C19 Sick

Xie Hui was lost in thought.

At that time, Chen Shaoguang's electrocardiogram had an abnormal fluctuation. The room started to tremble and he started to cough violently.

His blood pressure also started to drop.

The nurse in charge immediately sent out the notice of "critical condition. "

Xie Hui was already stunned on the side.

In his expectations, the current situation would not occur at all.

Zhao Wenxin rushed over anxiously and accompanied Liu Handong to rescue him.

"Mechanical auxiliary phlegm removal!"

"infrared treatment!"

"[Major resuscitation. . . ]"

Following Liu Handong's medical instructions, Chen Shaoguang's condition gradually stabilized.

"When it is necessary to suck phlegm. . . "

"Protective confinement Pran. . . "

"Blood oxygen saturation monitoring, electrocardiography monitoring, critical condition monitoring, ICU care routine. . . "

"Injection using Omeprazole Osikang [40 mg * 1]. "

"5% glucose injection (Asian soft bag). 5% 100 ml x 1 bag. "

"Sodium Liver Injection [2ml] 1. 25 million. [Ux10] / Box "

" 0. 9% sodium chloride infusion amphetamine. 500ml * 1 bag. "

"5% glucose infusion (subjugation bag). 5% 100 ml x 1 bag. "

"[Pericelestial Treatment Routine Treatment Routine through right femoral artery]"

" Postoperative care routine through right femoral artery Postoperative treatment for right femoral artery "

"There's a blood flow Monitoring Monitoring Bed next to it Postectal Cardiovascular Cardiovascular Cardiovascular. "

"Pressure bag to rinse the pipe. "

"Sodium heparin injection [2ml] 1. 25 million. [Ux10] / Box "

" 0. 9% sodium chloride infusion amphetamine. 500ml * 1 bag. "

"The right cervical intravenous vessel is placed in a tube to change the medication for PRN. "

"Postectal care routine through PICCO in the left venous artery. "

"Postoperative care for the left carotid artery through the catheter. Prn. "

"5% Glucose Injection (Abon Soft Bag). [5% 100 ml x 1 bag]"

"[Hydrogenic sustainable pine intravenous pump]"

" Continuous Blood Purification (Mechanical Technique) "

"Wolfberry acid is resistant to coagulation outside the body. "

"Place the blood vessel in the tube to change the medication. "

"Calcium chloride is being pumped into the venous vessels. "

"Perineurium continued to pump into the venous vessels. "

. . .

The condition changed, the patient was in a coma during the resuscitation, and the trachea was inserted. The ventilator assisted the ventilation. The pancreatic epinephrine was injected with 80 ug / min continuous intravenous pump. Patient's blood pressure is at 108 / 58 mHg, lactic acid measuring 8. 0 ml / l, Considering that the patient was suffering from severe infectious shock, he immediately activated the sepsisbulle. He left the relevant education and gave Tai an anti-infection treatment. He monitored the patient's infusion indices. Receiving critical report from the Medical Laboratory Department: Fiber Protein: 0. 3g / L, monitoring the obvious decline of the patient's Fiber Protein. Considering that it was related to serious infections, in order to avoid bleeding, Immediately apply for cold sediment infusion and monitor the patient's blood coagulation function.

Patient with severe infectious diseases, infectious shock level AKI 3. To perform capacity management, remove inflammation mediums, improve kidney function, and carry out CRT treatment. Therefore, right venous vessels were inserted into the double vena catheter by the bedside. The patient was placed flat on the bed, and the ultrasonography checked to see the right venous vein and femoral artery accompanying the patient. The femoral vein was located inside the femoral artery, and when the patient pressed on the venous vein with his head, he could see that the venous vein had collapsed. The 2cm ultrasonography point below the ligament of the abdominal trench was selected as the puncture point, and the local disinfection and draping were selected. 2% lidocain perpendicular anesthesia, under the guidance of ultrasonography, He tested the puncture point to the umbilical cord and inserted it into the skin at 30 degrees. He then drew back the dark red blood. Excluding the needle, the needle was inserted along the original way. He drew back the dark red blood and fixed the needle. The needle was inserted into the wire and the needle was removed. After the expansion of the skin and subcuticular tissue, he inserted the thread into the double venous deep vein catheter. Removing the thread, sealing the heparin water, The external stitch was fixed on the catheter, and it was covered with sterile gauze. There were no obvious changes to the signs of life after surgery. After setting the catheter, he gave CRT treatment to the bedside. Model CVH, treatment parameters: Bleed at 180ml / min, First diluted: 2000 ml, then diluted: 2000 ml. Ultrafiltration rate: 43. 6 ml / kg. Cancer acid anticoagulation: 180 ml / h, 10% calcium chloride 10ml / h, simultaneously substituting solution formula: physiological saline water 2500 ml + injecting water 850 ml + 10% GS10ml + 5% sodium carbonate 200 ml + 10% nitrogen chloride 12ml + 25% magnesium sulfuric acid 4ml. Zero balance.

The operation went smoothly. Postoperative precautions were to strengthen local care.

Experiment lab inspection indicators HB120g / L HCT40. 4; PLT54 = 109 / L; PT23. 6; [PT46. 5S]

Evaluation and purpose of blood transfusion. [According to the clinical symptoms and laboratory test results, the patient's PT and AP TT are estimated to be 1. 5 times more than normal. ] The infusion of blood was used to supplement blood coagulation, fibrous protein, and unstable blood coagulation (VIII, XIII, VWF). Cold infusion sediment. Type of blood transfusion ingredient: Decaying suspended red blood cells, frozen blood plasma, platelets, cold sediment blood coagulation factor, and other factors.

Injecting blood: Unit 9. 75% Healing: 575 milliliters.

Chen Shaoguang needed to be inserted into the dual catheter through the right side of the cervical vein. The operation was more or less to say that the patient's condition was critical. In order to open the venous channel, he needed to further monitor the blood dynamics. Therefore, he performed a ultrasonography on the right side of the bed to locate the double vena cadaver of the intravenous vessels in the right side of the neck. The patient took a lying position and took a pillow to lie on. His head was lowered by 20 degrees, and his neck was exposed. He turned his head to the left. Under the ultrasonography at the bedside, the cervical vein could be seen. When the head was pressed, the vein could be seen collapsing. After localizing the location near the triangular peak of the carotid artery, disinfecting and draping the area, 2% lidocain pericellular anesthesia, Under ultrasound's guidance, the needle was inserted at 30 degrees into the skin, and deep red blood was extracted. Excluding the test needle, the needle was inserted along the original test path. When the needle was retrieved, dark red blood was seen, and the needle was fixed. The needle was inserted into the wire and the needle was removed. After the expansion of the skin and subcuticular tissue, he inserted the thread into the double venous deep vein catheter. Removing the thread, sealing the heparin water, The external stitch was fixed on the catheter, and it was covered with sterile gauze. The depth of the catheter was 13cm. There were no obvious changes to the postoperative signs of life after surgery. The postoperative catheter was connected to the pressure switch to measure the venous pressure in the center of the catheter, which was 10mHg. The result: The operation went smoothly, and the postoperative precautions were strengthened. Maintain local dryness.

In addition, PICCO tubing also needed to be carried out immediately. The patient suffered from infectious pulmonary shock. In order to monitor the changes in blood flow, PCCO catheter was inserted into the left femoral artery by the bedside through the left artery. The patient took the pillow and laid flat on the bed. The ultrasonography at the bedside showed that the left femoral artery and femoral vein were accompanying the patient. He chose the lower part of the left ventral ligament, 2. 0cm below the left ventral ligament. The most powerful part of the femoral artery pulsation was the puncture point, local disinfection and draping. After 2% lidocain was sedated layer by layer, under ultrasonography's guidance, The puncture needle went in the direction of the navel, forming a 30 degree infusion needle with the skin, and when it was pulled back, bright red blood could be seen. Stabilizing the needle, inserting the wire from the needle. After removing the needle, he expanded the skin and subcuticular tissue. PICCO catheter along the wire, removing the wire, The arteries pressure transformer measured blood pressure 129 / 62 mHg, blood pressure 129 / 62 mHg, blood pressure. . . He sutured it with a fixed catheter and covered it with sterile gauze. The whole piercing process went smoothly. The patient's condition did not change. Surveillance of blood energy indicators: HR128BPM, MP77MHG, CVP10MHG, C4. 21L / M2, MI2. 28L / M2, SV32. 9ml, SVI 17. 1ml / M2, SVR1216DYN S. CM-5, SVI 2249DY. M 2. CM-5.

In the end, the operation went smoothly. Postoperative precautions were taken to strengthen local care and maintain partial dry.

After a while, Chen Shaoguang finally pressed the pause button on the way to the Grim Reaper.