A new doctor who came to help tried to lift the arm that was in the way, but it didn't move at all.
A disease suddenly appeared in Zheng Ren's mind. He walked into the surgery room and stood behind and took a look.
The system panel was bright red, and several diagnoses appeared in front of Zheng Ren.
Zheng Ren ignored diagnoses such as inguinal hernia and gallbladder stones. He paid attention to a simple diagnosis of malignant hyperthermia!
This disease... can be called a disease. The incidence is extremely low and it only appears when exposed to anesthesia.
It is one of the hidden dangers that the anesthesiology department is most afraid of.
Malignant hyperthermia is an inherited disease characterized by hypermetabolism. It is triggered after the patient is exposed to certain anesthetic drugs, and non-depolarizing muscle relaxants can delay the onset.
"Stop the anesthetic!" Zheng Ren shouted in a deep voice the moment he saw the diagnosis on the system panel.
None of the busy doctors and nurses had any idea. When they heard someone speaking, and the words were full of dignity and the unquestionable authority of the superior doctor, no one thought much about the reason. The anesthesiologist immediately stopped the anesthetic.
"Danquluolin, do you have any medicine ready?!" Zheng Ren almost shouted.
“…”
“…”
There was confusion in the operating room.
Dantrolene, what the hell is this
"Is it malignant hyperthermia?" The chief director of the anesthesiology department ran in from outside. He was tall and bear-like, and his mere presence could give people a strong and violent sense of oppression.
"Yes!" Zheng Ren looked at the patient and said without hesitation.
Not only the diagnosis on the system panel, the patient's severe convulsions, spasms, skeletal muscle stiffness, profuse sweating, and other symptoms are the most typical manifestations of malignant hyperthermia.
The temperature was not taken, but Zheng Ren believed that the patient's temperature was at least above 40 degrees Celsius.
The director of the anesthesiology department strode to the patient's side, and the doctors and nurses on both sides consciously moved out of the way.
After making a simple judgment, he hurriedly said: "The temperature of the cooling blanket is not low enough. Find other things to speed up the cooling."
After saying that, he immediately took out his mobile phone and dialed.
"I want a helicopter, go to Concordia. I want dantrolene. A patient has sudden malignant hyperthermia!" The voice of the director of the anesthesiology department was like a bell, and the whole operation room was trembling slightly.
Malignant hyperthermia is an extremely rare genetic disease and there is no way to prevent it. Moreover, the only hospital in China that conducts research on malignant hyperthermia is Union Medical College.
The caffeine-halothane isolated skeletal muscle contraction test has been carried out in the Department of Anesthesiology of Union Medical College. As for dantrolene, a specific drug for treating malignant hyperthermia, only the Department of Anesthesiology of Union Medical College has it nationwide.
Zheng Ren has read several reports, most of which are case reviews written by doctors from the Imperial and Magic Capitals. When doctors in Shanghai encountered this situation, they could only helplessly watch their patients die.
Not for anything else, just because there is no specific medicine.
In the Imperial Capital, because Xiehe is here, there is another option. (Note 1)
But even if a helicopter is called, it is still difficult to say whether the patient's life can be saved before dantrolene is obtained.
"Increase the oxygen flow and use the mask to inhale oxygen!" Zheng Ren shouted: "Increase the oxygen flow to more than 10l/min!!"
"Ice saline, sterile ice saline, intravenous administration, the fastest!"
"Monitor your temperature! Don't stop!"
"2 bottles of sodium bicarbonate for intravenous injection!"
"Hurry up, who is dazed! Hurry up and push the sodium bicarbonate quietly!"
"Nurse, take blood!"
"Instrument nurse, get off the stage! No need for sterility! Hurry up and collect blood, ions, and blood gases. Send them as soon as possible after collecting them. Tell the laboratory department that it's an emergency!"
Zheng Ren's roar kept ringing in the operating room, and he forgot his identity.
Although he had always avoided doing things on his behalf, which aroused the resentment of the doctors at the 912 Hospital, when he encountered a sudden serious illness like malignant hyperthermia, Zheng Ren threw everything behind him.
The sky is big and the earth is big, can it be bigger than a human life
"Call someone again to help with physical cooling. Where is the circulating nurse! Head nurse! Take the time to see if there is enough frozen salt water!"
Zheng Ren roared, seemingly crazy, but in fact he did not lose his mind. He has been calmly and calmly observing the patient's vital signs on the ECG monitor.
The patient's electrocardiogram initially showed shortening of the qt interval, high and symmetrical t waves, and a narrow and tent-shaped base.
Soon, Zheng Ren noticed that the P wave amplitude on the electrocardiogram decreased, the PR interval lengthened, and the P wave disappeared!
This is a sign of hyperkalemia. Although the test value has not come out, Zheng Ren can be sure with a high probability that the patient's blood potassium value may have exceeded 8mmol/l, or even reached the fatal level of 10mmol/l.
"Calcium gluconate, 5000mg, intravenous injection!" Zheng Ren narrowed his eyes, stared at the waveform of the ECG monitoring, and shouted.
"5000..." A nurse who had just arrived to help was shocked.
For clinical use, the limit dosage of calcium gluconate is 3g, which is 3000mg. 5000mg, is this amount really okay
The director of the anesthesiology department frowned and looked at Zheng Ren carefully. He didn't recognize him.
Whose doctor is this? Why are you directing the rescue here? But every one of them was timely, except for the excessive use of calcium gluconate.
He strode to Zheng Ren and asked in a deep voice, "Is it okay to exceed the limit?"
"The P wave is gone!" Zheng Ren stretched out his hand, pointed at the ECG monitor screen with his finger, and shouted, "The heart is about to arrest!"
Generally, in case of cardiac arrest, defibrillators, chest cardiac compressions, etc. can be used to rescue the patient.
But for patients with malignant hyperthermia, defibrillators are completely useless. And his whole body was stiff, like a stone, and he couldn't press his chest at all.
Zheng Ren was thinking that if his heart stopped, the effect might be better if he directly opened the chest, performed chest compressions under direct vision, and cooled the body with ice salt water.
However, this method is too extreme and intense, so it should be used as little as possible. And even if it was cut open, the internal and external intercostal muscles would be so tight that it would be impossible to even reach in.
The director of the anesthesiology department took a look at the electrocardiogram and knew that Zheng Ren was right, so he immediately asked the nurse to inject 5000 mg of calcium gluconate.
"How much urine output!"
"..." The operating room was already very busy, and no one was monitoring urine output. Zheng Ren stared closely at the ECG monitor. After he finished asking, there was silence around him.
The director of the anesthesiology department was stunned for a moment, then squatted down, looked at the urine bag, and said: "About 20ml."
"20... no, 80mg furosemide intravenous injection!" Zheng Ren said: "Monitor the urine output and keep it at 50-100ml/hour."
"Hyperventilate!"
"Yes, hyperventilation must be done excessively!"
"Have the test values come back yet? If not, go and get them!"
Instructions one after another echoed and surged in the operating room in an orderly manner.
More than a dozen doctors and nurses flew up without touching the ground.
And that arm was stretched out stiffly, as if made of iron, and it was constantly spasming and twitching at its own frequency.
…
Note 1: Beijing Sanbo Hospital also seems to have a sufficient amount of dantrolene in reserve.