Sleepless Doctor

"After troubleshooting the instrument failure and puncturing the needle by mistake, the patient found that the change of SaO2 was seriously inconsistent with SpO2. The reason for the analysis of the difference between the two is that SaO2 is the percentage of oxygen content and oxygen capacity, and its value is within a certain range and PaO2 Relevant."

　　 "The blood gas analyzer is based on this principle, and converts the actual SaO2 value through the measurement of PaO2 in the blood."

　　 "And SpO2 is based on the principle that different wavelengths of light will have different attenuations after passing through the arterial blood, and it is measured by photoplethysmography."

　　 Wu Mian began to talk about the basic principles of blood oxygen saturation measurement, and several veterans of anesthesia were confused.

　　Although they have used monitors for decades, they only know how to use them. They really don’t know the principles of specific construction machinery.

"There is really no way to explain this in plain and easy-to-understand terms." Wu Mian also saw the confusion of several directors, and he said immediately, "It involves the principles of mechanical engineering... By the way, several of them have learned it when they were in school. Do you study medical devices?"

　　 "Mr. Wu, no." Several people shook their heads.

　　 "Then I will try to be as simple as possible." Wu Mian had no choice but to hesitate and said.

　　 In fact, what he said before was about the principles of medicine, which sounded hard for ordinary people to understand, just like the reactions of several directors when talking about the principles of medical devices.

"One side of the pulse oximetry monitoring probe emits red light with wavelengths of 660nm and infrared light at 940nm, respectively. Oxidized hemoglobin and reduced hemoglobin have different absorption of the above two kinds of light, so the blood oxygen saturation is measured. Then it will be displayed on the monitor's machine."

"Based on this difference, the photoelectric sensor on the other side of the probe measures the light intensity of infrared light and red light after passing through the tissue, and uses spectrophotometry to measure the absorption of infrared light and red light, and then converts the ratio. Into SpO2."

　　 "The difference in the measurement methods led to the possibility of inconsistency between the two in the case of severe hypoxemia. The following conditions will lead to a false increase in SpO2."

"First, there is an increase in carboxyhemoglobin in the blood. The absorbance of carboxyhemoglobin and oxyhemoglobin are similar, and pulse oximetry can only distinguish oxyhemoglobin and hemoglobin, and cannot exclude carboxyhemoglobin, so it will cause the value of SpO2. On the high side."

　　"Second, methemoglobinemia may also cause this situation.

　　MetHb patients have larger absorption coefficients for red and infrared light, and their light absorption coefficient at a wavelength of 660nm is similar to that of hemoglobin, while at a wavelength of 940nm, the light absorption coefficient of MetHb is higher than that of hemoglobin and oxyhemoglobin.

　　 Therefore, if the actual arterial blood oxygen saturation is low, the SpO2 reading will be falsely high. On the contrary, the SpO2 reading will be falsely low. "

　　 "Third, patients with severe anemia may also experience similar conditions..."

"fourth…"

　　 "Fifth..."

　　 "Sixth..."

　　 "Twelfth, hereditary fetal hemoglobinemia..."

　　 "According to the medical history that Lao Ren said, I consider that this patient is more likely to have hereditary fetal hemoglobinemia, and it is recommended to check it after recovery after surgery. However, it is estimated that the patient will refuse, after all, it will have no effect."

　　 Everyone, including Dean Zhao, was dumbfounded. They looked at Wu Mian in a daze, with a dew.

　　 Especially Director Liu, who witnessed all the process at the scene. At the time, I thought it was a supernatural event. But when Mr. Wu said that, he discovered that there are more than a dozen diseases that may cause the blood oxygen saturation monitored on the monitor to be inconsistent with the actual oxygen concentration.

　　 Is this the gap between ordinary practitioners and top practitioners?

　　 As for hereditary fetal hemoglobinemia, several people have never heard of it.

　　 Originally thought Wu Mian was just shivering, but he kept talking about more than a dozen possibilities. After listening, the clinicians in the room were all in a cold sweat.

　　 There is a saying in the clinic—nothing happens, it means less surgery is done.

　　 Looking at it now, this sentence is really the experience summed up by the predecessors.

　　 I used to think that Wu Mian relied on the old man to become the editorial board member of the latest version of "Diagnostics". Now everyone understands that Mr. Wu is a person with real and great abilities.

Such a rare situation, a situation that several directors who have been on the battlefield have not encountered before, Mr. Wu talked about it, from medicine to medical equipment, and when it comes to diagnosis, he also cited more than a dozen diseases that can cause This abnormal situation...

　　 is really speechless.

　　 There is no harm without comparison.

　　 Everyone present felt that their heads had crit damage after another, and the health bar had been instantly cleared.

　　 Only Ren Haitao listened attentively. Seeing what he meant, if conditions permit, he must take a small notebook and write down what Teacher Wu said.

　　 After Wu Mian finished speaking, Ren Haitao continued to inquire about the diagnostic criteria for hereditary fetal hemoglobinemia.

　　 "Old Ren, I'll talk about it when I go back." Wu Mian said with a smile, "Let's go back on the plane in the afternoon, after a meal."

　　 "Oh, good." Ren Haitao was a little regretful, everyone could see his unwillingness.

　　 This person is really an idiot. There are not many people who are obsessed with technology right now. Dean Zhao looked at Ren Haitao curiously, thinking that this anesthetist named Ren Haitao has such a low EQ, where did Teacher Wu call the baby?

　　 But it was also fortunate that Ren Haitao was there, and someone who was "smart" was afraid that he would not care at all at that time. After all, there was no evidence to prove that the patient had a problem under the circumstances at the time. Everything was quiet. Who knew that the patient was already on the verge of life and death.

　　 Teacher Wu is interesting, and the people I found are also interesting. Dean Zhao smiled and opened a bottle of wine himself, first poured a glass for Wu Mian, and then a glass for Ren Haitao.

　　 The demonstration operation went smoothly, the cooperation between the two hospitals went smoothly, the piggyback solved a medical risk, and a patient who might have hypoxic brain death was "fished" back. This meal was extremely happy.

　　 Wu Mian was also good at dancing with long sleeves at the wine table, and had a very happy conversation with Dean Zhao, and finalized the next cooperation plan.

　　 "Teacher Wu, your level is really high, I toast you a glass." Director Liu toasted and respected Wu Mian with a glass of wine.

　　 "You're welcome." Wu Mian said with a smile, "It's no level, it's all clinically beaten, it's normal."

　　 "Uh..." Director Liu is a little bit confused, is Teacher Wu serious? To say that clinical beating is directly related to age. Teacher Wu is less than 30, why does he say that?

　　 "Director Liu, sit down." Wu Mian took a sip of wine and said, "During my internship in college, I encountered something in the gastrointestinal endoscopy room."

　　:. :