I Can See Health

Remember [new] in one second! "Let's replenish normal saline first." Zhou Bin said, "As for the amount of fluid replenishment, try to achieve a positive balance of at least 5000ml within 12 hours and a positive balance of 10000ml within 24 hours."

After speaking, Zhou Bin quickly gave the patient medical advice.

At this time, time is life.

The nurse also responded quickly and rehydrated the patient immediately.

…

Gu Xinyue kept looking at the medical instructions given by Zhou Bin, frowned and said, "Lu Chen, why do you need to use saline for rehydration? Why not use hypotonic fluid?"

Liquids are divided into isotonic, hypertonic and hypotonic.

Normal saline is isotonic saline.

At this time, the patient's osmotic pressure needs to be reduced. In theory, hypotonic fluids can be used.

Lu Chen smiled and said: "The osmotic pressure of hypotonic saline (0.45%-0.6%) is too low. Early large-scale infusion may cause the blood osmotic pressure to drop too fast and cause cerebral edema, so it is not the first choice. Only when sufficient Use with caution if serum sodium and osmotic pressure continue to rise after rehydration.”

"Oh." Gu Xinyue nodded, "What about Ringer's lactate?"

Lu Chen continued to explain: "The osmotic pressure of Lactated Ringer's solution is 273 mosm/l. After entering the body, as the lactate radicals are decomposed, the osmotic pressure will be further reduced. It is suitable for patients with a tendency of acidosis."

"Theoretically it is feasible, but it has not been widely clinically verified in HHS, so it has not been used yet."

"Is there such a thing?" Gu Xinyue was stunned.

He had never seen these ideas in textbooks.

Lu Chen nodded slightly and said: "The osmotic pressure of normal saline is 308 mosm/l. Compared with diabetic patients with high sugar and hypertonicity, it is a hypotonic liquid. It can effectively reduce osmotic pressure, replenish body fluids, and improve kidney function, so it should be the first choice. "

As for other hypertonic liquids, they are definitely not applicable.

"Congratulations, I received a +1 thank you from Gu Xinyue!"

Lu Chen smiled slightly, Lao Gu was good, and he even gave himself some gratitude points.

"What about the amount of fluid replenishment?" At this time, Gu Xinyue asked again, "So much replenishment in one day, I think it is a bit too much."

Lu Chen paused and said, "The patient's weight is 70kg, and his cumulative body fluid loss is 7000-15400ml."

"According to the principle of rehydration, 1000-2000ml of fluid should be replenished within the first 2 hours, 50% of the total infusion volume + the daily urine volume within the first 12 hours, and the cumulative loss should be made up within 24 hours."

"So taking the middle value, the patient should theoretically have a positive balance of at least 5,000ml within 12 hours and a positive balance of 10,000ml within 24 hours."

Gu Xinyue stared at Lu Chen in surprise.

This guy is really awesome!

So much theoretical knowledge is at your fingertips.

He has also learned this knowledge, but it is quite difficult to apply it in clinical practice.

Whether it was directly calculating the osmotic pressure from the biochemistry sheet, or calculating the amount of fluid replacement, Lu Chen reacted quickly.

"Congratulations, I received a +1 thank you from Gu Xinyue!"

After receiving another thank you point, Lu Chen smiled, this old Gu is really not bad!

He looks cold and indifferent on the surface, but he is really interesting on the inside.

"What's wrong, why are you looking at me like this?" Gu Xinyue glanced at Lu Chen.

Lu Chen patted Gu Xinyue on the shoulder, "Let's go and see the patient."

…

While actively replenishing fluids for the old man, Lu Chen reviewed the patient's heart ultrasound again.

Cardiac color ultrasound: left ventricular end-diastolic diameter and left ventricular ejection fraction were 43%.

"The ejection fraction is so low, and we have added so much fluid, heart failure is probably going to happen soon," Lu Chen said.

"Yes." Zhou Bin nodded, "There is nothing we can do about it. Rehydration is the most critical part now. When heart failure comes, we will treat it."

…

Back to the doctor's office.

There was a brief silence in the CCU ward, and no new emergency patients came in for a while.

Both Lu Chen and Gu Xinyue are filling in the records of their illness.

"I'll get off work in half an hour." Zhou Bin said with a smile, "Just hold on a little longer."

Lu Chen looked at the time, it was exactly five o'clock.

"Teacher Zhou, I will work the night shift tonight."

"Oh, you'll have to hold on for one more night then."

Lu Chen shrugged his shoulders.

Isn't it just the night shift in the CCU ward? He is already ready!

"By the way, bed 1 will be transferred to the general ward tomorrow morning." Zhou Bin suddenly said, "Which one of you will help remove the central venous catheter?"

"I'll do it." Gu Xinyue said immediately, "I've pulled it out several times before."

"Okay, go ahead." Zhou Bin said.

Gu Xinyue stood up and then winked at Lu Chen.

Lu Chen had no choice but to put down what he was doing and walked out of the doctor's office with Gu Xinyue.

"What are you doing? Remove the tube and let me go?" Lu Chen said angrily.

Gu Xinyue said calmly: "It's always good to have a helper. I'll give this opportunity to you next time."

Lu Chen shrugged his shoulders.

…

The two of them came to the side of bed No. 1 together.

The patient in bed No. 1 is an elderly male patient. The cause of hospitalization this time is severe heart failure.

After a week of treatment, the patient's condition has improved and he is ready to be transferred to the general ward tomorrow morning.

Although the patient's health points are only 65, the trend of change is a plus.

"Doctor, when will I be transferred out?" The patient was in a very anxious mood, and he looked at Gu Xinyue nervously.

In the CCU ward, family members are not allowed to accompany you.

The patient's daily eating, drinking and diarrhea are all handled by the nursing staff.

The average patient cannot tolerate this kind of ward environment.

Especially when the patient's condition improves, they can't wait to be transferred back to the general ward.

"Uncle, you can transfer out tomorrow morning." Gu Xinyue said.

"That's great!" A smile appeared on the patient's face.

"Uncle, let me help you remove this tube now." Gu Xinyue pointed to the tube on the patient's neck. "It may be a little uncomfortable, so you don't need to be too nervous."

"Okay, you can pull it out."

Gu Xinyue put on gloves, took iodophor disinfectant and cotton swabs, and disinfected the place where the tube was inserted in the neck several times.

"Uncle, please take a breath and hold your breath."

The patient did as Gu Xinyue said.

Gu Xinyue connected the catheter with a sterile syringe and extubated it while suctioning.

He quickly pulled out all the catheters.

The extubation process was very smooth and took less than a minute.

The patient did not feel any discomfort during the entire process.

"Uncle, let me help you hold this place for a while." Lu Chen said.

"Yes." The patient smiled and nodded, "Thank you doctor, the doctors today are really young!"

Gu Xinyue smiled, took a piece of gauze, and pressed the patient's puncture point.

"Lao Gu, since you've done it, I'll go back to the office first." After Lu Chen finished speaking, he was about to leave.

However, his eyes accidentally caught a glimpse of the changing trend of the health value on the patient's head.

From one plus sign, suddenly, it turned into two minus signs!