I Can See Health

   Chapter 489 The Shocked Grandpa

  The middle-aged women are very fast, and the application for water drop chips is completed quickly.

  Lu Chen took care of all the remaining places that needed to be signed and certified.

The fundraising project of   Waterdrop Fundraising was launched immediately.

  Lu Chen, as a medical staff, can prove the condition of the patient.

   He immediately forwarded it to his circle of friends.

   At the same time, Lu Chen also donated 200 yuan at the donation entrance.

   He is only a graduate student now, so he should not donate too much, just two hundred yuan to show his affection.

   After doing this, Lu Chen could only pray silently in his heart that the girl's condition would improve soon.

  Otherwise, it would cost tens of thousands of dollars to spend a day in CCU.

  …

   Back to the doctor's office.

   Lu Chen hadn't sat in the heat when the security guard at the entrance of CCU started shouting.

   "The patient is here!"

   Lu Chen was shocked when he heard the words, and his heartbeat jumped directly to 120 beats per minute.

"coming."

  Lu Chen and Gu Xinyue followed Zhou Bin to the door of CCU.

   An old man in his seventies was lying on the hospital bed.

   Uncle was lying on the bed, thin and gasping for breath. The ECG monitor beside the bed was beeping an alarm.

  Beside the bed, there is another accompanying doctor, who is Director Lin Cui of the eight districts in the heart.

   "Director Lin, what's the condition of the patient?" Zhou Bin said immediately.

  Lin Cui nodded slightly, she also saw Lu Chen beside her, her expression was stunned, and then she returned to her natural state.

   "The patient with heart failure has renal failure and oliguria. The serum potassium just checked upstairs is more than 7 mmol/L."

   Zhou Bin frowned, this kind of patient should have reached the level of dialysis, "Director Lin, the patient was transferred for CRRT?"

Lin Cui quickly shook her head: "That's not it. The patient had long-term atrial fibrillation and chronic heart failure, and the family did not consider invasive rescue and continuous renal replacement therapy (CRRT), but just wanted to come to the CCU for a transition, and when the condition improved, they were transferred to the general ward. "

   In fact, in the intensive care unit, they have become accustomed to such patients.

   However, once CRRT is given up, there is very little that doctors can do!

   Most of the time, the doctor just acts as a bystander to the patient's progress.

  …

   The patient was pushed in quickly.

   His condition was even worse than Lu Chen imagined.

  The uncle was lying on the hospital bed, wearing an oxygen storage mask, rolling his eyes, and snoring in rough clothes.

  Lu Chen looked at his health, the value was 47 in red, and the trend was three minus signs!

  …

  Three minus signs!

   After two days of treatment in the general ward upstairs, there are still three minus signs.

   This means that the previous treatments were basically useless!

   Zhou Bin patted the patient on the shoulder and shouted a few times, but there was no response.

  Lin Cui immediately said: "The family members said that when I woke up two days ago, my left limb suddenly became weak, and I couldn't speak well.

   "There was basically no urine in the first two days, but yesterday I urinated 1000ML."

   At this time, in Lu Chen's mind, a chain of diseases had already appeared, the basis of chronic heart failure, acute cerebral infarction led to acute exacerbation of heart failure, resulting in renal failure and oliguria.

   "The blood sugar between the fingertips is high."

   As soon as he entered the ward, the nurse routinely tested the patient's blood sugar.

   Zhou Bin frowned deeply, "With such a high blood sugar, what hypoglycemic drugs do you usually use?"

"I didn't know about diabetes before, and I didn't use anything." Lin Cui said, "But after coming to the ward, I took some insulin and took a diuretic for a day. It's just that we are a little strange. This patient, in the ward, the more the treatment heavier."

   "Today, the patient's condition is even worse. There is really no way. After communicating with the family, I can only push it to the CCU."

  Lin Cui's expression was very helpless.

   This is a very typical heart failure patient in the Department of Cardiology.

   But after diuresis, the effect is very poor!

   "Okay, I basically understand, thank you Director Lin." Zhou Bin nodded.

   Lin Cui left the CCU ward after briefly explaining the patient's condition.

  Lu Chen and Zhou Bin gave the patient a detailed physical examination.

   The patient's current heart rate is 90-110 beats/min, blood pressure is 80-90/50-60mmHg, respiration is 37 times/min, and oxygen saturation is 95% (oxygen storage mask).

   There is no obvious edema in the whole body, low skin temperature, no obvious wet rales on lung auscultation, and the heart sounds are ok.

  …

   Back to the doctor's office in the CCU ward.

  Lu Chen looked at the patient's examination and laboratory tests.

   On the day of entering the ward, the blood routine was normal.

  Brain natriuretic peptide (BNP) 2855pg/mL, blood glucose 43mmol/L, serum potassium 7.36mmol/L.

  Creatinine 255μmol/L, urea 47mmol/L, urine glucose 4+, occult blood 3+.

   ECG showed atrial fibrillation rhythm, heart rate 96 beats/min, extensive ST-segment depression in leads II, III, aVF and chest leads, and mild ST-segment elevation in lead aVR.

   Chest CT showed patchy shadows in the left lower lung, and head CT showed deepening of the sulcus gyrus, but no high-density shadows were seen.

   "In the past two days, a lot of diuretics have been used in the ward!" Lu Chen frowned.

  …

   Continue to look at the test sheet.

After 1 day of rehydration and diuresis, the next day serum potassium has dropped to 5.08mmol/L, blood sodium has risen to 145mmol/L, blood sugar has dropped to 16mmol/L, but renal function has continued to deteriorate, and creatinine has risen to 405μmol/L. Urea also rose to 51.57mmol/L.

   It seems that blood sugar has been basically controlled and urine has come out, but what caused the sharp deterioration of renal function?

   "This patient is tricky!"

  In the office, Zhou Bin sighed slightly after browsing all the examinations and tests.

   "It's no wonder that Director Lin will take the initiative to send patients down. Director Yilin's character, unless absolutely necessary, will not necessarily send patients to CCU."

   Director Lin Cui has a very strong reputation in the eight districts in his heart and is a strong person. Li Yao, the director of the eight districts, can't hold her down at all!

Another attending doctor in the    group, Li Hui, also came over and said, "At present, it is best for the patient to go directly to CRRT, but the patient's family refused. It's really not easy to handle!"

  …

   Back to the patient's condition.

"I have carefully analyzed the patient's current state, and now I mainly judge the cause of the patient's shock." As soon as Zhou Bin spoke, a group of graduate students in the office immediately gathered around, "Is it cardiogenic shock, septic shock, or low blood pressure? Volume shock?"

   Yansan's senior brother Cheng Dongbo was the first to speak: "The low blood pressure and shock caused by heart failure, Mr. Zhou, I think it should be cardiogenic shock."

   Zhou Bin shook his head, "It's not that simple. If it's just heart failure, after improving heart function and diuresis, the patient's condition is not relieved in time?"

   The people around were a little silent.

   At this time, Gu Xinyue said, "Mr. Zhou, this is what I think about it. Acute cerebrovascular disease leads to eating disorders, serious insufficient intake, resulting in hypovolemic shock and acute kidney injury."

   "The increase of inflammatory markers and pulmonary patch shadows do not rule out the possibility of aspiration pneumonia caused by coughing, and the recent poor blood sugar control has led to aggravation of infection."

   "Could there be a dual factor of cardiogenic and infectious?"

   Zhou Bin nodded slightly, "It makes sense."

   aside, Lu Chen never said a word.

   He has been reading all the examination reports of the patients.

   He felt that this patient was a little strange. Gu Xinyue made sense, but it was not enough to explain the continued deterioration of the patient's condition.

   (end of this chapter)