I Can See Health

   Chapter 492 Extubation!

   "Let's add normal saline first." Zhou Bin said, "As for the amount of rehydration, try to balance at least 5000mL within 12 hours and 10000mL within 24 hours."

After   , Zhou Bin quickly gave the patient a doctor's order.

   At times like this, time is life.

The response from the    nurse was also very quick, and the patient was given fluids immediately.

  …

  Gu Xinyue kept looking at Zhou Bin's doctor's order, frowned, and said, "Lu Chen, why do you need to rehydrate with normal saline? Why don't you use hypotonic fluid?"

   Liquids are divided into isotonic, hypertonic, and hypotonic.

   Normal saline is isotonic saline.

   At this time, the osmotic pressure of the patient should be reduced. In theory, hypotonic fluids can be used.

Lu Chen smiled and said: "The osmotic pressure of hypotonic saline (0.45%-0.6%) is too low, and a large amount of infusion in the early stage may cause the blood osmotic pressure to drop too quickly and cause cerebral edema, so it is not the first choice. Use with caution if serum sodium and osmolarity remain elevated after rehydration."

   "Oh." Gu Xinyue nodded, "What about lactated Ringer's solution?"

  Lu Chen went on to explain: "The osmotic pressure of lactated Ringer's solution is 273mOsm/L. After entering the body, with the decomposition of lactate, the osmotic pressure will further decrease. It is suitable for patients with acidosis tendencies."

   "It is theoretically feasible, but it has not been widely clinically validated in HHS, so it has not been adopted for the time being."

   "There is such a saying?" Gu Xinyue was taken aback.

   He had never seen these views in textbooks.

Lu Chen nodded slightly and said, "The osmotic pressure of normal saline is 308mOsm/L, which is a hypotonic liquid compared to diabetic hyperglycemic hypertonic patients, which can effectively reduce osmotic pressure, replenish body fluids, and improve renal function, so it should be the first choice. ."

   As for other hypertonic liquids, it is definitely not applicable.

   "Congratulations, +1 for the thank you from Gu Xinyue!"

  Lu Chen smiled slightly, Lao Gu was good, and gave himself a little thank you.

   "What about the amount of rehydration?" At this time, Gu Xinyue asked again, "I think it's a bit too much to refill so much in one day."

  Lu Chen paused and said, "The patient's weight is 70kg, and his cumulative body fluid loss is 7000-15400mL."

   "According to the principle of fluid replacement, 1000-2000 mL of fluid should be administered within the first 2 hours, 50% of the total amount of fluid infusion within the first 12 hours + the daily urine volume, and the accumulated loss should be made up within 24 hours."

   "So taking the middle value, theoretically, the patient should be at least 5000mL positive balance within 12 hours, and 10000mL positive balance within 24 hours."

  Gu Xinyue stared at Lu Chen in surprise.

   This guy is really amazing!

  With so much theoretical knowledge, you can get it at your fingertips.

   He has also learned this knowledge, but it is quite difficult to apply it in clinical practice.

   Whether it is to calculate the osmotic pressure directly from the biochemical chart, or calculate the amount of fluid replacement, Lu Chen responded very quickly.

   "Congratulations, +1 for the thank you from Gu Xinyue!"

   Received a little more thanks, Lu Chen smiled, this Laogu is really not bad!

   On the surface, it is cold and indifferent, but on the inside it is really interesting.

   "What's the matter, why are you looking at me like that?" Gu Xinyue glanced at Lu Chen.

  Lu Chen patted Gu Xinyue on the shoulder, "Let's go and see the patient."

  …

   While actively rehydrating the old man, Lu Chen reviewed the patient's heart ultrasound again.

   Echocardiography: left ventricular end-diastolic diameter 63mm, left atrium 50mm, left ventricular ejection fraction 43%.

   "With such a low ejection fraction, we have replenished so much fluid, and heart failure is likely to come soon." Lu Chen said.

   "Yeah." Zhou Bin nodded, "This is something that can't be helped. Now, fluid replacement is the most critical part. When heart failure comes, we will treat it."

  …

   Back to the doctor's office.

  The CCU ward had a brief period of tranquility, and there were no new emergency patients in this period of time.

  Lu Chen and Gu Xinyue are both making up the course records.

   "It's half an hour before get off work." Zhou Bin smiled, "You guys stick with it for a while."

  Lu Chen glanced at the time, it was exactly five o'clock.

   "Mr. Zhou, I'm working night shift tonight."

   "Oh, then you have to hold on for another night."

  Lu Chen shrugged.

   is the night shift in the CCU ward, he is ready!

   "By the way, bed 1 is going to be transferred to the general ward tomorrow morning." Zhou Bin suddenly said, "Which of you two help to pull out the central venous catheter?"

   "I'll come." Gu Xinyue said immediately, "I've pulled it out a few times before."

   "Okay, let's go." Zhou Bin said.

  Gu Xinyue stood up, then winked at Lu Chen.

  Lu Chen had to put down his work and walked out of the doctor's office with Gu Xinyue.

   "What are you doing? Pull out the tube and let me go?" Lu Chen said angrily.

  Gu Xinyue said lightly: "It's always good to have a helper. Next time, I'll give it to you."

  Lu Chen shrugged.

  …

   The two came to the side of the No. 1 hospital bed together.

   The patient in bed 1 is an elderly male patient. The cause of this hospitalization was due to severe heart failure.

   After a week of treatment, the patient's condition has improved and he is ready to be transferred to the general ward tomorrow morning.

   Although the patient's HP is only 65, the trend of change is a plus.

   "Doctor, when will I be transferred out?" The patient was very anxious, and he looked at Gu Xinyue nervously.

   Family members are not allowed to accompany you in the CCU ward.

   The patient's daily food, drink and laxation are all handled by nurses.

  General patients are unbearable in this ward environment.

  Especially when the patient’s condition improves, they can’t wait to be transferred back to the general ward.

   "Master, you can transfer out tomorrow morning." Gu Xinyue said.

   "That's great!" A smile appeared on the patient's face.

   "Master, I will help you unplug this tube now." Gu Xinyue pointed to the hose on the patient's neck, "It may be a little uncomfortable, you don't need to be too nervous."

   "Okay, you can pull it out."

  Gu Xinyue put on gloves, took iodophor disinfectant and cotton swabs, and disinfected the place where the neck tube was placed several times.

   "Master, you take a breath, then hold your breath."

   The patient did as Gu Xinyue said.

  Gu Xinyue connected the catheter with a sterile syringe, and extubated while suctioning.

   He quickly pulled out all the catheters.

The process of    extubation was very smooth, less than a minute before and after.

   During the whole procedure, the patient did not have any discomfort.

   "Master, I will help you press here for a while." Lu Chen said.

   "Well." The patient nodded with a smile, "Thank you doctor, the doctor is really young now!"

  Gu Xinyue smiled, brought a piece of gauze and pressed the patient's puncture point.

   "Old Gu, since you're done, I'll go back to the office first." After Lu Chen finished speaking, he was about to leave.

   However, his eyes accidentally caught a glimpse of the trend of the health value on the patient's head.

   From one plus sign, suddenly, to two minus signs!

   (end of this chapter)