When doctors have a simulated operating room

The two of them looked at each other.

This voice...

Why is it familiar?

It sounds like the voice of the girl in the clinic this morning.

They didn't even bother to eat lunch.

Zhang Yi and Chen Fang hurried to the second floor.

As a result, they saw that it was indeed the young man with kidney failure and the girl who came to the hospital with him.

The young man was lying on the ground with his eyes closed!

The girl was squatting on the ground and shouting: "Woo woo...Doctor, come and have a look! He fainted!"

Zhang Yi rushed forward.

It was found that the young man's carotid artery pulse disappeared and he didn't respond to calls.

He suddenly suffered ventricular arrest!

That is, sudden death!

We have to rescue him quickly!

While doing CPR, Zhang Yi said to Chen Fang:

"Push the stretcher over to the emergency room! This person is in ventricular arrest!"

When Chen Fang heard this, he quickly borrowed a stretcher from the B-ultrasound room next door.

The two lifted the young man onto the stretcher, and Zhang Yi pressed and ran after the stretcher.

"Quick! Make way! Please make way!"

The family members passing by saw this situation and consciously made way.

On the other side, the doctor on duty in the emergency room heard the hurried footsteps and the sound of the stretcher's wheels from a distance.

When he looked outside, he saw that it was Assistant Zhang and Doctor Chen who were pushing the patient to the emergency room.

The staff on duty consciously pushed the rescue medicine cart over.

"Oxygen, ECG monitoring, and intravenous access are all on!"

"One epinephrine, one lobeline and one dexamethasone!"

Zhang Yi immediately ordered after entering the emergency room.

"Okay!"

As soon as Zhang Yi spoke, the two nurses in the emergency room immediately took action.

After the medicine was injected, the heart rate and breathing increased significantly.

But the cardiac compression cannot be stopped.

We have to persist until the boy recovers his heartbeat and breathing.

"Add another lidocaine!"

"Okay."

Six minutes later, the rescue was successful.

The boy's heart resumed its autonomous beating.

Zhang Yi also breathed a sigh of relief.

Renal failure can indeed cause sudden death.

And the cause of sudden death is high potassium.

The kidneys have two main functions, one is filtering function, and the other is endocrine function.

The urinary system of the kidneys is like a sieve in the human body.

After the blood passes through the kidneys, the metabolic waste in it, such as urea nitrogen, creatinine, uric acid, etc., will be excreted from the body with urine.

And substances such as protein and fat will remain in the body.

Screen out the bad ones and keep the useful ones, which is a normal kidney filtering function.

However, when kidney failure occurs, the filtering function is impaired, and creatinine, uric acid and urea nitrogen cannot be discharged. The long-term accumulation of these things will cause acidosis, edema, increased blood uric acid and electrolyte imbalance in the human body.

Among them, the accumulation of potassium ions that cannot be discharged will cause hyperkalemia.

(Hyperkalemia is very likely to cause arrhythmia and sudden death.)

Then there is the endocrine function.

When the kidneys are damaged, they will secrete a substance called renin.

Originally, renin is secreted normally and will not cause harm to the human body under normal circumstances.

But once the kidneys are damaged, the blood flow to the kidneys decreases, the endocrine nerves of the kidneys are disordered, and renin will be secreted in large quantities without control.

Once renin is high, blood pressure will also increase, so it becomes renal hypertension.

(The reason why this patient has high blood pressure at a young age.)

In addition, the kidneys will secrete erythropoietin under normal circumstances.

Once the kidneys are damaged, erythropoietin decreases, and erythropoiesis disorders lead to anemia, which becomes renal anemia.

(The reason for this patient's anemia.)

In addition, the kidneys have another important endocrine function, which is to activate vitamin D3.

Most of the human body's vitamin D3 is synthesized through ultraviolet radiation.

(The content of D3 in food is very low, so it is better to get some sun exposure frequently.)

After vitamin D3 is produced, it first undergoes the first round of activation in the liver.

Then it undergoes the second round of activation in the kidneys. Only after the activation of the kidneys is the vitamin D3 truly biologically active.

It can participate in the body's metabolism, enhance immunity, and promote calcium absorption.

When the kidneys are damaged, active vitamin D is deficient, and calcium absorption is poor.

Therefore, various bone diseases, osteoporosis, etc. will occur.

These are a series of reactions of the body caused by renal failure.

This patient now has a sudden ventricular arrest, which means that the blood potassium level in the body exceeds the standard.

The primary treatment method is to excrete as soon as possible.

Potassium ions!

But the kidneys are already damaged, and potassium ions cannot be excreted from the urine, so dialysis is the only option.

Uremia is a general term for the symptoms of late renal failure.

Hemodialysis is to filter out harmful substances in the blood that the kidneys cannot excrete, and then re-inject them into the body.

"Zhang Yi, how could this person suddenly die? Is it really electrolyte imbalance caused by renal failure?"

Zhang Yi nodded:

"The combination of several symptoms does look like renal failure. It should be sudden death caused by high potassium after electrolyte imbalance."

After speaking, Zhang Yi turned his head and looked at the family members and asked:

"Did he urinate just now? Did he do a urine test?"

The girl cried and shook her head:

"No... No, I couldn't urinate... I just dripped a few drops."

"You are his wife, right? Let me make it clear to you first. Although we have pulled him back from the gates of hell, the situation is still not optimistic."

After looking at Zhang Yi, the girl kept crying.

She cried and begged Zhang Yi to save her.

Just at this time, the patient's blood test results came out.

Routine blood test:

White blood cells: 16x 10⁹/L ((4.0-10.0)x 10⁹/L)

Red blood cell count: 2.5×10ˆ12 (3.5-5.5×10ˆ12)

Hemoglobin measurement: 98g/L (normal male 130-170g/L)

After a row of blood routine tests, it can be basically confirmed that it is anemia.

Hemoglobin measurement is the main basis for confirming whether the patient is anemic.

Normal men are considered normal for more than 130, less than 120-90 is considered mild anemia, 90-60 is moderate anemia, and 30 is considered severe anemia.

Renal function:

Blood creatinine: 588μmol/L (50-120μmol/L)

Glomerular filtration rate: 20ml/min (90-120ml/min)

Looking at these two results, we can basically determine the degree of kidney damage and whether it is uremia.

(Urea nitrogen and uric acid values ​​are unstable and easily affected by other factors, so the diagnosis of uremia is basically based on creatinine and glomerular filtration rate.)

The normal glomerular filtration rate is 90-120ml per minute.

This guy is already 20!

If it is less than 15ml/min, it is end-stage renal disease, and life can only be maintained by hemodialysis.

Electrolytes:

Potassium ion: 6.8mmol/L. (3.5-5.5mmol/L)

Sodium ion: 152mmol/L. (135-145mmol/L)

Chloride ion: 103.3mmol/L. (98-107mmol/L)

Calcium: 2.0mmol/L. (2.10-2.55mmol/L)

Potassium and sodium are high, calcium is reduced, which is an electrolyte disorder.

Chen Fang took a look at the check list and said:

"Potassium is 6.8! In addition, the glomerular filtration rate is so low, potassium must not be excreted! How to deal with this? He has to go for dialysis, otherwise this guy is in danger."

The girl next to him started crying again and asked:

"Doctor, what's wrong with him? What disease does he have? Is it serious?"

Zhang Yi glanced at the girl and said helplessly:

"The preliminary diagnosis is severe kidney damage, that is, renal failure, inflammation, and it is likely that he is already in the uremia stage."