world famous doctor

Chapter 96 Nitrite Poisoning
After seeing this, the doctors and nurses present all sweated for the little boy.

Physical examination of little boy:
The body temperature is 36.7 degrees, the respiratory rate is 39 times per minute, and the breathing is irregular and superficial.

Irritability, convulsion-like movements, cyanosis of the whole body skin, extremities of the lips and extremities, bilateral pupils are equally large and round, there is light reflex, the neck is soft, the breathing sounds of both lungs are clear, no dry and wet rales are heard, and the heart rate is 110 Beats per minute, the heart rate is still regular, no noise is heard, the abdomen is flat and soft, the muscle tension of the limbs is slightly high, and no pathological symptoms are elicited...

The little boy's parents also followed.

His mother was so nervous that she was about to cry.

Zhou Chen's tense facial expression was slightly dignified.

According to his observation, the little boy was most likely poisoned.

But what kind of poison it is, is temporarily unknown.

When he was about to use the famous medical system to check the little boy's body, the little boy's father said tremblingly:

"The child ingested sodium nitrite by mistake!"

Hearing this, Dr. Zhang Jian became extremely restless.

That's right, this little boy was poisoned by nitrite.

Nitrite poisoning in children, also known as enterogenous cyanosis, is not uncommon in clinical practice.

The poisoning mechanism is generally that sodium nitrite converts ferrous iron in hemoglobin to ferric iron, and causes the loss of its oxygen-carrying function, resulting in hypoxia in the whole body tissue and myocardial damage with obvious changes in myocardial enzymes.

However, it is rare for this little boy to experience repeated cardiac arrest due to nitrite poisoning.

"Doctor...Doctor, please save my child..."

The little boy's father begged impatiently.

Zhou Chen briefly asked the patient's family about the boy's past physical condition.

"Does the child have a history of trauma? A history of special medication? A history of epilepsy?..."

"No, the child is always healthy."

The little boy's mother replied with tears in her eyes.

Subsequently, the medical staff quickly pushed the little boy into the emergency room.

The expression on the little boy's face was very painful, his eyes rolled up, his whole body was twisted and twitching, and his limbs were stiff.

A critical situation of loss of consciousness soon occurred.

After entering the emergency room, it was found through auscultation that the little boy's heartbeat was very slow, and it gradually became asystole. After 10-15 seconds, the heartbeat resumed at about 30 beats per minute.

With the help of nurses in the emergency department, they quickly performed gastric lavage on the little boy and established intravenous access at the same time.

Zhou Chen didn't hesitate at all. He used the two-hand back-holding cardiopulmonary resuscitation method to give first aid, and at the same time loudly ordered:
"Quickly add 35mg of methylene blue, plus slow intravenous injection of vitamin C, and prepare 300mg of hydrocortisone."

According to medical guidelines, the general dose of nitrite poisoning exceeds 15mg/kg, and children are prone to hemolytic reactions.

Once a patient suffers from severe hemolytic anemia, in addition to blood transfusion, intravenous infusion of hydrocortisone is required, which can actively prevent renal failure.

"Add an artificial airbag mask to assist breathing, and at the same time intramuscularly inject 0.3 mg of epinephrine." Zhou Chen said quickly.

As Dr. Zhang Jian, who has worked in the emergency department for many years, his hand covering the little boy was trembling slightly.

It could be seen that he was very nervous at the moment, and sweat kept dripping from his forehead.

Back then, he also experienced a patient with the same disease.

After a child younger than this was poisoned by nitrite, after a lot of efforts, he was not rescued in the end.

Although the child's parents didn't make trouble with the doctor or trouble him at the time, it took him a long time to get out of that shadow.

The so-called parental heart of the doctor, although the patients sent to the hospital are strangers to the doctor, the doctor will generally do their best to help them.

Under the medicine prescribed by Zhou Chen, less than a minute later, the little boy's heartbeat resumed again.

The ECG monitor showed that the heart rate was about 100 beats per minute, but the heartbeat was irregular.

Premature contractions of bigeminy can be heard with a stethoscope, and the heart sounds are strong.

Zhou Chen leaned closer to the ECG monitor and took a look.

The little boy's pulse oxygen saturation was only 0.30.

This is typical hypoxemia.

Zhou Chen straightened up, and hastily repeated again:
"Mask plus oxygen, intravenous methylene blue 35 mg, vitamin C 2 grams..."

Nurse Bai Ting nodded:

"Doctor Zhou, I've already used the medicine for him."

Vitamin C has a strong reducing effect and has a synergistic effect with methylene blue. It is generally used as the first-line drug for the treatment of nitrite poisoning.

Doctor Zhang Jian stood aside, he raised his head and took a deep look at Zhou Chen.

The medicine Zhou Chen chose was correct.

However, the amount of medicine he used was really not flattering.

There was no subtle expression on Zhou Chen's face, it was very serious.

Zhang Jian was a little worried.

If you come by yourself, you definitely dare not use 30 mg of methylene blue.

Generally speaking, according to the pediatric drug guideline, methylene blue is generally 1-2 mg per kg.

In other words, the little boy's weight of more than 10 kilograms can be up to 20 milligrams, and the maximum is 30 milligrams.

The dosage is small, and the dosage is cautious, which is of course beneficial, and it is not easy to cause physical damage to the patient.

But there is a disadvantage that sometimes the treatment effect cannot be achieved.

To grasp the effective and safe dosage, it is indeed very important to the doctor's clinical experience.

Zhang Jian's face was a little ugly, and cold sweat flowed down his temples from his forehead.

He leaned close to Zhou Chen's ear and asked in a low voice:
"How is it, are you sure?"

This question made the eyes of several emergency nurses beside him widen.

They really couldn't believe that a veteran doctor in the emergency department who has worked in the emergency department for many years and has rich experience in emergency rescue actually asked Gui Peisheng, who had just been working in the hospital for less than a week, for emergency rescue advice?

Are you sure this isn't a joke?
Zhou Chen looked serious.

He stared closely at the little boy lying on the emergency bed, and worried for him.

Although there is a famous doctor by his side, and he also knows the rescue steps, but he doesn't know whether it will be effective or not?How effective is it?
After this administration was maintained for about 10 minutes, the little boy suffered cardiac arrest again, and the symptoms were the same as before.

All the medical staff present looked up at Zhou Chen at the same time.

They seemed to be waiting for Zhou Chen's next order.

Zhou Chen was quite calm.

"Continue to perform cpr, and give oxygen through the mask..."

He rescued him for about 1 minute.

The little boy's heartbeat resumed again, and his consciousness gradually became clear, but he was extremely restless and kept crying.

The cardiac arrest was repeated three or four times, and each time there was a brief loss of consciousness, and the body twisted and twitched.

This is one of the manifestations of A-Story Syndrome.

Because the heart ejection function is lost in a short period of time, it will cause severe cerebral ischemia, loss of consciousness, fainting, convulsions...

(End of this chapter)