Chapter 739： Thiocyanate poisoning
Huang Dazhi’s doubts about surgery are not about diagnosis, but about techniques.
This kind of problem, Zheng Ren can demonstrate, specifically related to how to use in surgery, it depends on the understanding of each person.
Even if Zheng Ren does not hide, most people will not understand.
Professor Huang consulted two difficult super-selection and tactics. After the handover, the Xie Yi people finished the handover and walked out.
He knows the height of his eyebrows and knows that it is not a good time to chat at this moment. He laughs and takes Zheng Ren and others to the department.
On the way, Professor Huang did not say more, because Zheng Ren and Su Yun both fell asleep while walking. He is just careful, don't let the two walk asleep, fall or hurt.
Into the ward, Professor Huang came to the front of the director's office and smiled: "The director has specially reserved the door for you, saying that as long as you need it, feel free to come and rest."
"Thank you." Zheng Ren said vaguely.
Suddenly, there was a rush of footsteps in the hallway, and the sound of the wheels rubbing against the ground was loud.
Subconsciously, Zheng Ren opened his eyes. He is in the midst of shackles and thinks he is in a hospital in Haicheng.
"What's wrong?" Zheng Ren asked in a confused way.
"Boss, it seems to be rescue." Su Yun is also in a state of confusion, seeing the nurse pushing the flat car to a ward, guessed.
"Go and have a look." Zheng Ren also saw the situation, and then some spirit.
The Xie Yi people wanted to say something, but hesitated for a moment, and finally let Zheng Ren go.
She originally wanted to take a look at where Zheng Ren was sleeping, and then went to drive and watched what he could buy.
Unexpectedly, just down, I was rescued from the ward.
Zheng Ren strode into the ward and saw a patient twitching with his hands and feet. He wanted to dance and could not do it. It’s not clear what is said in the mouth with vagueness.
Nurses and doctors, as well as volunteers who are carers, are rescued in front of the bed, unable to see people, and the system panel has not given a diagnosis.
"Boss, this person is estimated to be a programmer, and the words of the dream are all code, but really dedication." Su Yun whispered.
"Programmer?"
"Listen to his words, it should be like this." Su Yundao.
"Is this not a postoperative patient? What happened?" Professor Huang was a little surprised, he asked quickly.
"Mr. Huang, patients with blood transfusion after stenting, blood pressure, motor disorders, blurred vision and other symptoms, followed by sputum, dizziness, headache, accompanied by nausea and vomiting, vomit is the stomach contents." The doctor reported.
"Stand?" Zheng Ren stunned.
The current patients, basically patients with hemorrhagic shock, blood transfusion is enough, generally no blood pressure.
Coupled with the stent, Zheng Ren immediately thought that he had diagnosed a patient with a abdominal aortic dissection when he first came.
The patient had a stent, and Zheng Ren was sure that there would be no problem with stenting. Your own surgical experience and the degree of surgical completion given by the big pig's hoof can be corroborated.
What's wrong?
He took a step forward and saw the patient while volunteering to pick up things.
The diagnosis given in the system panel at the top right of the field of view is postoperative embolization of the pelvic fracture, postoperative aortic dissection of the aortic dissection, and thiocyanate poisoning.
Already trapped, Zheng Ren misunderstood the diagnosis.
The first reaction is cyanide poisoning!
This is a big event, is there anyone who poisons?
Zheng Ren was scared of a spirit, and the whole person woke up.
Immediately, it was clear that it was thiocyanate poisoning, and it was quickly recalled in my mind.
Su Yun saw Zheng Ren in a wrong situation. He squeezed in and asked: "What happened to the boss?"
"Nothing." Zheng Ren shook his head, but he couldn't tell the matter about cyanide poisoning. If he said it, the goods could say this to next year.
"I am the postoperative patient of the abdominal aortic dissection aneurysm." Zheng Ren asked.
"Mr. Zheng, yes." Professor Huang felt the powerful atmosphere of the superior doctor and subconsciously called the teacher.
"What kind of buck is used?" Zheng Ren asked.
The aortic dissection aneurysm should also maintain a stable blood pressure after surgery, and the peritoneal shelf can completely block the rupture. Usually give 1-2 days of antihypertensive drugs, and then you can stop. It is nothing special, it is a routine treatment.
"Sodium nitroprusside, micro pump pumped, the dose is 8 μg / kg / min." The small doctor immediately reported the dose.
Zheng Ren then knew what was going on.
He sighed: "Stop the sodium nitroprusside, contact the Department of Nephrology immediately, and immediately do dialysis."
Professor Huang snorted. What is this operation? Acute renal insufficiency? Renal insufficiency is generally measured in urine volume, and the patient's urine volume is normal.
Although hemorrhagic shock causes less urine, it is less than 50 ml below one hour of renal insufficiency.
There are doubts about the question, but after he heard the words of Zheng Ren, he immediately subconsciously stopped the micro pump to pump sodium nitroprusside.
"Do not give too much disposal, be careful not to let the vomit appear aspiration, which can cause suffocation." Zheng Rendao.
"..." Professor Huang was puzzled. He arranged for the little doctor to contact the Department of Nephrology immediately. He came to Zheng Ren and asked: "Mr. Zheng, is acute renal failure?"
"Okay," Zheng Ren replied.
Sweat... sweat...
That's right, what is this answer?
For the first time, Professor Huang felt that Zheng Ren was not reliable, but this idea was only smothered in the bud.
The other person is a Nobel Prize candidate An identity can prove a lot of problems.
This is not counting, the surgery itself has also seen it, it is definitely the most powerful one I have ever seen, and the general clinical experience of this doctor is quite rich.
My own suspicion can only prove that my clinical experience is small and the diagnosis is wrong.
Professor Huang looked at Zheng Ren with inquiring eyes and waited for his explanation.
"It is thiocyanate poisoning." Zheng Rendao.
呃... Clinical use of sodium nitroprusside is commonplace. Many patients have high blood pressure and are controlled with sodium nitroprusside. For so many years, Professor Huang rarely heard the diagnosis of thiocyanate poisoning.
Not very few, but basically nothing.
Heterotoxic to thiocyanate, he sounds strange.
"It is a problem of sodium nitroprusside metabolism." Su Yun immediately thought of some possibilities, asked.
“Yeah.” Zheng Rendao, “Sodium nitroprusside is a kind of nitrohydrocyanate, a strong dilator that acts directly on the arteriovenous vascular bed.
Sodium nitroprusside is continuously pumped, first converted from red blood cells to cyanide, and then converted from the liver to the terminal metabolite thiocyanate.
Thiocyanate is excreted by the kidneys, and the half-life of normal renal function is 4 to 7 days. Patients with renal failure have accumulation. If the dose is too large, the metabolite thiocyanate in the blood is too high to be poisoned. ”
"But the patient has no abnormal renal function." Professor Huang tried to recall the test return of this patient, said.
"No before, now."
This kind of problem, Zheng Ren can demonstrate, specifically related to how to use in surgery, it depends on the understanding of each person.
Even if Zheng Ren does not hide, most people will not understand.
Professor Huang consulted two difficult super-selection and tactics. After the handover, the Xie Yi people finished the handover and walked out.
He knows the height of his eyebrows and knows that it is not a good time to chat at this moment. He laughs and takes Zheng Ren and others to the department.
On the way, Professor Huang did not say more, because Zheng Ren and Su Yun both fell asleep while walking. He is just careful, don't let the two walk asleep, fall or hurt.
Into the ward, Professor Huang came to the front of the director's office and smiled: "The director has specially reserved the door for you, saying that as long as you need it, feel free to come and rest."
"Thank you." Zheng Ren said vaguely.
Suddenly, there was a rush of footsteps in the hallway, and the sound of the wheels rubbing against the ground was loud.
Subconsciously, Zheng Ren opened his eyes. He is in the midst of shackles and thinks he is in a hospital in Haicheng.
"What's wrong?" Zheng Ren asked in a confused way.
"Boss, it seems to be rescue." Su Yun is also in a state of confusion, seeing the nurse pushing the flat car to a ward, guessed.
"Go and have a look." Zheng Ren also saw the situation, and then some spirit.
The Xie Yi people wanted to say something, but hesitated for a moment, and finally let Zheng Ren go.
She originally wanted to take a look at where Zheng Ren was sleeping, and then went to drive and watched what he could buy.
Unexpectedly, just down, I was rescued from the ward.
Zheng Ren strode into the ward and saw a patient twitching with his hands and feet. He wanted to dance and could not do it. It’s not clear what is said in the mouth with vagueness.
Nurses and doctors, as well as volunteers who are carers, are rescued in front of the bed, unable to see people, and the system panel has not given a diagnosis.
"Boss, this person is estimated to be a programmer, and the words of the dream are all code, but really dedication." Su Yun whispered.
"Programmer?"
"Listen to his words, it should be like this." Su Yundao.
"Is this not a postoperative patient? What happened?" Professor Huang was a little surprised, he asked quickly.
"Mr. Huang, patients with blood transfusion after stenting, blood pressure, motor disorders, blurred vision and other symptoms, followed by sputum, dizziness, headache, accompanied by nausea and vomiting, vomit is the stomach contents." The doctor reported.
"Stand?" Zheng Ren stunned.
The current patients, basically patients with hemorrhagic shock, blood transfusion is enough, generally no blood pressure.
Coupled with the stent, Zheng Ren immediately thought that he had diagnosed a patient with a abdominal aortic dissection when he first came.
The patient had a stent, and Zheng Ren was sure that there would be no problem with stenting. Your own surgical experience and the degree of surgical completion given by the big pig's hoof can be corroborated.
What's wrong?
He took a step forward and saw the patient while volunteering to pick up things.
The diagnosis given in the system panel at the top right of the field of view is postoperative embolization of the pelvic fracture, postoperative aortic dissection of the aortic dissection, and thiocyanate poisoning.
Already trapped, Zheng Ren misunderstood the diagnosis.
The first reaction is cyanide poisoning!
This is a big event, is there anyone who poisons?
Zheng Ren was scared of a spirit, and the whole person woke up.
Immediately, it was clear that it was thiocyanate poisoning, and it was quickly recalled in my mind.
Su Yun saw Zheng Ren in a wrong situation. He squeezed in and asked: "What happened to the boss?"
"Nothing." Zheng Ren shook his head, but he couldn't tell the matter about cyanide poisoning. If he said it, the goods could say this to next year.
"I am the postoperative patient of the abdominal aortic dissection aneurysm." Zheng Ren asked.
"Mr. Zheng, yes." Professor Huang felt the powerful atmosphere of the superior doctor and subconsciously called the teacher.
"What kind of buck is used?" Zheng Ren asked.
The aortic dissection aneurysm should also maintain a stable blood pressure after surgery, and the peritoneal shelf can completely block the rupture. Usually give 1-2 days of antihypertensive drugs, and then you can stop. It is nothing special, it is a routine treatment.
"Sodium nitroprusside, micro pump pumped, the dose is 8 μg / kg / min." The small doctor immediately reported the dose.
Zheng Ren then knew what was going on.
He sighed: "Stop the sodium nitroprusside, contact the Department of Nephrology immediately, and immediately do dialysis."
Professor Huang snorted. What is this operation? Acute renal insufficiency? Renal insufficiency is generally measured in urine volume, and the patient's urine volume is normal.
Although hemorrhagic shock causes less urine, it is less than 50 ml below one hour of renal insufficiency.
There are doubts about the question, but after he heard the words of Zheng Ren, he immediately subconsciously stopped the micro pump to pump sodium nitroprusside.
"Do not give too much disposal, be careful not to let the vomit appear aspiration, which can cause suffocation." Zheng Rendao.
"..." Professor Huang was puzzled. He arranged for the little doctor to contact the Department of Nephrology immediately. He came to Zheng Ren and asked: "Mr. Zheng, is acute renal failure?"
"Okay," Zheng Ren replied.
Sweat... sweat...
That's right, what is this answer?
For the first time, Professor Huang felt that Zheng Ren was not reliable, but this idea was only smothered in the bud.
The other person is a Nobel Prize candidate An identity can prove a lot of problems.
This is not counting, the surgery itself has also seen it, it is definitely the most powerful one I have ever seen, and the general clinical experience of this doctor is quite rich.
My own suspicion can only prove that my clinical experience is small and the diagnosis is wrong.
Professor Huang looked at Zheng Ren with inquiring eyes and waited for his explanation.
"It is thiocyanate poisoning." Zheng Rendao.
呃... Clinical use of sodium nitroprusside is commonplace. Many patients have high blood pressure and are controlled with sodium nitroprusside. For so many years, Professor Huang rarely heard the diagnosis of thiocyanate poisoning.
Not very few, but basically nothing.
Heterotoxic to thiocyanate, he sounds strange.
"It is a problem of sodium nitroprusside metabolism." Su Yun immediately thought of some possibilities, asked.
“Yeah.” Zheng Rendao, “Sodium nitroprusside is a kind of nitrohydrocyanate, a strong dilator that acts directly on the arteriovenous vascular bed.
Sodium nitroprusside is continuously pumped, first converted from red blood cells to cyanide, and then converted from the liver to the terminal metabolite thiocyanate.
Thiocyanate is excreted by the kidneys, and the half-life of normal renal function is 4 to 7 days. Patients with renal failure have accumulation. If the dose is too large, the metabolite thiocyanate in the blood is too high to be poisoned. ”
"But the patient has no abnormal renal function." Professor Huang tried to recall the test return of this patient, said.
"No before, now."
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