I can see the status bar

Chapter 478 Acute Pancreatitis (Part [-])
Acute pancreatitis can be divided into two categories: mild and severe.Although the manifestations are more or less the same excruciating pain, mild acute pancreatitis is generally not fatal—or even fatal.But severe disease is different, its prognosis is very poor.And the progress is very fast. What's more troublesome is that the development of severe pancreatitis is always unreasonable. It does not have a strict sequence of onset. It may cause multiple organ failure just after it appears, or it may be digested step by step. After the pancreas itself, it erodes other organs and tissues.

The pathogenic mechanism of acute pancreatitis is basically the same - except that acute pancreatitis caused by hyperlipidemia is not clear, alcoholic acute pancreatitis and biliary acute pancreatitis are both caused by the inability of the pancreas to discharge pancreatic juice smoothly, This leads to inflammatory reactions such as edema, hemorrhage, and even necrosis caused by the pancreas' self-digestion from the inside.At the same time, factors that cause this aseptic inflammatory response include oxidative stress, bacterial translocation, microcirculation disturbance and so on.The mechanism is complex, but in general the pathogenic mechanism is the same - under the influence of alcohol, the pancreas secretes more pancreatic juice, and the sphincter of Oddi at the end of the pancreatic duct may spasm, resulting in pancreatic duct obstruction.The biliary source is because gallstones block the passage from the ampulla of the hepatopancreas to the large nipple of the duodenum.

If it is a mild patient, it is generally just pancreatic edema.The condition is generally self-limiting—it recovers on its own after a period of time, even without medication or surgery.But severe acute pancreatitis is different. Whether it is edema or hemorrhagic necrosis, severe acute pancreatitis has a very high mortality rate.According to domestic statistics, the mortality rate of severe acute pancreatitis is between 10% and 30%.It is considered to be a type with a high mortality rate in acute abdomen.

For emergency physicians, it is very important to distinguish between "urgent" and "severe" patients' conditions.For diseases such as ureteral calculi that are unbearably painful but have a low mortality rate, it can be regarded as "urgent but not serious".It is advocated to relieve the pain of patients first, and then seek treatment.However, if the cancer is in the terminal stage and the family members of the patient clearly know the consequences of the disease, they choose conservative treatment or even give up treatment after being sent to the emergency department, which is considered "heavy but not urgent".

However, myocardial infarction, cerebral infarction, severe trauma, severe burns, poisoning and other diseases that progress rapidly and may directly lead to the death of the patient belong to the category of "urgent and severe".

And now lying on the rescue bed, what kind of type does Tian Xinghua belong to with a vague consciousness?

It was his 12-year-old son who sent Tian Xinghua to the hospital.In any case, it is impossible for the hospital to accept the signature of a person with limited capacity for civil conduct for rescue.If Tian Xinghua is to be given emergency treatment, it must be signed and authorized by the medical department.

But to apply for this signature, it is not something that Sun Lien can get by just making a phone call.If you want to sign, you must prove that the patient's condition is urgent enough to require rescue.In other words, unless it is clear that Tian Xinghua is indeed suffering from severe acute pancreatitis, the medical department will not risk being complained or even sued by the patient's family to give permission.

Sun Li'en glanced at the status bar above Tian Xinghua's head, and then sighed slightly.

"Tian Xinghua, male, 44 years old, pancreatic edema (03.25.33), hypoxemia (01.41.22), blood sugar 11.7mmol/L, (01.31.41), high serum amylase content (00.44.41)."

In terms of time maintenance, Sun Lien only glanced at the blood sugar, which lasted no more than two hours, and from the perspective of time, the onset of this symptom lagged behind pancreatic edema.It is basically certain that his hyperglycemic state was caused by acute pancreatitis.

If the blood sugar in patients with acute pancreatitis is higher than 10mmol/L, it can be directly regarded as acute severe pancreatitis.Although from a clinical point of view, it is necessary to cooperate with serum amylase or other organ tests to determine that it is severe, but Sun Lien is very sure that Tian Xinghua's situation is very dangerous.

"Give him oxygen, has the blood sugar level come out?" Sun Lien decided to rush the progress of the inspection, at least get the direct evidence of high blood sugar first, and then ask the medical office for authorization.Although it is considered a serious illness, Tian Xinghua's symptoms are not too bad, at least not too bad for now.If it drags on to organ failure or respiratory distress syndrome (ARDS) and systemic inflammatory response syndrome (SIRS), it will be troublesome.

"Blood sugar 11.8mmol/L. Brother Sun, does this person have diabetes?" Xiao Guo, a nurse, is fiddling with a blood glucose meter. The instrument used in the emergency room for preliminary blood sugar measurement is a small computer that can be used to test blood sugar at home. .The mini size in Xiao Guo's hands is really a bit embarrassing.

Sun Lien sighed, "If he has diabetes, I don't have to worry about it so much." This is one of the reasons why Sun Lien couldn't just rely on high blood sugar to ask for authorization - he couldn't produce evidence to prove that Tian Xinghua didn't have diabetes.If it is a diabetic patient, although the blood sugar level of 11.8mmol/L is high, it will not become evidence of severe acute pancreatitis.

"Little friend, is your father taking any medicine?" Sun Lien thought for a while, and decided to ask the patient's family first. Although it is difficult for a 12-year-old child to carry his father to the hospital, it is still possible to answer some questions accurately.

"Take medicine?" Tian Yu shook his head almost without hesitation, "My dad usually doesn't even have a headache, and I've never seen him take medicine."

Although it cannot be ruled out that Tian Xinghua suffers from diabetes, the weight of this evidence is still there.After asking Xiao Guo to go to the blood routine and serum amylase data again, Sun Lien led Tian Yu out of the emergency room.

"You just wait here." Sun Lien pointed to the seat in the rescue hall, and said to Tian Yu, "Look at the door, if your uncle comes, take him to the rescue room first You can wait for registration and the like." Sun Lien's plan was very simple, first find a way to send Tian Xinghua to the ICU, and get symptomatic treatment as soon as possible is the only way to save his life.

Back in the emergency room again, Sun Lien continued to direct the treatment, "Give him ulinastatin, 0.1 units of normal saline; [-] mg of octreotide intravenously, and monitor his blood pressure..." He thought for a while, "First Ask the gastroenterology doctor to come for consultation, and after the CT results come out, invite the liver and gallbladder doctors to come for consultation.”

In the current situation, I no longer care about the superstitious order of consultations in surgery first and then internal medicine. Sun Lien decided to wait for the gastroenterology doctors to see the patient's condition before asking the opinion of the hepatobiliary surgery - it is best to treat conservatively, after all. With the advancement of science and technology, doctors have realized that surgical treatment of severe acute pancreatitis may increase the risk of death.According to existing guidelines, surgery is not recommended unless severe acute pancreatitis has signs of infection or worsens under strict monitoring, or acute pancreatitis is caused by biliary causes.

Tian Xinghua, who was lying on the hospital bed, vomited again. He was restless on the hospital bed, obviously unconscious from the pain, but he still kept struggling.Seeing this, Sun Lien hurried over to appease the patient, but with little success.Tian Xinghua is now in a drunk state, and he cannot be given painkillers or sedatives, which is really troublesome.Sun Li'en pressed Tian Xinghua's hand for the third time to push his oxygen tube away, and then helplessly shouted to Guo Yulai, "Xiao Guo, bring restraints here!"

Tian Xinghua was tied up on the bed, and Sun Lien took advantage of the crowd and quickly arranged for a CT scan. There is no place to bind restraint belts on the examination bed of the CT machine, so it is better to take advantage of the crowd and ask a few more doctors to put on lead suits and finish the examination according to Tian Xinghua.

After the CT examination results come out, you should be able to go to the medical office for authorization based on the results.Sun Li'en went through the inspection sequence in his mind, and he was a little relieved to confirm that there was nothing missing.

Although entering the ICU may not necessarily save Tian Xinghua's life, it is not something he can handle.Sun Lien, nurse Xiao Guo and others pushed the hospital bed and ran to the imaging department.

(End of this chapter)