medical road high rise

Chapter 402 Withdrawal due to function

Chapter 4 and Four Withdrawal due to function

The patient's breathing gradually improved, and his lips became rosy.

"Doctor, I am in a hurry to urinate, can I... go to the toilet." The patient finished the sentence with difficulty in two breaths.

"Get a urinal for the patient." Qin Feng said.

At this time, it is definitely not suitable for the patient to get out of bed. If something goes wrong when getting out of bed to go to the toilet, no one can be held responsible. This is a work error.

"That way I can't urinate." The patient struggled.

"Then I'll insert a catheter for you."

"But……"

The patient tried to negotiate, but Qin Feng refused the patient's getting out of bed, and the patient did not compromise. Naturally, Qin Feng would not be deadlocked, and continued to do other work.

"Does the patient have any minor problems recently?" Qin Feng asked.

"He's been coughing recently," the patient's wife said.

cough?

It may be an upper respiratory tract infection, but pneumonia is not ruled out, especially the patient is short of breath now, and there is a possibility of severe pneumonia, but when Qin Feng auscultated the heart and lungs just now, it was obvious that the lungs were not heard at all. Dry and wet rales, so there is a high probability that it is not pneumonia.

In addition, the patient's electrocardiogram showed that the ST segment was a little abnormal, and the patient had chest tightness and shortness of breath. Although it was not like myocardial infarction, acute viral myocarditis and other diseases could not be discharged. Severe myocarditis would cause heart failure, resulting in similar wheezing and hypoxia. Case.

However, the patient's current condition, whether it is a heart or lung problem, is a big problem, especially for a person with a medical history like the patient.

After a while, the nurse sent over the results of the patient.

The patient's arterial blood gas results showed that the patient's partial pressure of oxygen was 68mmhg, which was lower than the normal value. This was measured while inhaling oxygen through a mask, which proved that the patient was indeed hypoxic.

The result of troponin is normal. Troponin is a protein that exists in cardiomyocytes. If there is necrosis of cardiomyocytes, troponin will leak out, and the concentration in the blood will also increase.

However, normal troponin does not rule out myocardial infarction. This is a detail of myocardial infarction. It takes several hours for troponin to increase, because there is a process of myocardial cell damage and necrosis during this process. , Troponin does not necessarily increase, dynamic observation is the best choice.

Qin Feng arranged a chest CT for the patient, and at the same time instructed the hospital director to use nitroglycerin injection to lower blood pressure and relieve heart failure.

Nitroglycerin can dilate blood vessels, reduce heart load, lower blood pressure, and relieve symptoms of heart failure.

When Qin Feng began to examine the patient, he found that there was an obvious raised mass in the patient's lower abdomen. Qin Feng took a closer look and found that this position happened to be above the bladder.

Qin Feng reached out and pressed gently.

"Doctor, stop pressing, I can't take it anymore, ouch." The patient yelled.

"Is this a swollen bladder?" Qin Feng was a little dazed, and tapped twice lightly, and a voice came out from inside, "Did you not go to the bathroom all day?"

"I'm on it, but I probably drank a lot of water today, didn't urinate much, and didn't feel good." The patient's speech was still intermittent, and he couldn't finish a sentence in one breath.

"Do you have benign prostatic hyperplasia?" Qin Feng asked.

"Yes, I have been taking Proscar." The patient said.

"You were sleeping at the time, and you had difficulty breathing, and then you were woken up by urinating?" Qin Feng asked.

The patient nodded.

Qin Feng asked a few more questions and finally found the reason why the patient had heart failure. This was because the patient's heart might not be very good. After all, he had high blood pressure and coronary heart disease, and the heart failure was caused by urinary retention.

The patient himself has benign prostatic hyperplasia, and usually may have difficulty urinating, and the urine accumulates in the bladder. The bladder capacity of a normal person may only be about 500ml, but in the case of urinary retention, the capacity may exceed 1000ml, and the patient will feel uncomfortable situation, then blood pressure rises, causing various nerve reflexes, and finally heart failure.

It's just that when Qin Feng used the catheterization bag, he found that the puncture needle couldn't go in.

This made Qin Feng a little confused. In the end, he could only use cystocentesis. This is already an operation, so it needs the signature of the family members.

But the family members were also very happy, signed directly, and pushed the patient to the operating room.

Qin Feng personally shot, punctured, and directly discharged about 500ml of urine in one breath. The patient's heart rate slowed down and his breathing became smoother.

Although there is still a lot of urine in the patient's bladder, it should not be pumped too much or too fast at once to avoid problems.

After observing for half an hour, I found that except for a little pain at the site of bladder puncture, other discomforts of the patient have almost recovered.

As for the patient's acute urinary retention, it is related to the patient's own prostatic hyperplasia. The urethra is already somewhat obstructed, and he may not be active in taking medicine.

After the observation, Qin Feng asked: "Did you stop the medicine without authorization?"

The patient nodded.

"Because the drug hindered my function, I stopped it myself, but I didn't tell my wife."

"You can't stop taking the medicine casually in the future. It's typical for you to feel better when you feel better. After you stop taking the medicine, it will lead to aggravated urethral obstruction and urinary retention," Qin Feng said.

The patient nodded in shame.

But Qin Feng can also understand, after all, that function is too important for a man, if he can't do it in front of his wife, he would be too ashamed.

After Qin Feng finished the treatment, he transferred the patient to the urology department, and the urology department also accepted it directly. Because the patient still has benign prostatic hyperplasia, plus the urinary retention this time, surgical resection is the best choice.

At ten o'clock in the morning, Qin Feng went to see the high school student patient, and found that the patient's condition was quite stable, so he pushed him directly to the operating room.

Qin Feng also went directly to the stage and took a look at the time, 10:30.

This time is not bad, Qin Feng directly arranges anesthesia.

After the anesthesia was over, Qin Feng picked up a scalpel and made a transverse incision in the patient's lower neck, one and a half fingers above the left clavicle, and then went all the way up to separate the subcutaneous tissue.

"Retractor."

The assistant for Qin Feng was Wang Xiong, Li Xuewen's intern. Qin Feng still likes this intern, and he is willing to take it with him.

Wang Xiong used a retractor to pull the patient's skin away, and then Qin Feng cut the platysma muscle vertically with a scalpel, separating the sternocleidomastoid muscle and the carotid artery sheath.

Put your fingers into the incision, carefully open the internal carotid artery and carotid artery, and find the vagus nerve under the two blood vessels.

This step is not difficult. If Qin Feng gives Wang Xiong a few words, Wang Xiong can also do it.

After all, when doing animal experiments in the academy, there was teaching about finding the vagus nerve.

(End of this chapter)