night shift.

Lao Ma from the emergency department called and said that there was a young female patient with low back pain and urine. She was in a bad condition. She hurried down to take a look.

Is your blood pressure OK? I asked.

After barely helping, Lao Ma said that the infection is very serious, so I will see the patient first. Before I could reply, Lao Ma had already hung up the phone.

I briefly explained to the nurse, put on a white coat and hurried to the emergency department.

When I arrived at the emergency department, I saw Dr. Sun in the urology department. I had a clear idea. It was probably a problem with urinary tract infection. If urinary tract infection occurs, it may be very dangerous. Some time ago, a young man died because of this, and we almost got into a lawsuit. So when we met such patients, everyone was trembling.

Lao Ma came over and told me that the patient was very young, had low back pain and had almost 2 days of urine. He took some medicine at the community hospital, but the effect was not good. The back pain was even worse tonight and he had fever, so he became nervous and came to see the emergency department.

Before I could see the patient, Lao Ma took out a stack of test sheets, including B-ultrasound and chest X-ray results, and handed it to me, saying that the B-ultrasound saw the left kidney, ureteral stones, and moderate to severe hydronephrosis. The infection index was very high, with more than 30,000 white blood cells. It should be no problem to diagnose urinary tract infection.

The blood in the human body flows in the blood vessels. When it flows to the kidneys, part of it will enter the ureter to form urine. If stones are blocked by the ureter, the urine cannot be discharged into the bladder smoothly, resulting in water accumulation in the ureter and kidneys. It is nothing simple. The key is that there may be bacteria on the surface of the stones, and the water will rot if it does not move. As more and more water accumulates, those bacteria may flow back into the blood, causing sepsis. In severe cases, septic shock or even multiple organ failure, which is extremely dangerous!

How about blood pressure, I asked Lao Ma.

Lao Ma signaled me to go to the bedside to see the patient. At this time, Dr. Sun from the urology department was already checking the patient.

The patient is a 24-year-old young woman. She just graduated and went to work nearby. She was in good health before, but for the first time she found out that she had kidney stones, which was both nervous and confused.

The patient was accompanied by her boyfriend. Lao Ma said that they were planning to get married at the end of this month, but they didn't expect such a thing to happen. It seems that the wedding date has been postponed.

You know all this, I asked Lao Ma in a low voice.

Lao Ma said that the tall and thin boy outside the door of the emergency room was her boyfriend, and he told me when he signed the letter.

I'll ask what to sign.

I signed the ICU for treatment, Lao Ma stared at me. My blood pressure was like this. Look, as soon as I entered the rescue room, my blood pressure was only about 90/50mmHg. I considered that she had septic shock and had a lot of fluids, so I almost had a pressure booster.

Only then did I notice the patient's condition.

The patient was lying on the rescue bed, curled up, probably because of severe back pain, his face was a little pale, his brows were frowning, and his expression was painful. But he was still clear and he was listening to us.

Electrocardiogram monitoring indicates that the blood pressure is 90/50mmHg, the heart rate is 119 beats per minute, and the blood oxygen saturation is still normal. The breathing is basically normal. The patient's heart rate is so fast and his blood pressure is too low, so he is probably in shock.

After seeing the patient, the three of us stood at the end of the bed and began to discuss the patient's removal.

Lao Ma asked Dr. Sun if he wanted to have surgery immediately and whether he would dare to undergo percutaneous nephrostomy drainage first.

Dr. Sun was a little hesitant and said that in theory, such kidney stones, ureteral stones and water accumulation and infection, the effect of using antibiotics alone will definitely not be good, because the stones are constantly blocked and you do not clear the ureter and let the urine be excreted. The infection will definitely not be well controlled, but it is not realistic to break the stones if you directly pull it on the operating table, because the patient is not suitable for lithotripsy surgery in this current situation, which is very risky and may not be tolerated.

Lao Ma and I agreed with Dr. Sun’s opinion.

You can consider doing percutaneous renal puncture and fistula first. As Dr. Ma said, temporarily draw out the accumulated water, ignore the stones first, and wait until the infection is controlled, and then do the second gravel stone removal surgery. Dr. Sun added.

Then go to your department for surgery first. If the situation is not good, you can arrange to go to the ICU. Lao Ma said with a smile.

Dr. Sun did not agree immediately, but said that the patient's blood pressure is low, his heart rate is fast, and his skin is also cold, and he is considering shock. At this time, even if he simply had an fistula, the risk would be quite high. Otherwise, he would go to the ICU first and use powerful antibiotics to see if the infection can be slightly controlled, and at the same time, anti-shock treatment should be treated to see if the vital signs can be further stabilized. At that time, it might be safer to have an fistula.

We understand Dr. Sun's idea.

But this is risky after all. If the antibiotics have poor anti-shock effect, you still have to bite the bullet and do nephrostomy to drain urine and pus. Moreover, the infection has always existed, so it is worth being wary of whether the antibiotics will be effective. It is very likely that the antibiotics will not work.

We told the patient's boyfriend that the tall boy was quite responsible and said that he completely agreed with the doctor's approach, but was it enough for me to sign alone? Should I ask my girlfriend's parents to come? But they are all in their hometown, so it may be tomorrow morning when they arrive at the hospital.

It can be seen that he was a little panicked, but even though he was panicked, his concern for his girlfriend was obvious to everyone.

I told Lao Ma that the patient is still awake now and she can sign it herself. Let’s go to the ICU tonight and see what will happen tomorrow.

Before going to the ICU, you can have another abdominal CT examination to see clearly, and the operation will be convenient at that time. Dr. Sun recommends.

That night, Lao Ma pushed the patient to the CT room, but fortunately the process went smoothly.

It was almost midnight when the patient arrived at the ICU.

The CT results also showed left kidney stones, ureteral stones and hydronephrosis infection, and perirenal ooze. In addition, no other problems were seen. The pancreas is good, the gallbladder has no stones, and the appendix is ​​also very good. The patient diagnosed kidney stones, urinary tract infection, and septic shock.

We became nervous as soon as we entered the ICU, after all, we were such a young patient.

I left blood culture for the patient and urine culture (and a little bit of urine), and at the same time I used imipenem to treat infection. imipenem is a very advanced antibiotic, so I can try to control the infection as soon as possible.

The patient was still awake and was a little afraid of the ICU. He asked me if her boyfriend could come in and accompany her. I said sorry, this place is closed management. If your boyfriend can come in, you should be stronger. If you have anything you want to tell him, I can tell you for you.

She thought for a moment, shook her head, and said that there was nothing special, but she was a little scared. I saw that her face was pale, but her painful expression seemed to be a little better than before.

You can treat it here with peace of mind, you will get better. We have dealt with many cases like you. Don’t worry, it’s a bit hard to live in the ICU. I comforted her and said.
Chapter completed!