This Doctor is Great

"Fuck, what's going on? Why is the blood pressure fluctuating?!"

Zhou Mo scolded while running wildly.

"Is it fake medicine?"

"It's not right. If you buy one fake medicine, it's worth it. If you buy several fake medicines, you're too 'lucky'."

"what is the reason behind the scene?"

Zhou Mo shouted to the nurse while running: "Bring the rehydration fluid, anti-shock, and booster drugs!!"

When Zhou Mo flew to bed 29 in the ward, the first thing he did was to take a look at the ECG monitor.

68/39!

Worth!

Really bungee jumping!

Quickly remove the syringe pump and stop the use of sodium nitroprusside antihypertensive drugs.

Soon, the nurse came in with a cart and brought the booster medicine.

injection!

Then the nurse quickly replenished the liquid, only replenishing the crystals that are not large.

(Crystals will often appear in subsequent chapters, so here is an explanation:)

(Low blood pressure is prone to shock, so rehydration should also be done. The principle of rehydration: first fast and then slow, first crystal and then glue, crystal glue combination, first salt and then sugar, see urine potassium supplement.)

(The so-called crystals refer to liquids with small molecules, short retention time in blood vessels, and play an important role in maintaining the relative balance of water inside and outside cells, such as normal saline, sodium lactate, glucose...)

Finally,

After 3 minutes, the patient's blood pressure finally stabilized.

Fortunately, there was no major problem, otherwise the patient would be in trouble if he had to be rescued.

"Take another ECG..." Zhou Mo ordered.

Soon, the electrocardiogram came out.

no problem.

Zhou Mo breathed a sigh of relief.

It doesn't seem to be a heart problem.

"By the way, have the troponin results come out?"

Zhou Mo picked up the ipad, checked it, hey, it came out, and the troponin was removed 3 minutes ago.

Creatinine protein: 0.09μg/L

normal range.

Therefore, myocardial infarction can be ruled out.

"What is the reason?"

"Excluding fake drugs, what else will affect blood pressure fluctuations?"

Zhou Mo fell into deep thought.

stroke it again.

What does the human body rely on to regulate blood pressure?

— Neuromodulation!

——Body fluid regulation!

Nerve regulation: There are "baroreceptors" in the carotid sinus and aortic arch. High or low blood pressure will cause changes in the baroreceptors, which will then be transmitted to the brain center, and then feedback to direct the blood vessels and heart to make corresponding adjustments. (popular saying, not entirely accurate)

As for the regulation of body fluids: the 'norepinephrine' and 'epinephrine' secreted by the adrenal medulla can strengthen the contraction of the heart and peripheral arterioles, thereby increasing blood pressure and strengthening breathing.

Finished strokes,

"It seems... I found the reason!"

Zhou Mo slapped his head!

"It should be it!"

"It's so simple, why didn't I think of it?"

"Sure enough, the textbook is amazing!"

What Zhou Mo thought of was the adrenal glands!

The reasoning is as follows:

There is a problem with the patient's adrenal gland, which leads to the secretion of a large amount of norepinephrine and adrenaline, which then leads to an increase in blood pressure.

The antihypertensive drugs used by the patient were useless. There was a kind of antihypertensive drug for adrenaline, but I didn't buy it.

Therefore, the effect of antihypertensive drugs is not obvious.

Maintain the high blood pressure level of 180-190 at the time of admission.

Then, Zhou Mo suggested that the patient should be given sodium nitroprusside, which lowered blood pressure very significantly and maintained it.

However, at this time, the patient's diseased adrenal glands began to no longer secrete norepinephrine and norepinephrine, so the patient began to significantly lower blood pressure.

Then, there was this kind of roller coaster, bungee jumping and blood pressure diving.

It just corresponds to the patient's sudden high blood pressure, and the effect of antihypertensive drugs is not obvious.

"However, this is all speculation..."

"It needs to be verified!"

Zhou Mo saw that the patient Chen Jianxin's condition had begun to stabilize, so he was relieved, and then walked quickly to the duty room.

Give the patient two additional emergency checks.

First, urine, to detect the levels of relevant hormones and their metabolites

Second, CT to see if there is any change in the adrenal gland.

B-ultrasound is also possible, but Zhou Mo suspects that the patient has 'adrenal tumor', so CT will be more accurate.

In addition to inspection, you can also prescribe a medicine empirically:

— Prescribe antihypertensive drugs corresponding to epinephrine,

Give it a try next time you step up. If the blood pressure is successfully lowered, it means that the patient is indeed as Zhou Mo thought, and there is something wrong with the adrenal gland.

At this time, Chen Jianxin's parents rushed to the hospital.

"Where is my son?"

"My son's name is Chen Jianxin, girl, check it out for me..."

"Chen Jianxin, right? Bed 29."

"Okay, thank you..."

The parents rushed to the 29-bed ward with apprehension. When they saw their son lying on the bed with a bunch of wires attached to his body (actually it was just an ECG monitor), they panicked.

"Son, what's the matter with you?"

"Son, don't scare me, mother only has you as a son, in case you have any troubles..."

The patient, Chen Jianxin, was not very clear about the situation, but he just told his parents not to worry, and he didn't dare to say that he almost died of cardiac arrest just now.

The parents were still worried and ran to the duty room to find a doctor.

Zhou Mo was writing the rescue records, checking the time with the nurses, and when he saw the patient's parents coming, he could only put down his work and patiently explain to them. He also didn't mention the sudden cardiac arrest, for fear that the two elderly people would have a heart attack on the spot.

After finally appeasing the two elderly people, Zhou Mo could continue to check the rescue process with the nurse.

...

Until 15:00 in the afternoon,

The urine test results are back.

Zhou Mo breathed a sigh of relief.

really!

Adrenal glands are in trouble!

Urine test results:

Methoxyl, 2x!

Norepinephrine, 1.1 times!

These two 'methoxy XX' are intermediate products of epinephrine and norepinephrine.

The two major increases show that both the adrenal gland and the demethylation have been greatly improved.

"I'm not running now!"

"There's something wrong with the adrenals."

"If you guessed correctly, in many papers, this situation is most likely to be adrenal pheochromocytoma."

Pheochromocytoma can easily cause significant changes in adrenaline and norepinephrine, which are much more obvious than other tumors.

16:30...

While Zhou Mo was reviewing the literature on pheochromocytoma,

The nurse yelled.

"Doctor Zhou, the blood pressure of the 29-bed patient has risen again, 185!"

"Don't panic...wait for me to pretend...ahh~~~~No, don't worry, I'm sure!!"

Zhou Mo looked calm!

Boy, I have mastered you! !

I am not afraid of you anymore!

Prescribe medicine.

"Use guanethidine..."

This is an inhibitor of the sympathetic nerve, which can effectively suppress the excitement of the sympathetic nerve and control the heart...

Epinephrine, norepinephrine, etc. These hormones will excite the sympathetic nerves in the human body, leading to high blood pressure, rapid heart rate, sweating, excitement, restlessness, etc.

Therefore, as long as you prescribe a drug that suppresses the sympathetic nerve, it will be OK.

.

I wrote about the adrenal gland last time, so this time I had an idea and wrote a case about the adrenal gland.