Auto chess in the operating room

Chapter 67 Therapeutic Hypothermia
The seventh room is under the brilliance of the tenement building, and everyone is overshadowed. The leaderboard is updated:

No.1唐楼 6+9+8+8+10+10+10=61
No.2杨铭 10+9+8+10+7+8+8=60
No.3李云迪 9+8+9+8+8+9+8=59
No.4程思思 9+8+9+8+8+7+8=57
No.5菜谈 8+8+7+7+8+7+8=53
No.6陆荣8+8+6+7+6+8+7=50
No.7云州7+7+7+6+7+6+7=47
In addition to Tanglou, Yunzhou, which is also a county-level city and county hospital, is also amazing. Although it does not have a high score, it is firmly ranked among the top eight.

"The little girl in Yunzhou is pretty good. She has a solid foundation. Our military hospital wants her."

Diao Xiwen stated directly that after all, the emergency training camp is to find and select young doctors with the most potential for each hospital.

Over the years, only those who enter the top three have the opportunity to enter the city's first hospital for further study, and the subsequent ones are selected by each city-level hospital.

Although Yunzhou is not as dazzling as Tanglou, being able to enter the military hospital for advanced studies is already a huge leap in career for an intern in a county hospital!
Among the eliminated contestants, Wu Qian's face was extremely ugly. Her score was shamefully fixed at 34, and Yunzhou was already preparing for the assessment of the eighth room.

As for Tang Lou, she was already numb, after all, Yang Ming's face was trampled under his feet.

"The eighth room, what kind of response will Yang Ming give?"

Everyone was talking about it, and in the midst of everyone's anticipation, the eighth ward was opened!
In the preparation room, for the first time, Yang Ming could only wait behind him.

He clasped his hands and fingers together, sat on the stool, his feet were off the ground, and his head was half down. No one knew what he was thinking.

Tang Lou shook his clothes and glanced at Cheng Sisi: "I'm going."

After Tang Lou entered the ward, the familiar scene was simulated again, and a short video was projected on a wall.

On screen:
A man in his 50s and his son were hiking in the wild together. When they climbed to the mountainside, they fainted and fell to the ground.

The patient's son had learned some simple cardiopulmonary resuscitation, and when the medical staff arrived, he had already performed 5 minutes of cardiopulmonary resuscitation.

Next, the screen switched to the emergency room.

The assistant doctor began to read the patient's medical record:

"The patient's heart rhythm was ventricular fibrillation (VF), and a total of 8 defibrillations were performed before spontaneous circulation recovery. The patient had a history of hypertension and type 2 diabetes, and was controlled by medication. There was a history of smoking for many years, and there was no family history of sudden cardiac death. history."

After the simulation in the previous seven rooms, Tang Lou was already familiar with the first aid process. He stretched out his hand, and the assistant doctor handed over the materials of the physical examination.

Patient vital signs:
Body temperature 37.5°C, blood pressure 105/55, heart rate 95, regular.

The patient was intubated, ventilated, and sedated with fentanyl and propofol.

Physical examination revealed normal heart sounds and clear breath sounds bilaterally.

GCS rated 3/15.

Hb14.6, WCC 15.3, PLT 275, cr95.

Arterial blood gas: ph7.15 pO2 22.5, pCO24, HCO3 20, lactic acid 7.5.

At the end of the physical examination data is a chest X-ray and ECG of the patient.

Tang Lou looked at it carefully.

"First question, please discuss the meaning of GCS score 3/15 and what needs to be done."

Tang Lou's understatement is the beginning of the discussion: GCS score, also known as Glasgow coma score.

The total score is 15 points, including the following three items:

Eye opening, language and movement have 4 points, 5 points and 6 points respectively.

Each project is divided into several levels:

If the eyes can be opened voluntarily, the score is 4 points, if the voice stimulation is 3 points, the pain stimulation is 2 points, and the eyes are not open 1 point.

5 points for normal language, 4 points for confused language, 3 points for inappropriate words, 2 points for incomprehensible sounds, and 1 point for no language.

6 points for being able to follow instructions, 5 points for being able to localize pain, 4 points for flexion of limbs in response to painful stimuli, 3 points for abnormal flexion with pain, 2 points for limb extension after painful stimuli, and 1 point for no response to pain.

The scores of the above three items are added together to form the total score of the Glasgow Coma Scale.

The highest score on the Glasgow Coma Scale is 15, indicating clear consciousness.
12 to 14 are divided into mild disturbance of consciousness,

9 to 11 are divided into moderate disturbance of consciousness,

A score below 8 is considered coma.

The patient's score is only 3 points, which means he is obviously in a coma, so he should be intubated and mechanically ventilated immediately.

"The answer to the first question is completely correct. +3 points"

"Second question, please use the materials provided in the scene reasonably and implement targeted treatment for patients."

After the assistant doctor finished speaking, he completely handed over the space in the middle of the room to Tang Lou.

In the center of the room is a patient wearing a mountaineering suit, and on the table to his left, there is a bag of white crystals, and in the cabinet to the right of the patient, there is a slight chill.

Tang Lou continued to observe and found a washbasin and a towel under the hospital bed.

Tang Lou walked over and opened the cabinet, a chill came over him, it turned out to be a bag of crushed ice.

There is a mercury thermometer on the table of another cabinet.

After thinking about it, Tang Lou naturally understood the purpose of the items in the scene, but he still needed to further confirm his guess.

"Assistant doctor, further blood tests, including arterial blood gas and renal function."

"Okay, Doctor Tang."

"You, check the ECG again, looking for cardiac ischemia"

"You, bedside ultrasound, look for pulmonary embolism, assess ventricular function, water load"

Tang Lou issued a clear command and started to use the items in the scene simultaneously.

"Come on, come here and help me move the washbasin here."

Tang Lou himself poured the crushed ice from the cabinet into it.

"Saline."

When Tang Lou was busy, some interns in the review room were a bit confused.

"What is he doing?"

"I don't know, but it looks amazing."

"Make a cup of ice cream? Wake up the patient."

"No, no, actually, he just wanted to challenge with an ice bucket."

"I think maybe he wants to tell everyone that the patient is already cold."

"."

When the eliminated contestants in the back row were shuffling their wits, the directors in the front row were different, with approving looks on their faces.

As the so-called layman watches the fun, the expert watches the doorway.

Niu Bolin directly told the purpose of the tenement building to the students in the back row:

"In this patient, it was clearly a shock initial rhythm out-of-hospital arrest, or OHCA. In such a patient we should be cooling to prevent secondary brain injury, which is called therapeutic hypothermia."

"If conditions permit, the ice blanket machine cooling method is naturally the best choice, but in the background, it is obvious that the patient is located in a remote mountainous area due to hiking, and the hospital must be in extremely poor conditions, so how to carry out cold therapy?"

"Under harsh surgical conditions, first aid is the time to test the ability and level of an emergency doctor. For example, Tang Lou is currently using the simplest but practical cold wet compress."

After the rest of the medical staff completed the inspections required by Tang Lou, Tang Lou simultaneously made ice water in the basin and used the towel as a treatment towel
"First remove all the patient's clothes, then soak the treatment towel in cold water, wring it out, preferably without dripping, apply it on the patient's body, and change it every 3-5 minutes. Monitor body temperature at any time and control it at 32-36°C .”

(End of this chapter)