world famous doctor

Chapter 14 Blood Pressure Crisis

The nurses in the emergency room were also a little confused for a moment.

She has not seen such a serious elderly patient with cerebral infarction for a long time.

While she was in a daze, Dr. Zhao immediately ordered: "Hurry up and monitor the patient's blood oxygen saturation continuously, and keep the blood oxygen saturation above 95 at all times."

"Oh, okay Dr. Zhao."

The emergency nurse came back to her senses, nodded, and immediately performed a blood oxygen test for the patient.

The next second, the blood oxygen saturation monitor indicated severe hypoxia, and the nurse immediately gave the patient oxygen.

During the operation, the nurse's hands were shaking slightly, even though the current operations are the most basic.

It can be seen that she is very nervous now.

As an emergency physician in a municipal hospital, Dr. Zhao has many years of clinical experience in first aid.

Even so, he still dare not neglect at this moment.

After Qian's mother suffered a cerebral infarction, Dr. Zhao immediately notified several other doctors in the emergency department, and they quickly rushed over to assist in the rescue.

For patients with cerebral infarction that onset within 0-6 hours, timely thrombolytic treatment can recanalize blood vessels, restore the blood supply to the ischemic penumbra area and the function of neurons, and effectively reduce the mortality rate.

Among them, the route of administration of thrombolytic therapy is divided into systemic intravenous administration and local arterial administration.

Arterial thrombolysis is guided by digital subtraction angiography, monitored by a screen, and injected with rt-pa from a catheter.

The matter was urgent, and the intravenous thrombolysis used by Zhou Chen to rescue Qian's mother last time was effective, so Dr. Zhao still chose to perform intravenous thrombolysis.

Dr. Zhao was very skillful. He ordered the nurse to inject 50% of the recombinant tissue plasminogen activator rt-pa 10 mg intravenously within 1 minute.

For the remaining doses, add liquid for intravenous infusion and control the infusion rate within 60 minutes.

After working for a long time, Qian's mother's blood pressure suddenly became abnormal.

The nurse panicked, and she said in surprise, "It's not good, the systolic blood pressure is 33kpa, and the diastolic blood pressure is 20kpa."

This is a blood pressure crisis!
Dr. Zhao calmed down, and immediately gave Qian's mother timely blood pressure control.

According to his past medical experience, he immediately ordered: "Quick! Nifedipine, 8 mg, injected by nasogastric tube."

"Yes, Doctor Zhao."

A wave of unrest, a wave of up again.

Patient Qian's mother's blood pressure was just under control thanks to the efforts of doctors and nurses. Unexpectedly, her intracranial pressure suddenly increased significantly.

Dr. Zhao, who is highly professional, was a little confused at this moment.

He wiped the sweat from his forehead, and then ordered the nurse to infuse 20ml of 30% mannitol quickly within 250 minutes.

Doing so will not only reverse brain herniation, but also limit the deterioration of the patient's neurological function.

This belongs to the infiltration therapy of western medicine.

At the same time, Dr. Zhao also provided hypothermia therapy and hyperventilation therapy to the patient.

A little bit of time passed, but the patient's clinical symptoms remained the same and were getting worse.

The effect of drugs to reduce intracranial pressure is not satisfactory.

In the rescue room, the busy medical staff suddenly stopped doing anything.

At this moment, everyone did not speak, and looked at each other.

In such a dignified atmosphere, the silence was terrifying, and the hearts of every medical staff were full of gloom, and they all felt the seriousness of the patient's condition at the same time.

Regarding cerebral infarction, all the drugs and methods that should be used have been used.

Including neuroprotective drugs, nimodipine, and anticoagulant therapy using the best aspirin and nadroparin calcium.

However, the condition of the patient Qian's mother is still developing in an unpredictable and opposite direction.

At the moment, we can only make the last step - unilateral craniectomy for decompression.

A doctor assisting in the rescue shook his head and reminded softly: "Doctor Zhao, look at the patient's condition... report him in critical condition immediately."

Several other emergency doctors present also nodded in agreement.

Dr. Zhao didn't think so much at this time, he just wanted to do his best to treat the patient.

He didn't say much, and immediately turned around and left the emergency room, and found Qian Botao who was anxiously pacing and waiting at the door.

He told Qian Botao about the seriousness of his mother's condition at the moment, and told him that a decompressive unilateral craniectomy is now necessary.

After listening to the doctor's further explanation, Qian Botao realized that unilateral decompressive craniectomy is craniotomy.

He is even more bewildered.

After a pause, he fixed his eyes on Dr. Zhao and asked seriously, "Then... Dr. Zhao, how risky is this operation? Can it be cured?"

"The risks and consequences of this surgery are unpredictable, but according to past clinical experience, elderly patients like your mother are physically intolerant and may have many complications and sequelae after surgery."

Qian Botao's brows furrowed deeper and deeper, and a sense of helplessness that he had never felt before lingered in his heart.

"Complications? Are... what are there?"

Dr. Zhao said seriously: "For example, intracranial rebleeding, infection, hydrocephalus, cerebrospinal fluid leakage, epilepsy, etc. are all possible. At that time, a second surgical shunt may be needed."

As he listened, Qian Botao's body felt weak for a while, and he almost couldn't stand upright.

"How...how did this happen?"

Dr. Zhao urged: "You make a decision quickly, the patient's condition is not optimistic, if this drags on, I'm afraid..."

As he spoke, he handed over the informed consent form for the operation.

Qian Botao hesitated to accept it, but he still dared not write.

He had never felt that a pen was so heavy.

This pen is related to his mother's life and death.

At this moment, a nurse rushed out of the rescue room in a hurry and said loudly, "Dr. Zhao is not well. The patient's intracranial pressure has increased, and now there is...hemorrhagic transformation."

Qian Botao, who was not a medical professional, naturally didn't know what the so-called hemorrhagic transformation meant?
But he could tell from the nurse's expression and tone that the situation was becoming more out of control.

Hemorrhagic transformation ht, is a hemorrhagic stroke in patients treated with intravenous thrombolysis for acute ischemic stroke.

This kind of treatment with a wolf in front and a tiger in the back is something Dr. Zhao has rarely encountered in his more than ten years of medical practice.

Deep in his heart, he could already predict that the patient's chances of survival have become very low.

But these words, as a doctor with professional ethics, cannot be casually revealed to the patient's family.

"Quick, sign immediately." Dr. Zhao said hurriedly.

Qian Botao took a long breath and tried his best to calm down his emotions.

Just when he was about to write and sign, he suddenly recalled what Zhou Chen said to him behind him when he left Baojitang Clinic just now.

"When you arrive at the municipal hospital, you must tell the emergency doctor that the blood vessels blocked by your mother are recanalized. After intravenous thrombolysis, there is a high possibility of 'hemorrhagic transformation' complications..."

(End of this chapter)