godfather of surgery

Chapter 284 Entering the ICU every year
Based on several major test data, it can be clearly diagnosed as lactic acidosis.

It was really lactic acidosis, which was a bit inexplicable. The anesthetist, Director Ouyang and Dr. Jin didn't understand how lactic acidosis happened.

The anesthesiologist glanced at Yang Ping, and he said indifferently: "Check for lactic acid", pointing out the direction in time, otherwise it would definitely take a lot of time.

It was too late to investigate the cause, so the anesthetist made a decisive decision and treated the symptoms first, putting life first.

"5% sodium bicarbonate 250ml, intravenous infusion, check urine output, measure central venous pressure!"

Supplementing alkali to correct acid is the top priority, and then replenish fluid to expand volume, and if necessary, hemodialysis should be performed to filter out lactic acid in the blood.

250ml of 5% sodium bicarbonate was put on, and the anesthesiologist began to use the formula to calculate the amount of alkali in his mind.

The nurse starts to measure the central venous pressure, and the fluid infusion should be adjusted at any time according to the central venous pressure.

The urine output has been more than 600 ml since the operation, and there is no water and sodium retention, so I can safely replenish alkali.

Director Ouyang has been engaged in orthopedics for 20 years. If it weren't for the training before the academic conference, how could he remember the formula for calculating the acid-base balance.

Not to mention the acid-base balance calculation formula, it is estimated that how to rescue lactic acidosis has been completely forgotten.

The training before the academic meeting has benefited a lot, which has strengthened the shortcomings of knowledge. Now, he can also keep up with the pace of anesthesiologists and understand the significance of these emergency measures.

Lactic acidosis, the mortality rate is 50.00%. When the blood lactic acid exceeds 25mmol/l, it is rare that it can be rescued successfully. Fortunately, it is only 8mmol/l at present, and it is not fatal.

"Send to ICU!"

The patient's vital signs stabilized temporarily, and Director Ouyang made a decision.

"Quick, push the bed." The anesthetist followed the bed, and the endotracheal tube was about to be taken off the line, so he had to hold the ball and go to the ICU.

Everything went wrong, everything went wrong, a good operation, a fracture inserted into the muscle, and a special guide had to be adjusted urgently. Now that the operation was successfully completed, I thought I could breathe a sigh of relief.

The manager of the equipment dealer was the most embarrassed at this time. The private rooms in the hotel were all booked. In this situation, he was still in the mood to eat. He stood by the side, and it was not appropriate to stay.

The manager was afraid that the patient had a problem, and Director Ouyang would blame them. Of course, no matter what, they couldn't be blamed.

What he was afraid of was that Director Ouyang would stop using their equipment in a fit of anger, even if they stopped using it for a period of time, there would be a lot of losses.

The patient was pushed out of the operating room, and Dr. Jin shouted: "Wei Danian's family—"

A large family, two elderly couples, and a middle-aged couple immediately gathered around.

Looking at Wei Danian lying on the bed, with a tube in his mouth, breathing with a rubber ball.

The patient's father, an obese middle-aged man, turned pale with shock: "What's wrong? Doctor, why can't it work if it's fine."

The grandma was dizzy for a while, and she was about to fall down. The patient's father immediately helped the old man.

"Happy New Year, New Year!" His mother shook his shoulder violently, weeping uncontrollably.

"I'm usually in good health. I can eat and drink. How did you do the surgery to make people like this." Grandma patted the edge of the bed.

"Lactic acid poisoning, the condition is dangerous, and I will be sent to the ICU immediately for rescue. My life is in danger at any time, so don't pull the bed." Dr. Jin pushed the bed, but it couldn't be pushed, and all the family members held on to the armrest.

"Lactic acidosis?"

The patient's father was familiar with this word, and immediately calmed down, his face turned from white to red: "Doctor, this happens to him every year, and he has to be admitted to the ICU at least once a year. He has been like this since he was a child. The doctor also said it was lactic acidosis, but after seeing Many hospitals just haven’t found out the cause of lactic acidosis.”

When the whole family heard about lactic acid poisoning, they stopped crying. They may have experienced too many times and became numb, or maybe they were lucky and rescued every time, so they were not very afraid.

"ICU, send to ICU, every attack is sent to ICU, and sometimes blood is washed." Father is familiar with the road and already knows the process, blood washing probably refers to hemodialysis.

"I asked the medical history several times, why didn't you mention lactic acidosis?" The doctor in charge of the bed gritted his teeth angrily.

"The child is afraid of pain, and afraid to tell you this situation, so he postponed the operation, so—" Wei Danian's mother whispered.

"Confused, really confused, can the disease be concealed?" Dr. Jin criticized fiercely, wishing to kick him.

Besides, this young man is already 25 years old, and he is still a child, so if he hurts, he will coax him: "Good boy! Be obedient."

The hospital bed was pushed toward the ICU with a grunt. The speed was too fast, and it was inevitable that there would be slight bumps.

"Slow down, slow down, doctor, the child is in pain." The grandparents were all anxious, for fear that the flat car would bump the child.

It takes time and seconds to save lives, and you don't even care about the bumps when the hospital bed is pushed faster?
Dr. Jin got angry: "Don't pull, let go!"

After several reprimands, the hands that were not helpful were pushed back.

The patient was finally sent to the ICU, and the door blocked the family members outside, and they slammed on the door.

"How high is the lactate level?" asked the doctor on duty.

"8mmol/l" Dr. Jin heaved a sigh of relief.

That's okay, there is hope, if it is higher than 25mmol/l, it is basically powerless.

In the final analysis, lactic acidosis is still metabolic acidosis. The acid-base balance of the human body is about 7.35 to 7.45. The increase or decrease of acid-base substances in the body exceeds the adjustment ability of the human body, which will cause changes in the pH value. This is called acid-base imbalance. can be life-threatening.

The causes of acid-base imbalance include respiratory factors and metabolic factors. The increase in lactic acid is caused by metabolic factors.

"Put on a ventilator, draw blood to check blood routine, biochemistry, liver and kidney function, blood lactic acid, blood gas analysis, put on a ventilator, and prepare a bedside hemofiltration machine—" The doctor on duty in the ICU sees many critically ill patients, as the first step in dealing with critically ill patients Professionals are better at handling these than orthopedists and anesthesiologists, and they are well equipped.

Even using the magic lung is commonplace, and any bedside hemofiltration machine is pediatrics.

The ICU doctor listened to the heart and the lungs, explaining the condition to Dr. Jin and the anesthesiologist.

After the handover, Lao Qin, the anesthesiologist, had time to ask Yang Ping, "How did you know about lactic acidosis?"

"Choose one of the two, diabetic patients, with typical Kussmaul breathing, of course consider acidosis."

Kussmaul breathing, also called acidosis big breathing, regular deep and fast breathing, which can eliminate more CO2 and play a certain role in compensating acidosis, which is a manifestation of the human body's self-compensation ability.

"The breath still smells of ketones. Those acidosis caused by salicylic acid, phosphoric acid, and sulfuric acid can be ruled out. The insulin is still hanging, and the pump speed is quite fast, so that the blood sugar can still soar to ketoacidosis. Said the insulin was fake, so the lactic acidosis could be bigger."

It's as simple as that, with clear and rigorous logical reasoning, from symptoms to pathophysiology, we peeled off the cocoons and found the answer in a few clicks.

The systematic super-training plan allows Yang Ping to compile human body anatomy, physiology, biochemistry, pathology, pathophysiology and clinical symptoms, test and inspection results into logical relationships, and to train continuously to train strong clinical logical thinking ability.

The devil-style training, each training system light screen can also correct errors, so that with continuous strengthening, even in an emergency, Yang Ping can quickly follow the logical chain from the symptoms to the deeper rules.

There is a deep logic behind any appearance, but you have not discovered it, or medicine has not discovered it for the time being.

Lao Qin, the anesthesiologist, thought carefully about Yang Ping's words. There was nothing wrong with it, there were no loopholes, and it wasn't blind. The reasoning process was the same as solving problems in high school.

How can an orthopedic doctor have such a strong diagnostic thinking ability? Lao Qin is a bit puzzled.

"Why does this patient suffer from repeated lactic acidosis? Now Jiangtangling - phenformin has been eliminated. There is no reason. We need to find the reason." Yang Ping explained to Dr. Jin that the patient was in their group.

The levels of diagnosis include symptom diagnosis, pathophysiological diagnosis, case anatomy diagnosis and etiological diagnosis.

Etiological diagnosis is the highest level, but unfortunately, there is no way to obtain etiological diagnosis for many diseases.

For example, common hypertension and diabetes, these two diagnoses are only symptom diagnoses, which are the lowest level of diagnosis in terms of diagnostic logic.

The lowest level of diagnosis means that the etiology is unknown, and the pathological anatomy and pathophysiology have not been thoroughly studied, so only symptomatic treatment can be performed.

Lactic acidosis can only be regarded as a pathophysiological diagnosis, and treatment can only proceed from the pathophysiological level.

This time it was fine, but it will happen again next time, because the cause of the disease has not been found.

If etiological treatment is to be carried out, etiological diagnosis must be obtained, which is precisely the most difficult.

"I'll go back and check the literature." Dr. Jin felt it was necessary.

However, whether Wei Danian can be saved is still unknown.

(End of this chapter)