Auto chess in the operating room

Chapter 42

Turning her head, Cheng Sisi saw Tang Lou's harmless handsome face, looking at her calculation steps seriously.

She pouted, after all, she was also a top student, and she also followed the basic principles of rehydration, and looked at Tang Lou with some dissatisfaction: "Then I have to ask Doctor Xiao Tang for advice."

"Don't dare, don't dare."

Tang Lou didn't hear the irony in Cheng Sisi's tone at all, and took Cheng Sisi's calculation paper and the case in the hands of the little nurse.

"First of all, we all know that normal people need important electrolytes every day. The blood sodium concentration of normal people is 135-150 mmol/L, and the daily sodium requirement is 4.5 g; while the blood potassium concentration is 3.5-5.5 mmol/L, the daily need is 3 g. 6～[-]g;

Followed by blood magnesium concentration 0.75 ~ 1.25 mmol / L, blood calcium concentration 2.25 ~ 2.75 mmol / L. "

Cheng Sisi nodded after listening to Tang Lou's explanation, but this was the most basic, and she knew it.

"Continue~"

Cheng Sisi still has some doubts about Tang Lou, is this the latest strategy for chasing girls?

But I am not a mindless nymphomaniac, and I can't tell him anything to make him look good!
"Well, now that we know the normal value, we need to understand the principle of rehydration. First of all, from the perspective of sodium supplementation, the principle of salt supplementation."

Cheng Sisi interrupted Tang Lou: "I know this. When the serum sodium is < 130 mmol/L, fluid replacement is needed. First add 1/3-1/2 of the total amount. The so-called supplementary salt is sodium chloride, which is commonly used in clinical practice. The infusion is 0.9% sodium chloride injection, also known as normal saline. I also follow the calculation formula: sodium supplement (g) = [(142-blood sodium measurement) x body weight x 0.6]17."

Cheng Sisi's head was almost close to Tang Lou's nose, and she took a pen to scratch the formula she used on the calculation paper.

Then, looking up at Tang Lou at close range, as the pride of a schoolmaster, he questioned: "The patient's blood electrolyte test shows that the serum sodium is 120 mmol/L. (g), isn't it?"

Cheng Sisi's snort sprayed on Tang Lou's face, but he had no distractions and was very academic:
"The formula is correct, and your calculation is correct, but don't you think 62g is a bit exaggerated?"

"Right is right, wrong is wrong, what is exaggeration? Medicine is only rigorous, there is no imagination, Doctor Xiao Tang!"

Cheng Sisi said seriously that she had memorized this formula dozens of times, and it was impossible for her to make mistakes.

"You forgot the most critical principle, that is, replenish 1/3~1/2 of the total amount on the first day, and the patient's heart can't stand it if you replenish the full amount of fluid. But you are the first time to replenish fluid, no It’s normal to know, it’s good to have experienced it once.”

Tang Lou explained.

Cheng Sisi opened her mouth slightly, thinking about it, it seems that she did mention such a sentence in a case class, but she didn't pay much attention to it at the time.

The proud body was slightly discouraged, and wanted to refute, but he was indeed negligent.

But looking at Tang Lou, Cheng Sisi was a little puzzled. Didn't this guy encounter a fluid replacement case for the first time? Why did he start to guide himself with rich experience?
Knowing the principle of rehydration on the first day, with Cheng Sisi's ability to infer other cases from one instance, he grabbed the calculation paper, recalculated, and then threw it to Tang Lou: "Hey, what about this time?"

Seeing Cheng Sisi frowned, looking at her triumphantly, begging for praise, Tang Lou smiled.

"Basically correct, but there are still a few points to pay attention to."

Tang Lou looked at it for a while, pretended to be serious on purpose, and said with some regret.

"Huh? Is there anything wrong?"

Cheng Sisi snatched the calculation paper with some disbelief, habitually put her index finger by her mouth, bit it lightly, and frowned to check the calculation.

"That's right?"

"The calculation result is correct, but the method of potassium supplementation is wrong."

Tang Lou was not teasing Cheng Sisi, and explained rigorously: "The principle of potassium supplementation is that the rate of potassium supplementation is <20 mmol/h; the concentration of potassium supplementation is 3/1000 ml. You remember this right. But you chose potassium chloride injection. It is also a point often overlooked by interns. Intravenous potassium supplementation is very painful and has low safety. Direct intravenous injection has higher requirements, and if the concentration of injection is wrong, it will easily lead to cardiac arrest.”

"Therefore, I suggest that the best potassium supplement solution is oral potassium supplementation. Since the patient's weight is 80kg, the electrolyte serum potassium after surgery is 2.5mmol/L. If calculated in detail, [(4.5-2.5)×80×0.4]13.4≈ 5 g, plus the daily requirement, is also 8-12 g. You count 10 g, no problem."

"Yes."

Cheng Sisi's eyes lit up. Since there was no rehydration plan, she didn't expect that potassium supplementation could be taken orally.

Cheng Sisi's mentality changed subtly. She was very passionate about academics and was very modest.

Looking at Tang Lou more and more curiously, this guy is obviously also an intern, but he looks like he has read countless people and has rich experience?
"The calcium regimen is fine. But you're missing something."

Tang Lou stared into Cheng Sisi's eyes, smiled slyly, and paused deliberately.

"Say, what else."

Cheng Sisi was completely convinced by Tang Lou now, and hurriedly asked.

"Rehydration, rehydration, you really rehydration? Except for these electrolytes, patients do not have much energy after surgery, especially after gastrointestinal surgery. Generally, they cannot eat normally for 1-3 days, so in addition to fluids and electrolytes, patients also need a lot. energy of."

Cheng Sisi suddenly understood, and blurted out: "Understood, we also need carbohydrates, amino acids, fat emulsion, trace elements, etc."

Tang Lou stroked his chin like a child, and nodded.

"Whee!"

"Shashasha~"

Cheng Sisi calculated on the calculation paper again, and then came up with a set of data: "Liquid volume 3365 ml, sodium supplement 21 (g), potassium supplement 10 g, daily glucose requirement 160 g, amino acid 96 g, triglyceride 56 g, 10 ml of trace element injection."

With the amount of rehydration, of course, it has not been completed yet, and a plan for rehydration, that is, specific reagents, must be produced.

Cheng Sisi looked at Tang Lou's appearance as an outsider, and felt a little competitive: "Little Doctor Tang, why don't you do some calculations to see if the plan you think of is the same as mine."

As he spoke, he took another blank sheet of paper and wanted to give it to Tang Lou.

"Need not."

Tang Lou's pretty index finger tapped his temple.

"mental arithmetic?"

Cheng Sisi looked at Tang Lou in surprise, a little unbelievable, but it was also reasonable, after all, there is a god of learning above a master of learning.

Looking at Tang Lou's handsome face, Cheng Sisi suddenly felt like someone else was looking at her, with high IQ and good looks.

"I'm so envious."

Cheng Sisi's heart speeded up a few times, and she suddenly felt that Lao Cheng's vision was still okay.

"Little nurse, remember the rehydration plan, it's a bit complicated."

Tang Lou spread a sunny and confident smile to the little nurse, who nodded like a fangirl, took out a pen and paper, and got ready, for fear of missing a word.

"Two bags of 500 ml of 10% glucose solution (glucose 2 g), add 100 g of potassium chloride and 1000 g of sodium chloride to the 3 ml solution."

The little nurse nodded obediently and quickly remembered.

"500 bags of 2 ml glucose sodium chloride injection (50 g glucose, 9 g sodium chloride), add 1000 g potassium chloride to the 3 ml solution. Then add 2 g of glucose sodium chloride solution to these 5 bags respectively ml trace element injection, pay special attention to the slow intravenous infusion.”

"Okay." The little nurse wrote a few words of special attention, and added a five-pointed star, then looked up at Tang Lou's handsome face, "You are so handsome, which department, I don't seem to have seen it before."

When the little nurse was distracted, Tang Lou continued to add:
"1250 ml of compound amino acid (15AA) solution (100 g of amino acids) contains 1.52 g of potassium ions and 2.5 g of sodium ions. An additional 2 g of potassium chloride can be added.

The last is 20 ml of 250% fat emulsion (50 g triglycerides). "

Cheng Sisi's eyes widened and she saw that the half-written rehydration plan was exactly the same. For the first time, she had doubts about her IQ.

"I just had a feeling, you're over???"

(End of this chapter)