world famous doctor

Chapter 295 Alveolar Lavage

After a night of desk work, Hu Zhaowei finally determined the specific treatment plan for his father.

He decided to find a hospital to treat him with fiberoptic bronchoalveolar lavage.

For this diagnostic technique, two inclusion criteria and five exclusion criteria had to be met.

Inclusion criteria, patients need to meet the diagnostic criteria for the acute exacerbation of COPD in the "Guidelines for the Diagnosis and Treatment of Chronic Obstructive Pulmonary Diseases" formulated by the Chronic Obstructive Pulmonary Disease Group of the Respiratory Branch of the Chinese Medical Association.

Patients in the alveolar lavage group agreed to use fiberoptic bronchoscopy.

Exclusion criteria for signing informed consent for special examination and treatment during alveolar lavage:

The duration of acute exacerbation of COPD exceeds 3 years.

Antibiotics have been used in the past 7 days.

Patients with definite or highly suspected pathogen infection in tissues other than the respiratory system.

Patients with unstable blood circulation system, severe cardiopulmonary failure, fingertip blood oxygen saturation <80% or active massive hemoptysis.

Patients with malignant arrhythmia, uncontrollable hypertension, and severe coagulation dysfunction.

Patients who have undergone surgery on the upper respiratory tract or upper gastrointestinal system in the past six months.

Patients whose basic condition is seriously exhausted or who are difficult to cooperate with diagnosis and treatment.

After comprehensive consideration, Hu Zhaowei chose the relatively large general hospital in Jiangzhou City—the Municipal Hospital.

After breakfast, he rushed to the city hospital and consulted with the city hospital.

After revealing his identity, the doctors and leaders in the hospital also treated him relatively well.

After all, he is a foreign respiratory medical expert with a good reputation.

The municipal hospital agreed to accept patients like his father, and at the same time signed a document, agreeing to let Hu Zhaowei, as a son, perform fiberoptic bronchoscopic alveolar lavage diagnosis and treatment for his father himself. Hu Zhaowei will bear all the consequences at his own risk.

In the afternoon, after some persuasion, Mr. Hu finally agreed to Dr. Hu Zhaowei's treatment plan.

They came to the municipal hospital together to go through the hospitalization procedures.

The hospital set up a temporary office for Hu Zhaowei alone for his use.

After Grandpa Hu was hospitalized, Hu Zhaowei first performed routine blood tests, arterial blood gas analysis in the absence of blood oxygen, inflammatory indicators, culture of sputum coughed up from the deep part of the trachea in the morning, and drug sensitivity tests.

At the same time, routine symptomatic treatments such as anti-infection, oxygen inhalation, expectorant elimination, bronchospasm relief, and correction of body fluid and electrolyte balance were given.

For patients with serious conditions like Mrs. Hu, Hu Zhaowei also monitors vital signs such as fingertip blood oxygen saturation, cuff blood pressure, heart rate (rhythm), and according to the pathogenic bacteria cultured from sputum and the results of drug sensitivity tests Antibiotics are suitable for anti-infection treatment.

On the basis of these symptomatic diagnosis and treatment, Hu Zhaowei plans to start the combined diagnosis and treatment of fiberoptic bronchoalveolar lavage tomorrow.

Several other doctors in the respiratory department of the municipal hospital would whisper about this matter behind his back.

"Let a doctor who is not hired by the hospital perform the operation on his father himself? This is the first time such a precedent has been set."

"Hey, you can't say that. If you search for his name, Hu Zhaowei, he is indeed a very good doctor in the respiratory department. Otherwise, the hospital wouldn't take such a risk."

"Yes, I think the leadership has its own considerations. Maybe the above may have some hope that he will be hired to work in the hospital in the future."

A deputy director came forward: "Think about it yourself. If you were a medical expert, would you trust an ordinary doctor to operate on your own father?"

The other doctors nodded thoughtfully.

The director who had been silent all this time finally spoke:
"Let's not think about it too much. We will try our best to cooperate with him then."

before performing this lavage.

For patients, appropriate fluid replacement must be given first, and fasting for six hours, water deprivation for four hours, injection of atropine 10mg three 0.5 minutes before the operation.

The operation officially started, and Mr. Hu was pushed into the operating room.

First, the anesthesiologist gave 2% ultrasonic atomization inhalation and 5 mL lidocaine injection to anesthetize the local surface mucosa of the throat, and used a nasal catheter to inhale high-concentration oxygen.

Hu Zhaowei held the airs of a famous doctor and said in an orderly tone:

"The concentration of oxygen uptake is set at 40%."

The nurse nodded, and immediately followed his instructions, not daring to be negligent, and immediately followed suit.

But even so, Hu Zhaowei still had a look of displeasure. He thought the other party's movements were a bit slow.

Next, Hu Zhaowei used the Olympus fiberoptic bronchoscope to diagnose and treat the airway of his old father lying on the operating table.

Check the opening of the airway and each leaf segment and the nature of the mucous membrane and exudate step by step through the nasal cavity or oral cavity.

The purpose of doing this is mainly to compare the lung X-ray and lung CT to show the lesion.

Careful attention is given to areas of atelectasis due to severe airway infection and airway obstruction.

Under such direct vision, try to clean up the exudate in the respiratory lesions to the greatest extent.

Hu Zhaowei's operation is as proficient as a ding jie ox.

Although this person has a bad temper.

Several other doctors present also secretly gave him a thumbs up in their hearts.

An expert is an expert. The hand holding the instrument is as stable as a mechanical arm, without any trembling.

It is also unusual for him to be so focused on performing surgery.

Hu Zhaowei took an appropriate amount of lavage fluid samples for his old father patient for pathogenic examination and drug susceptibility test of pathogenic bacteria, and then injected about 20mL of sterile normal saline that was similar to body temperature through the biopsy hole of the fiberoptic bronchoscope for multiple flushes. The total volume is 200mL, and the negative pressure is 150mmHg for suction.

It was not until the appearance of the lavage fluid became clear that Hu Zhaowei began to inject 10 mL of sterile normal saline + sensitive antibiotics into his father's lung segment for lavage.

It is worth reminding that in this step, if the infected bacteria are unknown, 10 mL of sterile normal saline + 0.2 g of amikacin should be injected empirically to lavage the lesion, and then sucked out under negative pressure.

In this step, it is necessary to check the amount of fluid sucked back in the irrigation bottle to ensure that the amount of irrigation fluid retained in the airway is as low as possible to less than a quarter of the infusion amount used.

Soon, Hu Zhaowei put down the medical equipment in his hand, and the whole lavage treatment process was completed within 30 minutes.

A nurse came forward and wiped the sweat from Hu Zhaowei's forehead.

When seeing his father lying on the operating table, even the simplest operation, the operator will be anxious and worried involuntarily.

Hu Zhaowei said to those householders: "Patients should be told to rest, fast and drink for 3 hours after the operation, and according to the severity of the patient's lung lesions and the amount of secretions, lavage treatment twice every 3-5 days..."

"Forget it, once." Hu Zhaowei changed his words again because of his father's advanced age and his poor body tolerance.

(End of this chapter)