Chapter 486: Stubborn 3 Minus Signs

Remember【New】 in one second!     "Lu Chen, what do you think is the main cause of the patient's illness?"

Lu Chen had not spoken, so Zhou Bin took the initiative to ask.

"Teacher Zhou, I have no clue yet." Lu Chen shook his head.

There are many clues at present, but they are very confusing, and he was at a loss for a while.

But what is certain is that the "three minus signs" on the patient's head indicate that his condition is getting worse and worse!

If the cause is not found quickly, it will be troublesome!

The patient's life is in danger at any time!

"Even if you can't tell the exact cause, you can always say something." Zhou Bin continued, "Just say it boldly, it doesn't matter if you are wrong, let's discuss it together."

She now looks at Lu Chen with a completely different perspective.

I have heard of Lu Chen before, and I think he is mostly a "famous" guy.

Now that I have personally contacted Lu Chen, although it has only been a few days, Zhou Bin has seen that Lu Chen is different from other students.

His clinical thinking and operational skills have far surpassed his peers.

Lu Chen frowned, looked up and looked around at everyone, and said slowly: "My idea is that the patient's procalcitonin and CRP are significantly elevated. The chest CT screening for admission shows patchy shadows in the left lower lung, and the possibility of acute septic shock cannot be ruled out. However, there has been no fever in recent days, and there is no abnormality in the blood routine test. The lung infection does not seem to be that serious."

"In addition, although the electrocardiogram shows widespread ST segment depression and ST segment elevation in the AVR, the increase in TNI in the past two days is not too high, from 0.022ng/ml to 0.42ng/ml, and there is no obvious deterioration of arrhythmia."

"Further ultrasound examinations show that the inferior vena cava is 0.9cm, the left heart is significantly enlarged, the left ventricular end-diastolic diameter, ejection fraction 40%, cardiac output, and ventricular wall motion are low."

"Therefore, I think the diagnosis of sepsis in the patient is still lacking. There is no factor of sudden deterioration of heart function, and the cardiac output is also OK, so the diagnosis of cardiogenic shock is not very valid."

As soon as the voice fell.

Everyone in the office was silent.

Gu Xinyue stared at Lu Chen's profile in a daze, and suddenly felt powerless.

Lu Chen's explanation was clear and well-documented, far more tenable than the simple "cardiogenic shock" and "septic shock" they said.

Zhou Bin, however, focused on the report in her hand.

Lu Chen's words kept lingering in her mind.

At this time, Lu Chen continued.

"And the patient's inferior vena cava is only 0.9cm, indicating severe volume deficiency. It seems that hypovolemic shock is the most likely, but the patient currently has no evidence of large-scale fluid loss and blood loss."

"Hypovolemic shock?"

Zhou Bin was stunned. This idea was completely different from what they had thought before!

It was not cardiogenic shock, nor was it septic shock, but hypovolemic shock!

"I'll ask the patient's family about their recent diet." Zhou Bin said immediately.

If the patient's diet is not good recently, it will also cause this kind of malnutrition and hypovolemic shock.

...

CCU ward, doctor-patient communication room

Zhou Bin called the patient's family in.

"How has the patient been eating and drinking these days?"

The family member was the patient's son, and he quickly said, "My dad has always felt a burning sensation in his stomach in the past half month. He doesn't eat much and just drinks soda."

"Only drinks soda?" Zhou Bin frowned, "Doesn't he eat any other food?"

"He eats very little." The family member sighed, "We don't dare to disobey him. If he wants to drink soda, we can only give it to him."

"Okay, I see. I'll come to you if there's any situation."

After Zhou Bin asked a few questions, he returned to the doctor's office.

"It seems that the intake is really not enough. In any case, rehydration should be done first to improve hemodynamics." Zhou Bin said to Lu Chen.

Lu Chen nodded.

For the time being, we can only treat the symptoms first. As for the cause of the disease, we can only explore it step by step during treatment.

...

Zhou Bin came to the old man's bed and prepared to perform a subclavian central venous puncture and catheterization on him.

Central venous catheterization can quickly rehydrate patients, especially for some critically ill patients.

"Teacher, I'll go with you." Gu Xinyue said.

"Okay, I just need a helper." Zhou Bin nodded slightly.

Central venous catheterization is a routine operation in ICU and CCU wards, but it is almost non-existent in ordinary wards.

Gu Xinyue pulled Lu Chen to the ward.

"Old Gu, why are you pulling me?" Lu Chen was still preparing to continue studying the patient's test results to see if he could find some clues.

"Let's take a look at central venous puncture and catheterization." Gu Xinyue said, "It's good to have many skills!"

Lu Chen nodded helplessly. In fact, he had practiced this kind of puncture operation many times in the system space, and his proficiency in central venous puncture and catheterization was about 75%.

However, because he had never practiced in reality, his proficiency stopped rising after reaching 75%.

This time, the opportunity to be an assistant was given to Gu Xinyue.

...

Gu Xinyue followed Zhou Bin with gloves.

"The most important thing for puncture is positioning." Zhou Bin said, "We can place central venous catheters in the jugular or subclavian, but the patient's comfort level is lower when the catheter is placed in the jugular, so we usually place the catheter in the subclavian."

Zhou Bin's puncture technique is very skillful.

After finding the puncture positioning point, the puncture needle went down and the puncture was successful immediately.

Gu Xinyue's job was to help implant the guidewire.

After the guidewire passed, the catheter was placed.

The most difficult step in the whole process was puncture.

The entry of other guidewires and catheters were secondary.

Lu Chen watched from the side, but he could not gain much experience. He just regarded it as accompanying Gu Xinyue.

Gu Xinyue's experience as an assistant several times will be of great help to his independent puncture in the future.

The central venous catheter was successfully placed, and the nurse immediately connected several groups of fluids to the central venous channel.

The rest was to observe the patient's reaction after the fluid infusion.

…

This old man with a serious condition is insignificant to the entire CCU ward.

Even Lu Chen's attention was diverted by the next patient.

In the afternoon, Lu Chen admitted another old lady with severe heart failure.

This old lady had been ill at home for a week, and she was willing to come to the hospital only when she couldn't lie down to sleep.

After treating this old lady, Lu Chen took the time to see the old man who had been admitted before.

After rapid fluid infusion, the inferior vena cava quickly rose to 1.3cm, and the blood pressure recovered compared to before. The systolic pressure could reach hg, and it seemed to be progressing in a good direction.

However, when Lu Chen came to the ward, he saw that the old man's life value was still three minus signs!

What's going on?