When doctors have a simulated operating room

Chapter 545

The girl's parents were shocked!

Is it so serious that she needs to be transferred to another hospital? ? They are heartbroken and sad.

What a thing!

The silly child had a quarrel with her family and then went to eat pesticides!

What a sin!

"Hurry up and get ready! I'll contact Union Hospital to see if they will accept her!"

The doctor at the county hospital didn't have time to waste. He yelled and hurried to make a phone call.

This girl is a bit strange. She said she ate the poison in the medicine, but nothing came out after gastric lavage? ?

According to her classmates' description, the girl started eating normally after secretly taking the medicine.

So now it has only been two hours since she ate.

It has only been one and a half hours since the gastric lavage.

It is impossible for gastric acid to be digested so quickly in one and a half hours, right?

Digested to the point where there is nothing left in the stomach? ?

At least some residues or something should be flushed out, right? ?

In the end, there was nothing, except for a little blood, the rest was water.

It is really strange!

And she started vomiting blood just after the gastric lavage!

Oh my goodness, this is even more strange!

So, in order to ensure that the patient has a greater chance of survival, the most important thing now is to send the patient to a large hospital to find the cause of the disease and then do hemodialysis.

Since the gastric lavage did not wash out anything, it is likely that it has been digested and absorbed by the body.

So without knowing what medicine was taken, blood filtration must be done first to prevent the condition from worsening.

The second reason is the vomiting of blood.

So far, since the gastric lavage was over, the patient has vomited blood twice.

The total amount of blood loss in the two times is 30 ml.

And the blood and blood clots were brought out with coughing.

The amount is not much, but the patient is still in danger because the cause is unknown.

The ability of the doctors in the county hospital is limited, and there are only two hemodialysis machines in the hospital, and the filter element is not the best one.

This child can only be sent to a large hospital for hemodialysis.

Soon, the emergency department of Union Hospital received a call for help.

"A girl who is unconscious after taking the medicine? Is she still shaking all over? Twitching? Coughing up blood? Is the amount of bleeding large?

Okay, you want to come here for hemofiltration, right? Okay, you can send her here.

Keep the phone open and contact at any time."

The doctor on duty in the emergency department today is Wang Yufei.

At around nine o'clock in the evening, Wang Yufei received this call.

Trembling after taking the medicine? Coma? Twitching? Coughing up blood?

Was it sleeping pills?

Long-term convulsions can cause metabolic acidosis.

If the acidosis is severe, myocardial depression will occur, and cardiac arrest is easy.

And there was also coughing up blood...

Hiss...

After receiving this call, Wang Yufei frowned.

He quickly called the dialysis room and asked them to prepare in advance.

If she really fell into a coma and convulsed after taking the medicine, but the medicine in her stomach had been completely digested, then the only way to survive was hemodialysis.

Two hours later, an ambulance from the county hospital stopped at the gate of the emergency building of Union Hospital.

I don't know whether it was lucky or unfortunate.

The girl had ventricular fibrillation as soon as she arrived at the hospital gate!

The staff on duty in the emergency department immediately carried the person to the emergency room.

Wang Yufei said to the nurse while running:

"Bring the defibrillator! Hurry up!"

Seeing this, the nurse did not slack off at all and carried the machine to the emergency room.

The electrocardiogram of ventricular fibrillation is an irregular wave line.

There is no pattern of ups and downs.

Once ventricular fibrillation occurs, defibrillation must be performed immediately.

In layman's terms, it is to use a strong pulse current to pass through the heart to eliminate arrhythmia, so that the heart can resume normal rhythm.

It is different from the rescue method for cardiac arrest.

Cardiac arrest is when the heart stops beating, and cardiopulmonary resuscitation, that is, heart compression and artificial respiration, is required to save it.

Ventricular fibrillation is the irregular tremor of the ventricle, which is also arrhythmia.

At this time, heart compression does not work, and only electrodes can eliminate ventricular fibrillation.

In the rescue room.

Wang Yufei took the electrode plate and quickly applied conductive gel to it and began to defibrillate.

"360 joules ready!"

Bang!

As the electrode plate approached the girl's chest, the current also passed through her heart.

The girl's entire upper body was slightly bounced up by the current.

Take another look at the electrocardiogram next to it.

It was still a mess of ripples.

"360 more joules ready!"

Bang!

As the electrode plate approached the girl's chest, the current also passed through her heart.

The girl's entire upper body was slightly bounced up by the current.

Take another look at the electrocardiogram next to it.

It was still a mess of ripples.

"360 more joules ready!"

Jiao!"

"360 Jiao is ready!"

Bang!

Another electric shock!

——

The girl's body was bounced up again!

Seeing that the situation was not right, another doctor on duty had to go outside the emergency room to ask the family members to sign.

Notice of critical illness.

Generally, signing this means that the patient is very likely to not survive.

Family members must prepare for the worst in advance.

In the emergency room, waves of family members' cries were soon heard from outside.

Originally, there were fewer people in the emergency room at night than during the day.

Except for some noisy discussions, most of the patients who were seeing a doctor in the emergency clinic were quite quiet.

When they cried like this, the whole emergency room could hear a lot.

Wang Yufei was also anxious when he heard the sound.

After two defibrillations, the ripples were still a mess.

Ventricular fibrillation has not been eliminated yet!

"... Come again! "Wang Yufei gritted his teeth.

The 360-joule electrode plate was moved towards the girl's chest again.

Bang!

The girl's body bounced up again.

Looking closely, there were even a few signs of burnt yellow on both sides of the chest.

But these are not the point!

The point is that this last defibrillation seems to have finally had some effect!

First, the heartbeat ripples changed, not as chaotic as before.

Then the girl could feel the pain of the current passing through her body.

"Um..."

On the hospital bed, the girl whimpered in pain twice.

Very good!

Although the person is still She is not awake but the pain is obvious!

This means that she has recovered.

After waiting for more than a minute, the heartbeat finally recovered.

But the blood pressure and heart rate are very low.

Immediately give her emergency medicine, and keep the triple-respiratory and triple-respiratory medicines ready at all times.

Half an hour later, the girl's blood pressure rose to 90/58mmhg.

Finally, her life was saved.

After rescuing her for such a long time, Wang Yufei's forehead was already sweating.

Looking up at the indicators on the monitor, Wang Yufei breathed a sigh of relief.

The blood pressure finally came up.

But...

"Huh? Why is her oxygen saturation so low even when she is breathing oxygen? Only 94%??"

"Xiao He, quickly draw blood for an emergency test of blood drug concentration, blood routine, liver and kidney function, and blood gas. Remember to tell the laboratory that it is an emergency test! Let them get the results as soon as possible."

"Okay! "

Noticing something was wrong, Wang Yufei quickly gave orders.

The blood drug concentration depends on what medicine she took. Wang Yufei suspected that it was a sedative, but the specific result depends on the test results.

Blood gas analysis checks the pH, oxygen and carbon dioxide content in the patient's blood.

Normal fingertip oxygen saturation should be 95-100%.

91-94% is considered insufficient oxygen supply, and below 90% is hypoxemia.

This patient is so young, still a child, the oxygen saturation should be around 98%.

In addition to the rescue process I have been giving her oxygen all the time. She has been fine for a while, but her oxygen saturation is still 94%?

How strange!

Ventricular fibrillation, cardiac arrest, low oxygen saturation, coma, pupils are not sensitive to light reflex, convulsions, coughing up blood...

At this moment, Wang Yufei felt like he was solving a puzzle.

Originally, she was just a girl who was in a coma and convulsions after taking medicine. How come her oxygen saturation is now low? ?

Low oxygen saturation means that the patient has problems with lung function, cannot breathe oxygen, and oxygen cannot enter the body. Over time, hypoxia will occur.

"By the way, where is the medical record transferred from the county hospital? Let me see."

The result of the blood test is not the indicator for the patient to be admitted to the hospital in the first place.

You have to look at the medical record from the county hospital before to know the blood routine, liver and kidney function and blood gas indicators of this girl when she was first admitted to the hospital.

"Here. "

Wang Yufei took the medical record and started to read it.

Main complaint: Paroxysmal limb convulsions for 20 minutes, sent to our hospital by ambulance.

Limb convulsions persisted, accompanied by responsiveness, confusion, and no incontinence.

Blood test:

pH value: 6.95 (7.35-7.45)

Oxygen partial pressure: 135mmhg (80-100mmhg)

Carbon dioxide partial pressure: 75mmhg (35-45mmhg)

Lactic acid: ＞15mmol/L (0.5-1.6mmol/L)

"Wow, the lactic acid is so high! How can the carbon dioxide partial pressure be so high? ?

Go get the trachea and do the tracheal intubation directly!"

Sure enough, it was predicted by Wang Yufei's divine prediction just now.

High carbon dioxide partial pressure means that the pressure of carbon dioxide in the blood is higher than the normal range.

It is more common in diseases such as chronic obstructive pulmonary emphysema.

But this little girl...

Emphysema at such a young age? ?

Impossible!

When people breathe, they perform two actions: inhalation and exhalation.

Inhalation is to inhale oxygen from the air, enter the lungs, and then supply oxygen to the whole body.

When oxygen travels throughout the body, it cooperates with the cells in the body, that is, organic matter, and after cooperation, a metabolic product is produced, called carbon dioxide.

Then exhalation is equivalent to exhaling the waste produced by these metabolisms, that is, carbon dioxide.

Inhalation and exhalation are both indispensable.

Without oxygen or carbon dioxide cannot be discharged, both will cause life-threatening.

The test results of this girl showed that the partial pressure of carbon dioxide was high.

It means that there is something wrong with the girl's lungs.

It is definitely not as simple as a coma and convulsion caused by taking medicine.

If it is just a simple convulsion, it will only lead to metabolic acidosis.

But the results show that the partial pressure of carbon dioxide has increased, which belongs to respiratory acidosis.

The causes of the two acidosis are different.

But this girl obviously has both metabolic and respiratory problems, so her lactate level is as high as 15mmol/L!

So the sudden cardiac arrest and ventricular fibrillation she had just got off the car are probably caused by myocardial depression due to acidosis.

The treatment for acidosis is to replenish alkali solution.

Sodium bicarbonate is the first choice, which increases the osmotic pressure of extracellular fluid and increases blood volume.

In the medical record of this county hospital, the doctor there did replenish alkali.

But only one bag of 500 ml was replenished.

Wang Yufei felt that it was not enough. The lactate level was so high that he had to replenish alkali to balance it.

"Give Wang Xinhui another set of sodium bicarbonate. In addition, bring the trachea over. I will directly intubate her."

The partial pressure of carbon dioxide is too high. Alkali replenishment to balance acidosis is one aspect of rescue, and opening the airway to remove the accumulated carbon dioxide in the body is also an important measure of rescue.

In this way, the acid-base balance in the patient's body can be achieved in the shortest time.

Otherwise, ventricular fibrillation may occur again.

"Okay!"

The liquid was quickly applied to the girl.

At this moment, the girl was still in a coma.

Although she was no longer coughing up blood, there was still a little bit of dried black blood at the corner of her mouth.

Wang Yufei put on gloves and prepared to pry open the girl's mouth with the trachea to create a better breathing channel for her.

Unexpectedly...

As soon as she opened her mouth, the other end of the trachea was just inserted.

"Cough cough... cough cough... vomit..."

The girl coughed up blood again!

She coughed hard!

But the blood coughed out was not much, only about ten milliliters, and most of it was blood clots.

Wang Yufei breathed a sigh of relief, fortunately it was not vomiting blood.

Vomiting blood is not just ten milliliters.

"Bring the suction tube over, let me see how much blood is in this child's throat?"

"Okay!"

Soon, the suction tube and machine were pushed over.

Buzz! Buzz!

The machine started, negative pressure suction.

When the mouth opener opened her mouth, the girl struggled unconsciously.

But she was soon held down by the nurse.

Wang Yufei took the straw and poked it deep into her throat.

As a result, it was full of blood!!

And it was the kind of blood clots!

"Cough cough... cough cough!" The girl frowned in pain.

While coughing, she coughed out the blood clots in her throat.

Wang Yufei's white coat was stained with blood.

The nurse also frowned in surprise:

"What's wrong with this child? Why is there so much blood in her throat? Did she take some medicine that caused upper gastrointestinal bleeding? Or pulmonary bleeding??"

Wang Yufei's expression was not very good either.

Damn, most of the drugs that cause coma after taking them are sleeping pills, which are also benzodiazepine drugs.

This kind of medicine is absolutely impossible to cause gastrointestinal bleeding or pulmonary bleeding!

It's really weird!

What's going on? !

Wang Yufei continued to poke in with the straw.

The more blood clots there are, the more he has to suck them out.

It is very likely that the blood clots blocked the patient's carbon dioxide partial pressure.

If the blood clots are not removed, it will be difficult to do tracheal intubation.

As a result, when she was poking, the girl coughed up blood again!

"Cough cough... cough cough!"

This time she coughed more violently, and a blood clot the size of a quail egg was coughed out by her.