Doctor: I picked up attributes in the hospital

Chapter 300 The Sleepless Night About to Begin

Chapter 300 The Sleepless Night About to Begin

Back in the ward, seeing Zhao Heng with a dignified expression, Liu Meng couldn't help asking: "Doctor Zhao, is this a confirmed diagnosis?"

"Yes, it was confirmed. The patient was indeed infected with Naegleria fowleri."

Zhao Heng nodded.

"This.."

When Liu Meng heard the news of the diagnosis, his mind went blank for a moment, and he didn't know what to say.

She had seen a report before that a 43-year-old man in Shenzhen City was playing in the water in a scenic spot. From the beginning of a headache and coughing to his death, it took only two short weeks. After examination, the patient was confirmed to be Nagel. Amoeba meningoencephalitis (PAM).

It's really scary to think about it. After being infected by this brain-eating worm, the initial symptoms will be nausea, headache, and fever, and then the symptoms will intensify: back pain, hallucinations, and inability to concentrate. Patients usually die within two weeks.

"Doctor Zhao, how should we treat him now?"

He is always a professional doctor. After a brief shock, Liu Meng quickly recovered and asked Zhao Heng.

"The pathogen is parasitic in the patient's brain, and now the patient has very severe cerebral edema, which will further squeeze the brain tissue, so at present, the most important thing is to treat the patient's cerebral edema."

"First, to reduce intracranial pressure, second to maintain adequate cerebral perfusion to avoid further ischemia and hypoxia, and finally to prevent brain herniation."

Zhao Heng thought for a while, and quickly gave a rough treatment plan and principles.

"So should we give patients mannitol, compound glycerin, and furosemide in combination?"

Liu Meng asked again.

Mannitol, which is the most commonly used osmotic diuretic drug in the clinical drug treatment of acute cerebral edema, is mainly 20% mannitol in clinical practice. Drug of choice for edema.

The compound glycerol has similar pharmacological effects to mannitol, and is also a hypertonic dehydrating agent, but without the adverse reactions of mannitol, such as rebound, electrolyte imbalance, kidney damage, etc., it is especially suitable for cerebral edema with insufficiency and failure of some organs patient.

The final furosemide, as a powerful diuretic commonly used in clinical practice, is also an important choice for the treatment of cerebral edema. Furosemide can inhibit the reabsorption of chloride and sodium ions in the medulla and cortex of the ascending branch of the loop of Henle. , affecting the formation and maintenance of hypertonic state of the renal medulla, weakening the concentration function of urine, promoting the massive excretion of chloride, sodium, potassium ions and water, thereby producing a strong diuretic effect and reducing cerebral edema.

"It can be used in combination, but for the treatment of cerebral edema, dehydration cannot be used alone. It is also necessary to prevent and treat cerebral vasospasm, and attention must be paid to improving cerebral blood flow."

"Add nimodipine, and treat the patient with mild hypothermia."

Zhao Heng thought for a while and said that Liu Meng's treatment thinking for patients is obviously still at the level of an emergency doctor, but the treatment of this patient cannot be considered purely from symptomatic treatment.

"Yes, Nimodipine is a dihydropyridine calcium channel blocker, which can inhibit the contraction of vascular smooth muscle by inhibiting the entry of calcium ions into cells, and has a certain therapeutic effect on nerve damage caused by cerebral edema. Mild hypothermia Treatment can regulate cerebral blood flow, reduce cerebral oxygen metabolism rate and improve cellular energy metabolism, reduce the release of excitatory amino acids, reduce the survival of oxygen free radicals, reduce intracellular calcium overload, thereby increasing the synthesis of neuron ubiquitin, Reduce neuronal necrosis and apoptosis, and promote the recovery of intercellular signal conduction."

"Doctor Zhao, your treatment plan can be said to be the hand of God!"

Liu Meng said in amazement.

Before she came to the ward, she had only heard that Zhao Heng's level of diagnosis and treatment was very high, but now she realized that this level is not only high, it is simply too high.

It can be said that for the treatment of an emergency such as cerebral edema, even Song Siming, the experienced director of the emergency department, may not be able to propose such a complete treatment plan in actual treatment.

The treatment plan proposed by Zhao Heng is not only a symptomatic treatment, but also lays a good foundation for the patient's future recovery.

Without extremely rich experience, a high level of medical theory, and an understanding of the mechanisms of various drug treatments, it is impossible to propose such a complete treatment plan.

"It's just a little more experience. I'm afraid I won't be able to get off work normally today. Be prepared to work overtime all night."

Zhao Heng said calmly, he was very indifferent to Liu Meng's amazement, and he had seen this kind of amazement on many people's faces.

This is also normal. According to common sense, at the age of his early twenties, he cannot have this level of clinical experience.

But in modern society, all kinds of incredible geniuses are born out of nowhere, and many people are publicized by various media. Therefore, it is not surprising that there is such a genius as Zhao Heng in Dongfang Hospital.

"Well, I'm also used to working overtime in the emergency department. Dr. Zhao, I may not be as good as you when it comes to the level of medical treatment. But if you want to say that the takeaway is delicious, then I know better than you."

Liu Meng said with a slight smile.

Working with Zhao Heng is still very pleasant. As for working overtime, it is commonplace for doctors, especially for doctors in top tertiary hospitals like Dongfang Hospital.

It would be strange if there was no overtime work in any week.

"Then let's start with the treatments we just mentioned, and pay close attention to the patient's condition. I'm right in the office. Come and talk to me if you have anything."

Zhao Heng nodded and said, this Liu Meng is still very good, and his professionalism is very solid, but his thinking needs to be broadened.

We must know that in clinical practice, solid professional quality and knowledge are important, but clinical thinking is actually more difficult to cultivate.

As for the treatment methods, no matter how cutting-edge and high-end treatment methods are, in the modern society with extremely advanced information, as a doctor, you have heard of them.

But whether a patient can be cured, in fact, there are two most critical points. The first point is diagnosis, that is, whether the patient's condition can be diagnosed with the least examination methods.

As for the second point, it is the means of treatment. Although the textbooks give a treatment plan for a certain disease, it is all a kind of statistical probability and data, and it is not applicable to every patient.

There are great individual differences between people, and the changes in the condition of specific individuals are also very complicated, which makes it even more necessary to prescribe the right medicine and add your own understanding to the basic treatment plan provided in the textbook .

These two points sound very simple, but it is a very difficult thing to really do it properly. Many doctors have been working for decades, but to be honest, they may not be able to touch this edge and reach this level.

(End of this chapter)