Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Chapter 145 Only endoscopic hemostasis! (Please subscribe!)

Generally, there are three most common reasons for upper gastrointestinal bleeding, which are bleeding caused by peptic ulcer, rupture and bleeding of esophageal and gastric varices, and acute bleeding caused by gastric mucosal injury.

If the bleeding is caused by peptic ulcer or gastric mucosal injury, the treatment is relatively simple.

Generally, the bleeding can be stopped by using drugs such as omeprazole, and then combined with fasting for a few days, it will basically be cured.

The rupture and bleeding of esophageal and gastric varices caused by liver cirrhosis is the most difficult type of upper gastrointestinal bleeding!

The more severe the portal hypertension in cirrhosis, the more severe the esophageal and gastric varices, and the greater the risk of rupture.

If you don't pay attention to your diet, you will experience upper gastrointestinal bleeding!

If a large blood vessel is damaged, the patient will vomit blood crazily, which can kill a person in an instant.

What's more, this old lady has turned from liver cirrhosis to liver cancer!
So she not only has upper gastrointestinal bleeding, but also has the risk of liver cancer rupture, which is very serious!

Several of their doctors couldn't help feeling helpless for a while, so they had to call Lin Yi over to see if he had any good countermeasures.

After Lin Yi understood the situation, he frowned and thought about it.

At this moment, the old lady on the hospital bed suddenly turned sideways.

Another "wow"!
A mouthful of blood gushed out directly!

"Quick, quickly buckle her back to prevent her from suffocating by aspiration."

A doctor shouted.

The nurse on the side jumped into action.

In just a few seconds, a pool of blood appeared on the ground, mixed with blood clots.

Suddenly, there was a strong smell of blood in the air.

After the old lady vomited blood, her face was as pale as paper, and her body was even weaker. Then she tilted her head and fell into a coma!

Seeing this, the doctor on the side hastily shouted:

"Speed ​​up the infusion speed, and open another set of intravenous access."

"Adjust the norepinephrine to 5 ml per hour, and increase the amount of octreotide."

Lin Yi stared at the unconscious old lady, frowning.

Sure enough, her condition continued to worsen.

Counting this time of vomiting blood, she has already vomited blood three times!
According to observation and description, her hematemesis should have reached about 1500ml.

This accounts for nearly one-third of the total blood volume in the human body.

Even though blood transfusions have been going on, if effective first aid measures are not taken quickly to stop the bleeding from the ruptured blood vessel, then the old lady's life is hanging by a thread, and she is close to death!
At this time, the doctor named Yang Nan looked anxiously at Lin Yi and asked him:
"Doctor Lin, what should we do now? She has already vomited so much blood! It's not an option to continue like this!"

Lin Yi glanced at the ECG monitor next to him.

The old lady's blood pressure dropped again, her heart rate and breathing increased, and she was obviously in critical condition.

Even with blood transfusions and vasopressors, her blood pressure still didn't rise.

This means that it is very likely that her stomach is still bleeding. The reason why she doesn't vomit blood again is that the amount of hematemesis has not yet reached.

It is very likely that after a few minutes or ten minutes, the old lady will vomit blood again.

Immediately afterwards, Lin Yi looked at Yang Nan and asked him:

"Have you contacted the gastroenterology department or the endoscopy department?"

"In this case, she needs to stop the bleeding under the microscope or ligate the blood vessels."

Upon hearing this, Yang Nan immediately said:

"They were asked to come here at the beginning, but they said that microscopic hemostasis or ligation of ruptured blood vessels can only be done when the condition is stable."

"But no one would dare to do it for her when there is a possibility of rebleeding at any time."

"Given her such an operation under such circumstances, it is likely to increase the amount of bleeding and aggravate the condition."

"If the old lady vomits blood again while the bleeding is being stopped under the microscope or the blood vessel is ligated, it will be completely over!"

Lin Yi immediately insisted:

"The truth is true, but this is the only solution. If you don't do this, then this old man will have no cure!"

"But the risk is too great. If there is a problem in the process, it will not be worth the loss!"

Yang Nan shook his head and sighed, then said:
"Forget it, I've done everything I can do anyway. I thought you would have other ideas. Since you don't, I'll go and explain it to her family directly!"

"What are you going to tell her family?"

Lin Yi couldn't help staring at him and asked.

Yang Nan froze for a moment, then said:

"Of course it is to tell them clearly that the old lady's physical condition in all aspects, I am afraid that this test will not be able to pass, so that they can be mentally prepared."

After Yang Nan finished speaking, his eyes were full of regret.

This is the biggest helplessness of being a doctor. Even if you try your best, you are still powerless. You can only watch the patient being swallowed up by the disease under your nose...

After speaking, he took a deep breath, turned around and walked towards the door of the emergency room.

"Wait a minute."

Lin Yi said something to him later.

"Huh? Is there anything else?"

Yang Nan couldn't help turning his head in doubt.

"Let me do endoscopic hemostasis for her, I can't just give up like this."

"What? Are you going to do endoscopic hemostasis?"

Yang Nan stared at Lin Yi with wide eyes in surprise.

The people in the endoscopy room have made it very clear just now. With the current situation of the old lady, the difficulty factor of hemostasis under the endoscope is too high, and the risk is too great!
Even the doctors who specialize in it say no, you say yes?

Although he also knew that Lin Yi had done such an awesome operation to stop bleeding with bare hands, that operation was completely different from the endoscopic hemostasis operation.

So Yang Nan couldn't help but said:
"Doctor Lin, I know you have a unique skill. But... You know the old lady's situation now. Her stomach is still bleeding. In principle, endoscopic hemostasis should not be performed."

"Now we have used all the treatment options we can give her. Even if we can't save her, her family members can't say anything."

"However, if the old lady suffers from cardiac arrest and dies during the endoscopic hemostasis, then her family members will trouble you!"

The reason why Yang Nan had this concern was also for Lin Yi's sake.

Because the patient was bleeding, endoscopic hemostasis was performed on her. Although it was not a violation of the regulations, it was not an indication for endoscopic operation.

If something happened to the patient and the family members seized on it and got entangled, Lin Yi would definitely be in trouble!

This is also the real reason why the doctors of the endoscopy department and the gastroenterology department refused to perform endoscopic hemostasis for the old lady!
Based on the principle of protecting themselves, doctors will not take this risk.

But Lin Yi said firmly:

"I understand what you said, don't worry, I have my own measure. If you drag it on, the old man will definitely die!"

"OK then……"

Yang Nan looked at Lin Yi and nodded vigorously.

The other medical staff present also stared at Lin Yi with complicated eyes.

They knew that Lin Yi had silently taken a great risk in order to save the old man!

In fact, Lin Yi made this decision because he was eager to save people on the one hand, and on the other hand, he did have enough confidence in his skills!
As the saying goes, people with high skills are bold!

"Which one of you can help to borrow the endoscope from the endoscopy department? Let's not delay any longer!"

Afterwards, Lin Yi looked at the people around him and asked.

"I'll go! I'm familiar with that side!"

A doctor agreed and ran outside immediately.

Because they don't have a gastroscope in the emergency department, if they want to use a gastroscope, they can only borrow it from the endoscopy department.

At this time, the vital signs of the old lady were not stable, and she was still in a coma.

Although the blood pressure did not continue to drop, it did not increase significantly, and the heart rate was always fast, and the breathing was also fast.

Although the amount of blood transfusion and fluid replacement has been increased, the condition has not improved significantly.

She wasn't bleeding gushes, but she could still vomit blood again over time.

Yang Nan once again increased the dosage of norepinephrine and metaraminol to the old lady.

It is hoped that these vasopressor drugs can increase the blood pressure of the old lady.

A few minutes later, the doctor who went to borrow the instrument came back with a gastroscope!
"So fast?"

Everyone couldn't help being surprised.

"Of course, I have a very good relationship with Deputy Director Ma of the Department of Endoscopy. It's just a matter of one word! He's here too!"

After the doctor finished speaking, everyone noticed that there was indeed a doctor behind him.

Deputy Director Ma waved and smiled at everyone, and then said:
"Hi everyone! I just heard from Xiao Liu that someone is going to do endoscopic hemostasis for the old lady in this situation, so I'll come over and have a look!"

"Deputy Director Ma, this is Dr. Lin."

Xiao Liu immediately pointed to Lin Yi and said to him.

"Oh?"

After seeing Lin Yi being so young, Deputy Director Ma couldn't help but a trace of disappointment flashed in his eyes.

At first, when he heard that someone wanted to do this operation, he thought it was some doctor who was good at it, so he was surprised and wanted to learn it.

But now it seems that this is a newborn calf who is not afraid of tigers, he is a young boy!

Afterwards, he couldn't help looking at Lin Yi seriously and asked:

"Young people, do you know how the risk of endoscopic hemostasis in the patient with bleeding? This is not a child's play!"

Lin Yi nodded calmly and replied:
"Deputy Director Ma, I know, so let me come."

Seeing Lin Yi's confident appearance, Deputy Director Ma swallowed a breath and nodded slightly.

Afterwards, he just said lightly:
"Okay then, as long as you have the numbers."

Young people have to suffer a little to grow up...

Sometimes, you have to pay the price for your youthful arrogance!

There are seven contraindications for endoscopic hemostasis:

[-]. Acute upper respiratory tract infection and severe pharyngitis.

Second, severe respiratory insufficiency.

[-]. Extreme exhaustion or uncorrected shock, hemodynamic instability.

[-]. Uncontrolled hypertension and heart failure.

[-]. Severe spinal deformity, descending aortic aneurysm, suspected gastrointestinal perforation.

[-]. Bleeding combined with perforation.

[-]. The patient is uncooperative or unconscious and unable to cooperate.

The old lady's current condition, in addition to bleeding, also meets many of the contraindications.

In this case, the implementation of endoscopic hemostasis can be said to be against the sky!

That's why Deputy Director Ma didn't agree to operate on her in the first place!
At this time, Lin Yi didn't bother to explain so much, he had already arranged for the medical staff to prepare all the equipment, and was ready to start operating on the old lady.

Although the old lady has entered a coma, Lin Yi still gave her some sedative drugs to prevent anxiety during the intubation process.

Then, Lin Yi moved!
Seeing Lin Yi deftly inserting the gastroscope into the patient's esophagus, Deputy Director Ma's expression turned serious.

Judging by the way this kid operates, he doesn't look like a novice at all, but like a seasoned master who has gone through a lot of tempering.

Judging from the camera-entry technique shown alone, Deputy Director Ma even felt that he could not be as skilled and silky as Lin Yi!

And when he operated the gastroscope into the patient's esophagus, he inserted it directly without any hesitation or twisting the direction.

What does this mean?This shows that he has absolute confidence in his own skills!
He is so young... how could he have such skills?
Is it a genius? !

In just a few seconds, Lin Yi operated the gastroscope and entered the patient's stomach.

At this time, a picture of the patient's stomach appeared on the gastroscope monitor.

Several doctors immediately went up and stared at the screen on the monitor, and were instantly taken aback!
I saw that the old lady's stomach was full of blood!

The lens of the gastroscope has been flooded with blood, and the entire monitor only shows a bright red color, occasionally some bubbles in the stomach can be seen flashing.

It can be seen from these pictures that the blood vessels in the old lady's stomach are still bleeding!

Sure enough, as Lin Yi expected before, if this continues, the old lady will soon vomit blood again!

As a large amount of blood covered the lens and blocked the line of sight, Deputy Director Ma couldn't help feeling tense at this moment.

He couldn't help but rejoice that he was undoubtedly correct in denying this operation at the beginning. In this case, hemostasis is extremely difficult!

Lin Yi used the suction device carried by the gastroscope to suck up the blood inside, and then there will be a steady stream of blood pouring out.

It is very difficult to find the ruptured blood vessel.

Deputy Director Ma couldn't help shaking his head.

This kid is useless...

It's good for young people to be aggressive, but they can't ignore the advice of their seniors just because they are good at it.

After all, seniors have eaten more salt than you have traveled!
"This screen is full of blood, how to operate it?"

"Yeah, just after inhaling, it was only clear for a second or two, and then it was covered by a large piece of red again!"

"It gives me a headache just looking at it...how can I do this!"

"Now it's really hard to ride a tiger!"

"Yeah, it feels like this is getting more complicated now!"

"You should have listened to Deputy Director Ma from the very beginning, and don't operate!"

The surrounding doctors looked at the picture on the screen and couldn't help discussing anxiously in low voices.

Lin Yi didn't care about the worries of the people around him at this time, but concentrated his attention and stared at the screen tightly.

(End of this chapter)