The Godfather of Surgery

A definitive diagnosis of lactic acidosis can be made based on several major test data.

It's really lactic acidosis. It's a bit inexplicable. The anesthesiologist, Director Ouyang, and Dr. Jin didn't understand how it could be lactic acidosis.

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

Too late to investigate the cause, the anesthesiologist made a decisive decision, first symptomatic treatment, life-saving first.

5% sodium bicarbonate 250ml, intravenous drip, check urine volume, measure central venous pressure!

The top priority is to supplement the base and correct the acid, and then supplement the fluid to expand the volume, and if necessary, perform hemodialysis to filter out the lactic acid in the blood.

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

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

Since the beginning of the operation, the urine output has reached more than 600 milliliters, and there is no water and sodium retention, so you can safely supplement the alkali.

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

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

The training before the academic conference has benefited a lot, and the shortcomings of knowledge have been strengthened. Now, he can also keep up with the rhythm of the anesthesiologist and know the meaning of these rush measures.

Lactic acidosis has a mortality rate of 50%. When blood lactate exceeds 25mmol/l, it is rare to be able to rescue successfully. Fortunately, it is only 8mmol/l at present, which is not to the point of inevitable death.

Send to ICU!

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

Quick, push the bed. The anesthesiologist followed the bedside. The tracheal tube was to be taken offline, so he could only hold the ball and go to the ICU.

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

The equipment dealer's manager was the most embarrassed at this time. The private rooms in the hotel were already booked. In this situation, people still have the heart to eat. He stood by the side, and it was not appropriate to stay, so he could only wait stupidly.

The manager was afraid that there was something wrong with the patient, and Director Ouyang blamed them. Of course, in any case, they could not be held responsible.

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

The patient was pushed out of the door 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, he was breathing on a ball.

The patient's father, an obese middle-aged man, was shocked: What's wrong? Doctor, it's not good if it's good.

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

Da Nian, Da Nian! His mother shook his shoulders, weeping.

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

Lactic acid poisoning, the condition is dangerous, and I will be sent to the ICU for rescue immediately. There is life-threatening danger at any time. Don't pull the bed. Dr. Jin pushed the bed, but couldn't push it.

Lactic acidosis?

The patient's father was very familiar with this term, and immediately calmed down, his face turned from white to red: Doctor, this happens to him every year, and he has to stay in the ICU at least once a year. It has been like this since he was a child. The doctor also said it was lactic acidosis, but after seeing In many hospitals, the cause of lactic acidosis has not been found.

When the whole family heard about lactic acidosis, they stopped crying. They may have experienced too many times and become numb, or they may be lucky and rescued each time, so they are not very afraid.

ICU, send to ICU, every episode is sent to ICU, and sometimes he has to wash blood. My father is familiar with the road and already knows the process. Washing blood probably refers to hemodialysis.

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

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

Confused, really confused, can the illness be concealed? Dr. Jin criticized fiercely, wishing for a kick.

Besides, this young man is twenty-five years old, and he is still a child. He will coax him when he hurts: Good! Be obedient.

The hospital bed was pushed towards the ICU, too fast, and it was inevitable that there would be some small bumps.

Slow down, slow down, doctor, the child hurts. Grandparents, grandparents, and grandparents were anxious, for fear that the flat car would overturn the child.

It's a race against time to save lives, and do you also care about the bumps when the hospital bed is pushed too fast?

Dr. Jin got angry: Don't hold on, let go!

After a few reprimands, the hands that were doing a disservice were backed away.

When the patient was finally sent to the ICU, the family members were kept out by the gate, and they slammed on the door.

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

8mmol/l Dr. King breathed a sigh of relief.

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

Lactic acidosis is still metabolic acidosis in the final analysis. The acid-base of the human body is balanced, and the pH value is about 7.35 to 7.45. The increase or decrease of acid-base substances in the body exceeds the human body's ability to regulate, which will cause changes in the pH value. This is called acid-base imbalance. life-threatening.

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

Get on the ventilator, draw blood to review the blood routine, biochemistry, liver and kidney function, blood lactate, blood gas analysis, get on the ventilator, and prepare the bedside hemofiltration machine— The ICU doctor on duty saw many critically ill patients, and as an expert in dealing with critically ill patients Professionals, who are better at handling these than orthopedists and anesthesiologists, are also fully equipped.

Even using the magic lung is commonplace, and any bedside blood filter is a pediatrician.

The ICU doctor listened to the heart and the lungs, and handed over the condition with Dr. Jin and the anesthesiologist.

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

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

Kussmaul breathing, also known as acidosis breathing, is a regular deep and fast breathing, which can eliminate more CO2 and play a compensatory role for acidosis, which is a manifestation of the 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 the blood sugar can soar to ketoacidosis. Saying insulin is fake, so lactic acidosis may be bigger.

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

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

Devil-style training, the light screen of the training system can also correct errors every time, so that with continuous strengthening, even in an emergency, Yang Ping can quickly follow the logic chain from the symptoms to the deeper rules.

There is a deep logic behind any appearance, it's just that you haven't discovered it, or the medicine has not discovered it for the time being.

Lao Qin, an anesthesiologist, carefully recalled Yang Ping's words. There was no fault, no loopholes, and no blindness. The reasoning process was the same as high school problem solving, and it was well-founded.

How could an orthopedic doctor have such a strong ability to diagnose? Lao Qin was a little puzzled.

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

The levels of diagnosis include symptom diagnosis, pathophysiological diagnosis, case anatomical 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 diagnoses 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 is possible.

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

This time it's good, but it will happen again next time, because the cause has not been found.

If you want to treat the cause, you must obtain the cause diagnosis, which is precisely the most difficult.

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

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