The excitement outside the hospital has nothing to do with Sun Lien. When Vice President Liu walked out of the rescue hall, Xu Yourong called. The calm Xu Yourong sounded a little nervous. She didn't say what was going on, but just urged Sun Lien.
Come to her office right away.
Although he was a little worried about Dean Liu, it was normal behavior to stay away under such circumstances. Sun Lien looked back and saw that the crowd outside seemed to be in a stable mood, so he climbed up the stairs to the sixth floor.
Xu Yourong does not have her own office. Her office is the same as that of other neurosurgeons, squeezed into a room that is not very spacious. It uses acrylic partitions that are common in the clerical departments of third-rate private companies to separate individual rooms.
. Different from private enterprises, the light gray tables inside are quite spacious. Basically, the length of each table is more than 1.2 meters. And they are without exception filled with various books and ancient styles.
Get a rare 4:3 ratio 17-inch LCD computer display.
Xu Yourong was sitting in front of the computer, reading a document. His face was full of anxiety.
"What's going on?" Today is an operation day in the Neurosurgery Department of the Fourth Central Hospital. Most of the neurosurgery doctors are working on the patient's brain or nervous system on the operating table, so there are a lot of vacancies around. Sun Lien took care of it.
He pulled a stool over, sat down next to Xu Yourong and asked, "Isn't it convenient to talk on the phone?"
Xu Yourong turned around and said to Sun Li'en, "Just now... a call came to my mobile phone. The person on the other end of the phone said that Dr. Bruce asked him to help deliver the message and let me read these documents..." She pointed
Pointing to the content on the computer screen, "A research report from the University of Maryland Hospital does not recommend the use of vitamin C to acidify urine in patients with acute methamphetamine poisoning. If there is renal insufficiency, acidifying urine may cause myoglobin to
Crystals in the renal tubules aggravate kidney damage."
This treatment method is not groundless. Sun Lien quickly realized that the focus of this treatment method is to protect the organs, especially the liver and kidneys, which have positive significance for poisoning patients. As the largest detoxification organ and the most important excretory organ in the human body, the liver and
Whether the kidneys can work smoothly will largely determine whether the poisoned patient can survive.
There is no clear answer to the question why urine is green, but at least these urines prove that Gao Yan's body is still working hard, trying to make everything function normally.
The principle of acidified urine treatment belongs to organic chemistry. Sun Lien is not very good at it, but he finally understands the mechanism of this process. There is an -nh2 bond in methamphetamine directly connected to the benzene ring, and this hydrogen molecule can be ionized out
Acidifying urine can reduce its ionization and try to maintain its molecular characteristics. Such methamphetamine is not easily reabsorbed by the renal tubules into the blood.
The essence of injecting vitamin C to acidify urine is to reduce the kidneys' reabsorption of methamphetamine, thereby increasing its excretion. What really increases urine output is mannitol and the eight liters of liquid that will be replenished in one day.
.
Although it is not yet certain when and how much methamphetamine Gao Yan used, what is certain is that during this period, his kidneys have been working under a high load. This means that his kidneys are very
Functional impairment may have occurred.
"Arrange kidney function tests and liver function tests as well." The most important thing now is to immediately find out the extent of Gao Yan's physical damage. "Stop vitamin C first, and continue mannitol and liquid supplementation."
"It has been arranged." Xu Yourong moved faster than Sun Lien. She pointed to the electronic report on the screen, "The report that just came out after I called you, the blood creatinine increased to 596 μmol/l, and the blood β2-microspheres
The protein has increased to 3.1 mg/l.”
Sun Lien's face suddenly fell. He leaned back in his chair and lamented, "What a huge landmine!"
The normal reference value of blood creatinine is generally between 62 and 115 μmol/l. If it suddenly jumps to 596 μmol/l, it is basically the kidneys shouting, "I'm done with it!". When blood β2-microglobulin increases,
Decreased proximal tubule reabsorption function illustrates the specific structural parts of the kidney that "strike".
Gao Yan's condition was not renal dysfunction, but acute renal injury. In words that everyone can understand, he had symptoms of acute renal failure.
"Adjust the treatment plan." Sun Lien scratched his head, "With acute renal function injury, we can no longer rely on his own body function to recover. In this case, he will have to go to a dialysis machine."
Xu Yourong looked sad, "We also need to control the amount of fluid replenishment, which must be controlled within two liters per day."
Sun Lien nodded and said, "Call the ICU and ask them to stop the medicine immediately." After a pause, Sun Lien asked, "If acidifying the urine doesn't work, what about alkalinizing the urine? Alkalinizing the urine can relieve the pain.
Kidney damage?"
"You..." Xu Yourong looked like a monster and hesitated to speak. After looking at Sun Lien for a few times, she suddenly laughed again. "I can only blame you for being so unusual these days. I really
I regard you as my superior doctor." She knocked on the table with her hand and said sternly, "The kidney damage has already occurred, and alkalinizing your urine now won't be of much help. And the symptoms that have appeared show that,
His kidney damage was not caused by crystals produced by acidifying urine, but was caused by acute methamphetamine intoxication."
Sun Lien nodded with some embarrassment. Since he could see the status bar, Sun Lien's mentality has indeed undergone some subtle changes. In the past, he could only follow the orders of his superior doctors for treatment, but he began to gradually build up his confidence. With the help of his past
What he has learned can guide the way of thinking of superior doctors, and even directly deal with patients. But in the end, he is still just an undergraduate medical student who has just graduated. He has insufficient experience and insufficient knowledge.
Now Sun Lien is like a sensitive humanoid comprehensive physical examination machine. He can detect the patient's symptoms very keenly, but he is unable to give appropriate treatment and treatment plans. The first few patients were handled properly. On the one hand, it was because of Liu Tangchun and others.
People are on hand to assist, partly because their symptoms are relatively simple and are considered normal emergency treatment.
But Gao Yan's situation is different. Strictly speaking, his kidney injury should be taken over by the nephrology department. However, in the emergency mode of the Fourth Central Hospital, the receiving doctor still has to continue to be responsible for the treatment before the transfer is clear. This becomes
A comprehensive test of Sun Lien's knowledge.
It would be great if there was a nephrology doctor in the team. For the first time, Sun Lien felt that his small team had shortcomings that urgently needed to be made up for.
"Go to dialysis." Sun Lien smiled sheepishly, "Dialysis can filter out toxins and waste in the blood, and it should also be effective against methamphetamine."
Xu Yourong hesitated and asked, "Do you want ganaloxone?"
Naloxone is a very special drug. Its effect on the human body is mainly reflected on opioid receptors, and it is a commonly used clinical opioid receptor antagonist. It has a very high affinity for opioid receptor nerves and can block opioid receptors.
Block the effects of opioids on receptors in the human body.
To put it simply, naloxone is like a group of strong men who like to jump in line. They easily pass through the brain-blood barrier and can reach the maximum concentration within a few minutes after intravenous injection. With their own strength, they have a strong effect on μ receptors.
Due to its affinity, naloxone can competitively antagonize various types of opioids. It can also reverse the effects of opioids and relieve the symptoms of opioid overdose.
The problem is that although methamphetamine can also act on opioid receptors, it is not an opioid after all. It is not even a sedative or analgesic. After using naloxone, these strong men firmly controlled the receptors.
, and will also hinder further treatment.
To improve the severe kidney condition, increasing the blood supply to the kidneys is an important solution. However, this solution requires the use of dopamine, and the dopamine receptors will be "controlled" by naloxone, causing the dopamine injected into Tadine to lose its effect.
But if naloxone is not used, although increasing the blood supply to the kidneys may save his kidneys, it also means that methamphetamine will continue to play a role in his brain, stimulating and poisoning Gao Yan's cranial nerves. If time
If it is too long and the scope of irreversible damage is too large, he will directly become brain dead.
Regardless of the kidneys, kidney failure may cause chain-type multiple organ failure. High severity can lead to death.
Regardless of the kidneys, prolonged stimulation will completely damage his brain. Gao Yan will still die.
Sun Lien was stunned.
After a long silence, he whispered, "Please give me naloxone."
Although kidney failure is scary and may cause multiple organ failure, after all, there is a dialysis machine in front of it. Its threat is no greater than brain damage. Even if kidney failure occurs, lifelong dialysis or kidney transplantation can at least maintain a high level of severity.
life. And brain damage... there is no such thing as brain transplantation.
Sun Lien stood up and said to Xu Yourong, "I'm going to talk to Gao Yan's family. You can contact the doctors in the nephrology department. Ask them to come for a consultation to see if there is any way to deal with this kidney injury."
The waiting hall at the entrance of the ICU is not an area set up for patients. Its service targets are the uneasy family members of patients who are waiting outside the ICU door.
Gao Yan's parents gradually recovered from their initial anger. Their son, now 21 years old, left them and came to live in Ningyuan. Without the supervision of his parents, the children sometimes did cause troubles that made people feel uncomfortable.
Incredible chaos, sometimes even endangering their own lives.
Gao Yan's parents sat in the ICU waiting hall and didn't waste a minute. They took Gao Yan's mobile phone handed over by the doctor and called every contact in the phone book. Many people heard the old couple's voices.
In the end, he simply chose to hang up. Some people who were in contact with his son, while hesitating, mentioned Gao Yan's bad habits.
The old couple were completely dumbfounded. In despair and worry, anger and panic, they hugged each other and cried.