I can see health

Chapter 492 Extubation!

"Replenish the normal saline first." Zhou Bin said, "As for the amount of rehydration, try to balance at least 12mL within 5000 hours and 24mL within 10000 hours."

After speaking, Zhou Bin quickly gave the patient a doctor's order.

At times like this, time is life.

The nurse's response was also very quick, and the patient was rehydrated immediately.

……

Gu Xinyue kept looking at Zhou Bin's doctor's order, frowned, and said, "Lu Chen, why do you need to use normal saline for rehydration? Why don't you use hypotonic liquid?"

Liquids are divided into isotonic, hypertonic, and hypotonic.

Normal saline is isotonic saline.

At this time, to reduce the osmotic pressure of the patient, 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 quickly and cause cerebral edema, so it is not the first choice. Only when it is sufficient Use with caution if serum sodium and osmolality continue to rise after fluid rehydration."

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

Lu Chen continued to explain: "The osmotic pressure of Lactated Ringer's solution is 273mOsm/L. After entering the body, the osmotic pressure will be further reduced with the decomposition of lactate radicals. It is suitable for patients who are prone to acidosis."

"It is theoretically feasible, but it has not been widely clinically verified in HHS, so it has not been adopted for the time being."

"There is such a saying?" Gu Xinyue was taken aback.

He had never seen these views in textbooks.

Lu Chen nodded slightly, and said: "The osmotic pressure of normal saline is 308mOsm/L, which is a hypotonic liquid compared to diabetic hyperglycemic hyperosmolar patients. It can effectively reduce osmotic pressure, replenish body fluids, and improve kidney function, so it should be the first choice. .”

As for other hypertonic fluids, it is definitely not applicable.

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

Lu Chen smiled slightly, Lao Gu was good, and even gave himself a little thank you.

"What about the amount of rehydration?" At this time, Gu Xinyue asked again, "I need to replenish so much in one day, I think it's a bit much."

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

“依据补液原则，应在开始2小时内补液1000-2000mL，开始12小时内补液输液总量的50%+当日尿量，在24小时内补足累计丢失量。”

"So taking the middle value, in theory, the patient should be at least 12mL positively balanced within 5000 hours, and 24mL positively balanced within 10000 hours."

Gu Xinyue stared at Lu Chen in surprise.

This guy is really amazing!

So much theoretical knowledge comes at your fingertips.

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

Whether it is directly calculating the osmotic pressure from the biochemical sheet, or calculating the amount of rehydration fluid, Lu Chen reacted very quickly.

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

After receiving another thank you value, Lu Chen smiled, this Lao Gu is really not bad!
On the surface, he is cold and indifferent, but in his heart he is really meaningful.

"What's the matter, why are you looking at me like that?" Gu Xinyue glanced at Lu Chen.

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

……

While actively rehydrating the old man, Lu Chen re-examined the patient's echocardiogram.

Cardiac ultrasound: left ventricular end diastolic diameter 63mm, left atrium 50mm, left ventricular ejection fraction 43%.

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

"Hmm." Zhou Bin nodded, "There's no way around this. Rehydration is the most critical part now. When heart failure comes, we will treat it."

……

Go back to the doctor's office.

There was a brief silence in the CCU ward, and there were no new emergency patients for a period of time.

Both Lu Chen and Gu Xinyue are supplementing the progress records.

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

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

"Teacher Zhou, I'm on night shift tonight."

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

Lu Chen shrugged his shoulders.

Isn't it just the night shift in the CCU ward, he is ready!
"By the way, bed 1 is going to be transferred to the general ward tomorrow morning." Zhou Bin said suddenly, "Which of you two will help pull out the central venous catheter?"

"Let me do it." Gu Xinyue said immediately, "I've pulled it out a few times before."

"Okay, you go." Zhou Bin said.

Gu Xinyue stood up, then winked at Lu Chen.

Lu Chen had no choice but to put down the work at hand, and walked out of the doctor's office with Gu Xinyue.

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

Gu Xinyue said lightly: "It's always good to have a helper. Next time, I will give you this opportunity."

Lu Chen shrugged his shoulders.

……

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

The patient in bed 1 was an elderly male patient, and the cause of hospitalization this time was severe heart failure.

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

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

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

In the CCU ward, family members cannot be accompanied.

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

Ordinary patients can hardly bear this kind of ward environment.

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

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

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

"Grandpa, I will help you pull out this tube now." Gu Xinyue pointed to the hose on the patient's neck, "It may be uncomfortable, you don't need to be too nervous."

"Okay, you can pull it out."

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

"Master, you take a breath, and then hold your breath."

The patient did what Gu Xinyue said.

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

He quickly pulled all the catheters out.

The extubation process was very smooth, taking less than 1 minute before and after.

During the whole process, the patient did not have any discomfort.

"Master, let me help you press here for a while." Lu Chen said.

"Yes." The patient nodded with a smile, "Thank you, doctor, the doctor is really young now!"

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

"Lao Gu, since you're done, 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 change trend of the life value on the patient's head.

From one plus sign, suddenly, it became two minus signs!

(End of this chapter)