medical road high rise

Chapter 361 The man who woke up

Invincible Chapter 363

Seeing Qin Feng start to lose himself in thinking and typing on the keyboard, Zhang Yao and Yue Meng also started to do their own things, and they were wise enough not to disturb Qin Feng.

Qin Feng thought for a while and decided that the first question would be to start with the crisis of muscle weakness.

“Which statement is most accurate regarding myasthenic crisis?”

A. Inspiratory negative pressure less than or equal to 40cmH2O indicates myasthenic crisis.

B. A forced vital capacity of 20ml/kg indicates a myasthenic crisis

C. Relying on blood oxygen saturation to detect the status of nurses is an effective method for patient detection

D. The course of disease in patients with milder myasthenia can be predicted
Qin Feng also inserted a picture with an introduction to the problem of myasthenia gravis written on it.

Negative inspiratory pressure less than or equal to 30cmH2O or forced vital capacity less than or equal to 20ML/kg indicates myasthenic crisis and airway damage. During acute exacerbation, the respiratory status must be carefully detected, inspiratory negative pressure, vital capacity and tidal volume, relying only on blood oxygen Saturation detection of respiratory status can be misleading and potentially dangerous.

During the initial phase of neuromuscular hypoventilation, carbon dioxide is retained but arterial oxygenation is maintained, which may yield false predictions about the patient's respiratory status.

2. How to distinguish myasthenic crisis from cholinergic crisis
A. Only myasthenic crisis can cause bronchospasm with wheezing, bronchitis, respiratory failure, sweating and cyanosis.
B. Miosis and SLUDGE (salivation, lacrimation, urinary incontinence, diarrhea, gastrointestinal distress, and vomiting) syndrome mark a myasthenic crisis.

C. Crisis can only be distinguished by studying the cause of the acute exacerbation
D. Cholinergic crisis is similar to organophosphate poisoning

After Qin Feng finished typing this question, he suddenly wrote his own answer at the back.

Cholinergic crisis is caused by an overdose of cholinesterase inhibitors, with signs and symptoms similar to those of organophosphate poisoning, and excessive accumulation of acetylcholine-stimulated striated muscle at the nicotinic junction may produce flaccid paralysis and clinical severity Muscle weakness is indistinguishable.

Key to the management of patients with myasthenia gravis is the management of myasthenic crisis and cholinergic crisis that may have similar presentations, for example, myasthenic crisis and cholinergic crisis can cause bronchospasm with wheezing, bronchitis, Respiratory failure, sweating, and cyanosis, among others.

Miosis and SLUDGE syndrome may also signal cholinergic crisis, but these symptoms are not always present on examination.

……

Qin Feng has been finishing all five questions, and uploaded them to the intranet together. At the same time, he sent a copy to Director Zhao, but he has not received a reply yet.

Stretching, Qin Feng combined all the issues that could be considered into these five issues. 90.00% of myasthenia gravis cannot get rid of these issues. As long as they can understand it thoroughly, in the diagnosis of myasthenia gravis The above is absolutely at home.

"Doctor Qin, the emergency center called. A car accident patient was sent here. The condition is very serious. I heard that a steel bar pierced one person's neck and another person's head at the same time." The hospital chief pushed away panting. The door of Qin Feng's outpatient room opened.

Qin Feng was stunned for a moment, "Are you sure the same steel bar pierced two people?"

"Yes, I also asked, and the emergency center replied like this." The hospital chief nodded.

Qin Feng stood up quickly, shook his body, and asked seriously: "How thick is the steel bar?"

"About 2 cm in diameter."

Without further ado, Qin Feng asked the hospital manager to lead the way.

When waiting for the ambulance to arrive, Qin Feng was a little confused because there was a large truck following behind the ambulance.

The ambulance driver stuck his head out and shouted, "The patient is in the car behind."

Qin Feng led the crowd towards the big truck with a bewildered face. When he walked in, Qin Feng found that the fender of the big truck had been removed, and the doctor and nurse on board were squatting there, holding a bottle of saline.

Seeing Qin Feng approaching, the doctor on board said quickly, "The steel bars are too long to fit into the ambulance. We can only ask the traffic police to help get into the truck."

The flat car was pushed over, Qin Feng looked at the situation of the two patients, and Qin Feng, who was used to seeing big scenes, couldn't help but gasped.

A two-meter-long steel bar directly penetrated the neck of a young woman and the left temple of a young man, and penetrated directly from the right skull.

The blood had completely stained the clothes of the two of them red, and Qin Feng also found it extremely difficult.

Because both of them had penetrating wounds, one to the neck and the other to the head.

Qin Feng also admired the traffic police and the on-board doctor for being able to carry two patients onto a large truck, which is a very risky thing to do now.

If you are not careful, the steel bars will directly damage the brain and aorta, killing the two people directly.

"Doctor Qin, we can combine two flat carts together to make a tool that goes up and down at an angle," said the hospital chief.

"This method is fine. OK, hand over the wheelbarrow first, and at the same time go to the warehouse to ask for some ropes and boards." Qin Feng said.

Soon, Director Zhao also came to the scene in person, mainly because the condition of the two patients was too serious.

It is unjustifiable that the director is not present.

Qin Fenghe and Zongzhu always put metal plates under the two flat cars and tied them tightly.

"Try it, remember that the flat car must not shake." Qin Feng and the general manager of the hospital tried to lift it and reinforced it, but they couldn't feel the shaking.

"Come on, help and lift the patient onto the flat car. Don't be fast, but be sure to be steady." Qin Feng said.

Qin Feng personally started and directed, and five or six people spent a lot of energy before transferring the patient to the ground safely.

Director Zhao immediately went to clear the emergency room and sent all the doctors and nurses on duty to the outpatient department.

Because the problem with the steel bars must be solved first before subsequent rescue operations can be carried out.

After all, the two-meter-long steel bars occupied more than half of the entire hall, let alone entering the operating room, even entering the emergency room was a bit difficult.

Doctors in large hospitals still have ways to deal with this kind of patients.

Pushing into the emergency hall, those who lined up were evacuated, but the family members and patients were all taken aback.

"What's going on? It scares me to death."

"Let me go, with such thick steel bars, are these two people sure they can be saved?"

The medical staff also organized quickly, clearing out the emergency room, leaving a large enough space, and surrounding it with isolation tape.

"Quickly prepare two infusion poles, open the second intravenous channel for both patients, and replenish a large amount of normal saline."

"Push over two ECG monitors at the same time."

After the infusion started, the man whose head was penetrated came to life.

"Where am I? Where's my wife?"

"Don't move, don't worry, your wife is right next to you." Qin Feng shouted quickly.

"Wife, what's wrong with you, wife, talk." The man also knew that his head was pierced, so he didn't dare to turn his head to look, so he could only shout.

"Your wife's neck was injured and she can't speak for a while. Do you still remember how you were injured?" Qin Feng asked.

"It's all my fault. My wife has said she won't let me ride a motorcycle, so I asked her to accompany me today, and I didn't wear a helmet. When the truck towing goods in front dropped steel bars, I pressed the brakes, and the steel bars came over. I lost consciousness in an instant."

(End of this chapter)