I Can See Health

   Chapter 490 Stubborn Three Minus

   "Lu Chen, what do you think is the main cause of the patient?"

  Lu Chen didn't speak for a while, so Zhou Bin took the initiative to ask.

   "Mr. Zhou, I don't have a clue yet." Lu Chen shook his head.

   There are many clues, but they are very confusing, and he can't figure it out for a while.

   But one thing is for sure, the "three minus signs" on the patient's head indicate that his condition is getting worse!

  If you don't find the reason quickly, you will be in trouble!

   The patient's life is in danger at any time!

   "Even if you can't say the exact cause, you can always say something." Zhou Bin continued, "Just say it boldly, it doesn't matter if you say it wrong, let's discuss it together."

   She now sees Lu Chen in a completely different way.

   I had heard of Lu Chen before, and I thought most of him was a young man with a "fake name".

   Now that I have personally contacted Lu Chen, although it has only been a few days, Zhou Bin has already seen that Lu Chen is different from other students.

   His clinical thinking and operational skills have far surpassed those of his peers.

Lu Chen frowned, looked up at everyone, and said slowly: "My thoughts, the patient's procalcitonin and CRP are significantly elevated, and the chest CT for admission screening can see patchy shadows in the left lower lung. The possibility of acute septic shock is ruled out. However, there has been no fever in recent days, no abnormal blood routine, and the lung infection does not seem to be that severe."

"In addition, although the ECG showed extensive ST-segment depression and ST-segment elevation in aVR, the increase in TnI in the past 2 days was not too high, from 0.022ng/mL to 0.42ng/mL, and it was not obvious. Worsening arrhythmia."

   "Further ultrasonography showed that the inferior vena cava was 0.9 cm, the left heart was significantly enlarged, the left ventricular end-diastolic diameter was 63 mm, the left atrium was 50 mm, the ejection fraction was 40%, the cardiac output was 6 L/min, and the ventricular wall motion was low."

   "So, I think, the diagnosis of sepsis is still lacking in the patient, there is no sudden deterioration of cardiac function, the cardiac output is OK, and the diagnosis of cardiogenic shock is not very established."

The voice of    just fell.

   Everyone in the office was silent.

  Gu Xinyue stared blankly at Lu Chen's side face, a feeling of powerlessness suddenly appeared in her heart.

  Lu Chen's explanation is coherent and well-documented. It is far more tenable than the simple words "cardiogenic shock" and "septic shock" that they say.

   Zhou Bin stared at the report sheet in his hand.

   Lu Chen's words had been lingering in her mind.

   At this time, Lu Chen continued.

   "The patient's inferior vena cava is only 0.9cm, suggesting severe volume depletion. It seems that the possibility of hypovolemic shock is the greatest, but the patient currently has no evidence of massive fluid loss and blood loss."

   "Hypovolemic shock?"

   Zhou Bin was taken aback, this idea was completely different from what they thought before!

   Not cardiogenic shock, nor septic shock, but hypovolemic shock!

   "I'm going to ask the patient's family about their recent diet." Zhou Bin said immediately.

  If the patient has a bad diet recently, it will also cause this kind of malnutrition and hypovolemic shock.

  …

  CCU ward, doctor-patient communication room.

   Zhou Bin called the patient's family in.

   "How is the patient eating and drinking these days?"

  The family member is the son of the patient. He quickly said: "My dad has always felt a fever in his stomach for the past two weeks. He doesn't eat much, so he drinks soda."

   "Only drink soda?" Zhou Bin frowned, "Don't you eat other foods?"

   "I ate very little." The family members sighed, "We don't dare to disobey him. If he wants to drink soda, we can only give it to him."

   "Okay, I understand, I'll come to you again if there is any situation."

After    Zhou Bin asked a few questions, he returned to the doctor's office.

   "It seems that the intake is really not enough, no matter what, first add fluids to improve hemodynamics." Zhou Bin said to Lu Chen.

  Lu Chen nodded.

   For the time being, we can only treat symptomatically. As for the cause of the disease, we can only explore it step by step in the treatment.

  …

   Zhou Bin came to the old man's bed, ready to perform a subclavian central venous puncture for him.

  Central venous catheter can quickly rehydrate patients, especially for some critically ill patients.

   "Teacher, let me go with you." Gu Xinyue said.

   "Okay, I just need a helper." Zhou Bin nodded slightly.

   Central venous catheterization is a routine operation in ICU and CCU wards, but it is almost non-existent in ordinary wards.

  Gu Xinyue and Lu Chen came to the ward together.

   "Lao Gu, what are you doing with me?" Lu Chen was also going to continue to study the patient's test sheet to see if he could find some clues.

   "Let's take a look at the central venous puncture and catheterization." Gu Xinyue said, "It's too much skill to press yourself!"

  Lu Chen nodded helplessly. In fact, he had trained many times in the system space for this kind of puncture operation, and his proficiency in central venous puncture and cannulation was about 75%.

   However, because there is no real-life drill, after the proficiency rises to 75%, it will no longer rise.

   Gu Xinyue was given the opportunity to be an assistant this time.

  …

  Gu Xinyue took the gloves and followed behind Zhou Bin.

   "The most important thing for puncture is positioning." Zhou Bin said, "Our central venous catheter can be placed in the neck or under the clavicle, but the intubation in the neck is less comfortable for the patient, so we generally place the catheter under the clavicle."

   Zhou Bin's puncture technique is very skilled.

  After finding the puncture anchor point, the puncture needle goes down, and the puncture is successful immediately.

  Gu Xinyue's job is to help implant guide wires.

After the    guide wire is passed, the catheter is placed.

  The most difficult step in the whole process is the puncture.

   The entry of other guide wires and catheters is secondary.

  Lu Chen watched from the side, but he couldn't gain too much experience, so he should be with Gu Xinyue.

  Gu Xinyue's experience as an assistant several times will be of great help for him to pierce independently in the future.

  The central venous catheter was successfully placed, and the nurse immediately connected several sets of fluids to the central venous channel.

   The rest is to observe the response of the patient after rehydration.

  …

   This old man in critical condition is insignificant to the entire CCU ward.

   Even Lu Chen's attention was diverted by the next patient.

   In the afternoon, Lu Chen received another old lady with severe heart failure.

  This old lady was sick at home for a week, and she was unable to lie down and sleep, so she was willing to come to the hospital.

   After dealing with the old lady, Lu Chen took the time to take a look at the old man who had been treated before.

  After rapid rehydration, the inferior vena cava quickly rose to 1.3cm, and the blood pressure also recovered from before. The systolic blood pressure can reach 90-100mmHg, which seems to be progressing in a positive direction.

   It's just that when Lu Chen came to the ward and saw the health of the old man, it was still a trend of three minus signs!

what happened?

   (end of this chapter)