My medical skills are a billion points

The source of calcitonin is mainly a chemical indicator of the severity of the infection.

The higher the procalcitonin, the more severe the infection.

Normal procalcitonin is generally less than 0.5ug/L, but this patient has reached more than 200, which is very rare.

The lactate value is a biochemical indicator in blood gas analysis.

Lactic acid exists in small amounts in the human body, but is of particular clinical significance.

Lactic acid can represent the quality of the body's circulation.

Lactic acid is produced when the body is hypoxic, when oxygenation of tissues and organs has been reduced.

If the lactic acid increases, it means that the body is in a state of ischemia and hypoxia, that is, the patient's circulatory state is not good.

Checking the patient's lactic acid is very important for judging whether the patient's body circulation is good or not.

Some diseases can cause abnormal lactic acid metabolism, causing lactic acid to accumulate in the body, leading to lactic acidosis in patients.

The clinical significance of lactic acid detection is a relatively reliable indicator.

The lactic acid concentration of normal people is 0.1-1.7mmol/L.If it exceeds 2.0mmol/L, the patient's tissue oxygenation should be considered insufficient.

The higher the lactic acid detection value, the more serious the patient's circulatory disturbance.

Generally, if lactic acid continues to exceed 4.0mmol/L, the risk of death of the patient is very high.

But now Gao Yingjun introduced that the patient's lactic acid value was as high as 9.0mmol/L, which fully shows that the patient's condition is not optimistic.

If his lactic acid level cannot be lowered, then this person will be close to death.

Listening to Gao Yingjun's introduction, Xiao Chu frowned slightly.

According to the results of blood tests, the patient's infection was very serious.

However, according to the results of the patient's CT color ultrasound and other examinations, the source of the infection was not found.

And all the critical symptoms of this patient were caused by severe infection.

Both coma and shock are caused by infection.

If the source of infection is not found out and dealt with, then the patient cannot be cured at all.

The results of the patient's blood test and radiological examination were contradictory, so Gao Yingjun was confused and couldn't find the cause of the patient.

Next, Xiao Chu used a stethoscope to auscultate the patient's cardiopulmonary function in detail, and then palpated the condition of the patient's abdomen.

I have come to a conclusion in my heart.

And Xiao Chu's conclusion, which is the root cause of the patient, was completely judged by Xiao Chu based on his own experience.

After repeated deliberation and deliberation, Xiao Chu came to the conclusion that the source of infection for this patient must be in the abdominal cavity.

Because once the abdominal cavity is infected, the symptoms of the whole body will be particularly severe, and it is difficult to treat, and the mortality rate of the patient is high.

The most likely cause of this patient's severe abdominal infection was the rupture or perforation of the hollow viscera.

The most likely is the small intestine perforation or the large intestine perforation, causing severe infection caused by the flow of the feces to the abdominal cavity.

This is the only way to explain the patient's condition.

The 3D medical intuitive imaging ability suggests gallbladder gangrene and perforation of the sigmoid colon.

Under the ability of 3D medical intuitive images, the patient's whole body organs are invisible in his eyes, and no disease can escape his eyes.

Xiao Chu could clearly feel that this patient's gallbladder had been festered and gangrene, and it was swollen out of shape.

Moreover, there was a soybean-sized perforation on the sigmoid colon, and the feces inside were continuously flowing out into the abdominal cavity.

But because of this patient, he has been hospitalized for several days, and he hasn't had a drop of water or food.

So there is not much in his intestines, and therefore there is not much fluid in the abdominal cavity.

But as long as it is intestinal perforation, if it is discovered early, it is better to have surgery in time.

If it is discovered late, there are many kinds of bacteria in the intestinal tract, and once it flows into the abdominal cavity, it will cause serious infection.

Thus causing the patient's septic shock, persistent high fever, increased lactic acid and other symptoms.

After Xiao Chu passed the verification of his passive ability, he already knew the patient's condition clearly in his heart.

With his current medical experience and knowledge, it can be said that he doesn't need passive abilities at all, and he can judge the patient almost exactly.

Of course, in order to make the diagnosis of the disease [-]% accurate, there can be no mistakes.

Sometimes, Xiao Chu still needs the help of passive abilities.

After all, he is a doctor, and there can be no mistakes in diagnosing diseases and performing operations.

Once there is a mistake, it may be a life.

Seeing Xiao Chu finished examining the patient, he was silent in thought.

Gao Yingjun looked at him without any expectation, and asked casually: "Xiao Chu, what is the condition of this patient? What do you think?"

Xiao Chu glanced at Gao Yingjun who had no hope for him, and replied: "The source of infection of this patient is in the abdominal cavity. I think he has a perforated colon."

Xiao Chu's answer was relatively conservative.

And he didn't specify what part of the perforation was, and he didn't mention gallbladder gangrene.

Otherwise, if the situation in the patient's stomach is described in too much detail, it will be unimaginable.

"What?"

And Gao Yingjun was stunned immediately.

To be honest, Gao Yingjun asked Xiao Chu to come over to help him take a look, and he didn't have much hope for him.

I just want to have one more doctor who knows the patient's condition so that we can discuss difficult cases.

Of course Gao Yingjun also knew that Xiao Chu was good at surgery, but he was not necessarily so good at diagnosing difficult and miscellaneous diseases.

After all, there are many intractable diseases in the world, and Xiao Chu is not a god, so it is impossible to see the patient's condition at a glance.

As for Xiao Chu's claim that the patient had a perforated colon, which was the root cause of the abdominal infection, Gao Yingjun didn't believe it at all.

It's not like he didn't examine the patient.

This patient has also undergone abdominal color Doppler ultrasound and abdominal CT, and did not see any major problems.

How could Xiao Chu judge that this patient had a perforated colon?

Gao Yingjun blinked, his small eyes were full of disbelief.

Chapter 109

He looked at Xiao Chu and asked: "Xiao Chu, the abdominal color ultrasound I did for this patient only showed that there was cholecystitis, and cholecystitis would not cause such serious symptoms, and there was not much hint on the CT, you Are you sure he has a perforated colon?"

Since Gao Yingjun didn't believe it, Xiao Chu decided to give him some strong medicine.

He nodded and said again: "I think this patient has colon perforation, and the most likely possibility is sigmoid colon perforation, because perforation in this part is relatively common."

But Gao Yingjun shook his head and said: "Xiao Chu, your diagnosis is too arbitrary, isn't it?"

Xiao Chu smiled lightly and said, "This patient, when you do abdominal CT and abdominal color Doppler ultrasound, can you see fluid in the abdominal cavity?"

Gao Yingjun nodded immediately.

"Yes, but the peritoneal effusion found is very little, it should be caused by inflammatory exudation, and this does not explain anything!"

Gao Yingjun firmly believed in his own ideas, and still did not consider the possibility of colon perforation.

And Xiao Chu pointed to the patient's stomach and said: "If you don't believe me, you can puncture the peritoneal fluid, and you will understand after a test!"

Seeing how confident Xiao Chu said, Gao Yingjun's heart began to waver.

After all, the patient's condition is more serious now, and the cause has not been found, which makes him very anxious.

If the cause cannot be found out, the patient's condition cannot be cured, and the patient's life may not be saved.

Now that Xiao Chu gave him a direction, he should investigate further.

Furthermore, after he saw this patient, he also considered whether it was abdominal infection.

However, since the results of the inspection did not match, he did not consider the issue further.

But now that Xiao Chu firmly proposed it again, Gao Yingjun had to think carefully again.

Gao Yingjun thought for a while, and then said: "Okay, Xiao Chu, just as you said, I will puncture the peritoneal fluid to see what it is.

If it is really colon perforation as you said, I am afraid that this patient will have to undergo an exploratory laparotomy immediately. "

Isn't that obvious?

Since it is considered that the patient has a perforated hollow organ, an exploratory laparotomy should be performed immediately.

Only by thoroughly finding out the cause and cleaning up the source of infection can the patient survive.

Otherwise, if the patient's disease is not eliminated, no matter how good the medicine is, it will not be able to save the patient's life.

Since the paracentesis was going to be performed, Gao Yingjun immediately went to the treatment room and brought the medical instruments used for the paracentesis.

He wants to perform abdominal puncture on this patient himself.

In general, paracentesis is a simple technique.

Even an intern can learn this operation with a little effort.

Simple operations like this are usually performed by interns or fellow doctors.

And now, as a senior resident doctor, Gao Yingjun actually did this operation himself.

It can be seen how much he attaches importance to this patient.

I saw Gao Yingjun personally go into battle, demonstrating the paracentesis operation.

Several interns soon gathered around to study.

Seeing a lot of interns coming up to learn how to operate, this inspired Gao Yingjun's idea of ​​showing off.

He first arranged the prepared medical equipment, and then put on sterile gloves.

Using iodophor gauze, begin to disinfect the patient's abdominal puncture site.

While disinfecting, he explained seriously.

"Look, what we are doing today is the paracentesis, the first step is disinfection, you must master the disinfection steps.

Since the puncture site is a clean site, when we sterilize, we must sterilize it from the inside out. It is best to sterilize it three or four times to prevent the abdominal cavity from being incompletely sterilized during the puncture. "

After Gao Yingjun explained to the interns, he also sterilized the poison.

Start by picking up the sterile hole drapes and drapes.

Gao Yingjun continued to explain.

Seeing Gao Yingjun showing off a bit, Xiao Chu just smiled indifferently and didn't care about him.

Gao Yingjun is actually not bad.

It's just that sometimes it's a little narcissistic and a little funny.

"Look, the paracentesis we are going to do is first of all to locate. Does anyone of you know how to locate the paracentesis?"

After Gao Yingjun laid out the hole towel, he looked at the interns around him and asked a question.

Liu Qing stood up and replied: "Paracentesis is currently used clinically, and the most commonly used site is the patient's lower left abdomen.

That is, the middle and outer third of the line connecting the navel and the left anterior superior iliac spine. Puncture at this point will reduce the number of viscera in the abdominal cavity and minimize the damage. It is clinically divided into diagnostic puncture and therapeutic puncture. puncture. "

After Liu Qing finished answering, she didn't look at Gao Yingjun, but looked at Xiao Chu.

Seeing Xiao Chu nodding slightly to her, Liu Qing showed a happy smile.

Liu Qing thought in her heart that she must not make a fool of herself in front of Xiao Chu.

And Gao Yingjun, who was preparing for the piercing, of course also saw Liu Qingqing's action.

He originally wanted to show off his strength in front of the interns.

But he didn't expect that the intern he brought would ask Xiao Chu for his opinion after answering the question.

This made Gao Yingjun feel very depressed!

The interns I brought with me were actually in Cao Ying, with my heart in Han.