Chapter 850： Malignant hyperthermia
A new doctor who helped to lift the arm that was in the way, but the arm did not move.
Zheng Ren’s mind suddenly had a disease. He walked into the surgery and stood behind and glanced.
The system panel is bright red, and several diagnoses appear in front of Zheng Ren.
Zheng Ren directly ignores the diagnosis of inguinal hernia and gallstones. He pays attention to a simple diagnosis - malignant fever!
This disease... can be called a disease, the incidence is extremely low, only when exposed to anesthesia.
It is one of the few dark mines that the anesthes department is most afraid of.
Malignant hyperthermia is a hereditary disease characterized by high metabolism. Triggered by the patient's exposure to certain anesthetic drugs, non-depolarizing muscle relaxants can delay the onset.
"The anesthetic drug stopped!" Zheng Ren saw the moment of the system panel diagnosis, and he screamed.
Doctors and nurses who are busy in a group have no idea, they hear someone talking, and the words are full of majesty and superior doctors, and no one thinks why, the anesthesiologist stopped the narcotic drugs directly.
"Dan Qu Lorraine, is there a preparation for medicine?!" Zheng Ren said almost with embarrassment.
"..."
"..."
The operating room is in awesome.
Dan Qu Lorraine, what is this ghost?
"Is it a malignant fever?" The director of the anesthesiology ran in from the outside. He was a burly figure, like a bear. It was a figure that could give people a strong and violent sense of oppression.
"Yes!" Zheng Ren looked at the patient and said without hesitation.
Not only the diagnosis of the system panel, the patient's severe convulsions, convulsions, skeletal muscle stiffness, sweating, and so on, are the most typical manifestations of malignant hyperthermia.
There is no body temperature, but Zheng Ren believes that the patient's body temperature is now at least 40 degrees Celsius.
The director of the anesthesiology department strode to the patient, and the doctors and nurses on both sides consciously let go.
After his simple judgment, he said in a hurry: "The temperature of the cooling blanket is not low enough to find other things and accelerate the cooling."
After that, he immediately took out his mobile phone and called out.
"To helicopter, to Concord, I want Dan Qu Lorraine, there are patients with sudden malignant fever!" The voice of the director of the anesthesiology department is like Hong Zhong, and the whole surgery is slightly trembling.
As a very rare genetic disease, malignant hyperthermia has no way to prevent it. Moreover, domestic hospitals that have research on malignant hyperthermia have only Concord.
The caffeine halothane-exclusive skeletal muscle contraction test has been carried out in the Concord Anesthesiology Section. The special drug for the treatment of malignant hyperthermia, Dan Qu Lorraine, is only available in the Concord Anesthesiology Department.
Zheng Ren has read several reports, most of which are summaries of doctors written by the doctors of Emperor and Modu. The doctor of the Magic City encountered this situation and could only watch the patient die.
Nothing else, just because there is no specific drug.
In the Imperial Capital, there is an option because there is a Concord. (Note 1)
But even if the helicopter is called, can you keep the patient's life before Dan Qu Lorra takes it, it is still difficult to say.
“Improve the oxygen flow, the mask absorbs oxygen!” Zheng Ren said: “The oxygen flow rate is increased to 10L/min!!”
"Ice salt, sterile ice water, veins, the fastest!"
"Monitor temperature! Don't interrupt!"
"Two sodium bicarbonate static push!"
"Hurry up, who is squatting! Hurry and push sodium bicarbonate!"
"Nurse, blood collection!"
"Device nurse, step down! Do not need to be sterile! Hurry to collect blood, ions, blood gas, take the time to send, tell the laboratory, emergency!"
Zheng Ren snorted and kept ringing in the operating room. He forgot his identity.
Although he has always avoided doing things more and more, causing resentment from the 912 hospital doctors, when he encountered a serious illness such as malignant fever, Zheng Ren left everything behind.
Big heavens, can you live a big life?
"Call again, come to help the physical cooling. Tour the nurse! Headmaster! Take time to see if the amount of frozen salt water is enough!"
Zheng Ren groaned, seemingly crazy, but in fact did not lose his mind. He has been calmly and calmly observing the vital signs of the patient on ECG monitoring.
The patient's electrocardiogram began to show a shortened Q-T interval, a high T-wave symmetry, and a narrow base and a tent.
Soon, Zheng Ren noticed that the amplitude of the P wave on the electrocardiogram was reduced, and the P-R interval was extended and the P wave disappeared!
This is the performance of hyperkalemia, although the test value did not come out, but Zheng Ren can affirm the probability, the patient's blood potassium value may have exceeded 8mmol / L, and even reached the fatal level of 10mmol / L.
"Calcium gluconate, 5000mg, static push!" Zheng Ren's eyes picked up, staring at the waveform of ECG monitoring, snarls.
"5000..." A nurse who had just arrived to help was shocked.
For clinical use, the limit of calcium gluconate is 3g, which is mg. Is this amount really good?
The director of the anesthesiology department frowned and looked at Zheng Ren carefully. He did not know.
Who is this doctor? How did you direct the rescue here? However, each one is timely, except for the excess amount of calcium gluconate.
He strode to Zheng Ren's side and asked, "Is there no problem?"
"P wave is gone!" Zheng Ren reached out and pointed his finger at the screen of ECG monitoring. He said: "The heart stops immediately!"
In general, sudden cardiac arrest can also be rescued by means of defibrillators and chest compressions.
However, in patients with malignant hyperthermia, the defibrillator is useless. And the whole body is stiff, like a stone, and can't press the thorax.
Zheng Ren is thinking, if the heart beats, directly open the chest, do direct chest compressions, plus the body's ice brine cooling, the effect may be better.
But this method is too extreme and intense, and you don't have to use it as much as possible. And even if it is cut, the muscles inside and outside the intercostal space are tight, and it is estimated that even the hands can not reach.
The director of the anesthesiology department took a look at the electrocardiogram and knew that Zheng Ren was right. He immediately asked the nurse to push 5000mg of calcium gluconate.
"How much urine!"
"..." The operating room has been busy, no one is monitoring the amount of urine. Zheng Ren stared closely at the ECG monitoring. After he asked, he was silent.
The director of the anesthesiology department stunned and then went down halfway, looked at the urine bag and said: "20ml or so."
"20... No, 80mg fast intravenous injection!" Zheng Rendao: "Monitor urine volume, keep at 50-100ml / hour."
"Give hyperventilation!"
"Yes, hyperventilation, must be excessive!"
"The test value is back! No, I will remind you!"
A series of instructions, in an orderly manner, echoed in the operating room, squatting.
More than a dozen doctors and nurses flew up without a foot.
And that arm, the hard state of the outstretched, the iron hitting the general, only twitching at their own frequency.
......
Note 1: Beijing Sanbo Hospital seems to have a sufficient amount of Danzhu Lorraine's reserve medication.
:. :
Zheng Ren’s mind suddenly had a disease. He walked into the surgery and stood behind and glanced.
The system panel is bright red, and several diagnoses appear in front of Zheng Ren.
Zheng Ren directly ignores the diagnosis of inguinal hernia and gallstones. He pays attention to a simple diagnosis - malignant fever!
This disease... can be called a disease, the incidence is extremely low, only when exposed to anesthesia.
It is one of the few dark mines that the anesthes department is most afraid of.
Malignant hyperthermia is a hereditary disease characterized by high metabolism. Triggered by the patient's exposure to certain anesthetic drugs, non-depolarizing muscle relaxants can delay the onset.
"The anesthetic drug stopped!" Zheng Ren saw the moment of the system panel diagnosis, and he screamed.
Doctors and nurses who are busy in a group have no idea, they hear someone talking, and the words are full of majesty and superior doctors, and no one thinks why, the anesthesiologist stopped the narcotic drugs directly.
"Dan Qu Lorraine, is there a preparation for medicine?!" Zheng Ren said almost with embarrassment.
"..."
"..."
The operating room is in awesome.
Dan Qu Lorraine, what is this ghost?
"Is it a malignant fever?" The director of the anesthesiology ran in from the outside. He was a burly figure, like a bear. It was a figure that could give people a strong and violent sense of oppression.
"Yes!" Zheng Ren looked at the patient and said without hesitation.
Not only the diagnosis of the system panel, the patient's severe convulsions, convulsions, skeletal muscle stiffness, sweating, and so on, are the most typical manifestations of malignant hyperthermia.
There is no body temperature, but Zheng Ren believes that the patient's body temperature is now at least 40 degrees Celsius.
The director of the anesthesiology department strode to the patient, and the doctors and nurses on both sides consciously let go.
After his simple judgment, he said in a hurry: "The temperature of the cooling blanket is not low enough to find other things and accelerate the cooling."
After that, he immediately took out his mobile phone and called out.
"To helicopter, to Concord, I want Dan Qu Lorraine, there are patients with sudden malignant fever!" The voice of the director of the anesthesiology department is like Hong Zhong, and the whole surgery is slightly trembling.
As a very rare genetic disease, malignant hyperthermia has no way to prevent it. Moreover, domestic hospitals that have research on malignant hyperthermia have only Concord.
The caffeine halothane-exclusive skeletal muscle contraction test has been carried out in the Concord Anesthesiology Section. The special drug for the treatment of malignant hyperthermia, Dan Qu Lorraine, is only available in the Concord Anesthesiology Department.
Zheng Ren has read several reports, most of which are summaries of doctors written by the doctors of Emperor and Modu. The doctor of the Magic City encountered this situation and could only watch the patient die.
Nothing else, just because there is no specific drug.
In the Imperial Capital, there is an option because there is a Concord. (Note 1)
But even if the helicopter is called, can you keep the patient's life before Dan Qu Lorra takes it, it is still difficult to say.
“Improve the oxygen flow, the mask absorbs oxygen!” Zheng Ren said: “The oxygen flow rate is increased to 10L/min!!”
"Ice salt, sterile ice water, veins, the fastest!"
"Monitor temperature! Don't interrupt!"
"Two sodium bicarbonate static push!"
"Hurry up, who is squatting! Hurry and push sodium bicarbonate!"
"Nurse, blood collection!"
"Device nurse, step down! Do not need to be sterile! Hurry to collect blood, ions, blood gas, take the time to send, tell the laboratory, emergency!"
Zheng Ren snorted and kept ringing in the operating room. He forgot his identity.
Although he has always avoided doing things more and more, causing resentment from the 912 hospital doctors, when he encountered a serious illness such as malignant fever, Zheng Ren left everything behind.
Big heavens, can you live a big life?
"Call again, come to help the physical cooling. Tour the nurse! Headmaster! Take time to see if the amount of frozen salt water is enough!"
Zheng Ren groaned, seemingly crazy, but in fact did not lose his mind. He has been calmly and calmly observing the vital signs of the patient on ECG monitoring.
The patient's electrocardiogram began to show a shortened Q-T interval, a high T-wave symmetry, and a narrow base and a tent.
Soon, Zheng Ren noticed that the amplitude of the P wave on the electrocardiogram was reduced, and the P-R interval was extended and the P wave disappeared!
This is the performance of hyperkalemia, although the test value did not come out, but Zheng Ren can affirm the probability, the patient's blood potassium value may have exceeded 8mmol / L, and even reached the fatal level of 10mmol / L.
"Calcium gluconate, 5000mg, static push!" Zheng Ren's eyes picked up, staring at the waveform of ECG monitoring, snarls.
"5000..." A nurse who had just arrived to help was shocked.
For clinical use, the limit of calcium gluconate is 3g, which is mg. Is this amount really good?
The director of the anesthesiology department frowned and looked at Zheng Ren carefully. He did not know.
Who is this doctor? How did you direct the rescue here? However, each one is timely, except for the excess amount of calcium gluconate.
He strode to Zheng Ren's side and asked, "Is there no problem?"
"P wave is gone!" Zheng Ren reached out and pointed his finger at the screen of ECG monitoring. He said: "The heart stops immediately!"
In general, sudden cardiac arrest can also be rescued by means of defibrillators and chest compressions.
However, in patients with malignant hyperthermia, the defibrillator is useless. And the whole body is stiff, like a stone, and can't press the thorax.
Zheng Ren is thinking, if the heart beats, directly open the chest, do direct chest compressions, plus the body's ice brine cooling, the effect may be better.
But this method is too extreme and intense, and you don't have to use it as much as possible. And even if it is cut, the muscles inside and outside the intercostal space are tight, and it is estimated that even the hands can not reach.
The director of the anesthesiology department took a look at the electrocardiogram and knew that Zheng Ren was right. He immediately asked the nurse to push 5000mg of calcium gluconate.
"How much urine!"
"..." The operating room has been busy, no one is monitoring the amount of urine. Zheng Ren stared closely at the ECG monitoring. After he asked, he was silent.
The director of the anesthesiology department stunned and then went down halfway, looked at the urine bag and said: "20ml or so."
"20... No, 80mg fast intravenous injection!" Zheng Rendao: "Monitor urine volume, keep at 50-100ml / hour."
"Give hyperventilation!"
"Yes, hyperventilation, must be excessive!"
"The test value is back! No, I will remind you!"
A series of instructions, in an orderly manner, echoed in the operating room, squatting.
More than a dozen doctors and nurses flew up without a foot.
And that arm, the hard state of the outstretched, the iron hitting the general, only twitching at their own frequency.
......
Note 1: Beijing Sanbo Hospital seems to have a sufficient amount of Danzhu Lorraine's reserve medication.
:. :
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