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

The blood flow of the inferior vena cava and part of the right atrium wall patch also returned to the previous unobstructed state after widening.

Zhou Chao breathed a sigh of relief.

"Lin Yi, the operation was successful!"

Wang Qiaoya also said excitedly.

"The effect of the operation is obvious! The edema of the patient's upper and lower limbs has improved significantly!"

After the operation, they performed a CT of the superior and inferior vena cava for the patient.

The CT results were also unexpectedly satisfactory.

Walk out of the operating room and back to the consulting room.

Yin Liang found Lin Yi.

"Brother Yi, I received a patient here today, and the situation is a bit strange. Why don't you come and have a look?"

Lin Yi nodded after listening, and then asked:
"What's the patient's condition?"

"The patient is a 53-year-old male."

Yin Liang began to introduce the basic situation of the patient to Lin Yi.

"This patient had a stone in his left kidney with a diameter of one centimeter. Since the stone could not be crushed by ultrasound outside the body, the local municipal hospital performed a percutaneous kidney stone removal on him. It used a conventional surgical method. "

"This patient had undergone the operation for the first two days, and nothing happened. His vital signs were relatively stable. It was today, the fifth day after the operation. Abdominal pain, abdominal distension accompanied by fever suddenly appeared, and his blood oxygen saturation dropped, and his blood pressure Also down.

"Vital signs are very unstable."

"The local hospital saw that the vital signs could not be controlled, so it was transferred to our hospital."

"After this patient came, he had blood routine, PCT, abdominal CT and abdominal color Doppler ultrasound."

"The white blood cells in the blood routine are relatively high, and the PCT is also high. There is no major problem in the chest CT, but there is no obvious problem in the abdominal CT."

"The problem with the kidney surgery is not serious, and the color Doppler ultrasound only showed cholecystitis. The most critical problem for this patient now is that his blood pressure has been unable to maintain, and the blood pressure can barely rise a little with the use of vasopressors."

"Judging from the current situation, this patient is obviously in septic shock. The infection is so severe that it caused shock, but what I am more concerned about is, where is the source of the infection? Can't I find it?"

"I did all the checks that should be done, but I couldn't find an obvious source of infection. You say it's weird."

After Yin Liang finished explaining the patient's history of present illness in detail, he still looked puzzled.

After hearing about the cause of the disease, Lin Yi also had a rough judgment on this patient in his heart.

But what is the specific reason, causing severe infection.

Where is the source of infection?

Of course, you need to see the patient before you can be sure.

Lin Yi stood up and said, "Let's go see the patient."

No matter how detailed the patient's medical history is, Lin Yi can't tell what kind of disease the patient is without seeing the patient himself.

Lin Yi and Yin Liang soon arrived at the emergency intensive care unit.

The patient was a man in his 50s with a pale complexion and was in a coma.

He was intubated and assisted by a ventilator.

There is also a drainage tube on the left waist, which belongs to the drainage tube of the kidney stones made in a local hospital.

Yin Liang pointed to the data on the ECG monitor and continued to introduce the patient's condition.

"Brother Yi, look at this patient. His blood pressure is extremely unstable now. He has already used norepinephrine and metaraminol bitartrate, but his blood pressure is still unstable."

"It drops from time to time. Now the amount of booster drugs has been taken away, and his procalcitonin is particularly high, reaching more than 200."

"And the lactic acid is also very high, which is around 9.0mmol/L. This patient's microcirculation is very poor, and the infection is particularly serious. It is estimated to be very dangerous."

The source of calcitonin is mainly a chemical indicator of the severity of the infection.

The higher the procalcitonin, the more severe the infection.

Normal procalcitonin is generally less than 0.5ug/L, but this patient has reached more than 200, which is very rare.

The lactate value is a biochemical indicator in blood gas analysis.

Lactic acid exists in small amounts in the human body, but is of particular clinical significance.

Lactic acid can represent the quality of the body's circulation.

Lactic acid is produced when the body is hypoxic, when oxygenation of tissues and organs has been reduced.

If the lactic acid increases, it means that the body is in a state of ischemia and hypoxia, that is, the patient's circulatory state is not good.

Checking the patient's lactic acid is very important for judging whether the patient's body circulation is good or not.

Some diseases can cause abnormal lactic acid metabolism, causing lactic acid to accumulate in the body, leading to lactic acidosis in patients.

The clinical significance of lactic acid detection is a relatively reliable indicator.

The lactic acid concentration of normal people is 0.1-1.7mmol/L.If it exceeds 2.0mmol/L, the patient's tissue oxygenation should be considered insufficient.

The higher the lactic acid detection value, the more serious the patient's circulatory disturbance.

Generally, if lactic acid continues to exceed 4.0mmol/L, the risk of death of the patient is very high.

Now, according to Yin Liang, the lactic acid value of this patient is as high as 9.0mmol/L, which fully shows that the patient's condition is not optimistic.

If his lactic acid level cannot be lowered, then this person will be close to death.

Listening to Yin Liang's introduction, Lin Yi frowned slightly.

According to the results of blood tests, the patient's infection was very serious.

However, according to the results of the patient's CT color ultrasound and other examinations, the source of the infection was not found.

And all the critical symptoms of this patient were caused by severe infection.

Both coma and shock are caused by infection.

If the source of infection is not found out and dealt with, then the patient cannot be cured at all.

The results of the patient's blood test and radiological examination were contradictory, so Yin Liang was confused and could not find the cause of the patient.

Next, Lin Yi used a stethoscope to auscultate the patient's cardiopulmonary function in detail, and then palpated the condition of the patient's abdomen.

I have come to a conclusion in my heart.

And Lin Yi's conclusion, which is the root cause of the patient, was judged by Lin Yi completely based on his own experience.

After repeated deliberation and consideration, Lin Yi came to the conclusion that the source of infection for this patient must be in the abdominal cavity.

Because once the abdominal cavity is infected, the symptoms of the whole body will be particularly severe, and it is difficult to treat, and the mortality rate of the patient is high.

The most likely cause of this patient's severe abdominal infection was the rupture or perforation of the hollow viscera.

The most likely is the small intestine perforation or the large intestine perforation, causing severe infection caused by the flow of the feces to the abdominal cavity.

This is the only way to explain the patient's condition.

Lin Yi guessed that this patient's gallbladder was probably festered and gangrene, and it was swollen badly.

And there may be a perforation on the sigmoid colon, and the feces inside are constantly flowing out into the abdominal cavity.

But because of this patient, he has been hospitalized for several days, and he hasn't had a drop of water or food.

So there is not much in his intestines, and therefore there is not much fluid in the abdominal cavity.