Based on several major test data, lactic acidosis can be clearly diagnosed.
It's really lactic acidosis. It's a bit inexplicable. The anesthesiologist, Director Ouyang and Dr. Jin didn't understand how lactic acidosis could occur.
The anesthesiologist glanced at Yang Ping and said calmly: "Check for lactate", pointing out the direction in time, otherwise it would definitely waste a lot of time.
There was no time to investigate the cause, so the anesthesiologist made a prompt decision and treated the symptoms first, putting life-saving first.
The first priority is to replenish alkali and correct acid, then replenish fluids to expand the volume, and if necessary, perform hemodialysis to filter out the lactic acid in the blood.
250ml of 5% sodium bicarbonate was added, and the anesthesiologist began to mentally calculate the amount of alkali supplementation using a formula.
The nurse begins to measure the central venous pressure, and fluid replacement should be adjusted at any time based on the central venous pressure.
The urine output from the beginning of the operation to now is more than 600 milliliters. There is no water and sodium retention, and alkali supplementation can be safely carried out.
Director Ouyang has been engaged in orthopedics for 20 years. If it weren’t for the training before the academic conference, he would never have remembered the calculation formula of acid-base balance.
Not to mention the acid-base balance calculation formula, I guess I have completely forgotten how to rescue lactic acidosis.
The training before the academic conference was very beneficial, and his shortcomings in knowledge were strengthened. Now, he can keep up with the anesthesiologists and understand the significance of these emergency measures.
Lactic acidosis has a mortality rate of 50%. When blood lactate exceeds 25mmol/l, it is rare to be rescued successfully. Fortunately, it is currently only 8mmol/l, so it is not certain to die.
"Send to ICU!"
The patient's vital signs were temporarily stable, and Director Ouyang made a decision.
"Quick, push the bed." The anesthesiologist followed the bedside. The endotracheal tube had to be disconnected, so he had to hold the rubber ball and go to the ICU.
Everything went wrong, everything went wrong. After a good operation, the fracture was inserted into the muscle, and the special guide was adjusted urgently. Now that the operation was successfully completed, I thought I could breathe a sigh of relief, but then I got into this kind of thing again, and I suddenly suffered from lactic acidosis for no reason. The manager of the equipment dealer was most embarrassed at this time. The hotel rooms were all booked. In this situation, he still had time to eat. It was inappropriate for him to stand by and stay, so he could only wait stupidly.
The manager was afraid that something would go wrong with this patient and Director Ouyang would blame them. Of course, no matter what, he couldn't hold them responsible.
What he was afraid of was that Director Ouyang would stop using their equipment in a fit of anger. Even if it were stopped for a period of time, there would be a lot of losses.
As the patient was pushed out of the operating room, Dr. Jin shouted: "Wei Danian's family members——"
A large family, two elderly couples, and a middle-aged couple immediately gathered around.
Looking at Wei Danian lying on the bed, with a tube in his mouth and breathing through a rubber ball.
The patient's father, an obese middle-aged man, was shocked: "What's wrong? Doctor, why is it not working well?"
Grandma felt dizzy and was about to fall down. The patient's father immediately helped the old man.
"New Year, New Year!" His mother shook his shoulders violently and burst into tears.
"I usually have good health and can eat and drink. How did you do the surgery to make me look like this?" Grandma patted the edge of the bed.
"Lactic acid poisoning, the condition is critical, and I will be sent to the ICU for rescue soon. My life is in danger at any time, so don't hold on to the bed." Dr. Jin pushed the bed, but it couldn't be pushed. The family members all held on to the armrests and refused to let go.
"Lactic acidosis?"
The patient's father was very familiar with this term and immediately calmed down, his face turning from white to red: "Doctor, this happens to him every year. He has to be admitted to the ICU at least once a year. He has been like this since he was a child. The doctor also said it was lactic acidosis, but after seeing
Many hospitals have not found the cause of lactic acidosis."
When the whole family heard about lactic acidosis, they stopped crying. Maybe they had experienced it too many times and were numb, or maybe they were lucky enough to be rescued every time, so they were not so scared.
"ICU, send me to ICU. Every time I have an attack, I send me to ICU. Sometimes I have to do blood washing." My father is familiar with the road and already knows the process. Blood washing probably refers to hemodialysis.
"After asking several times about the medical history, why didn't you mention lactic acidosis?" The doctor in charge of the bedside gritted his teeth angrily.
"The child is afraid of pain and afraid of telling you about this situation, so he postpones the operation, so——" Wei Danian's mother whispered.
"Confused, really confused, how can the condition be concealed?" Dr. Jin criticized harshly, wishing he could kick him.
Besides, this young man is already twenty-five years old, and he still acts like a child. He will coax him when it hurts: "Be good! Be obedient."
The hospital bed was pushed toward the ICU so fast that there was inevitably a slight bump.
"Slow down, slow down, doctor, the child is in pain." Grandparents and grandparents were all anxious, fearing that the flat car would knock the child over.
You have to race against time to save a life, and you still care about the bumps in the hospital bed as it is pushed too fast?
Dr. King was angry: "Don't hold on, let go!"
It took several scoldings to get rid of the unhelpful hands.
The patient was finally sent to the ICU. The door blocked the family members from outside, and they banged on the door.
"How high is the lactate level?" asked the doctor on duty.
"8mmol/l" Dr. Jin breathed a sigh of relief.
That's okay, there is hope, but if it is higher than 25mmol/l, there is basically no way to recover.
In the final analysis, lactic acidosis is metabolic acidosis. The human body's acid-base balance is about 7.35 to 7.45. If the acid-base substances in the body increase or decrease, exceeding the body's ability to regulate, it will cause changes in the pH value. This is called an acid-base imbalance.
Can be life-threatening.
The causes of acid-base imbalance include respiratory factors and metabolic factors. Increased lactic acid is caused by metabolic factors.
"Get on the ventilator, draw blood to review blood routine, biochemistry, liver and kidney function, blood lactate, blood gas analysis, put on the ventilator, prepare bedside hemofiltration machine -" The doctor on duty in the ICU has seen many critically ill patients.
Professionals are better at handling these than orthopedic surgeons and anesthesiologists, and they are also well-equipped.
Even the use of magic lung is commonplace, and a bedside hemofiltration machine is pediatrician.
The ICU doctor listened to the heart and lungs, and explained the condition to Dr. Jin and the anesthesiologist.
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After completing the handover, the anesthesiologist Lao Qin had time to ask Yang Ping: "How did you know about lactic acidosis?"
"Choose one of the two, if a diabetic patient has typical Kussmaul breathing, acidosis should of course be considered."
Kussmaul breathing, also called acidosis breathing, involves regular deep and fast breathing, which can eliminate more CO2 and play a certain compensatory role in acidosis. It is a manifestation of the body's self-compensation ability.
"The breath still smells of ketones. The acidosis caused by salicylic acid, phosphoric acid, and sulfuric acid can be eliminated. The insulin is still hanging, and the pump speed is quite fast. In this way, the blood sugar can still soar to ketoacidosis. It can only
It is said that the insulin is fake, so lactic acidosis may be greater."
It's that simple, clear and rigorous logical reasoning, from symptoms to pathophysiology, peeling off the cocoon, and peeling off the answer in just a few clicks.
The system super training plan allows Yang Ping to compile human anatomy, physiology, biochemistry, pathology, pathophysiology and clinical symptoms, and test results into logical relationships, and continuously train and train strong clinical logical thinking ability.
Devil-like training, the system light screen can correct errors every time. With continuous reinforcement, Yang Ping can quickly follow the logical chain from symptoms to deeper rules even in emergencies.
There is a deep logic behind any appearance, but you just haven't discovered it, or medical science has not yet discovered it.
Lao Qin, the anesthesiologist, carefully reviewed Yang Ping's words and found that there were no flaws or loopholes. He was not blind. The reasoning process was the same as solving problems in high school and was well-founded.
How can an orthopedic surgeon have such a strong diagnostic thinking ability? Lao Qin is a little confused.
"Why does this patient have repeated lactic acidosis? Now Jiangtangling-phenformin has been eliminated. There is no reason. We need to find the reason." Yang Ping told Dr. Jin that the patient was from their group.
The levels of diagnosis include symptom diagnosis, pathophysiological diagnosis, case anatomy diagnosis, and etiology diagnosis.
Cause diagnosis is the highest level, but unfortunately, there is no way to obtain cause diagnosis for many diseases.
For example, the common diagnoses of high blood pressure and diabetes are only symptom diagnoses and are the lowest level diagnoses in terms of diagnostic logic.
The lowest level of diagnosis means that the cause of the disease is unknown, and the pathological anatomy and pathophysiology have not been thoroughly studied, so only symptomatic treatment can be achieved.
Lactic acidosis can only be regarded as a pathophysiological diagnosis, and treatment can only start from the pathophysiological level.
It's fine this time, but it will happen again next time because the cause has not been found.
If you want to treat the cause, you must obtain the cause diagnosis, which is precisely the most difficult thing.
"I'll go back and check the literature." Dr. Jin felt it was necessary.
However, it is still unknown whether Wei Danian can be rescued.
