I can see health

Chapter 490 The Stubborn Three Minus Signs

"Lu Chen, what do you think is the main cause of the patient?"

Lu Chen didn't speak for a while, so Zhou Bin took the initiative to ask.

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

There are many clues at present, but they are very confusing, and he can'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 you don't find the reason quickly, you will be in trouble!
The patient's life is in danger at any time!
"Even if you can't tell the exact cause of the disease, you can always tell something." Zhou Bin continued, "Just say it boldly. It doesn't matter if you say something wrong. Let's discuss it together."

She looks at Lu Chen in a completely different way now.

I've heard of Lu Chen before, and I think he's probably a young man with a "vain name".

Now that he has personally contacted Lu Chen, although it is only a few days, Zhou Bin has already seen that Lu Chen is different from other students.

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

Lu Chen frowned, looked up at everyone, and slowly said: "My thoughts, the patient's procalcitonin and CRP increased significantly, and the chest CT of the admission screening showed patchy shadows in the left lower lung. The possibility of acute septic shock was ruled out. However, there has been no fever in the past few days, no abnormalities in the blood routine, and the lung infection does not seem to be 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, and it was not obvious. Worsening arrhythmia."

“进一步的超声检查，提示下腔静脉0.9cm、左心明显增大、左室舒张末径63mm，左房50mm、射血分数40%、心输出量6L/min、室壁运动偏低。”

"So, I think that the diagnosis of sepsis in the patient is still lacking. There is no factor of sudden deterioration of cardiac function, and the cardiac output is not bad. The diagnosis of cardiogenic shock is not established."

The voice just fell.

Everyone in the office was silent.

Gu Xinyue stared blankly at Lu Chen's profile, feeling a sense of powerlessness in her heart.

Lu Chen's explanation is clear and well-documented, far more tenable than the simple words "cardiogenic shock" and "septic shock" they said.

Zhou Bin looked intently at the report in his hand.

Lu Chen's words kept lingering in her mind.

At this time, Lu Chen continued.

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

"Hypovolemic shock?"

Zhou Bin was taken aback, this idea was completely different from what they had thought before!

Not cardiogenic shock, not septic shock, but hypovolemic shock!
"I'll ask the patient's family members about their diet recently." Zhou Bin said immediately.

If the patient has a poor diet in the near future, it will also cause this kind of malnutrition and hypovolemic shock.

……

CCU ward, doctor-patient communication room.

Zhou Bin called the patient's family members in.

"How is the patient's food and water these days?"

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

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

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

"Okay, I see, I will come to you again if there is any situation."

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

"It seems that the intake is really not enough. No matter what, the fluid should be replenished 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 step by step in the treatment.

……

Zhou Bin came to the old man's hospital bed, ready to perform subclavian central venous catheterization for him.

The central venous catheter can quickly rehydrate the patient, which is especially suitable for some critically ill patients.

"Teacher, I'll 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 almost none in general wards.

Gu Xinyue pulled Lu Chen to the side of the ward.

"Lao Gu, why are you dragging me?" Lu Chen was going to continue to study the patient's test sheet to see if he could find some clues.

"Let's take a look at the central venous catheterization." Gu Xinyue said, "It's so skillful that you don't overwhelm yourself!"

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

However, because no real-world drills have been conducted, after the proficiency has risen to 75%, it will no longer increase.

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

……

Gu Xinyue held the gloves and followed behind Zhou Bin.

"The most important thing about puncture is positioning." Zhou Bindao, "Our central venous catheter can be inserted in the neck or under the clavicle, but the internal catheter in the neck is less comfortable for patients, so we usually insert the catheter under the clavicle."

Zhou Bin's piercing technique is very skillful.

After finding the puncture positioning point, the puncture needle goes down, and the puncture is successful immediately.

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

After the guide wire passes, the catheter 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 sidelines, but he didn't gain much experience, so let's just treat it as a companion to Gu Xinyue.

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

The central venous catheter was successfully inserted, and the nurse immediately connected several sets of fluids to the central venous channel.

The rest is to observe the patient's reaction after rehydration.

……

This old man in a 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 took in another old lady with severe heart failure.

The old lady had been ill at home for a week, and she was so procrastinated that she couldn't lie down and sleep, so she was willing to come to the hospital.

After dealing with the old lady, Lu Chen took the time to 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 90-100mmHg, and it seems to be progressing in a good direction.

It's just that when Lu Chen came to the ward, he saw that the old man's health was still in the trend of three minus signs!

what happened?
(End of this chapter)