This doctor has a system

Chapter 517 580. Patient with weak limbs and fractures

The patient ran a red light and was driving in the wrong direction, so he was held fully responsible.

Because of this, she cried in the ward every day, thinking that the traffic police's decision was unfair.

"Although I ran a red light and drove against the flow, but apart from the facts, didn't he do anything wrong?"

"My mistake was that I met a fool like you when I was leaving the house." Her husband was sensible. "How many times have I told you not to violate traffic rules? Are you deaf?"

The patient was arguing with her husband while doing nebulization. Soon she felt something strange, she felt anxious and had difficulty breathing.

She quickly told her husband that she was not feeling well.

"Miao Cuihua, can you be more quiet?" the husband said unhappily, "You always do this when we have a fight, right?"

"Look at you, you dead man!"

"Fuck your mother." Miao Cuihua was furious, "Call a doctor for me!"

"This contains a nebulizer solution of salbutamol." Director Jin took a look and said to her, "Some patients get anxious easily after using it."

He asked the patient to observe for a while.

But after more than two hours, Miao Cuihua felt that her condition had become more serious. Not to mention the panic, which she could bear, but the chest tightness worsened, and she felt weak all over, and she couldn't even lift her legs.

"Doctor, could it be that there is something wrong with his brain after the fall?" Miao Cuihua's husband was a little worried.

"Didn't you say that he didn't hit his head at that time?" Director Jin asked.

"No, I was stuck on the holly tree in the green belt." Miao Cuihua recalled her ostrich-like posture at the time, "My hands touched the ground first, but my head didn't."

That shouldn't be the case, Director Jin thought, and a sudden disease appeared in his brain.

"Isn't it a pulmonary embolism?"

Gao Feng carefully examined the patient. Auscultating the lungs revealed slightly coarse breathing sounds, but no obvious dry or wet rales. The heart rate was indeed fast, at 108 beats per minute.

What is strange is that the patient's muscle strength has indeed decreased significantly. The upper limbs are difficult to define due to fractures, but the muscle strength of the lower limbs is only level III, while the muscle strength of normal people's upper and lower limbs is both level V.

The patient was already on oxygen, but was still complaining of chest tightness.

During the questioning, Gao Feng learned that Miao Cuihua had a history of chronic bronchitis and she had been smoking for more than 20 years.

She caught a cold two days before the fracture, which triggered an attack of chronic bronchitis, so Director Jin's subordinate doctor gave her nebulization.

"So you felt chest tightness before?"

"Yes, but it's different from now." Miao Cuihua was a little impatient, "This time I felt like I didn't have the strength to breathe."

"Director Gao, could it be a pulmonary embolism?" Director Jin asked, "Let's do a pulmonary artery CTA."

Da Gaofeng didn't think it was the case. Although the patient had a high-risk factor for pulmonary embolism: fracture, her clinical symptoms were not consistent with pulmonary embolism.

Moreover, pulmonary embolism does not lead to decreased muscle strength in the limbs.

"You can check a D-2 aggregate to see." Gao Feng said, "Oh, and draw some blood gas."

It takes at least an hour for the D-2 polymer test results to come out, but blood gas tests are very quick.

Blood gas refers to blood gas analysis, which is a blood analysis of gas exchange performed on a blood gas analyzer. It is an important examination item for emergency treatment and monitoring of patients, and is mainly used to diagnose respiratory failure, acid-base imbalance, and hypoxemia.

The reason why Gao Feng asked for a blood gas test was very simple. First of all, one test for every patient with chest tightness would definitely not be enough. Second, he had just considered hypokalemia.

Director Jin was still worried, so he discussed with the patient and decided to do a pulmonary artery CTA. "We should also do a head CT scan to make sure we didn't miss anything."

This is of course the safest option, and it would be best if the patient agrees.

10 minutes later, the blood gas results came out. Gao Feng took a look and saw potassium: 2.1mmol/L.
It's hypokalemia.

Gao Feng immediately called Director Jin.

"It's all done. I'm sweeping inside now."

Director Jin was a little embarrassed. "The same goes for the imaging department. I did say the patient's condition is very serious, but you don't have to rush."

"Can you refund our fees?" he said to Director You of the Radiology Department with a flattering face.

"The fees cannot be refunded. If you don't leave, I will chop your head off." Director You said to him.

Director Jin returned to the office in a depressed mood.

"Director Gao, how could the patient suddenly have low potassium when he was fine?" He felt very puzzled.

There are only a few reasons for low potassium: insufficient intake, excessive loss, or too much potassium entering the cells.

Miao Cuihua has always had a good appetite. There is no problem of insufficient intake, and it is not justifiable that she loses too much. The patient's bowel movements are normal.

That means too much potassium has entered the cells.

This situation occurs when large amounts of glucose solution are used clinically, especially when insulin is used at the same time. In addition, some drugs can also cause this.

Gao Feng reviewed Miao Cuihua's medications and said, "It should be caused by the salbutamol aerosol solution."

"Can this medicine also cause hypokalemia?" Director Jin really didn't know. Their orthopedic department rarely uses drugs in this area and has never encountered this situation before.

Salbutamol is a selective β2-adrenergic receptor agonist that acts on bronchial smooth muscle β2 receptors to produce bronchial dilation;

In addition to acting on β2 receptors, it increases the activity of Na+-K+-ATPase pump and Na+-K+-2Cl- symporter, promoting the entry of potassium ions into cells; in addition, it may increase insulin release (bringing K+ into cells while lowering blood sugar), ultimately causing a decrease in serum potassium.

In fact, in recent years, it has been found that, in addition to salbutamol, bronchodilators commonly used in respiratory medicine, such as terbutaline and formoterol, all have the risk of causing hypokalemia.

Some clinicians have found that after using beta-receptor agonists, the patient's serum potassium drops by more than 0.6~1 mmol/L in a short period of time.

High doses of β2 agonists can even reduce the patient's blood potassium level to 0.05~0.25 mmol/L.

Based on the potassium-lowering effect of beta-receptor agonists, some doctors have taken a different approach, pointing out that this mechanism can be used in emergency treatment of severe hyperkalemia.

After receiving potassium supplementation treatment, Miao Cuihua's symptoms quickly eased, and her indignant complaints were heard again in the ward.
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"Brother Liang, I broke up." The team member said to him.

"I know. Didn't you cry?" Wang Liang said casually.

"How do you know I cried?" the team members were very puzzled.

"I heard from Wang Zhuo in your dormitory that Huang Li'an was howling miserably."

"Damn it! I specifically told him not to go out and tell anyone about it." Huang Lian was furious. "You bastard, I'm going to beat him up when I get home tonight!"

"You can't go home tonight." Wang Liang said leisurely, "It's our group's turn to work overtime today."

"Brother Liang, I think it's not good to work overtime every day. I don't have time to spend with my wife, and I earn so much money but have no place to spend it."

"No, we have wives. Do you have wives?" Wang Liang glanced at him and said, "Why do you worry about that?"

(End of this chapter)