NovelTags Chapter 477
Chapter 477
If you consider "adrenal adenoma",
The whole case of this patient is reasoned as follows:
When an adrenal adenoma is 'excited', the "adrenal gland" secretes a large amount of hormones including dopamine, epinephrine, norepinephrine and so on. This in turn triggers sympathetic excitement – > the heart gets excited, leading to an increase in blood pressure.
Conversely, when the adrenal adenoma is not 'excited', hormone secretion is greatly reduced, which then affects the sympathetic nerves – > the heart 'rests', resulting in lower blood pressure.
this
It perfectly explains the patient's blood pressure, like a roller coaster, up and down.
However, everything has yet to be verified.
Need to check:
urine, to measure the level of relevant hormones and their metabolites
· CT, or ultrasound, to see if there are changes in the adrenal glands.
While the patient's condition is still stable,
Push to do CT now!
The urine in the middle was sent to the laboratory department.
Lin Feng returned to the consultation room and continued to diagnose other patients.
......
After 20 minutes,
The CT results were fed back to Lin Feng.
Really!
· CT results show: there are signs of tumors!
Next, continue to wait for the urine result.
After another hour, the results of the urine test came in.
Urine methoxyepinephrine, 2 times! Other hormones have also been greatly improved!
Sure!
It must be an adrenal adenoma!
And with Lin Feng's experience, the probability should be pheochromocytoma.
Because of changes such as dopamine, epinephrine, and norenaline, pheochromocytoma is the most obvious.
"Doctor Lin, the patient's blood pressure has risen again, 185!"
"Calm..."
Since Lin Feng had already determined what the cause was, he would not fall into a dazed panic, and everything became certain.
"Give guanethidine to patients..."
This is an inhibitor of sympathetic nerves, which can effectively inhibit the excitation of sympathetic nerves and control the heart...
soon
The feedback from the rescue room came back, and the patient's blood pressure was quickly controlled.
At this time, the patient's parents rushed over, and on the way they learned that their son had been rescued, while going to see the patient's son who was still in a coma, and then ran to Lin Feng's consultation room to thank Lin Feng for his kindness.
"Thank you, Dr. Lin!"
"If it weren't for Dr. Lin, my son would be gone! Thank you! "
The old father and mother said happily.
However, Lin Feng did not dare to tell them a fact, although cardiopulmonary resuscitation is timely, it is difficult to say whether the patient will have cerebral hypoxia leading to various sequelae. The patient is so young that he hopes to be able to carry it.
This fact, he only told the patient's wife.
"Doctor Lin, then why does my son just have a headache, and then his heartbeat is gone?"
The patient's father asked in fear.
"It's because your son's adrenal glands have a tumor..."
"Huh? Tumor? "
The two old men almost didn't get scared into a heart attack.
Lin Feng was helpless and comforted again.
In fact, adrenal adenomas, generally benign, are fine if they are removed.
Next
The male patient needs to be hospitalized and then have surgery.
"Laparoscopic tumor resection surgery"!
Only when the tumor is removed can this 'roller coaster' blood pressure be completely cured.
One hour later, the patient woke up and was able to get up and walk, and was stunned when he knew that he was almost dead.
Quickly ran to Lin Feng's consultation room, thanked Lin Feng for saving his life, and apologized to Lin Feng for his ignorance.
......
Conclusion: If the effect of antihypertensive drugs is not good, it may be the wrong drug, or high blood pressure caused by other reasons, try to find out.
......
......
At this point,
6th floor, Hand Surgery,
A quarrel between family members and doctors is raging.
"Doctor, my son's finger, when it was delivered, the finger was brought, and the finger was fine, you tell me now, it can't be sutured, you say, how to deal with this matter?" If I don't lose money, I won't leave today!"
"Don't get excited, now that the finger is not connected, we are also very uncomfortable, but you have to understand that we doctors are not gods, not patients come to our hospital, we can cure it..."
The cause of the matter is because,
While working in the workshop, a 25-year-old patient had his finger broken (disconnected state).
He was then sent to the hand surgery department at Harmony Hospital.
This kind of surgery is best completed within three hours, otherwise it will be difficult to face, because blood vessels and other constriction, tissue necrosis, the longer it is, the more difficult it is.
And, even worse, the patient is strangled, not cut off.
There is a huge difference between the two.
If you cut it, the section will be very neat and easy to stitch.
If it is strangled, the section is blurred, and the blood vessels and nerves are sparse, which increases the difficulty of suturing.
In addition, there is an even bigger problem:
Because this patient was strangled, the tendons of his fingers were pulled out, and the length of the withdrawal was up to 20cm!
So
The difficulty of this operation is very high.
Then, the chief physician of the hand surgery personally performed the operation.
Fingers are broken, the operation focuses on blood vessels, tendons, and nerves, and the rest of the bones, flesh, and skin are easy to handle.
outcome
The operation searched for 2 hours, but could not find the right finger artery.
For heart surgery, artificial blood vessels can be used.
However, finger arteries can not have artificial blood vessels, on the one hand, finger arteries are too thin, on the other hand, there is no high heart value, so there are currently no artificial blood vessels of finger arteries on the market.
In the end, the operation had to be declared over.
However, this result made the parents very dissatisfied.
The son's broken finger is the index finger, which is very important, and the son is only 23 years old, young, and without this finger in the future, I am afraid that it will be difficult to find a daughter-in-law.
So, the parents quarreled with the doctor.
"I don't care, it's your fault anyway, I also believe that you sent him in harmony with the hand surgery... Now that my son's hand can't be stitched, you must be responsible! "
"Yes, I already knew that it was better to call Dr. Lin Feng over..."
As he spoke, it seemed that the two parents trusted Lin Feng more, perhaps weakly.
When the doctor outside the hand heard this, he was a little angry.
Although Lin Feng is very powerful, it is not comparable to the strength of the department of hand surgery.
"You can go to Lin Feng, I can call you now."
"Hit it, hit it!"
......
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