Chapter 738 Thiocyanate Poisoning

Huang Dazhi's doubts about the operation do not lie in the diagnosis, but in the technique.

As for the technique, Zheng Ren can demonstrate it. When it comes to how to use it in surgery, it depends on everyone's understanding.

Even if Zheng Ren didn't hide his secrets, most people wouldn't be able to understand it.

After Professor Huang consulted the two more difficult methods of super-selection and bolt removal, Xie Yiren finished the handover and walked out.

He knew the ups and downs of his eyebrows, and knew that this was not a good time to chat, so he led Zheng Ren and others to the intervention department with a smile.

On the way, Professor Huang didn't say anything more, because Zheng Ren and Su Yun were about to fall asleep walking. He was just careful not to let the two of them fall asleep while walking, fall or bruise.

After entering the ward, Professor Huang came to the door of the director's office and said with a smile: "The director specially left the door for you, saying that you can come and rest at any time if you need it."

"Thank you very much." Zheng Ren said vaguely.

Suddenly, there was a rush of footsteps in the corridor, and the sound of wheels rubbing against the ground was loud.

Subconsciously, Zheng Ren opened his eyes. In a trance, he thought that he was in the first courtyard of Haicheng City.

"What's wrong?" Zheng Ren asked in a daze.

"Boss, it seems to be emergency treatment." Su Yun was also in a dazed state, and guessed when he saw the nurse pushing the emergency medicine cart to a ward.

"Go and take a look." Zheng Ren also saw the situation clearly, and then became more energetic.

Xie Yiren wanted to say something, but hesitated for a while, and finally let Zheng Ren go.

She originally wanted to take a look at where Zheng Ren was sleeping, and then drive around to see if she could buy something to eat.

Unexpectedly, as soon as he got down, he encountered the rescue of the ward again.

Zheng Ren strode into the ward, and saw a patient with slightly twitching hands and feet, who wanted to dance but couldn't. What is said in the mouth is vague, not clear.

Nurses, doctors, and volunteers serving as nurses are rescuing the bedside. No one is seen, and the system panel has not given a diagnosis for the time being.

"Boss, this person is probably a programmer. All he talks about in his sleep is code. He is really dedicated." Su Yun whispered.

"programmer?"

"From his delirium, it should be like this." Su Yun said.

"Isn't this a postoperative patient? What's the matter?" Professor Huang was a little surprised, and he asked hastily.

"Mr. Huang, the patient underwent blood transfusion after stenting to reduce blood pressure, and developed symptoms such as ataxia, blurred vision, and then delirium, dizziness, headache, accompanied by nausea and vomiting, and the vomit was stomach contents." The doctor reported.

"Stent?" Zheng Ren was taken aback.

Today's patients are basically patients with hemorrhagic shock, and blood transfusion is enough, and generally there is no blood pressure reduction.

Coupled with the stent, Zheng Ren immediately remembered that he had diagnosed a patient with abdominal aortic dissection when he first came here.

That patient had a stent, and Zheng Ren was sure that there would be no problem with the stent. His own surgical experience and the degree of completion of the surgery given by Dazhu's Trotters can all prove it.

What's going on here?

He took a step forward and saw the patient while the volunteer was picking up something.

The diagnoses given by the system panel at the upper right of the field of view are: after interventional embolization of pelvic fracture, after stenting of abdominal aortic dissection aneurysm, and thiocyanate poisoning.

Already sleepy and confused, Zheng Ren misunderstood the diagnosis.

The first reaction is cyanide poisoning!

This is such a big deal, did someone poison it?

Zheng Ren was so frightened that he woke up completely.

Then it was clear that it was thiocyanate poisoning, and the memory quickly recalled in my mind, and my expression moved slightly.

Seeing that Zheng Ren's situation was not right, Su Yun squeezed forward and asked, "What's wrong, boss?"

"It's okay." Zheng Ren shook his head, but he couldn't tell Su Yun about the cyanide poisoning. If he did, he could talk about it until next year.

"Is it a postoperative patient with abdominal aortic dissection aneurysm?" Zheng Ren asked.

"Teacher Zheng, yes." Professor Huang felt the strong aura of the superior doctor, and subconsciously called the teacher.

"What do you use to lower your blood pressure?" Zheng Ren asked.

After the operation of aortic dissection aneurysm, the blood pressure should be kept stable, and it is enough to wait for the peritoneal frame to completely block the breach. Generally, antihypertensive drugs are given for 1-2 days, and then they can be stopped. Nothing special, just routine treatment.

"Sodium nitroprusside, pump in the micropump, the dose is 8 μg/kg/min." The little doctor immediately reported the dosage.

Zheng Ren then knew what happened.

He said in a deep voice: "Stop the sodium nitroprusside, contact the nephrology department immediately, and go for dialysis immediately."

Professor Huang was startled, what kind of operation is this? Acute renal insufficiency? Renal insufficiency is usually manifested in urine output, and this patient's urine output was normal.

Although hemorrhagic shock leads to oliguria, it is less than 50ml per hour due to renal insufficiency.

If he had doubts, he had doubts, but after hearing Zheng Ren's words, he immediately and subconsciously stopped the micro pump to inject sodium nitroprusside.

"You don't need to deal with it too much, just be careful not to inhale the vomit and cause suffocation." Zheng Ren said.

"..." Professor Huang was puzzled. He arranged for the little doctor to contact the nephrology department immediately, came to Zheng Ren and asked, "Mr. Zheng, is it acute renal failure?"

"Probably." Zheng Ren replied.

Sweat...profusely...

Be it, what kind of answer is this.

For the first time, Professor Huang felt that Zheng Ren was a little unreliable, but this idea was killed in the bud as soon as it surfaced.

As the other party is a candidate for the Nobel Prize, one identity can prove many problems.

That's not to mention, I have seen the operation myself, it is definitely the most awesome one I have ever seen, and generally this kind of doctor has quite a lot of clinical experience.

My own doubts can only prove that I have little clinical experience and my diagnosis is wrong.

Professor Huang looked at Zheng Ren inquiringly, waiting for his explanation.

"It's thiocyanate poisoning," Zheng Ren said.

Uh...sodium nitroprusside is commonly used in clinical practice. Many patients have high blood pressure, which must be controlled with sodium nitroprusside. For so many years, Professor Huang rarely heard the diagnosis of thiocyanate poisoning.

Not very little, but almost none.

Thiocyanate poisoning, he sounds so strange.

"It's a problem with the metabolism of sodium nitroprusside." Su Yun immediately thought of some possibilities and asked.

"Yes." Zheng Ren said, "Sodium nitroprusside is a kind of nitrohydrocyanide, a strong dilator that directly acts on the arteriovenous vascular bed.

Sodium nitroprusside is continuously pumped in, and it is first converted into cyanide by red blood cells, and then converted into terminal metabolite thiocyanate by rhodanese in the liver.

Thiocyanate is excreted by the kidneys, and the half-life of those with normal renal function is 4 to 7 days. Patients with renal failure have accumulation. If the dose is too large, the metabolite thiocyanate in the blood is too high, which is prone to poisoning. "

"But the patient has no abnormal renal function." Professor Huang tried to recall the patient's test results and said.

"It wasn't there before, but now it is."