Chapter 485: The Old Man in Shock

Remember [New] in one second! The middle-aged woman was very fast and the application for Shuidichou was completed immediately.

Lu Chen then completed all the remaining places that needed signatures and proofs.

The Shuidichou project was immediately opened.

As a medical staff, Lu Chen could prove for the patient.

At the same time, Lu Chen also donated 200 yuan.

He is only a graduate student now, and the donation should not be too much.

After doing all this, Lu Chen could only pray silently in his heart that the girl would wake up soon.

Otherwise, it would cost tens of thousands of yuan to stay in the CCU for a day.

...

Back to the doctor's office.

Before Lu Chen could sit warm, the security guard at the door of the CCU started shouting.

"A patient is coming!"

Lu Chen was shocked when he heard this, and his heartbeat jumped directly to 120 beats/minute.

"Here it comes."

Lu Chen and Gu Xinyue followed Zhou Bin to the door of the CCU.

There was an old man in his seventies lying on the bed.

The old man was lying on the bed, thin and breathing heavily. The ECG monitor next to the bed was beeping an alarm.

There was another accompanying doctor next to the bed, Director Lin Cui from the eighth area of ​​the heart.

"Director Lin, what's the patient's condition?" Zhou Bin asked immediately.

"Heart failure patient, combined with renal failure and oliguria. The blood potassium just checked upstairs was more than 7 mmol/l."

Zhou Bin frowned. This kind of patient should have reached the level of dialysis. "Director Lin, the patient was transferred down for CRRT?"

Lin Cui shook her head quickly: "No. The patient had a long-term atrial fibrillation and chronic heart failure. The family did not consider invasive rescue and continuous renal replacement therapy (CRRT)."

In fact, in the intensive care unit, they were already accustomed to such patients.

However, once CRRT was abandoned, there was very little that doctors could do!

Most of the time, doctors just acted as bystanders to the patient's condition.

...

The patient was soon pushed in.

His condition was worse than Lu Chen had imagined.

He was lying on the bed, wearing an oxygen mask, rolling his eyes, and breathing heavily.

Lu Chen looked at his life value, the value was 47 in red, and the trend was three minus signs!

...

Three minus signs!

After two days of treatment in the ordinary ward upstairs, it was still three minus signs.

This means that the previous treatment was basically useless!

Zhou Bin patted the patient's shoulder and shouted a few times, but there was no response.

Lin Cui said: "The family said that when he got up two days ago, he suddenly felt weak in his left limbs, couldn't speak clearly, couldn't eat, couldn't get up, and had a cramp once, so he rushed to the emergency room."

"There was basically no urine in the first two days, and urinated 1000ml yesterday."

At this time, Lu Chen's mind had already appeared a chain of diseases, the foundation of chronic heart failure, acute cerebral infarction caused acute aggravation of heart failure, and caused renal failure and oliguria.

"The blood sugar between the fingertips is high."

As soon as he entered the ward, the nurse routinely measured the patient's blood sugar.

Zhou Bin frowned, "With such high blood sugar, what kind of hypoglycemic drugs do you usually use?"

"I didn't know about diabetes before, and I didn't use anything." Lin Cui said, "But after coming to the ward, I used some insulin and a diuretic for a day. It's just that we are a little surprised that this patient is getting worse in the ward."

"Today the patient's condition is even worse. There is really no way. After communicating with the family, we can only push him to the CCU."

Lin Cui's expression was very helpless.

This is a very typical heart failure patient in the cardiology department.

But after diuresis, the effect is extremely poor!

"Okay, I basically understand it, thank you Director Lin." Zhou Bin nodded.

After Lin Cui briefly explained the patient's condition, she left the CCU ward.

Lu Chen and Zhou Bin gave the patient a detailed physical examination.

The patient's current heart rate is 90-110 beats/min, blood pressure 8hg, respiration 37 times/min, and blood oxygen saturation 95% (oxygen storage mask).

There is no obvious edema in the whole body, the skin temperature is low, there is no obvious moist rales in the lungs, and the heart sounds are OK

…

Back to the doctor's office.

Lu Chen looked through the patient's test results.

On the day of entering the ward, the blood routine was normal.

Brain natriuretic peptide (BNP) 2855pg/ml, blood sugar 43mmol/l, blood potassium 7.36mmol/l.

Creatinine 255mmol/l, urea 47mmol/l, urine sugar 4+, occult blood 3+.

The electrocardiogram showed atrial fibrillation rhythm, heart rate 96 beats/min, extensive ST segment depression in II, III, Avf leads and chest leads, and mild elevation of the ST segment in Avr leads.

Chest CT showed patchy shadows in the left lower lung, and head CT showed deepening of brain sulci and gyri, but no high-density shadows were seen.

"A lot of diuretics have been used in the ward these two days!"

…

Continue to look through the test sheets.

After one day of fluid replacement and diuresis, the next day, blood potassium had dropped to 5.08mmol/l, blood sodium rose to 145mmol/l, and blood sugar dropped to 16mmol/l, but kidney function continued to deteriorate, creatinine rose to 405mmol/l, and urea also rose to 51.57mmol/l.

It seems that blood sugar has been basically controlled and urine has come out, but what caused the sharp deterioration of kidney function?

"This patient is very difficult!"

In the office, Zhou Bin sighed slightly after browsing all the examinations and tests.

"No wonder Director Lin took the initiative to send the patient down. According to Director Lin's personality, he would not necessarily send the patient to the CCU unless it was absolutely necessary."

Director Lin Cui has a very loud reputation in the eighth area of ​​cardiology. She is a strong person, and Director Li Yao of the eighth area can't suppress her at all!

Li Hui, another attending doctor in the group, also came over, "In the current state of the patient, it is best to go directly to CRRT, but the patient's family refused, which is really not easy to deal with!"

...

Back to the patient's condition.

"I have carefully analyzed the patient's condition. Now the main thing is to determine the cause of the patient's shock." Zhou Bin analyzed carefully, and a group of graduate students gathered around him. "Is it cardiogenic shock, septic shock, or hypovolemic shock?"

Cheng Dongbo, a senior in the third year of graduate school, spoke first: "Low blood pressure and shock caused by heart failure, I think it should be cardiogenic shock."

Zhou Bin shook his head, "It's not that simple. If it's just heart failure, then after improving heart function and diuresis, the patient's condition did not improve in time?"