super anesthesiologist

Chapter 10 DIC Great Rescue (please support, please collect, please recommend, thank you!!!)

Disseminated intravascular coagulation (DIC) is not a disease, but a clinically very dangerous complication. It is a contradictory manifestation of the coexistence of extensive coagulation and bleeding in patients due to various reasons, and patients are prone to multiple organ dysfunction syndrome. symptoms lead to death.

When Li Xiumei heard this, her relaxed mood immediately became tense again.

"Doctor Lin, you, what did you just say?" She questioned, her voice trembling.

Just after Li Mengxia's most difficult problem of uterine bleeding was solved, a greater danger came, which she couldn't accept for a while.

"Notify the blood transfusion department immediately, send 20 units of suspended red blood cells, and another 2000ml of plasma. 10 bags of platelets (therapeutic dose)." Lin Xiaobei didn't have time to pay attention to Li Xiumei, and directly issued an order to Li Qiong.

At this time, the best blood product is actually fresh whole blood, but it is impossible for the blood bank in the hospital to have it in stock.This is because whole blood is not easy to store and is wasteful.Generally speaking, a bag of whole blood can only treat one patient. If it is separated into red blood cells, platelets, and plasma, it can treat multiple patients according to different needs.

Lin Xiaobei's expression was stern and serious, Li Xiumei didn't dare to doubt his judgment.

At this time, the uterus, which had just recovered, began to flush again.This time, not only was the surgical wound oozing blood, but even red dots appeared on the wall of the uterine cavity.

"Director Li, you just hold it down like this."

At this time, there are two crucial issues that need to be addressed: anticoagulation and hemostasis.These are two contradictory and interdependent issues. Anticoagulation will aggravate bleeding, but hemostasis will cause blood to coagulate. This is why DIC is difficult to handle.

“柳絮，把肝素配好，12.5-25mg+10%葡萄糖（10%GS）250ml ，滴速控制在40分钟。”

"Hello, Mr. Yu Ping (head anesthesia nurse, in charge of anesthetic drugs and consumables)? Hurry up and take the ice pillow to Room 16." Lin Xiaobei touched Li Mengxia's forehead, but she didn't have a fever.

When the patient is in shock and is about to undergo cardiopulmonary resuscitation, it is very important to protect the brain. Cooling the head can effectively reduce the oxygen consumption of the brain tissue, thereby protecting the brain tissue.

Although Li Mengxia's condition has not yet developed to such a bad point, Lin Xiaobei did this to plan ahead and prevent problems before they happen.

"Hello, is this a pharmacy? I'm Lin Xiaobei, an anesthesiologist. We have a patient who is in urgent need of antiplatelet drugs due to hemorrhage during surgery. Do you have dipyridamole here?"

"Let me check, um, yes, how much do you want?"

"Bring two boxes first."

……

Lin Xiaobei was busy but not chaotic, calmly directing Li Qiong and Liu Xu who were free to move in the operating room, as well as Li Xiumei, Liu Lu and Hu Shuang, the equipment nurse on the stage.He had to do this. When it was time to save time, a high-level doctor who could hold his breath and make correct judgments in time was especially needed to take command, otherwise the whole audience would be in chaos.

This urgent reminder was very effective. The blood transfusion department quickly sent the prepared blood source to the operating room in time, including 12 units of suspended red blood cells, 1300ml of plasma, and 6 bags of platelets.

According to the latest "Guidelines for Clinical Blood Transfusion", every application for 2 units of red blood cells requires the patient's blood gas to see if there is any indication for blood transfusion, and the Hb and Hct should be continuously reported to the blood transfusion department for heavy bleeding and emergency treatment, and plasma transfusions should also be provided PT, APTT, otherwise it will be settled later, and the doctor is suspected of excessive blood transfusion.

So when Lin Xiaobei saw that the blood transfusion department could allocate so many blood sources at one time, he was already very satisfied and even grateful to Dade.

Although he can judge Li Mengxia's current condition, he must have the corresponding medical supplies to save people, including blood and medicine, otherwise, it is difficult for a clever woman to cook without rice.

When the blood source arrives, there is hope.

"Central venous transfusion of platelets, peripheral venous transfusion of red blood cells."

"Liu Xu, help me check my blood pressure."

"Li Qiong, check your coagulation function urgently."

"Where's the blood transfusion warmer?"

"10% calcium chloride 10ml intravenous injection."

"Dexamethasone 10mg, intravenous infusion."

……

Li Qiong was so busy running around, Lin Xiaobei saw that she really couldn't handle it, so he decided to do some operations himself.

Pressurized blood transfusion, pressurization, volume expansion.

Central venous pressure showed that CVP rose to 4cmHg, radial artery BP was 85/56mmHg, and HR was 122 beats/min.

After emergency treatment, Li Mengxia's condition improved greatly.

"Doctor Lin, the ice pillow has been brought." Yu Ping came in really fast, and she came in with the department director Lin Chaobing and the deputy clinical director Yang Wenhai.

"Director Lin, Director Yang," Lin Xiaobei said that the incident happened so suddenly that there was no time to inform him, and then briefly reported the progress of the patient's condition to the two department directors.

When he said that he had embolized Li Mengxia's left and right iliac arteries, the two directors' eyes widened, they were shocked, and they frowned.

"Dr. Lin's technique is really good. As soon as he finished filling (gelatin sponge particles), the patient stopped bleeding. DIC was also the first to be discovered and treated by him. He treated it very appropriately, and the patient's condition is now much better than before. "Li Xiumei complimented Lin Xiaobei without wasting any time on stage.

As an ordinary doctor in the anesthesiology department, he dared to blindly perform internal iliac artery embolization without the assistance of contrast fluoroscopy.If she hadn't seen it with her own eyes, she would never have believed it.

When Li Xiumei saw the expressions of the two directors of the anesthesiology department, she knew that they were blaming them.An anesthesiologist acting so recklessly, and in the operating room, will have a very adverse negative impact on the department, especially when a medical accident occurs, it will implicate the leaders and colleagues.

Li Xiumei was worried that Lin Xiaobei would be criticized, after all, everything he did was for the patients.

Lin Xiaobei's technical level is nothing to say, but his status is still not comparable to that of the department leader, and he must obey the superior management.

But she is different, she is the director of the obstetrics department, and she is at least on the same level as Director Lin in terms of status.She had to protect Lin Xiaobei with her own identity.

She knew the development of Li Mengxia's condition very well in her heart.

In order to reduce bleeding, the uterus is pressed hard, and the amniotic fluid is inevitably squeezed into the blood vessel, causing amniotic fluid embolism, and then develops into disseminated intravascular coagulation (DIC).

Thanks to Lin Xiaobei...

Although his operation violated the norms, the fact is that he succeeded, and the effect was very good, saving the patient once.If it were not for the timely embolization of the internal iliac artery, it is difficult to predict whether Li Mengxia can persist until now, but the symptoms of DIC will definitely be much more serious.

In Li Xiumei's mind, Lin Xiaobei is now a god.He commanded in an orderly manner, rescue measures were timely, and rescue drugs were used properly.

The most obvious feeling was that the amount of blood stained on the gauze she was pressing was gradually decreasing. During her spare time, she secretly scanned the monitor on the anesthesia machine, and the patient's vital signs were slowly improving.

All this shows that Lin Xiaobei commanded properly and handled it correctly.

Li Xiumei didn't want him to be disturbed by external pressure, so she smiled and said to Lin Chaobing: "Director Lin, it is enough to have Dr. Lin here, too many people will only add to the chaos."

She unceremoniously issued a eviction order.

Directors Lin Chaobing and Yang Wenhai stood aside and did not speak.Needless to say, the data on the monitor display shows that Li Mengxia is temporarily out of danger.

Even if the dipyridamole provided by the pharmacy was delivered, Lin Xiaobei said to Liuxu in a low voice: "Use 400-600mg to prepare 100ml of saline and instill it intravenously."

He himself pumped Li Mengxia's blood and handed it to Yu Ping, "Check it out for me."

"Li Qiong, take another blood test to cross-check the coagulation function."

CVP已经上升到6cmH2，动脉血压稳定在102/65mmHg，心率慢慢下降到 98次/分，SPO2 100%。

All blood products have been transfused.

The infusion channels of Lin Xiaobei's two groups were infused with crystalloid (balanced fluid) and Wanwen (colloid instead of plasma) on the other.

"Hey, blood transfusion department? Have you prepared the remaining blood for us?"

"There are only four units of suspended red, 300ml of plasma, and no platelets."

"That's alright, send up the matching one first, our patient is in a hurry to lose."

Blood gas showed Hbg 7.1g/L. Although Li Mengxia's vital signs have gradually returned to normal, the anemia is still severe, and the operation is not over yet, and there will be a small amount of blood loss.

PH 7.55, HCO3- 56mmol/L, K+ 2.1mmol/L, metabolic alkalosis with hypokalemia.

“将10%氯化钾10ml加入5%葡萄糖100ml中，用50ml注射器泵入，速度20ml/h。”

After finishing the treatment, Lin Xiaobei said to Li Xiumei on stage: "Director Li, how is the patient's abdominal bleeding?"

Li Xiumei peeled off the gauze, turned the uterus left and right, and said with a happy face: "There is basically no bleeding now."

Then she asked, "Doctor Lin, can I close my abdomen now?"

"Yes." Lin Xiaobei nodded, and for the sake of safety, he asked Li Qiong to draw blood for urgent blood tests, blood coagulation function and thromboelastogram.

At this time, there was a series of "ding" sounds in his mind, and the golden panel jumped out, [Super Anesthesiologist Training System Prompt: Task completed, endotracheal intubation: +5; central venous puncture: +10; vital signs monitoring: +10; application of basic theoretical knowledge: +20; arterial puncture: +5.

Reward: energy potion: 5 pieces; 10 gold bracelets].

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(End of this chapter)