Chapter 284 Going to ICU every year
Based on several major test data, lactic acidosis can be clearly diagnosed.
It was really lactic acidosis. It was a bit inexplicable. The anesthesiologist, Director Ouyang and Dr. Jin didn't understand how lactic acidosis could occur.
The anesthesiologist glanced at Yang Ping and said calmly: "Check for lactate", pointing out the direction in time, otherwise it would definitely waste a lot of time.
There was no time to investigate the cause, so the anesthesiologist made a prompt decision to treat the symptoms first and save lives first.
"5% sodium bicarbonate 250ml, intravenous infusion, check urine output, measure central venous pressure!"
The first priority is to replenish alkali and correct acid, then replenish fluids to expand the volume, and if necessary, perform hemodialysis to filter out the lactic acid in the blood.
250ml of 5% sodium bicarbonate was added, and the anesthesiologist began to mentally calculate the amount of alkali supplementation using a formula.
The nurse begins to measure the central venous pressure, and fluid replacement should be adjusted at any time based on the central venous pressure.
The urine output from the beginning of the operation to now is more than 600 milliliters, and there is no water and sodium retention, so alkali supplements can be safely taken.
Director Ouyang has been engaged in orthopedics for 20 years. If it were not for the training before the academic conference, he would not have remembered the acid-base balance calculation formula.
Not to mention the acid-base balance calculation formula, I have probably forgotten all about how to rescue lactic acidosis.
The training before the academic conference was very beneficial, and his shortcomings in knowledge were strengthened. Now, he can keep up with the anesthesiologists and understand the significance of these emergency measures.
Lactic acidosis has a mortality rate of 50%. When the blood lactate exceeds 25mmol/l, it is rare to be rescued successfully. Fortunately, it is currently only 8mmol/l, so it is not certain to die.
"Send to ICU!"
The patient's vital signs were temporarily stable, and Director Ouyang made a decision.
"Quickly, push the bed." The anesthesiologist followed beside the bed. The endotracheal tube had to be disconnected, so he had to hold the ball and go to the ICU.
Everything went wrong, everything went wrong. After a good operation, the fracture was inserted into the muscle, and the special guide was adjusted urgently. Now that the operation was successfully completed, I thought I could breathe a sigh of relief, but then I got into this kind of thing again, and I suddenly suffered from lactic acidosis for no reason.
The manager of the equipment dealer was most embarrassed at this moment. The private rooms in the hotel were all booked. In this situation, he still had time to eat. It was not appropriate for him to stand by and stay, so he could only wait stupidly.
The manager was afraid that something would go wrong with this patient and Director Ouyang would blame them. Of course, no matter what, he couldn't hold them responsible.
What he was afraid of was that Director Ouyang would stop using their equipment in a fit of anger. Even if it were stopped for a period of time, there would be a lot of losses.
As the patient was pushed out of the operating room door, Dr. Jin shouted: "Wei Danian's family members——"
A large family, two elderly couples, and a middle-aged couple immediately gathered around.
Looking at Wei Danian lying on the bed, with a tube in his mouth and breathing through a rubber ball.
The patient's father, an obese middle-aged man, was shocked: "What's wrong? Doctor, why is it not working well?"
Grandma felt dizzy and was about to collapse. The patient's father immediately helped the old man.
"New Year, New Year!" His mother shook his shoulders violently, sobbing.
"I usually have good health and can eat and drink. How did you perform the surgery to make me look like this?" Grandma patted the edge of the bed.
"Lactic acid poisoning, the condition is critical, and he will be sent to the ICU for rescue immediately. His life is in danger at any time, so don't hold on to the bed." Dr. Jin pushed the bed, but it couldn't be pushed. The family members all held on to the armrests and refused to let go.
"Lactic acidosis?"
The patient's father was very familiar with this word and immediately calmed down, his face turning from white to red: "Doctor, this happens to him every year. He has to be admitted to the ICU at least once a year. He has been like this since he was a child. The doctor also said it was lactic acidosis, but after seeing Many hospitals have not found the cause of lactic acidosis.”
The whole family stopped crying when they heard about lactic acidosis. Maybe they had experienced it too many times and were numb, or maybe they were lucky enough to be rescued every time, so they were not so scared.
"ICU, send me to ICU. Every time I have an attack, I send me to ICU. Sometimes I have to do blood washing." My father is familiar with the business and already knows the process. Blood washing probably refers to hemodialysis.
"I asked about the medical history several times, but why didn't you mention lactic acidosis?" The doctor in charge gritted his teeth angrily.
"The child was afraid of pain and told you about the situation, so he postponed the operation, so-" Wei Danian's mother whispered.
"Confused, really confused. Can the condition be concealed?" Dr. Jin criticized harshly, wishing he could kick him.
Besides, this young man is already twenty-five years old, and he still acts like a child. He will coax him when he is in pain: "Be good! Be obedient." The hospital bed is pushed toward the ICU, too fast, and it is inevitable that there will be some small bumps.
"Slow down, slow down, doctor, the child is in pain." The grandparents were anxious, fearing that the flat car would knock the child over.
You have to race against time to save a life, and you still care about the bumps in the hospital bed as it is pushed too fast?
Dr. King was angry: "Don't hold on, let go!"
After several scoldings, the unhelpful hands were dismissed.
The patient was finally sent to the ICU. The door blocked the family members from outside, and they banged on the door.
"How high is the lactate level?" asked the doctor on duty.
"8mmol/l" Dr. Jin breathed a sigh of relief.
That's okay, there's hope, but if it's higher than 25mmol/l, there's basically no way around it.
Lactic acidosis is ultimately metabolic acidosis. The human body's acid-base balance is about 7.35 to 7.45. If the acid-base substances in the body increase or decrease, exceeding the body's ability to regulate, it will cause changes in the pH value. This is called an acid-base imbalance. Can be life-threatening.
The causes of acid-base imbalance include respiratory factors and metabolic factors. Increased lactic acid is caused by metabolic factors.
"Get on the ventilator, draw blood to review blood routine, biochemistry, liver and kidney function, blood lactate, and blood gas analysis, put on the ventilator, and prepare a bedside hemofiltration machine—" The doctor on duty in the ICU has seen many critically ill patients. Professionals are better at handling these than orthopedic surgeons and anesthesiologists, and they are also well-equipped.
Even the use of magic lung is commonplace, and bedside hemofiltration machines are nothing more than pediatrics.
The ICU doctor listened to the heart and lungs, and explained the condition to Dr. Jin and the anesthesiologist.
After completing the handover, the anesthesiologist Lao Qin had time to ask Yang Ping: "How did you know about lactic acidosis?"
"Choose one of the two, if a diabetic patient has typical Kussmaul breathing, acidosis should of course be considered."
Kussmaul breathing, also called acidosis breathing, involves regular deep and fast breathing, which can eliminate more CO2 and play a certain compensatory role in acidosis. It is a manifestation of the body's self-compensation ability.
"The breath still smells of ketones. The acidosis caused by salicylic acid, phosphoric acid, and sulfuric acid can be eliminated. The insulin is still hanging, and the pump speed is quite fast. In this way, the blood sugar can still soar to ketoacidosis. It can only It is said that the insulin is fake, so lactic acidosis may be greater.”
It's that simple, clear and rigorous logical reasoning, from symptoms to pathophysiology, peeling off the cocoons, and peeling off the answer in just a few clicks.
The systematic super training plan allows Yang Ping to compile human anatomy, physiology, biochemistry, pathology, pathophysiology and clinical symptoms, and test results into logical relationships, and continuously train and train strong clinical logical thinking ability.
Devil-like training, the system light screen can also correct errors every time he trains. With continuous reinforcement, even in emergencies, Yang Ping can quickly follow the logical chain from symptoms to deeper rules.
There is a deep logic behind any appearance, but you just haven't discovered it, or medical science has not yet discovered it.
Lao Qin, the anesthesiologist, carefully reviewed Yang Ping's words and found that there were no flaws or loopholes. He was not blind. The reasoning process was the same as solving problems in high school and was well-founded.
How could an orthopedic surgeon have such a strong diagnostic thinking ability? Lao Qin was a little confused.
"Why does this patient have repeated lactic acidosis? Now Jiangtangling-phenformin has been eliminated. There is no reason. We need to find the reason." Yang Ping told Dr. Jin that the patient was treated by them.
The levels of diagnosis include symptom diagnosis, pathophysiological diagnosis, case anatomy diagnosis, and etiology diagnosis.
Cause diagnosis is the highest level, but unfortunately, there is no way to obtain cause diagnosis for many diseases.
For example, the common diagnoses of hypertension and diabetes are only symptom diagnoses and are the lowest level diagnoses in terms of diagnostic logic.
The lowest level of diagnosis means that the cause of the disease is unknown, and the pathological anatomy and pathophysiology have not been thoroughly studied, so only symptomatic treatment can be achieved.
Lactic acidosis can only be regarded as a pathophysiological diagnosis, and treatment can only start from the pathophysiological level.
It got better this time, but it will happen again next time because the cause has not been found.
If you want to treat the cause, you must obtain the cause diagnosis, which is precisely the most difficult thing.
"I'll go back and check the literature." Dr. Jin felt it was necessary.
However, it is still unknown whether Wei Danian can be rescued.
(End of chapter)