Chapter 300 The sleepless night is about to begin

Author: Favorite fried potatoes

Chapter 300 The sleepless night is about to begin

Returning to the ward and seeing Zhao Heng with a solemn expression, Liu Meng couldn't help but ask: "Dr. Zhao, is this confirmed?"

"Yes, it has been confirmed. The patient is 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 read a report before that a 43-year-old man in Shenzhen City was playing in the water in a scenic spot. From the onset of headache and coughing to death, it only took two weeks. After testing, the patient was confirmed to have Naegleria flexneri.

Lymebic meningoencephalitis (PAM).

It’s really scary to think about it. After being infected by this brain-eating worm, you will initially feel nausea, headache, and fever. Then the symptoms will worsen: back pain, hallucinations, difficulty concentrating, and the patient usually dies within two weeks.

"Dr. Zhao, how should we treat it now?"

He was always a professional doctor. After a brief shock, Liu Meng quickly came to his senses and asked Zhao Heng.

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

"First, we need to reduce intracranial pressure, secondly, we need to maintain adequate cerebral perfusion to avoid further ischemia and hypoxia, and finally we need to prevent the occurrence of cerebral herniation."

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

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

Liu Meng asked again.

Mannitol is the most commonly used osmotic diuretic drug in the clinical drug treatment of acute cerebral edema. The main clinical application is 20% mannitol. Due to its strong effect and rapid excretion, in most cases, it is used to treat acute cerebral edema.

The drug of choice for edema.

Compound glycerol has similar pharmacological effects to mannitol and is also a hypertonic dehydrating agent, but it does not have the adverse reactions of mannitol such as rebound, electrolyte disorders, kidney damage, etc. It is especially suitable for cerebral edema where some organs have dysfunction and failure.

patient.

Finally, furosemide, as a powerful diuretic commonly used in clinical practice, is also an important choice in the drug treatment of cerebral edema. Furosemide can inhibit the reabsorption of chloride ions and sodium ions in the medullary and cortical parts of the ascending branch of the medullary loop.

, affects the formation and maintenance of the hypertonic state of the renal medulla, weakens the concentration function of urine, promotes the excretion of large amounts of chlorine, sodium, potassium ions and water, thereby producing a powerful diuretic effect and reducing cerebral edema.

"It can be used in combination, but for the treatment of cerebral edema, we cannot simply use dehydration. We must also prevent and treat cerebral vasospasm and pay attention to improving cerebral blood flow."

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

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

"Yes, nimodipine is a dihydropyridine calcium channel blocker. It can inhibit the contraction of vascular smooth muscle by inhibiting the entry of calcium ions into cells. It also has a certain therapeutic effect on nerve damage caused by cerebral edema. And mild hypothermia

Treatment can regulate cerebral blood flow, reduce cerebral oxygen metabolism, 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 neuronal ubiquitin.

Reduce neuronal necrosis and apoptosis and promote the recovery of intercellular signal conduction."

"Dr. Zhao, your treatment plan can be said to be the work of God!"

Liu Meng said in amazement.

Before coming to the ward, she had only heard that Zhao Heng's level of diagnosis and treatment was very high, but now she discovered that this level was not only high, but extremely high.

It can be said that for the treatment of emergencies such as cerebral edema, even the experienced emergency department director Song Siming may not be able to come up with such a complete treatment plan during actual treatment.

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

Without extremely rich experience, a very 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.

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

Zhao Heng said indifferently. He was very indifferent to Liu Meng's exclamation. He had seen this kind of surprise on the faces of many people.

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

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

"Well, I'm used to working overtime in the emergency department. Doctor Zhao, I may not be as good as you in terms of medical treatment. But if you want to know which takeaway restaurant is delicious, I know better than you."

Liu Meng said with a slight smile.

It is very pleasant to work with Zhao Heng. As for working overtime, this is a common occurrence for doctors, especially those in top tertiary hospitals like Oriental Hospital.

It would be strange if I didn't have to work overtime any week.

"Then let's start with the treatments we just mentioned. Pay close attention to the patient's condition. I'm in the office. If you have anything, come and tell me at any time."

Zhao Heng nodded and said, Liu Meng is still very good and very professional, but he needs to be more open-minded in his thinking.

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

When it comes to treatment methods, no matter how cutting-edge or high-end they are, in a modern society where information is extremely developed, as a doctor, you have heard of them.

But whether a patient can be cured or not, there are actually 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 treatment. Although textbooks provide treatment plans for certain diseases, they are all statistical probabilities and data, and they are not applicable to every patient.

There are great individual differences between people. In a specific individual, the changes in the condition are also very complex. This makes it even more necessary to prescribe the right medicine and add your own understanding to the basic treatment plans provided in textbooks.

.

These two points sound very simple, but it is a very difficult thing to really do it. Many doctors, after working for decades, may not be able to touch this edge and reach this state.
Chapter completed!