blenderwars Chapter 189
Chapter 189
Chapter 189
At any time, patients who are in a coma must rule out the possibility of hypoglycemia!
so,
Lin Feng subconsciously wanted to test the blood sugar of this patient.
There are several commonly used methods for blood glucose measurement:
·Fingertip blood, testing blood sugar, this is the fastest and most convenient
·Venous blood to test blood sugar
·If you have diabetes and need to monitor your blood sugar multiple times a day, you can wear “Dynamic Blood Glucose Monitoring”.
Lin Feng instructed the nurse:
“Pick him a finger!”
“OK!”
Nurse, Zha!
After a few seconds, the result came out!
1.4mmol/L!
“I go!”
The nurse exclaimed!
Lin Feng and others took a look and were surprised.
Only 1.4!
So low!
Normal blood sugar level, between 2.8 and 6.0mmol/L!
And this patient turned out to be only half of the lowest normal value!
“Hurry up and inject high sugar intravenously, 30 ml…not 40 ml!!”
Lin Feng quickly ordered.
This blood sugar is too low, scary!
The so-called high glucose refers to 50% glucose injection (a tissue dehydration hypertonic solution), half of which is a rapid intravenous injection of 20-50ml.
The general intravenous glucose solution has a concentration of 5% or 10%!
(Ps: Both bolus injection and intravenous infusion are intravenous injections, but one is syringe bolus injection and the other is suspension needle)
After pushing high sugar, Lin Feng breathed a sigh of relief.
But frowned again.
“Is it convulsions caused by low blood sugar?”
Lin Feng looked at the patient’s husband: “When did your wife eat…”
Patient’s husband: “Eat this morning, I ate several big steamed buns, hungry!”
Lin Feng, other doctors and nurses looked at each other.
Surprised in my heart.
After eating so much, it is still so low blood sugar?
There is definitely a problem!
Conversely, the inference is that if the patient is really in a coma and limb twitching caused by a hypoglycemic episode, then the bolus injection of stabilizer will of course not be effective.
So, isn’t it epilepsy?
Is it low blood sugar?
Lin Feng asked the husband of the patient: “Recall, did the patient have cold sweats and rapid heartbeat before he passed out?”
Many people with low blood sugar have symptoms such as empty stomach, dizziness, cold sweats, rapid heartbeat, uncomfortable walking, etc.
The reason is: When hypoglycemia occurs, the body’s mechanism will work hard to raise blood sugar, thereby secreting some hormones that stimulate blood sugar. These hormones will cause the heartbeat to speed up, and people will have cold sweats.
The patient’s husband recalled.
“It seems like sometimes, sometimes not…”
At this time,
The nurse suddenly exclaimed:
“Look, she won’t twitch anymore!”
Lin Feng and others looked at it, and sure enough, the female patient who was still twitching in her limbs suddenly stopped twitching.
“That’s right, it’s hypoglycemia! 08!”
“It’s not epilepsy, at least this time it wasn’t caused by epilepsy. (Because diazepam is useless)”
The fog seems a lot clearer!
The husband is a little unbelievable.
impossible? We have been treated for four or five years, and now tell me it’s not epilepsy? Just kidding!
orn…
Lin Feng ignored the husband’s complicated mood.
“Your wife, do you have a history of diabetes before?”
“No, I didn’t find it at all before!”
Lin Feng nodded.
So, here comes the problem!
Why does the patient, without a history of diabetes, suddenly have hypoglycemia after eating breakfast?
The answer is:
endocrine!
The neurologist doesn’t understand this, but Lin Feng definitely understands!
The patient may have endocrine diseases, resulting in hypoglycemia!
What kinds of hormones in the human body can raise blood sugar?
There are the following:
·Glucagon…
·Various glucocorticoids…
·Thyroxine…
And what about the hormones that lower blood sugar?
There is only one!
insulin!
Therefore, we see that those high blood sugar patients in daily life need to take “insulin” every day!
Therefore, this female patient on the hospital bed should have a problem with insulin secretion. A large amount of insulin was secreted, which caused a rapid drop in blood sugar!
“What caused the secretion of large amounts of insulin?”
Lin Feng’s first reaction was:
“Insulinoma!”
The reasons are as follows:·Pancreatic islets: The pancreas is an irregular cell group scattered in the pancreas and is used for secretion. Three kinds of cells: A (or a2) cells secrete glucagon; B (or β) cells secrete insulin; and D cells.
·Insulinoma: It is pancreatic β-cell tumor or β-cell hyperplasia, which finally causes excessive insulin secretion.
Insulinomas often have the typical Whipple triad:
· “Symptoms of Hypoglycemia”…
· “Coma and neuropsychiatric symptoms”…
· “Easily attack after fasting or work”……
Doesn’t this correspond to the symptoms of this female patient?
Lin Feng felt relieved, and there was a joy in solving puzzles in his body!
“It turned out to be an insulinoma?”
“It’s really possible!”
“Doctor Lin is still great!”
Lin Feng rolled his eyes and stopped the group of doctors and nurses: “I called to ask the CT room to see if there is any space to plug in…”
Needless to say, Lin Feng’s popularity is natural. Most of the imaging department are female colleagues, who have long been obsessed with Lin Feng.
As long as Lin Feng goes in person, he can definitely jump in the line!
20 minutes later,
Lin Feng pushed the patient into the imaging department, and colleagues in the neurology department followed curiously.
10 minutes later……
Abdominal CT results: There is a 1cmX1cm mass on the tail of the pancreas.
confirmed!
There is a tumor in the pancreas!
Whether it is an insulinoma or not, you need to make a pathology to know after the excision.
Next, it’s surgery.
…
On the third day,
The operation is ready.
Surgery location: emergency operating room
Surgical plan: Minimally invasive laparoscopic pancreatectomy
Chief Surgery: Lin Feng, Ichisuke Song Ziming, Wu Haoming (named: Emergency Department Xiaoming)
Onlookers: Hepatobiliary, spleen and pancreatic surgery doctors heard that Lin Feng robbed another operation, and they also came to onlookers to study.
…
The operation started,
Lin Feng is familiar with the road and uses three-hole laparoscopy to explore the abdomen.
first step,
Probe!
Lin Feng first explored the liver, hilar area, and mesenteric roots for metastases…
Result: no metastases
Lin Feng then began to cut the gastro-colon ligament to expose the pancreas, carefully observe the location and size of the tumor and the extent and extent of tumor invasion…
Result: Visual inspection of benign tumor, no spread, etc…
Lin Feng breathed a sigh of relief.
As long as it is a benign tumor, with Lin Feng’s strength, the spleen can be preserved, which is good news for patients. If it is a malignant tumor, the spleen needs to be removed.
The second step,
Separate the spleen!
free.
Lin Feng carefully used forceps to pull on the right side to expose the posterior lateral spleen-kidney ligament and spleen-phrenic ligament, and cut these ligaments with scissors.
Then free all the way, continue to separate and cut the gastrosplenic ligament along the greater curvature of the stomach to the fundus of the stomach, and ligate the short gastric blood vessels one by one.
third step,
Separate the body and tail of the pancreas!
Last step Lin Feng has completely freed the greater curvature of the stomach and spleen.
Next, Lin Feng began to incise the peritoneum behind the pancreatic body and free it all the way to the tail, completely separating the tail from other tissues.
the fourth step,
Ligation and cut off the splenic artery and vein!
Lin Feng lifted the spleen together with the body of the pancreas and the tail, revealing the arteries and veins of the spleen.
Double ligation,
Then cut off.
the fifth step,
Removal of pancreatic body and tail!
Lin Feng measured it and sutured a needle on the upper and lower edges of the pancreas at the proximal end of the predetermined tangent line, and ligated deeply. The purpose is to block the transverse blood vessels of the pancreas and reduce bleeding.
Then use satinsky forceps to remove the body and tail of the pancreas on the predetermined tangent line.
Take out the tail of the pancreas (the part with tumor) and take it for pathological examination.
The sixth step:
Deal with the pancreatic stump!
Lin Feng used 1-0 silk thread to puncture the pancreatic duct, and then used 4-0 silk thread to suture the pancreatic stump section.
Check the wound and after hemostasis fully,
Place the drainage tube.
The seventh step,
Rinse and disinfect…
Suture the abdominal incision layer by layer…
End the operation!
Duration: 2 hours and 15 minutes…
This is a relatively simple operation for Lin Feng.
For those doctors who are studying, Lin Feng’s surgical skills are extremely adept, and the sense of hierarchy, rhythm, and weight are all just right.
Looking at this operation is like looking at an exquisite handicraft. Just looking at it can satisfy people’s aesthetic needs.
It’s so beautiful, this surgery!
Deeply attracted!
One day later, the pathology of the tumor came out.
It really is an insulinoma!
After a day’s time, observing the patient’s blood sugar and insulin levels, it really returned to normal.
Now, everything came to light!
If the patient does not have epilepsy during the next eight years of follow-up, it is certain that the pancreatic islet tumor is the cause, not the epilepsy.
What makes Lin Feng happy is that the brain damage caused by long-term hypoglycemia episodes did not appear in this female patient.
This is a blessing in misfortune!
However, there is one problem that has not been resolved!
“Why, the county hospital used to presume diazepam for the patient to stop the epilepsy of the female patient? (The effect is not effective when it works)”
Lin Feng deliberately asked the Press Department (the department for external liaison) to call the county hospital, and the medical records were quickly transferred.
After seeing the medical records, Lin Feng understood!
·The first treatment record: 10mg intravenous injection of stability needle + 250ml intravenous infusion of 5% glucose
·The second treatment record: 10mg of stable needle static push…
·The 5th treatment record: 10mg intravenous injection of stability needle + 300ml intravenous infusion of 5% glucose
·The 8th treatment record: …
The truth is completely revealed!
When the time is not working, it is because of the use of glucose, so it works.
And without glucose, it won’t work.
The entire 4 to 5 year treatment process was because of this ‘glucose’ which covered up the real cause!
“I am awesome!”
Lin Feng laughed and felt very happy!
Every good doctor is born with the attributes of a detective!
…
Lingnanxi, a county hospital.
Internal medicine.
The attending physician Wang Chongming is the attending physician of Liu Guizhen, a female patient with epilepsy.
When he learned that his patient had gone to the City No. 1 Hospital in Peng City, he was stunned.
The first hospital in the city asked for medical records, so he was naturally very cooperative.
However, he quickly called the husband of the female patient Liu Guizhen.
“Hello!”
“Doctor Wang, hello, what’s the matter?!”
“Did you go to the No. 1 Hospital of Pengshi?”
“Yes, thanks to Dr. Lin Feng, who deserves to be a genius doctor, I found the cause of my wife’s illness.”
“Found it? What’s the reason?”
Wang Chongming also has a headache for this female patient.
After four or five years of treatment, this female patient is already a well-known patient in the county hospital, and most of the related doctors have seen her.
However, in the past four to five years, the cause of epilepsy has not been found!
Many doctors have headaches!
The patient’s husband was pleased: “Yes, the cause has been found!”
Wang Chongming: “What is the reason?”
Patient’s husband: “It seems to be called pancreas or cancer…I don’t know much about it either.”
Puff~~~
Wang Chongming took a sip of water!
Shock!
“Isn’t it epilepsy? How is it a tumor?”
“Dr. Lin Feng said that it was not epilepsy, but some kind of tumor, and then caused excessive insulin secretion, resulting in low blood sugar… My wife is not epilepsy, but low blood sugar…”
“………………”
Wang Chongming didn’t understand what excessive insulin secretion was, because he was not a doctor in that category.
But he knows that low blood sugar does cause fainting, convulsions…
He quickly went to the professional network to search for information on pancreatic tumors, and finally set his sights on “insulinoma.”
After reading the relevant information, I finally understand.
“It turned out to be an insulinoma!”
“No wonder I haven’t found the cause, it turned out to be in the wrong direction, not epilepsy, but low blood sugar!”
Combined with my own treatment and use Diazepam injection, sometimes no glucose is added, sometimes glucose is added, which leads to “Vantim’s dysfunction”!
Everything is understood!
The doctors at the First Hospital of Pengshi City are really amazing!
Wang Chongming admired him.
Wang Chongming suddenly remembered something: “Wait, did you just say that the doctor is Lin Feng?”
The husband of the female patient: “Yes, that’s the very famous Lin Feng. We also listened to his fame and then called him.”
Wang Chongming was surprised.
He thought that Lin Feng became an Internet celebrity because of his momentum and handsomeness, but he didn’t expect his strength to be really strong.
hang up the phone.
Wang Chongming told the other doctors the news.
Soon, it spread throughout the hospital.
The doctors who had seen the female patient Liu Guizhen were all stunned.
“What? It turned out to be insulin cancer? Low blood sugar?”
“Not epilepsy?”
“What the hell!”
“No wonder we haven’t found the reason for four to five years!”
Sighed for a while.
…
…
Lin Feng is on duty,
After get off work, prepare to go to the dining hall to eat, and then go back to sleep.
Just when Lin Feng passed the emergency department,
Suddenly heard Director Zhou’s roar,
“If you don’t go for a checkup, what are you doing in this hospital?”
Lin Feng was surprised!
He had never seen Director Zhou be so angry. This was the first time.
Old Zhou, don’t be angry!Your heart can’t bear it!
Then I heard Director Zhou’s loud roar.
“I said, you must send your son to CT right away. Don’t delay!”
Lin Feng saw that the situation was not right.
Lin Feng doesn’t care about the patient’s condition, but at least Director Zhou’s anger must be controlled, otherwise the heart load will be too great and it will be very dangerous!
Lin Feng quickly ran into the emergency department.
“Doctor Lin!”
When Lin Feng came in, the nurses all said hello.
Lin Feng: “What’s the situation?”
Xiaoli explained: “A couple came to the emergency room with their children, fainted, low blood pressure, and the condition is not clear. The director wanted the parents to do CT. As a result, the parents thought that CT was expensive and refused to…”
Lin Feng nodded and hurriedly came to Director Zhou’s side.
“Director, calm down first, calm down…”
What’s the situation of the patient? Lin Feng doesn’t care, let Director Zhou 930 calm down before talking.
“Lin Feng…”
Director Zhou was relieved when he saw Lin Feng coming.
“Director, you are so angry, your heart can’t stand it, I will take over this patient…”
“good.”
Director Zhou was still very relieved of Lin Feng and told Lin Feng:
“This patient has a problem, please pay attention…”
Lin Feng nodded.
At this time, Lin Feng had time to see the family.
Middle-aged couple, probably in their 40s.
And lying on the hospital bed is a junior high school student wearing a ‘third middle school’ uniform, a boy, about 14 or 15 years old…
At this time, this junior high school student is connected to the ECG monitor.
Heart rate is 129 beats/min, breathing is 20 beats/min, blood pressure is 98/50mmHg, blood oxygen saturation is 85%…
Lin Feng’s heart tightened.
The heart rate is too high!
Too little breathing!
Low blood pressure!
Low blood oxygen!
“Thank you for trouble…”
Lin Feng came to the patient, flashed a flashlight, and looked at his pupils.
A lot of information can be seen from the pupils alone.
If the two pupils are not equal in size, consider whether there is any disease in the brain.
If the pupils are dilated and fixed, the patient is almost dead.
Lin Feng checked his pupils,
·The patient is unconscious and does not respond to light.
·The pupils reflect light, and they are equal to the same circle. There is no trauma to the head. It is probably not a craniocerebral problem.
Then check other places.
· Touched his limbs, it was cold,
·The face is slightly pale, it is estimated that there is anemia
Combine this with low blood pressure.
Obviously, the patient was in shock!
What shock is it?
I didn’t see the trauma there, so it’s hard to judge it as hemorrhagic shock. There may also be infections, allergies, heart attacks, etc.
Need to be further ruled out.
Listen to the heart and lungs, there is no problem.
Go down and look at the abdomen.
Touch it!
I go!
Very drumming!
It’s almost taut, as if being supported by something!
Is it intestinal paralysis?
Flatulence?
Or abdominal effusion?
Lin Feng pushed and found that the whole stomach was heavy to the touch, not like gas, but like liquid.
It is estimated that the possibility of effusion is high!
Lin Feng has a rough judgment!
It’s heavy bleeding!
Abdominal bleeding!
Then lead to hemorrhagic shock!
At this time, Lin Feng also heard his father explain:
Dad: “It’s not that I don’t want to do CT, but whether your CT can accurately find the problem!”
The mother agreed: “Yes, I have long heard that the hospital is very dark. I like to open all kinds of checkups. The expensive ones are going to die. I have a stomachache at random. I do some checkups. A few hundred and a thousand are gone, but in the end I found something sick. nothing.”
Lin Feng: “………………”
This kind of thing does exist in many hospitals.
However, this is actually a normal phenomenon, just like that female patient Liu Guizhen, if diabetes is not detected in the end, it is estimated that there will be a lot of examinations, and all CT and MRI have been performed.
In the end, if the cause is not found, it must be gone after more than a thousand.
But this is not a problem with the hospital.
From a subjective point of view, the doctor is not to make you this thousand dollars, but to diagnose the cause of the disease.
Lin Feng stood up.
“You don’t want to spend money, do you?”
“I just made a judgment. Your son should be in hemorrhagic shock and may be dead at any time. You said, do you want to do this check…”
Lin Feng’s attitude is a bit cold.
————————
ps: End of today, regardless of chapter, 4000+5700=9700 words
. .