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Chapter 840 Antitussive

Vomiting blood is not the main reason why Qiu Zhenhua is now limp and weak.He had difficulty moving and had weakness from anemia and aspiration pneumonia.

The patient himself had bullae, which means he had problems with increased pressure in the alveoli.As a result of increased pressure within the alveoli, a number of alveoli rupture and air-containing sacs form.Such vesicles are called "bulae".

The bullae themselves are generally relatively stable.Unless the number of bullae is large and the volume is relatively large, doctors generally will not treat bullae.

Rupture of larger bullae may cause spontaneous pneumothorax.But the cough just now did not induce the rupture of the bullae—it gave birth to a new bullae instead.

The bleeding in the bullae was completely atomized under Qiu Zhenhua's repeated coughing, and then entered other alveolar tissues along the bronchi.This hemorrhage-reinhalation process seriously affected Qiu Zhenhua's alveoli's ability to exchange oxygen, which made him quickly fall into hypoxemia.

The amount of bleeding this time was not small. According to Sun Li'en's estimation, the amount of blood Qiu Zhenhua sprayed on the ground alone was one to two hundred milliliters.And Qiu Zhenhua was probably on the verge of anemia before.Now that so much blood came out suddenly, the hemoglobin level dropped immediately.

This is why Sun Li'en immediately called for rescue.The rate at which Qiu Zhenhua's blood oxygen saturation drops depends entirely on the rate of intrapulmonary hemorrhage.The more he bleeds, the worse his cough, which aerosolizes the blood further impairs alveolar function.At the same time, bleeding causes hemoglobin to drop, and there are fewer red blood cells in the blood responsible for transporting oxygen.This further exacerbated his hypoxia.

To stop this process, the most important decision is to stop the bleeding as soon as possible.But... Sun Lien really has no experience in how to stop the bleeding in the alveoli.

If the bleeding is slow but hard to stop, consider vitamin K or fresh frozen plasma.But the bleeding inside the alveoli...and it seems that the amount is not small now, Sun Lien is a little uncertain whether to have an operation immediately.

The emergency bed soon arrived at the ninth consultation room, and sent Qiu Zhenhua to the emergency room.The nurses were busy giving Qiu Zhenhua oxygen, while Sun Lien pulled Qiu Huaqiang aside, "Your father's situation is quite troublesome now, I will arrange for an examination right away, you go and cancel my emergency department number first, and then Sign up for an ordinary emergency department number. If you don’t have enough money with you, then you need to pay arrears first.”

"What's wrong with my dad?" Qiu Huaqiang asked, "How did he get this blood?"

"I don't know, so we have to do an examination right away." Sun Li'en increased his speaking speed, trying to explain the situation to the patient's family members in the shortest possible time, "The amount of bleeding is not too large now, but the bleeding of the elderly may affect the oxygen transport capacity of the blood .And the bleeding occurs in the respiratory tract, and coughing up blood can also cause difficulty in breathing. We need to find the location of the bleeding as soon as possible, and then stop the bleeding. The bleeding may be stopped through drugs, minimally invasive surgery or even open chest surgery—in order to save the patient’s life, We will use various means, but this requires your cooperation as a family member."

"This..." Qiu Huaqiang was stunned for a moment, "But I don't have any money..."

"If you don't have any money, let's settle the arrears first." Sun Lien said, "If the situation permits, let's see if the medicine is okay."

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The incident happened suddenly, and Qiu Huaqiang did not bring enough money with him.Under Sun Lien's instruction, Liang Baoan, who was outside the emergency room, helped Qiu Huaqiang handle the arrears procedures.At the same time, doctors from the Department of Thoracic Surgery, Respiratory Medicine, and Department of Anesthesiology have also rushed to the emergency room.

"If the source of the bleeding is not determined, it is impossible for us to come up with a surgical plan." The doctor of the Thoracic Surgery Department first rejected Sun Lien's proposal for emergency surgery. "The blood supply to the lungs is too complicated. If it is a single lung hemorrhage, it may be possible to stop the bleeding by resection. But if it is a double lung hemorrhage, no one can guarantee that the compensation of the lungs after resection can keep up with the needs of the human body."

"We don't have any good hemostasis plan either... But after the location of the bleeding is determined, we may be able to do some emergency treatment through a bronchoscope." The doctors in the Department of Respiratory Medicine don't have any immediate solutions, "Use The hemostatic gel packs the bronchi at the point of bleeding, first of all to ensure that the blood will not enter other alveoli."

The attitude of the anesthesiology department was more straightforward, "He is at this age, and he has internal bleeding in the alveoli, so he will have a very poor tolerance to anesthesia. As long as the situation permits, try to avoid surgery. The patient may not be able to get off the stage. But... you can consider Temporarily suppress his cough with anesthesia—for example, with benproperine.”

Phenproperine is a potent peripheral nerve antitussive, non-addictive and twice as effective as codeine at the same dose.Its safety is quite good, except that it may cause constipation, there are basically no other serious side effects.

Sun Lien quickly wrote out this prescription, and at the same time prescribed a combination of vitamin K and frozen fresh plasma infusion for Qiu Zhenhua.And asked the nurse to inhale pure oxygen for Qiu Zhenhua, trying to reverse the hypoxic situation as soon as possible - his current blood oxygen saturation is 91%, which is quite dangerous for young people.But for a 72-year-old like Qiu Zhenhua...it's not that dangerous.

The oxygen demand of the elderly's body is much weaker than that of young people, so although this level of blood oxygen saturation makes him almost unable to stand on his own, it is not enough to endanger life.

The consulting doctor temporarily left the emergency room, and the blood routine results that Sun Lien asked for had already come out - Qiu Zhenhua's current hemoglobin content was 97g/L, which belonged to mild anemia.

"Do you need to give him a unit of suspension red first?" Yuan Ping'an rushed to the scene after hearing the news. After seeing the data, his first reaction was to give Qiu Zhenhua a blood transfusion to enhance his oxygen delivery capacity. Did you mention 107 grams?"

Sun Lien glanced at Yuan Ping'an, "He has 97 grams. If you go to the blood bank to ask for blood with this data, do you believe they can beat you out?"

Ningyuan's blood supply is relatively better than other second- and third-tier cities.This is mainly because Ningyuan has troops stationed there, as well as many universities.These people are the main source of unpaid blood donation.However, relative affluence does not mean that blood products can be supplied in unlimited quantities.As a major emergency center, the blood bank of the Fourth Hospital is the largest in Ningyuan.This also means that the blood bank of the Fourth Hospital also needs to serve as an emergency blood supply source for other surrounding hospitals.Under such pressure, the blood bank of the Fourth Hospital is near the warning line almost every day, and even occasionally falls directly below the warning line.

Applying for blood transfusion for a patient with a hemoglobin level of 97g/L, the blood bank staff of the Fourth Hospital would really go crazy.

"Then his current state is not good." Yuan Pingan said helplessly, "Now it is 100% pure oxygen, and the blood oxygen saturation is only about 92%. His nerves were damaged."

Sun Li'en was silent for a while, then shook his head, "Let's see if the bleeding can be stopped first, and if it doesn't work, send it to the compound operating room. While doing CT to clarify the location of the bleeding, there is an emergency operation."

Although the anesthesiology department was worried that Qiu Zhenhua would not be able to tolerate anesthesia, but when that time came, the emergency surgery had to be done.

(End of this chapter)