Acute pancreatitis is divided into two categories in terms of severity: mild and severe. Although they all present with more or less the same severe pain, mild acute pancreatitis generally does not kill people — or even progress to death. But severe disease is different, and it has a poor prognosis. And the progress is very rapid, what is more troublesome is that the development of severe pancreatitis is always not according to common sense, it does not have a strict order of onset, it may lead to multi-organ failure just after it appears, or it is possible to digest the pancreas itself little by little, and then erode other organs and tissues.

The pathogenic mechanism of acute pancreatitis is basically the same - except for acute pancreatitis caused by hyperlipidemia, which is not yet clear, alcoholic acute pancreatitis and biliary acute pancreatitis are caused by the inability of the pancreas to drain pancreatic juice smoothly, resulting in inflammatory reactions such as edema, bleeding, and even necrosis caused by the pancreas starting to digest itself from the inside. Factors that contribute to this aseptic inflammatory response include oxidative stress, bacterial translocation, circulatory disorders, and so on. The mechanism is complex, but the pathogenesis is generally the same—the pancreas secretes more pancreatic juice under the influence of alcohol, and the sphincter of Oddi at the end of the pancreatic duct may spasm, resulting in pancreatic duct obstruction. The biliary is because gallstones block the passage from the ampulla of the hepatopancreas to the head of the duodenum.

If the disease is mild, it is usually just pancreatic edema. The condition is generally self-limiting—it recovers on its own after a period of time, even without medication or surgery. But severe disease is different, whether it is edema type or hemorrhagic necrotizing, severe acute pancreatitis has a fairly high mortality rate. In domestic statistics, the mortality rate of severe acute pancreatitis is between 10% and 30%. It is considered to be the type of acute abdomen with a high mortality rate.

It is very important for emergency physicians to distinguish between the "urgent" and "severe" aspects of a patient's condition. Diseases that are unbearable in pain such as ureteral stones, but have a low mortality rate, can be regarded as "urgent but not serious". It advocates first relieving the patient's pain and then seeking treatment. However, if the cancer is terminal and the patient's family is clearly aware of the consequences of the disease, and chooses conservative treatment or even gives up treatment after being admitted to the emergency department, it can be regarded as "serious but not urgent".

However, diseases such as myocardial infarction, cerebral infarction, severe trauma, severe burns, poisoning, etc., which progress rapidly and may directly lead to the death of the patient, belong to the category of "acute and severe".

And now lying on the rescue bed, what type does Tian Xinghua, who is not very conscious, belong to?

It was his 12-year-old son who sent Tian Xinghua to the hospital. In any case, it is impossible for the hospital to accept the signature of a person with limited civil capacity for rescue. If Tian Xinghua is to be given rescue treatment, it must be signed and authorized by the medical department.

But to apply for this signature, Sun Lien is not just a phone call. If you want to sign, you have to prove that the patient's condition is urgent enough to be resuscitated. In other words, unless it is clear that Tian Xinghua is indeed suffering from severe acute pancreatitis, the medical office will not risk being complained or even prosecuted by the patient's family.

Sun Lien glanced at the status bar above Tian Xinghua's head, and then sighed slightly.

Tian Xinghua, male, 44 years old, pancreatic edema (03.25.33), low blood oxygen (01.41.22), blood glucose 11.7mmol/L, (01.31.41), high serum amylase content (00.44.41). ”

In terms of time maintenance, Sun Lien only glanced at his blood sugar, which lasted no more than two hours, and from the perspective of time, the occurrence of this symptom lagged behind pancreatic edema. It is almost certain that his hyperglycemic state is caused by acute pancreatitis.

If the blood sugar of a patient with acute pancreatitis is higher than 10 mmol/L, it can be directly regarded as acute severe pancreatitis. Although clinically speaking, it is necessary to cooperate with serum amylase or other organ examinations to determine that it is a severe disease, Sun Lien is very sure that Tian Xinghua's condition is very dangerous.

"Give him oxygen, has the blood sugar level come out?" Sun Lien decided to urge the progress of the examination, at least get direct evidence of high blood sugar first, and then go to the medical office for authorization. Although it is considered a serious illness, Tian Xinghua's symptoms are not too bad, at least not too bad now. If you delay organ failure or respiratory distress syndrome (ARDS) and systemic inflammatory response syndrome (SIRS), you can be troublesome.

"Blood sugar 11.8mmol/L. Brother Sun, does this person have diabetes?" Nurse Xiao Guo is fiddling with the blood glucose meter, the instrument used in the emergency room for preliminary blood sugar measurement, which is a small machine that can be used to test blood sugar at home. That mini size is really a bit unbearable in Xiao Guo's hands.

Sun Lien sighed, "If he has diabetes, I don't have to worry so much." This is also one of the reasons why Sun Lien can't directly rely on high blood sugar to ask for authorization - he can't produce evidence to prove that Tian Xinghua does not have diabetes. In diabetic patients, a blood glucose level of 11.8 mmol/L, although high, is not enough to be evidence of severe acute pancreatitis.

"Children, what kind of medicine does your father usually take?" Sun Lien thought about it and decided to ask the patient's family first. Although it is difficult for a twelve-year-old child to carry his father to the hospital, it is still possible to answer some questions accurately.

"Take medicine?" Tian Yu shook his head almost without hesitation, "My dad usually doesn't even have a headache and brain fever, and I've never seen him take medicine." ”

Although it cannot be ruled out that Tian Xinghua has diabetes, there is still weight in this evidence. After asking Xiao Guo to go to the hemogenolysis routine and serum amylase data again, Sun Lien led Tian Yu out of the rescue room.

"You're here and waiting. Sun Lien pointed to the seats in the rescue hall and said to Tian Yu, "You look at the door, if your uncle comes, take him to the rescue room first, and you can wait a little longer for registration or something." Sun Lien's plan is very simple, first find a way to send Tian Xinghua to the operating table, and completing pancreatic dredging and drainage as soon as possible is the only way to save his life.

Back in the emergency room, Sun Lien continued to direct the treatment, "Give him ulinastatin, 100,000 units with normal saline, monitor blood pressure...... "After the CT results come out, ask doctors outside the liver and gallbladder to come for consultation." ”

According to the consultation order of surgery first and then internal medicine, Sun Lien decided to wait for the doctors outside the liver and gallbladder to see the patient's condition before asking the opinion of the department of gastroenterology.

Tian Xinghua, who was lying on the hospital bed, vomited again, he was restless on the hospital bed, obviously unconscious from pain, but he still kept struggling. Seeing this, Sun Lien hurriedly went over to comfort the patient, but with little effect. Tian Xinghua is now drunk, and he can't give him painkillers or sedatives, which is really nerve-wracking. Sun Lien held down Tian Xinghua's hand for the third time and wanted to open his oxygen tube, and then shouted helplessly to Guo Yulai, "Xiao Guo, bring the restraint here!"

Tian Xinghua was tied to the bed, and Sun Lien took advantage of the crowd to quickly arrange a CT examination. There is no place where the restraint belt can be tied on the examination bed of the CT machine, so it is better to take advantage of the large number of people to call a few more doctors to wear lead suits and finish the examination according to Tian Xinghua.

After the results of the CT scan are available, you should be able to go to the medical office for authorization based on the results. Sun Lien went through the inspection sequence in his heart, confirmed that there was nothing missing, and breathed a sigh of relief.

Although he was on the operating table, he might not be able to save Tian Xinghua's life, but that was not something he could handle. Sun Lien, nurse Xiao Guo and others pushed the hospital bed and ran to the imaging department.