I can see health

Chapter 489

The speed of the middle-aged women is very fast, and the application for Shuidichou is completed very quickly.

Lu Chen took care of all the remaining places that needed to be signed and certified.

The fundraising project of Shuidichou was launched immediately.

As a medical staff, Lu Chen can prove the patient's condition.

He immediately forwarded it to his circle of friends.

At the same time, Lu Chen also donated 200 yuan at the donation entrance.

He is just a graduate student now, so donating too much should not be too much, 200 yuan is a token of his heart.

After doing this, Lu Chen could only silently pray in his heart that the girl's condition would improve soon.

Otherwise, staying in CCU for one day will cost tens of thousands of dollars.

……

Go back to the doctor's office.

Before Lu Chen could sit in the heat, the security guard at the gate of the CCU started shouting.

"Here comes the patient!"

When Lu Chen heard this, he was startled, and his heartbeat jumped to 120 beats per minute.

"coming."

Lu Chen and Gu Xinyue followed Zhou Bin to the entrance of the CCU.

An old man in his 70s was lying on the hospital bed.

The uncle was lying on the bed, thin, panting heavily, and the ECG monitor beside the bed was beeping an alarm.

Beside the hospital bed, there is an accompanying doctor, who is Director Lin Cui from the Eighth District of Xinxin.

"Director Lin, what's the patient's condition?" Zhou Bin asked immediately.

Lin Cui nodded slightly, and she also saw Lu Chen beside her, she was taken aback for a moment, and then returned to her natural state.

"Patients with heart failure, combined with renal failure and oliguria, the serum potassium just checked upstairs is more than 7 mmol/L."

Zhou Bin frowned. This kind of patient should have already reached the level of dialysis, "Director Lin, the patient was transferred to do CRRT?"

Lin Cui shook her head quickly: "That's not true. The patient had long-term atrial fibrillation and chronic heart failure, and the family members did not consider invasive rescue and continuous renal replacement therapy (CRRT). They just wanted to go to the CCU for a transition and the condition improved, so they were transferred to the general ward. "

In fact, in the intensive care unit, they are already used to this kind of patients.

However, once CRRT is given up, there is very little that doctors can do!

Most of the time, doctors just act as bystanders to the patient's progress.

……

Patients are quickly wheeled in.

His condition was even worse than Lu Chen imagined.

The uncle was lying on the hospital bed, wearing an oxygen storage mask, rolling his eyes, and breathing heavily.

Lu Chen looked at his HP, the value was 47 in red, and the trend was three minus signs!
……

Three minus signs!
After two days of treatment in the general ward upstairs, it was still three minus signs.

This shows that the previous treatment is basically useless!
Zhou Bin patted the patient's shoulder and yelled a few times, but there was no response.

Lin Cui immediately said: "The family members said that when Qian Qian woke up two days ago, she suddenly felt weak in her left limb, couldn't speak well, couldn't eat, couldn't get out of bed, and even suffered from cramps once, so she was rushed to the hospital."

"Basically no urine in the past two days, but 1000ML yesterday."

At this time, in Lu Chen's mind, a chain of diseases had already appeared, the foundation of chronic heart failure, acute cerebral infarction leading to acute exacerbation of heart failure, causing renal failure and oliguria.

"The blood sugar between the fingertips is high."

As soon as he entered the ward, the nurse routinely tested the patient's blood sugar.

Zhou Bin frowned deeply, "With such a high blood sugar, what kind of hypoglycemic drug do you usually use?"

"I didn't know about diabetes before, and I didn't use anything." Lin Cui said, "But after coming to the ward, I took some insulin and a diuretic for a day. It's just that we are a little strange. This patient, in the ward, the more treatment heavier."

"Today, the patient's condition is even worse. There is really no other way. After communicating with the family members, we can only push it to the CCU."

Lin Cui's expression was very helpless.

This is a very typical heart failure patient in the Department of Cardiology.

But after diuresis, the effect is extremely poor!
"Okay, I basically understand, thank you Director Lin." Zhou Bin nodded.

After Lin Cui briefly explained the patient's condition, she left the CCU ward.

Lu Chen and Zhou Bin conducted a detailed physical examination on the patient.

患者目前心率90-110次/分，血压80-90/50-60mmHg，呼吸37次/分，血氧饱和度95%（储氧面罩）。

There is no obvious edema in the whole body, low skin temperature, no obvious moist rales on lung auscultation, and the heart sound is OK.

……

Go back to the doctor's office in the CCU ward.

Lu Chenfan looked at the patient's examination and tests.

On the day of entering the ward, the blood routine was normal.

Brain natriuretic peptide (BNP) 2855pg/mL, blood sugar 43mmol/L, blood potassium 7.36mmol/L.

Creatinine 255μmol/L, urea 47mmol/L, urine sugar 4+, occult blood 3+.

Electrocardiogram showed atrial fibrillation rhythm, heart rate 96 beats/min, extensive ST-segment depression in leads II, III, aVF and chest leads, and mild ST-segment elevation in lead aVR.

Chest CT showed patchy shadows in the left lower lung, and head CT showed deepened sulci without high-density shadows.

"In the past two days, a lot of diuretics have been used in the ward!" Lu Chen frowned.

……

Continue to look through the test sheet.

After one day of invigorating fluids and diuresis, the next day, the blood potassium dropped to 1mmol/L, the blood sodium rose to 5.08mmol/L, and the blood sugar dropped to 145mmol/L, but the renal function continued to deteriorate, and the creatinine rose to 16μmol/L. Urea also rose to 405mmol/L.

It seems that the blood sugar has been basically controlled, and the urine is coming out, but what caused the sharp deterioration of kidney function?
"This patient is tricky!"

In the office, Zhou Bin sighed slightly after browsing through all the inspections and tests.

"It's no wonder Director Lin would take the initiative to send the patient down. Director Yilin's character, unless it is absolutely necessary, he might not necessarily send the patient to the CCU."

Director Lin Cui's reputation in the eighth district is very famous in her heart, and she is a strong person. Li Yao, the director of the eighth district, can't hold her down at all!

Li Hui, another attending doctor in the group, also came over, "At present, the patient's condition is such that it is best to go directly to CRRT, but the patient's family refused, so it is really not easy!"

……

Back to the patient's condition.

"I have carefully analyzed the patient's current state, and now I mainly judge the cause of the patient's shock." As soon as Zhou Bin opened his mouth, a group of graduate students in the office immediately surrounded him, "Is it cardiogenic shock, septic shock, or hypoglycemia?" Volume shock?"

Cheng Dongbo, the brother of Yansan, spoke first: "The low blood pressure and shock caused by heart failure, Mr. Zhou, I think it should be cardiogenic shock."

Zhou Bin shook his head, "It's not that simple. If it's just heart failure, then after improving heart function and diuresis, the patient's condition hasn't been relieved in time?"

People around were a little silent.

At this time, Gu Xinyue said: "Mr. Zhou, this is how I think about it. Acute cerebrovascular disease leads to eating disorders, and the food intake is seriously insufficient, leading to hypovolemic shock and acute kidney injury."

"The increase in inflammatory indicators and the patchy shadows in the lungs do not rule out the possibility of aspiration pneumonia caused by coughing, coupled with the recent poor blood sugar control, leading to aggravated infection."

"Could it be the dual factors of cardiogenic and infectious?"

Zhou Bin nodded slightly, "It makes sense."

On the side, Lu Chen remained silent.

He has been looking through all the examination reports of the patients.

He felt that this patient was a bit strange. What Gu Xinyue said made sense, but it was not enough to explain the continuous deterioration of the patient's condition.

(End of this chapter)