor was quiet.

Luo Hao had a bad thought in his mind, but when he took a look at the system panel, he found that there was no emergency task and his luck value was shining brightly.

The entrance to the emergency room was also quiet.

It should be fine.

"Fat emulsion, static push!" A voice came to Luo Hao's ears.

Gan!
problem occurs!
"Fat emulsion? What is it used for?" Chen Yong wondered.

"The medium- and long-chain fat emulsion we usually use is generally used for fluid replenishment." Luo Hao said as he strode over.

A stretcher was pushed out from the treatment room, with a female patient lying on it, and Ye Qingqing was beside her.

She didn't cry, but her face was full of indifference. It seemed that her best friend's fainting was very sudden, and Ye Qingqing was not prepared at all.

The tomboyish Ye Qingqing was stunned by the sudden attack. Luo Hao often saw this situation.

But... didn’t you say I have to sew it myself?

Along the way, Luo Hao was still thinking about how to tell this to the people in the emergency department.

Although he was using the name of Dr. Luo from Peking Union Medical College and was on good terms with people from all departments, this kind of thing was indeed a bit beyond the rules.

From a distance, the patient was shivering all over, his hands were twitching, and his head was shaking.

The doctor ran and shouted, and the patient was able to open his eyes but did not respond.

He could not cooperate with the pain localization examination, was very irritable, and had cold extremities of both hands and feet. After being pushed into the emergency room, he was connected to an ECG monitor, with blood pressure of 109/62 mmHg, heart rate of 100 beats/min, and blood oxygen of 92%.

"Luo Hao, what's going on?" Chen Yong asked puzzledly.

There are traces of sutures on the patient's right eyelid, which means it must have been sewn complete.

Is it because of needle phobia?
But this kind of needle sickness is a bit too serious.

"Didn't you hear that they used fat emulsion? It's caused by lidocaine allergy."

"What? Lidocaine can cause allergies?! Fat emulsion can also treat allergies?!" Chen Yong was surprised.

In clinical applications, lidocaine is injected directly into patients without even a skin test.

Lidocaine is also used for local anesthesia in every interventional surgery. Since Chen Yong came to the clinic, he has used lidocaine at least a thousand times.

I have never seen or heard of a case of allergy to lidocaine.

Moreover, Chen Yong had never heard of using fat emulsion to treat allergies.

Luo Hao did not participate in the rescue. This is Union Hospital, not a county hospital, and the technical level is at the top level in the country.

Although they encountered an extremely rare situation, the doctors in the Union Hospital Emergency Department still carried out the rescue work in a methodical manner.

Dexamethasone 10 mg was injected intravenously for anti-allergic effect, diazepam 10 mg was injected intravenously to suppress convulsions, 20% fat emulsion was injected intravenously to antagonize the effect of local anesthetics, and adrenaline was injected intravenously.

Soon, the patient lost consciousness, the pulse of the carotid artery disappeared, and breathing stopped, which was considered to be respiratory and cardiac arrest.

The emergency doctor immediately performed chest compressions, and after about 10 seconds, the patient regained consciousness and resumed breathing.

Heart rate 100 beats/min, blood oxygen 89%, blood pressure 90/50 mmHg, and convulsions continued.

"Luo Hao, go ahead." Chen Yong urged with a frown.

"It's the same if I go there. Teacher Sun is on duty in the emergency department. He was the one who taught me back then."

Luo Hao shrugged and spread his hands.

Besides, she wasn’t even wearing white clothes, and the situation was still under control, so Luo Hao didn’t want to get involved.

It looked scary, with respiratory and circulatory arrest, but he came back to life after 10 seconds of external chest compressions. It was probably transient.

Luo Hao knew what was going on.

The patient continued to intensify the fluid infusion and applied 15 mg of diazepam again after 10 minutes to suppress convulsions. The ECG monitor indicated sinus tachycardia.

The emergency room doctors kept issuing medical orders.

We asked all relevant departments of the hospital to come for consultation and provided treatment in advance.

The purpose of the consultation is...to make a collective decision, but after coming here, it was a similar plan, so I gave it to him first.

The patient was given promethazine, methylprednisolone sodium succinate for injection, fat emulsion, and fluid infusion. Midazolam was also given, and anti-allergic measures such as warming and catheterization were adopted. Seizures were suppressed, the effects of local anesthetics were antagonized, and blood volume was supplemented.

Before all the consultation personnel in the hospital arrived, the patient's condition had improved.

After more than 10 minutes, the patient was conscious, answered questions clearly, convulsions stopped, complexion was ruddy, skin was warm, blood pressure was 104/69 mmHg, heart rate was 90 beats/min, blood oxygen was 100%. Catheterization was 850 ml. The condition was relatively stable.

"Here." Luo Hao stood at the door and looked at the monitor. "It looks scary, but it's actually very simple."

Chen Yong knew that he should speak less in Luo Hao's home court, otherwise he would be rude at any time and anywhere.

But even if he didn't say anything, Luo Hao said naturally, "Fat emulsion, the 20% kind, very few people know that it can also neutralize lidocaine. When I was at Donglian Mine, I went to the emergency department and saw that they didn't have any 20% fat emulsion available."

"..."

"If something happens, we won't know how to rescue him." Luo Hao was helpless. "I borrowed a bottle of fat emulsion from the pharmacy and put it in the emergency department, but the head nurse sent it back later, saying it was a cost." "..."

"Actually, I don't know whether it's better to let a similar patient teach the emergency department a lesson, or to keep the world peaceful."

"Today is peaceful, tomorrow is peaceful, but it may not be peaceful the day after tomorrow."

"Then what did you do?" Chen Yong couldn't help but asked.

"An exam." Luo Hao smiled. "I asked them at least 20 times to neutralize acute lidocaine allergy with 10% fat emulsion. It was mixed into the exam questions as one of the performance evaluation results of the emergency department."

"!!!"

"If I take the test a few more times and see such unfamiliar questions, I think it will be of some use. I can't do anything more than that. If I haven't seen this kind of emergency allergy before, I really don't know. If I don't know, I'll just do it blindly." (Note)
Chen Yong expressed regret for what Luo Hao said, but then he thought again and realized that he really didn't know.

"Here, let me test you." Luo Hao looked at the patient who had recovered and felt relaxed. "Tell me the key points of the rescue you just saw."

"Hurry up and tell me. I use my brain well. I'm not like Lao Meng who has to take notes with a pen and paper."

"Meng is a smart guy. He just put it on display for me to see. Is this what you call a sense of ritual?"

"Huh? Old Meng, that old bastard!" Chen Yong scolded.

"A sense of ritual is very important, especially when you are training new people. They will be more serious if there is a sense of ritual. There are some things you still need to learn more from Lao Meng." Luo Hao smiled.

"Go ahead."

"First, protect the airway and give pure oxygen. If necessary, perform endotracheal intubation to control the airway and avoid hypoxemia and hypercapnia. Hyperventilation is generally used, and the airway should be established quickly at this time to avoid the use of local anesthetics for surface anesthesia."

"second……"

"Sixth, give 20% fat emulsion intravenously as soon as possible."

Luo Hao counted on his fingers to explain to Chen Yong the steps of emergency first aid.

As Chen Yong listened, he checked every scene he had just seen.

It was just as Luo Hao said, the doctors in the emergency department of Peking Union Medical College encountered an extremely rare patient with lidocaine allergy, but they were busy but not chaotic, and each step was very formal.

Just as Luo Hao said, it seems that there should have been systematic training in Union Medical College.

He wrote it down secretly.

If I really were to perform the surgery independently and the patient had an allergic reaction right after the anesthesia and I had to start emergency treatment, I couldn't just call Luo Hao.

Of course, the call must be made.

As for recruiting people, Luo Hao didn't care at all, and even unconsciously instilled things like recruiting people and collective decision-making into Chen Yong.

But when Luo Hao comes, we have to do something, just like now.

Doctors from various departments came to take a look. They all looked very relaxed, and some even joked - the patient is fine, why did you call me here?

That’s about it, Chen Yong wrote it down silently.

"Senior Brother." Ye Qingqing didn't come out until this time.

"It was a close call." Luo Hao first characterized the incident. "If I were here, I would definitely have to suffer from an allergy and need emergency treatment. But it's okay as long as the person is fine. Allergies are just minor problems. It's better to have an allergy in Union Hospital than in other small hospitals."

"Brother, I don't think so." Ye Qingqing said firmly.

"Oh, how is that possible?"

"You've always been lucky. My dad said that if you do some of the dirty work, it will always go smoothly. Maybe if you do the sewing, you won't be allergic to it."

Although Ye Qingqing did not study medicine, she came from a medical family and was knowledgeable. She did not blame the emergency doctor, but attributed everything to the man's bad luck.

Having said that, Luo Hao had nothing else to say and thought Ye Qingqing was right.

"Luo Hao." Chen Yong was deep in thought when he suddenly spoke, interrupting the conversation between Luo Hao and Ye Qingqing.

"what happened?"

"I remember you always chat with patients for a while when you give them anesthesia. Is that to prevent allergies?"

Luo Hao raised his eyebrows. Chen Yong was really meticulous and remembered all this.

Every time I have a surgery, I first give myself a little lidocaine subcutaneously, chat with the patient, and wait for a few minutes. Only when I see that there is no allergic reaction will I actually start the anesthesia.

It's a bit cumbersome, but Luo Hao is a doctor who has seen how terrible lidocaine allergy is, so he would rather have a little trouble than get himself into a similar predicament.

Even Luo Hao knew the first aid for lidocaine allergy by heart.

"Yes."

"Excuse me, is there any other good solution?"

"We need to do a lidocaine skin test before the operation, but very few hospitals will have this skin test. The nurses will be very unhappy and the patients' families will think it is overcharged. So, we can only give a little before the operation and then have a chat."

Chen Yong seemed to be thinking about something.

"Qingqing, how are you studying?"

"Senior brother, I'm about to graduate from graduate school. You ask me about my studies? Shouldn't you ask me about scientific research and experiments?" Ye Qingqing asked back.

Luo Hao breathed a sigh of relief, indeed.

Ye Qingqing tutored herself when she took the college entrance exam, so she asked the question naturally.

"What is your experiment about?"

"Liquid shape-shifting metal."

"???"

"Terminator?" Chen Yong asked.

"It's related to medical treatment. My supervisor is in poor health and is about to retire. It just so happens that Teacher Qi at Gongda is working on a related project, so my boss wrote a note and asked me to continue my research with Teacher Qi."

"Is it related to medical treatment?" Luo Hao thought for a moment. "I remember a news report a few years ago saying that the liquid metal robot of Gongda University has entered the clinical trial stage."

"Brother~~~" Ye Qingqing smiled and hugged Luo Hao's arm, "When I go to do it, I will give you all these contents."

Luo Hao smiled and nodded.

It is probably that there is some gap between Qi Yuanliang and the doctor, and the communication is not so smooth.

Yes, it is extremely difficult to find a reliable doctor to cooperate with clinical trials.

It's not just clinical trials, but also finding the related points among them, which is not something that ordinary doctors can do.

Different trades are like different mountains, so it is normal for progress to be slow. If it were me and Ye Qingqing, it shouldn't be a big problem.

Luo Hao expressed his emotion that the playful tomboy Ye Qingqing could actually engage in such high-end research.

Children will grow up one day.

"It's a deal then! I'll go to Teacher Qi's lab at Gongda after the Chinese New Year."

"Okay." Luo Hao agreed, "Just don't be naughty when the time comes."

"I'm already so old, can you please stop looking at me with tinted glasses?"

Luo Hao smiled, pulled out his arm and raised his hand to comb Ye Qingqing's hair.

Her hair was very short, and it returned to its original shape when she shook her head. It seemed that Luo Hao had been doing her hair for so many years that she had gotten used to it.

"Luo Hao, what if the patient is allergic?" Chen Yong was still worried about lidocaine allergy.

"The lipid local anesthetics used include procaine, chloroprocaine, and tetracaine," Luo Hao explained. "We don't always have them, but I have two bottles of procaine in my cabinet."

"Tetracaine? I remember this is from the ENT department..."

"Tetracaine is a mucosal surface anesthetic, and its mechanism of action is different."

Although Luo Hao explained patiently, Chen Yong could vaguely hear Luo Hao's inner thoughts - the foundation of doctors graduating from other medical schools was really not solid.

He pulled out his cell phone and searched for procaine.

Procaine is an early ester local anesthetic. It has weak penetration into the skin and mucous membranes, so it must be injected. In order to reduce toxicity and prolong the duration of action, a small amount of epinephrine is often added to the mixture, which can extend the duration of action by 1 to 2 hours. The commonly used concentration is 1% to 2%.

It turned out to be a lipid anesthetic, and Chen Yong gradually understood what it was.

It turns out that there are so many details in the clinical practice, and this bastard Luo Hao didn't even tell him. Chen Yong glared fiercely at Luo Hao who was chatting with Ye Qingqing.

During the chat, the patient had fully recovered, as if he had not just suffered respiratory and circulatory arrest. He asked to get out of bed and had his urinary catheter removed.

After all, she was Ye Qingqing’s best friend, and Luo Hao wasn’t wearing white clothes, so it was not easy for him to go in and see.

We should avoid suspicion when necessary, and Luo Hao was quite cautious about this.

"Then you go ahead and do your work. Remember to tell me when you go to the provincial capital and I will pick you up," Luo Hao reminded.

"Row."

"I will be back tomorrow. If you need anything, please tell me in advance. Your brother is too busy to handle everything right now."

“Does substitute teaching need to be so serious?”

"We can't mislead our students."

After a brief explanation, Luo Hao and Chen Yong left.

Chen Yong had been thinking about the use of lidocaine, and despite the huge buff of Union Hospital, he still gritted his teeth and asked Luo Hao more relevant information.

Fortunately, Luo Hao did not show off, nor did he explicitly say that Chen Yong had a poor foundation. He explained things to Chen Yong bit by bit.

"Why didn't you tell me before?" Chen Yong asked with some dissatisfaction.

"There are too many relevant details, and you will be impatient." Luo Hao smiled, "I'll tell you after you see it, and you will remember it clearly."

Chen Yong remembered what his grandfather always said when he was a child.

Luo Hao's "daddy" vibe is becoming stronger and stronger, and it is obvious in words.

I went back to rest, no conversation took place that night, and I rushed back to the provincial capital the next day.

However, when Luo Hao carefully examined the system panel before going to bed, he found that the currency in the system mall had increased by 10!
He thought about it carefully and decided that it might be because of this incident.

But the damn system didn't provide any instructions for the mall, so Luo Hao had to figure it out on his own.

Everything finally returned to calm. Every day I admitted patients, performed surgery, and wrote medical records. The days passed by like flowing water.

Normally the review for the Young Thousand Talents is held in the middle of the year, but this year's review has been postponed. Luo Hao has no choice but to look at the long-term main quests and salivate over the rewards.

As summer goes and autumn comes, the leaves gradually turn yellow.

Chen Yong also obtained a license for interventional imaging and can perform surgeries himself.

Despite this, Luo Hao still did not let him perform the surgery independently.

Usually, Luo Hao performs one operation by himself, and lets Director Shen Zizai watch Chen Yong perform the other.

After all, Chen Yong had only been involved in interventional surgery for less than a year, so Luo Hao was still cautious.

One day.

Shen Zizai sat leisurely next to technician No. 66, just holding a small teapot in his hand.

Although he was wearing a lead suit, he did not show any desire to undergo surgery.

It's more like an old director who has been rehired after retirement. He is only responsible for holding the line, while as for charging into battle, there will be successors.

"Director, Doctor Chen's surgeries are getting more and more stable, but it's not good for you to enjoy yourself like this." Technician No. 66 asked as he watched Chen Yong anesthetizing a patient in the operating room.

"No, it's not bad at all, isn't this quite good?"

……

……

Note: I have used lidocaine for thousands of times and have never seen an allergic reaction. This is truly a rare situation, and I admire the diagnosis and treatment of the emergency doctors in the hospital that reported the case.

(End of this chapter)