I Can See Health

Remember [new] in one second! "Lu Chen, what do you think is the main cause of the patient's illness?"

Lu Chen remained silent, so Zhou Bin took the initiative to ask.

"Teacher Zhou, I don't have a clue yet." Lu Chen shook his head.

There were many clues at present, but they were also very confusing, and he couldn't figure it out for a while.

But what is certain is that the "three minus signs" on the patient's head indicate that his condition is getting worse!

If we don't find the reason soon, we'll be in trouble!

The patient's life is in danger at any time!

"Even if you can't tell the exact cause, you can always tell something." Zhou Bin continued, "Just say it boldly. It doesn't matter if you are wrong. Let's discuss it together."

She looked at Lu Chen completely differently now.

I've heard of Lu Chen before, and I thought he was mostly a young man with "a false reputation".

Now that he has met Lu Chen in person, although it has only been a few days, Zhou Bin has already seen that Lu Chen is different from other students.

His clinical thinking and operational skills far exceed those of his peers.

Lu Chen frowned, raised his head, looked around at everyone, and said slowly: "My opinion, the patient's procalcitonin and crp were significantly elevated, and the chest CT scan for admission screening showed patches of left lower lung. No, The possibility of acute septic shock has been ruled out. However, there has been no fever in the past few days, there are no abnormalities in blood tests, and the lung infection does not seem that serious.”

"In addition, although the electrocardiogram showed widespread ST segment depression and avr ST segment elevation, the increase in TNI in the past 2 days was not too high, from 0.022ng/ml to 0.42ng/ml, which was not obvious. Worsening arrhythmias.”

"Further ultrasound examination showed that the inferior vena cava was 0.9cm, the left heart was significantly enlarged, the left ventricular end-diastolic diameter, the ejection fraction was 40%, the cardiac output was 6l/min, and the ventricular wall motion was low."

"So, I think the diagnosis of the patient's sepsis is still lacking. There is no sudden deterioration in cardiac function, the cardiac output is still okay, and the diagnosis of cardiogenic shock is not very valid."

The words just fell.

Everyone in the office was silent.

Gu Xinyue stared blankly at Lu Chen's side face, and suddenly felt a sense of powerlessness in her heart.

Lu Chen's explanation was clear and well-evidenced, and was far more tenable than the simple "cardiogenic shock" or "septic shock" they said.

Zhou Bin, however, looked at the report sheet in his hand intently.

Lu Chen's words kept lingering in her mind.

At this time, Lu Chen continued.

"The patient's inferior vena cava is only 0.9cm, indicating severe volume deficiency. It seems that hypovolemic shock is the most likely possibility, but the patient currently has no evidence of massive fluid loss or blood loss."

"Hypovolemic shock?"

Zhou Bin was stunned. This idea was completely different from what they had thought before!

Not cardiogenic shock, not septic shock, but hypovolemic shock!

"I'm going to ask the patient's family how their diet is lately." Zhou Bin said immediately.

If the patient has not had a good diet recently, it will also cause malnutrition and hypovolemic shock.

…

CCU ward, doctor-patient communication room.

Zhou Bin called the patient's family members in.

"How is the patient eating and drinking these days?"

The family member is the patient's son. He quickly said: "My dad has always felt a burning sensation in his stomach in the past two months. He doesn't eat much and drinks soda."

"Only drink soda?" Zhou Bin frowned, "Don't you eat any other food?"

"He eats very little." The family members sighed, "We don't dare to disobey him. If he wants to drink soda, we can only give it to him."

"Okay, I understand. I'll come back to you if anything happens."

After Zhou Bin asked a few questions, he returned to the doctor's office.

"It seems that the amount is really not enough. No matter what, let's replenish fluids first to improve hemodynamics." Zhou Bin said to Lu Chen.

Lu Chen nodded.

For the time being, we can only treat the symptoms first. As for the cause of the disease, we can only explore it step by step during treatment.

…

Zhou Bin came to the old man's hospital bed and prepared to perform subclavian central venous puncture and catheterization on him.

Central venous catheterization can quickly replenish fluids for patients, and is especially suitable for some critically ill patients.

"Teacher, let me go with you." Gu Xinyue said.

"Okay, I just need a helper." Zhou Bin nodded slightly.

Central venous catheterization is a routine operation in ICU and CCU wards, but it is almost non-existent in ordinary wards.

Gu Xinyue pulled Lu Chen to the ward.

"Lao Gu, why are you holding me back?" Lu Chen was going to continue studying the patient's test sheets to see if he could find any clues.

"Let's take a look at central venous puncture and catheter placement." Gu Xinyue said, "You have so many skills but you are not overwhelmed!"

Lu Chen nodded helplessly. In fact, he had trained this kind of puncture operation many times in the system space, and his proficiency in central venous puncture and cannulation was about 75%.

However, because there was no real-life practice, the proficiency level stopped increasing after it reached 75%.

This time the opportunity to be an assistant was given to Gu Xinyue.

…

Gu Xinyue held the gloves and followed Zhou Bin.

"The most important thing about puncture is positioning," Zhou Bin said. "We can insert central venous catheters in the neck or under the clavicle, but with internal catheters in the neck, the patient's comfort is less, so we usually insert the catheter under the clavicle."

Zhou Bin's puncture technique is very skillful.

After finding the puncture positioning point, insert the puncture needle and the puncture will be successful immediately.

Gu Xinyue's job is also to help implant guide wires.

After the guide wire passes, the tube is placed.

The most difficult step in the whole process is the puncture.

The entry of other guide wires and catheters is secondary.

Lu Chen watched from the side, but he didn't gain much experience, so he just thought he was accompanying Gu Xinyue.

Gu Xinyue's experience as an assistant several times will be of great help to him for independent punctures in the future.

The central venous catheter was successfully placed, UU Reading www.uukanshu.net The nurse immediately connected several groups of liquids to the central venous channel.

All that's left is to observe the patient's reaction after rehydration.

…

This old man who is in critical condition is insignificant to the entire CCU ward.

Even Lu Chen's attention was diverted by the next patient.

In the afternoon, Lu Chen admitted another old lady with severe heart failure.

This old lady had been ill at home for a week, and she was so sick that she could no longer lie down to sleep, so she decided to come to the hospital.

After dealing with the old lady, Lu Chen took the time to take a look at the old man who had been treated before.

After rapid rehydration, the inferior vena cava quickly rose to 1.3cm, and the blood pressure also recovered compared to before. The systolic blood pressure can reach hg, and it seems to be progressing in a good direction.

But when Lu Chen came to the ward, he saw that the old man's health was still trending at three minus signs!

what happened?