medical road high rise

Chapter 474 Wrong

Chapter 476 Wrong

After intubating the patient, Qin Feng discovered the problem.

What came out of the patient's lungs was not pneumonia liquid, but gastric juice and food residue, which is a typical aspiration situation.

Qin Feng thinks that when the patient was unconscious, the gastric juice flowed back into the throat, then entered the airway, all the way down to the lungs.

This is also the reason why the patient's white blood cells are not very high, so the patient's current situation is shortness of breath due to coma and aspiration.

Qin Feng used the aspirator to slowly draw out the liquid from the patient's lungs, and then inserted the oxygen tube. The patient's blood oxygen began to rise continuously, and his physical signs tended to stabilize.

However, Qin Feng still didn't relax. Gastric juice was inhaled into the lungs, which would cause blockage of the airway, possibly suffocation, and even death.

Although this situation has not yet occurred in the patient, it is very troublesome if the gastric juice enters the lungs. The gastric juice is acidic and will damage the fragile tissues of the lungs, such as the bronchi.

And there are a lot of bacteria in the gastric juice, and these bacteria will also bring great bacterial infections to the lungs.

"Use a gastric tube to suck out the gastric juice and waste from the patient's body." Qin Feng emphasized, "At the same time, perform a deep vein puncture."

The patient's current condition is still relatively complicated. After a puncture, after an accident, it can be discovered in time and the drug injection can be performed.

In fact, Qin Feng can also arrange an MRI for the patient. Brain CT cannot detect cerebral infarction before edema, but MRI is possible.

It's just that the patient still can't get rid of the ventilator, so naturally he can't enter the MRI room for examination.

After explaining, Qin Feng went out to find the family members of the patient.

"Who are you from the patient?" Qin Feng asked.

"I am his son, how is my dad doing now?" the patient's son asked.

"The situation is not very good. Has your father taken any food or medicine recently?"

"It's just a common home-cooked dish. My dad doesn't usually take medicine, but my dad likes to drink a little wine every day." The patient's son said, "It's just that my dad drank a lot today. I guess there is a bottle of it." gone."

"Did your father fall into a coma after drinking, or did he pass out after a while?" Qin Feng asked.

"It must have been an hour or two."

Qin Feng nodded, then alcoholism is ruled out. Patients with alcoholism are all acute, and they will appear drunk and coma after drinking.

"You said your dad drinks every day, how much does he usually drink?"

"Four or two."

Four taels, that is two glasses of wine, Qin Feng suddenly remembered a disease, Wernicke encephalopathy.

This kind of disease is easy to get by typical alcoholics. It belongs to the common metabolic encephalopathy of chronic alcoholism and is an emergency caused by thiamine deficiency.

Another characteristic of Wernicke's encephalopathy is that the patient's double pupils will have symptoms of loss of light reflex, which exactly matches the patients in the emergency room.

After Qin Feng got the information he wanted, he returned directly to the emergency room and prescribed vitamin B1 infusion for the patient.

Long-term alcoholics, whether they are patients or not, will have vitamin B1 deficiency in the gastrointestinal tract. Excessive B1 deficiency will lead to neurological dysfunction and even coma.

And vitamin B1, another name is thiamine, Wernicke's encephalopathy is caused by long-term lack of vitamin B1.

After finishing the arrangement, Qin Feng left.

After the infusion is completed, if the patient still cannot wake up, then other diseases should be considered and other examinations should be done at the same time.

At around ten o'clock in the evening, Qin Feng received a call from the chief resident of the emergency department. The patient woke up, and it was confirmed that it was Wernicke's encephalopathy, and it was enough to treat it according to the treatment method for Wernicke's encephalopathy.

This kind of disease does not require surgery, but after being discharged from the hospital, you must pay attention to your diet and refrain from drinking alcohol, otherwise there is a possibility of recurrence at any time.

Qin Feng packed up his things and prepared to go home, but was called by Li Xuewen again.

"The patient has been unconscious? Falling from a height of five or six meters? Okay, I see, I'll come right over."

Qin Feng briefly understood the patient's situation, yawned and rushed towards the ward.

"How many inspections have you done?" Qin Feng asked.

"It was delivered in the afternoon. All the necessary inspections were basically done, but no problems were found." Li Xuewen said.

"Could it be acute respiratory distress syndrome?" Qin Feng asked.

Acute respiratory distress syndrome is caused by severe infection, trauma, shock and other internal and external impacts. The manifestations of this disease are dyspnea, shortness of breath, confusion and other symptoms.

It's just that acute respiratory distress syndrome is easily confused with pulmonary embolism, but Li Xuewen shook his head and said: "It's not acute respiratory distress syndrome. The patient's lung image has no bilateral shadows, and the degree of hypoxia is also very low. Moreover, I gave He has been on a ventilator for so long and has not shown any signs of ventilator-related lung injury."

Qin Feng nodded and pondered for a while.

The patient fell, and the height of the fall was five or six meters, and vibration conduction would also occur. The patient's brain may have been injured, and there may be contusion, bleeding or even embolism.

Wait, Qin Feng looked at the medical record and found a problem.

That is, Li Xuewen ignored a problem, that is, fractures. Patients will fracture when they fall from a height of five or six meters.

When the patient was brought in, he was diagnosed with rib fractures, femur fractures, and tibia and fibula fractures.

The latter two are long bone fractures, and a problem must be considered, fat embolism.

This is a disease in which symptoms such as difficulty breathing and impaired consciousness will appear within four to eight hours after a pelvic or long bone fracture. It is a very serious condition and may be life-threatening at any time if not treated properly.

Its appearance is that the fat is carried by the bone and penetrates into the blood vessels, blocking the small blood vessels. At the same time, some fat embolisms block other blood vessels along the blood vessels, and fat embolism occurs.

"First do a physical examination on the inner thigh of the patient. I suspect that the patient's symptoms are caused by fat embolism." Qin Feng said.

Li Xuewen directly arranged the examination, and found a small number of needle-shaped bleeding spots on the patient's inner thigh. Li Xuewen took samples and arranged for examination.

If there are fat droplets in the blood, it proves that Qin Feng's diagnosis is correct, and the patient's symptoms are due to fat embolism.

Half an hour later, the intern who sent the samples came back panting because he left urgently.

"Teacher Li, Doctor Qin, there are fat droplets in the sample fluid. This is the test report." The intern handed the results to Qin Feng.

"How is this possible..." Qin Feng took the result, then frowned, and gave the patient a detailed physical examination again.

"No, the patient is suffering from shortness of breath caused by fat embolism. These bleeding points all have obvious subcutaneous bleeding of fat embolism." Qin Feng let go of his hand.

(End of this chapter)