The person who was pushed into the emergency room this time was a middle-aged man in his forties with a slightly obese body.
He was seen lying on a stretcher, breathing irregularly. No matter how Chen Xia called him, he did not respond. It was obvious that he was unconscious. The key point was that the patient had paroxysmal spasms in his left limbs, twitching.
Chen Xia quickly asked, "What's wrong with the patient?"
"Doctor, we don't know what happened. We were playing mahjong tonight, and Lao Qin got a good card. He shouted excitedly, and then suddenly he started having a severe headache and vomiting non-stop. He passed out a short while later, and we rushed him over."
Chen Xia thought that this was usually a stroke, the most dangerous type of emergency.
But Yuezhou Fourth Hospital doesn’t have a neurosurgery department or a brain surgery department, so I’m doomed.
"Quick, Wan Lu, monitor vital signs and open an intravenous line. Wu Shaochen, go to the Third Surgery Department and call the doctor on duty. Tell him it might be a cerebral hemorrhage and request an emergency consultation."
After giving the instructions, Chen Xia immediately underwent a physical examination.
The patient was already in a coma. His left pupil was 2mm and his right pupil was 3mm, of different sizes. His light reflex was dull. Lung fields were clear on auscultation. His heart rate was 120 beats/min, regular. The right pupil had a positive Babinski sign.
"Wan Lu, report your blood pressure."
"220 on top, 130 on bottom."
Chen Xia took a deep breath. What had he done wrong today? Why did he encounter three patients with hypertension emergency room in one night?
"Don't throw away the blood pressure monitor, always measure it."
Chen Xia was anxious now. He suspected it was a cerebrovascular accident, but without emergency CT and MRI, he couldn't confirm it, and ordinary X-rays were of no use at all.
However, the patient's condition was very critical and he entered a strange state. His breathing was sometimes fast and sometimes slow, and his heartbeat was getting slower and slower. The key point was that his blood pressure was also very low. The second measurement returned to 140/100 mmHg.
This fluctuating pattern often indicates the formation of brain herniation. If it reaches this stage, with current medical technology, the patient is already beyond saving.
"Lin Chenxing, quickly put him on mannitol. Where are his family members? When will they arrive?"
At this time, several people rushed in from outside, one of them was a woman who came in howling.
As soon as he entered the emergency room, he immediately jumped on the patient and said, "Lao Qin, Lao Qin, what's wrong with you? Ah, Lao Qin, you can't die!"
Chen Xia didn't bother to say too much and asked hurriedly, "Are you the patient's family members?"
A middle-aged man stepped forward and asked, "Doctor, I am the patient's brother. How is my brother?"
"The situation is very grim. The patient has suffered a cerebral hemorrhage, and based on his symptoms, he may have developed a brain herniation. We have issued a critical illness notice, so please be mentally prepared."
At this time, the doctor on duty in the Department of Surgery III also arrived. After an examination, he also highly suspected brain hernia.
Du Guobiao finally emerged from the operating room and inquired about the patient's condition. Chen Xia explained everything in detail. He then repeated the physical examination, revealing exotropia, bilateral dilated pupils, and a loss of light reflexes.
When Director Du looked up and saw the rapid intravenous drip of mannitol, a barely perceptible complex look flashed across his eyes.
The patient's wife was still screaming, "Doctor, doctor, please save my husband. He is only 40 years old and we have three children."
Chen Xia opened his mouth but couldn't say anything. Several patients' families were called to Director Du's office to explain things.
Brain herniation may not be an incurable disease in a few decades, and there is at least a 50% chance of survival.
But the prerequisite is that once the disease is confirmed, a craniotomy must be performed quickly to remove the cause as soon as possible, such as clearing intracranial hematoma or removing brain tumors.
If the diagnosis is difficult or the cause cannot be eliminated even if it is confirmed, palliative surgery can be used to reduce intracranial hypertension and rescue brain herniation.
But Yuezhou Fourth Hospital does not have a neurosurgery department now. This kind of advanced surgery can be performed in the capital or Shanghai, but not in a small city like Yuezhou, which does not have the technology or ability.
Chen Xia felt a little reluctant, but there was nothing he could do. He couldn't bear to do this kind of surgery either.
The day gradually brightened. After a night of hard work, the blood pressure of the first two hypertensive patients finally dropped slowly after emergency treatment. As expected, they survived this time.
But there are always regrets in life. The third and youngest middle-aged man finally couldn't make it and his breathing and heart stopped suddenly.
Chen Xia and several young doctors performed emergency rescue, but after half an hour, the electrocardiogram was still a straight line.
In fact, this kind of rescue is also done for the family members to see. It is basically impossible for a miracle to happen. Even if the medical level is so advanced in later generations, the mortality rate is still half.
After dawn, the patient was carried back home amid the cries and shouts of his family members.
When the outpatient clinic started working in the morning and the emergency department was empty, Du Guobiao called Chen Xia into his office and closed the door.
"Xiao Chen, there's something wrong with your handling of the third patient today. If you're considering cerebrovascular disease, it's not recommended to lower the blood pressure too low. Generally, maintaining it at around 180 mmHg is sufficient.
If you used mannitol, the intracranial pressure would have dropped sharply, but the hematoma might have expanded further and there might have been further bleeding. You should have used nimodipine to lower your blood pressure first."
Chen Xia was a little confused for a moment, and quickly explained:
"Director Du, I'm following the textbook. It clearly states that mannitol can be used to lower intracranial pressure, reduce cerebral edema, and prevent brain herniation."
Du Guoji continued, "Using mannitol to lower blood pressure has always been controversial. If you lower the blood pressure too much in the case of a stroke, it will further reduce cerebral blood perfusion and aggravate cerebral ischemia and hypoxia."
If it is a cerebral hemorrhage, due to the increase in intracranial pressure, hypertension is a reflex reaction to increase intracranial blood flow. If the blood pressure is lowered too much, the arterial pressure will not be able to counteract the intracranial vascular pressure, aggravating the occurrence of hypoxic encephalopathy and increasing cerebral edema.
Another key point is that your previous diagnosis was all speculation, without any evidence. Furthermore, cerebral hemorrhage does not equal intracranial hypertension, right? So, what are the indications for mannitol use?"
Chen Xia was speechless after being asked this question. It was indeed a bit difficult for him, a surgical expert in his previous life, to answer such a cutting-edge question in internal medicine.
A sense of frustration ensues.
Seeing him like this, Du Guobiao smiled instead: "It's okay. In fact, the outcome of this patient is the same whether he takes the medicine or not. You have done a good job tonight. I am very satisfied. Don't worry about it."
Chen Xia scratched his head. "Old Du, why don't you let me go to the surgical team? I think my surgical skills are better than my internal medicine skills."
"Get lost, this is surgery, not killing a chicken, forget it."
Chen Xia was so upset that she wanted to cry but had no tears. The internal medicine department was simply not a place for people to stay.
Continue read on readnovelmtl.com
