I can see the status bar

Chapter 105

The excitement outside the hospital had nothing to do with Sun Lien.When Vice President Liu stepped out of the rescue hall, Xu Yourong called.A calm Xu Yourong's tone was a little nervous. She didn't say what was going on specifically, but just urged Sun Lien to come to her office immediately.

Although I was a little worried about Dean Liu, it was normal behavior to stay away in this situation.Sun Li'en looked back and saw that the crowd outside seemed to be emotionally stable, so he climbed the stairs to the sixth floor.

Xu Yourong doesn't have her own office.Her office, like other neurosurgeons, is crammed into a not-so-spacious room.Inside, single rooms are separated by acrylic partitions that are common in the civilian departments of third-rate private enterprises.The difference from private enterprises is that the light gray tables inside are quite spacious—basically each table is more than 1.2 meters long.Without exception, it is full of all kinds of books and the rare 4-inch LCD computer screen with a 3:17 ratio.

Xu Yourong was sitting in front of the computer, looking at a document.His face was full of anxiety.

"What's the matter?" Today is the surgery day of the Department of Neurosurgery of the Fourth Central Hospital. Most of the neurosurgery doctors are on the operating table competing with the patient's brain or nervous system, so there are quite a lot of vacancies around.Sun Li'en grabbed a stool, sat down beside Xu Yourong and asked, "Is it convenient to talk on the phone?"

Xu Yourong turned her head and said to Sun Li'en, "Just now...a call came to my cell phone. The person on the other end said that Dr. Bruce asked him to help pass the message and let me read these documents..." She pointed Pointing to what was on the computer screen, “University of Maryland Hospital study reports that acidification of urine with vitamin C is not recommended for patients with acute methamphetamine intoxication. If renal insufficiency is present, acidification of urine may lead to myoglobin in the Crystallization in renal tubules aggravates renal damage."

This treatment method is not groundless, and Sun Lien quickly understood the key point of this treatment method - protecting organs, especially liver and kidney, has positive significance for poisoned patients.As the largest detoxification organ and the most important excretory organ of the human body, whether the liver and kidney can work smoothly will largely determine whether the poisoned patient can survive.

The question of why the urine is green is still unclear, but at least these urines prove that Gao Yan's body is still working hard, trying to make everything work properly.

The principle of acidifying urine treatment belongs to organic chemistry.Sun Li'en was not particularly good at learning, but he finally understood the mechanism of this process.In methamphetamine, there is an -NH2 bond directly attached to the benzene ring, and this hydrogen ion can be ionized.Acidification of the urine reduces its ionization and preserves its molecular properties as much as possible.And such methamphetamine is not easily reabsorbed into the blood by the renal tubules.

The essence of injecting vitamin C to acidify urine is to reduce the reabsorption of methamphetamine by the kidneys, so as to achieve the purpose of increasing excretion.What really increases the urine output is mannitol and the full eight liters of fluid that will be replenished within a day.

Although it is still uncertain when and how much methamphetamine Gao Yan used.But what is certain is that during this time, his kidneys have been working at a high load.And this also means that his kidneys may have been damaged.

"Arrange kidney function tests, and liver function tests as well." The most important thing now is to immediately understand the extent of Gao Yan's physical damage. "Vitamin C is stopped first, and mannitol and fluid supplementation continue."

"It's been arranged." Xu Yourong moved faster than Sun Lien, and she pointed to the electronic report on the screen, "The report just came out after I called you, the blood creatinine increased to 596 μmol/L, the blood β2-microspheres The protein has risen to 3.1mg/L."

Sun Li'en's face darkened immediately, he leaned back in his chair and lamented, "Big mine!"

The normal reference value of serum creatinine is generally between 62 and 115 μmol/L.Suddenly jumping to 596μmol/L, it is basically the kidneys shouting loudly, "I quit!".The increase in blood β2-microglobulin indicates the specific "strike" of the kidney structure - the proximal convoluted tubule reabsorption function decline.

Gao Yan is not renal dysfunction, but acute renal injury.In words that everyone can understand, he has symptoms of acute renal failure.

"Adjust the treatment plan." Sun Li'en scratched his head, "Acute kidney injury, surely he can no longer be expected to rely on his own body functions to recover. In this case, he has to go to a dialysis machine."

Xu Yourong had a sad expression on her face, "We need to control the amount of rehydration, it must be controlled within 2000ml per day."

Sun Lien nodded and said, "Call the ICU and tell them to stop the medicine quickly." After a short pause, Sun Lien asked, "If acidifying urine doesn't work, what about alkalizing urine? Alkalinizing urine can relieve his pain. Is your kidney damaged?"

"You..." Xu Yourong looked at the monster's expression, and hesitated to speak.After taking a few glances at Sun Lien, she suddenly laughed again. "I can only blame you for being so unusual these days. I really regard you as my superior doctor." She knocked on the table with her hand and said seriously, "Kidney damage has formed, you are alkalizing your urine now. Fluids will not help much. And the symptoms that have appeared suggest that his kidney damage is not due to crystals produced after acidifying the urine, but acute methamphetamine poisoning."

Sun Lien nodded with some embarrassment.Since being able to see the status bar, Sun Lien's mentality has indeed undergone some slight changes.In the past, he could only follow the orders of the superior doctor for treatment, but he gradually built up his self-confidence.Relying on what we have learned in the past, we can guide the way of thinking of superior doctors and even treat patients directly.But at the end of the day, he is still just a recent undergraduate medical student.He has little experience and little knowledge.

The current Sun Lien is like a sensitive humanoid comprehensive medical examination machine.He can detect the patient's symptoms very keenly, but he can't give a suitable treatment and treatment plan - the first few patients were treated properly, on the one hand because of the assistance of Liu Tangchun and others, and on the other hand because of their symptoms It is relatively simple, and it is still the normal treatment content of emergency department.

But Gao Yan's situation is different.Strictly speaking, his kidney injury should be taken over by the Department of Nephrology.However, under the emergency mode of the Fourth Central Hospital, the receiving doctor still has to continue to be responsible for the treatment before making a clear referral.This became a comprehensive test of Sun Lien's knowledge.

It would be great if there is a nephrologist 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 Li'en smiled embarrassedly, "Dialysis can filter out toxins and waste in the blood, and it should also be effective for methamphetamine."

Xu Yourong asked after a while, "Do you want ganaloxone?"

Naloxone is a very special drug.Its effects on the human body are mainly reflected in opioid receptors, and it is a commonly used opioid receptor antagonist in clinical practice.It has a high affinity for opioid receptor nerves and can block the action 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 readily cross the brain-blood barrier and are able to reach their maximum concentration within minutes of intravenous administration.Relying on its own strength—it has a strong affinity for μ receptors, naloxone can competitively antagonize various opioids.And reverse the effect of opioids and relieve the symptoms of opioid overdose.

The problem is that, while methamphetamine also acts on opioid receptors, it’s not an opioid after all—it’s not even a sedative or pain reliever.After using naloxone, these strong men firmly held the receptors, and at the same time hindered further treatment.

To improve severe kidney conditions, increasing the blood supply to the kidneys is an important solution.But this approach requires the use of dopamine -- and dopamine receptors are "hijacked" by naloxone.Causes 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 work in his brain, stimulating and poisoning the severe cranial nerves.If the time is too long and the scope of irreversible damage is too large, he will be directly brain-dead.

Regardless of the kidneys, kidney failure can trigger cascading multi-organ failure.Gao Yan will die.

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, "Take naloxone."

Kidney failure is terrible, although it may cause multiple organ failure.But after all, there is a dialysis machine in front.It's no more of a threat than brain damage.Even if kidney failure occurs, life-long dialysis or kidney transplantation can at least maintain a high life.And brain damage...there is no such thing as a brain transplant.

Sun Li'en stood up and said to Xu Yourong, "I'll go talk to Gao Yan's family members, you can contact the nephrology doctor. Ask them to come over for a consultation and 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.It serves the family members of patients who stay outside the ICU and feel restless.

Gao Yan's parents gradually recovered from the initial anger.The son is 21 years old this year, and he left them to live in Ningyuan.And without parental supervision, kids do sometimes make incredible messes—sometimes even with their own lives in danger.

Gao Yan's parents sat in the waiting hall of the ICU for not a minute. They took Gao Yan's mobile phone handed over by the doctor and called every contact in the phone book.Many people chose to hang up directly after hearing the voices of the old couple, while some people who had contacts with their son mentioned Gao Yan's bad habits while hesitating.

The old couple were completely dumbfounded.In desperation and worry, anger and bewilderment, they hugged each other and cried.

　Today is a chapter of 3000 words. (Akimbo proudly)

　　
　
(End of this chapter)