Sleepless Doctor

　　Various pipelines have been replaced with new ones under the swift action of medical staff, which prevents the sporadic problems of pipelines to the greatest extent.

　　 The rescue medicine has entered the patient's body, and the rescue is being carried out in an orderly manner. There is enough time, Wu Mian has his own judgment.

　　 However, patient words put more pressure on the anesthesiologist.

The background "music" is the alarm of various instruments. Radial artery puncture monitors blood pressure invasively. The value displayed on the screen fluctuates constantly. Although the cliff-like fall is stopped under the action of large doses of rescue medication, it can only be maintained at a very high level. Low value.

　　 The anesthesiologist was already wet with sweat, and he kept tilting to the side and back slightly at an angle with a weird posture, and a nurse wiped his sweat. But his eyes dared not leave the B-ultrasound screen for a second, and he meticulously executed every word of the unknown teacher behind him.

　　 Although I don’t know who is behind me, the various professional vocabulary and the order of rescue, especially when I didn’t worry at the beginning, I did a differential diagnosis first to find a correct way, which made Ren Haitao, an anesthesiologist, feel more confident.

　　 is definitely a big cow, otherwise who would dare to do this. Although there is a big cow directing the rescue, Ren Haitao is not sure that the rescue will be achieved.

　　 Just go all out, he really tried his best. Anesthesiologists are professionally sensitive, and they subconsciously look at them when they hear alarms from monitors, ventilators, and other instruments.

　　 But he knows his responsibility.

　　 "Sonuo phased array probe P21, in M ​​mode, the sampling line is placed about 2cm away from the right atrium-inferior vena cava junction, and the maximum and minimum diameters are measured."

　　 "The IVC is obviously slender, with a diameter of <1cm, indicating insufficient capacity and capacity responsiveness."

　　 The anesthesiologist is very nervous. Generally, there is a very complicated calculation formula to do this.

　　 Mechanical ventilation breathing variability—IVC inspiratory expansion rate=(IVCmax-IVCmin)/IVCmin. I usually let myself count, and it takes at least two or three minutes to hold a pen and paper.

　　 Now, two or three minutes may determine the life and death of the patient.

　　 Quite complicated calculation formula, quite cumbersome calculation process, quite... Anyway, thinking of this formula makes Ren Haitao a headache.

　　 This is not the college entrance examination, but it is more difficult than the last big question in the college entrance examination, countless times more difficult.

　　 But the big cow's voice behind him didn't say any value, just adjusted the infusion volume and continued.

　　 The anesthesiologist was startled slightly. He didn't think that the calm and confident man behind him commanding the rescue could not even use this formula. The various remote controls before him proved that he had studied deeply in e-FAST.

　　 It must be the big cow who calculated the result in his mind, and the infusion guided by the result was just there... the anesthesiologist was just a moment of surprise, and Wu Mian's voice behind his back became severe, like a knife on Ren Haitao's back.

　　 "Anaesthetist, concentrate!"

　　 He didn't scold anyone, but the anesthesiologist felt more scared than scolding himself.

　　 Under the crushing of the technical level, the anesthesiologist has already developed an emotion called fear in his heart.

　　 "The probe is placed at the apex of the heart, 1 to 2 cm inside the midclavicular line of the fifth intercostal space on the left, slightly upward, and the direction sign points to the patient's left shoulder."

　　 "Slide... the probe is first placed on the long axis of the left ventricle next to the sternum, and slide the probe toward the apex of the heart. Well, well done."

　　 "Pay attention to the interventricular septum, pay attention!"

　　 "When the interventricular septum just disappears, rotate the probe 90 degrees clockwise...turn!"

　　 "Push the end of the probe down slightly and tilt the probe so that the ultrasound beam points to the right shoulder. Yes, that's it."

　　 The B-ultrasound probe is constantly walking back and forth between the heart and the inferior vena cava, and the infusion sequence is often adjusted according to the images provided by the B-ultrasound.

　　 A large amount of rapid expansion under the guidance of cardiac B-ultrasound, the colloidal fluid was changed to succinyl gelatin, with crystals interspersed in the middle. Elevate the lower limbs by 15°, and increase the return of the heart blood volume with the posture.

　　 Sometimes the crystal is given at full speed, sometimes it is to advance the subsequent colloid, and sometimes it is necessary to reduce the infusion speed.

　　 At first, there were people who pondered and thought about it, such as the anesthesiologist who was being rescued.

　　 Soon, everyone's thinking can no longer keep up with Wu Mian's speed, and they are doing their best without time, let alone thinking.

　　 Everyone has become a puppet, letting the hand behind it control it.

　　 Time passed by one minute and one second, and the patient's blood pressure fell steadily and slowly rose. Various values ​​gradually returned from the critical value to the lower limit of the normal level.

　　 Measured lactic acid 3 times, pumped KCl4g, calcium gluconate; dripped 250ml sodium bicarbonate intravenously to correct body acidosis and electrolyte balance disorder.

　　 I don't know how long it has passed, and the beeping urging voice gradually weakened.

1 second…

10 seconds…

60 seconds…

　　 The clear command voice did not appear. Someone wondered if the rescue was successful?

　　 Impossible things happen in front of you, no matter how true it seems, it will make people feel unbelievable.

2 minutes…

5 minutes…

"Professor Wu…"

　　 "Prepare for mannitol."

　　 Director Xu and Mian Wu of the Anesthesiology Department said at the same time.

　　 "..." Director Xu of the Anesthesiology Department buzzed. UU reading www.uukanshu.com

　　 The patient's blood pressure returned to 70/45 mmHg, which is considered to have temporarily got rid of the fatal shock state. In Director Xu's opinion, at this time, we will accept the patient and send the patient to ICU for a few days for recuperation.

　　 The next troublesome thing is how to explain to the patient's family and strive for the patient's family's understanding.

　　 This kind of shock that comes and goes without a trace, no one wants it to be.

　　 But Teacher Wu Mian actually gave it to mannitol!

Mannitol is a very common and commonly used medicine. It is a good diuretic that reduces intracranial pressure, intraocular pressure and treats kidney drugs, dehydration drugs, sugar substitutes, and is also used as an excipient for tablets and solid and liquid drugs. Thinner.

　　The patient is still in shock, so he should give mannitol in a hurry. What if the shock cannot be controlled?

　　 But he blamed Teacher Wu Mian's doctor's orders in person, and Director Xu couldn't do this kind of thing.

　　 It's not that I can't, it's that I dare not.

　　 Not to mention the series of glorious history before Wu Mian, and just the rescue process just now, tell everyone clearly how strong this teacher Wu is.

"Give it, I know it in my heart." Wu Mian smiled slightly, and said, "Generally, patients with anaphylactic shock will have complications of increased intracranial pressure. If brain tissue edema is not controlled in time, there is a 2.23% possibility. There will be serious consequences."

　　Severe consequences refer to brain death, and the patient becomes a vegetative, as everyone knows.

　　 But mannitol...low blood pressure...shock...

　　 These few contradictory nouns are combined, which makes people feel at a loss. The rescue was successful just now, and the patient got rid of hypotension. If this is given to mannitol, what should I do in case of shock again?

　　 "Ms. Wu, is 250ml enough?" Director Xu hesitated for a few seconds before asking in a low voice.