Auto chess in the operating room

Chapter 65 Four Definitions of AKI

Tanglou entered the ward.

After the darkness, the female model appeared in front of Tang Lou.

The assistant doctor saw that it was Tang Lou, took the case on purpose, and paused for a while, but didn't read the question: "Ahem~"

Tanglou naturally understood that this was a deliberate attempt to "make things difficult" for him and retaliate for his previous taunting.

"Please!"

Tang Lou stretched out his hand, very gentlemanly inviting the young lady to continue the discussion.

This is more or less the same, since you are so handsome and sincerely invited me, this girl is not as knowledgeable as you.

"Patient: Female, 55 years old, was sent to the emergency department by her community contracted doctor. In the past 3 weeks, her shortness of breath gradually worsened, her lower extremities were edema, and her weight increased by 10 kg. She denied chest pain and no history of cardiovascular disease. She denied any urinary activity. Gastrointestinal symptoms."

"In the family history, two of her sisters have rheumatoid arthritis."

Tang Lou nodded, took the physical examination again and looked at it:
vital signs:

体温：36.7°C；血压105/70mmHg；心率90/分、律齐，呼吸：24次/分。

Oxygen saturation 93% (non-oxygen inhalation).

"Dr. Tang, the patient has obvious dyspnea when speaking, but he is conscious. Cardiac examination significantly increased JVP (+ 6 cm), and respiratory examination showed obvious moist rales at the bottom of both lungs. Abdominal examination was normal. Pitting edema was seen below both knees .”

The assistant doctor continued to add.

Tang Lou took the patient's X-ray film again, which showed a small amount of bilateral pleural effusion and pulmonary congestion.

".Hb11.4, WCC 8.5, PLT 220, Na 131, K 6.4, Ur 35, Cr 220, HCO3 18.

Venous blood pH is 7.25.

Patient's previous examination showed a Cr of 5" at the last examination 80 months ago

"First question, what is the doctor's diagnosis and the patient's further examination?"

For the first question, Tang Lou was naturally at his fingertips:

"Through vital signs and preliminary physical examination, it can be found that the patient exhibits symptoms and signs of excess body fluid, accompanied by hyponatremia, hyperkalemia and metabolic acidosis. It is an obvious acute acoustic injury, also known as AKI."

"There are various definitions for AKI: Improving Kidney Outcomes Worldwide, KDIGO
KidneyDisease: Improving Global Outcomes defines AKI as meeting any of the following:
i.SCr increased ≥0.3mg/dl (≥26.5 umol/L) within 48 hours;

ii. SCr increased ≥ 1.5 times the baseline value, which is known or assumed to have occurred within the previous 7 days;

iii. Urine output < 0.5ml/kg/h for 6 hours.

Obviously, we can get from the physical examination that the patient's baseline Cr value is 80mol/L, and 220mol/L is nearly three times the baseline level, which can diagnose AKI. "

"above!"

Tang Lou looked at the assistant doctor in a personable manner.

The corner of the young lady’s mouth twitched. It’s no problem to diagnose AKI, but when most people mention the definition of AKI, they will use the classic domestic terms.

The definition of KDIGO proposed by Tang Lou is somewhat beyond the answer on the card in her hand.

"Wait a minute."

The assistant doctor ran out dutifully, picked up his mobile phone and called his colleagues in the reference room:

"Dongyao, Dongyao, I'm Dongguai, a large-scale pretentious incident happened in the examination room, I can't control it, I need help~"

"speak English!"

".KDIGO definition, how do I know how to pronounce KDI. I want to know and ask you. Oh..Exactly correct?.Okay"

After a few minutes, the assistant doctor ran back with a dark face. Looking at Tang Lou's harmless smiling face, he became more and more sure that this guy did it on purpose!
The definition of AKI proposed by Tanglou is more authoritative and rigorous than the domestic classic definition, but it is really unfamiliar.

It's like picking a name for a normal person named Tang Lou, he insists on a Tang Lou (if you know one, I lose)!

Isn't this embarrassing the little nurse? I should be just a question-reading machine who is too emotional, ignorant and incompetent?

"The doctor is asked to continue to answer the further examination of the patient."

The assistant doctor announced to continue answering the question without any sense of accomplishment.

Tang Lou nodded, and continued his super-class answer. He really wanted to keep a low profile, but a task with a total score of 90 was pending. In order to get a full score, he had to answer everything he knew. come out.

Tang Lou is also in a dilemma, with a delicate and trivial analysis:
There are three main pathogenic types of AKI:

(i) Prerenal (i.e. hypoperfusion)

(ii) Renal (i.e. kidney disease itself)
(iii) Post-renal (i.e. urinary tract obstruction).

Initial evaluation should attempt to determine what is causing the patient's AKI.

So the first step of a urine test is necessary and must be done immediately because it can help determine whether there is evidence of disease in the kidneys themselves.

For example, erythrocyte casts and glomerulonephritis, white blood cell casts and interstitial nephritis, or acute tubular necrosis can be seen in the urine of renal tubular epithelial cell shedding.

The second key examination is renal ultrasonography to determine whether there is obstruction. In case of obstruction, hydronephrosis or hydroureter can be seen on ultrasound.

For fear of missing one, it is like when answering a question in a liberal arts subject, you will never give up until you fill the answer column.

Tang Lou earnestly continued to add:
"On this basis, further examinations, such as serological testing for glomerulonephritis, can be performed."

After thinking about it again, there should be nothing missing, so Tang Lou stopped.

The assistant doctor licked his lips. This is simply a detailed version of the answer. In fact, only the urine test and kidney ultrasound can be judged to get full marks.

The assistant doctor suddenly missed Yang Ming's cherishing words like gold, and said so much that the scores are worthless for the saliva consumed by Tang Lou:

"First question, the answer is absolutely correct. +4""

"Second question, could the doctor briefly describe the initial treatment plan for HDU?"

The assistant doctor arbitrarily emphasized the voice on the brief description, for fear of casting a shadow on the minds of those scumbags in the review room.

In the review room, the directors were also dumbfounded.

"Although Tang Lou's answer is a little exaggerated, solid theoretical knowledge is indeed rare in this age group."

Diao Xiwen looked at Tang Lou as he looked at the second Li Yundi, who was just as handsome, and also liked to twitch.

To say "I love you" is to say that tonight's night is so beautiful.

But it's really compelling.

Among the eliminated contestants in the back row, there were also a lot of emotions.

"If I don't search Baidu, I can't understand the answer of the great god."

"It turns out that there are four ways of writing Lu Xun's Hui characters. It's really not a joke. Next time I must put my hips on my hips in front of the nurse Xiao Meimei: Hey, have you heard of the four definitions of AKI?"

"If you grow up like a Tang Lou, even if there are eight colors of shit, the little girl will listen to it with great interest. Unless you know the ten ways of driving a Porsche."

The companion on the side said with disgust.

"."

"I don't know if Yang Ming lost the second question, can Tang Lou get full marks?"

"It's very possible. I think Tang Lou belongs to the kind of people with great stamina. After all, it's the first time I don't have experience, so I can't do it. The more I go on, the better I will be!"

"Full marks, full marks!"

Many players in the back row became Tang Lou's support team.

Tang Lou's calm answer sounded in the ward:

"Initial HDU management of this patient should focus on the two major complications arising from AKI - volume and electrolyte issues."

". Regarding volume, a urinary catheter should be inserted so that urine output can be accurately measured and fluid intake, output, and balance recorded hourly"

"This patient presents clinically with volume overload, as supported by the chest radiograph. Therefore, diuretic therapy should be administered to both relieve symptoms and observe the effect on urine output. IV furosemide is the diuretic of choice agent"

When Tang Lou was discussing diuretics, the rest of the simulators in the ward also followed Tang Lou's treatment plan.

One of the little nurses drew a needle of furosemide and was about to simulate pricking it into the model's vein.

"Wait a minute, there is a problem with your dose drawing!"

Tang Lou's gaze was like a torch, and he stopped her movement coldly!
　I found that I was always not punctual on weekends. I lay down and had lunch before getting up to type, hahaha, it was all because of the quilt that sealed me.

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(End of this chapter)