A patient who fell from a building more than 40 meters high for eight hours should not have symptoms of acute alcoholism, either from a physical or botanical point of view.

Even if he has been accustomed to the status bar for almost two years, Sun Lien still maintains the habit of "passing the brain first" for all the prompts in the status bar. And this habit played a crucial role in this moment - it only took him a few seconds to reflect what was happening to Zhang Junyi now.

Before falling from the building, Zhang Junyi drank a lot of wine. Even if Sun Lien only saw it, his alcohol consumption should be more than 700 ml.

Eight hours, for an average adult, it is not too difficult for the liver to metabolize these alcohols. But Zhang Junyi's situation is completely out of step with "ordinary".

The fall from a height left him with severe trauma and internal bleeding. The body's self-protection mechanism will concentrate the blood from the rest of the body to the core as much as possible, giving priority to ensuring the blood supply to the lungs, heart and nervous system.

The digestive tract was in an almost quiescent ischemic state during this period, and the anesthetic drugs had an inhibitory effect on the smooth muscles during the operation, and his digestive tract was basically in a state of non-functioning.

As the digestive tract stops moving, the absorption of alcohol and food stored in the gastrointestinal tract is suspended. Ethanol, which has already entered the bloodstream, is replaced by internal bleeding and massive blood transfusions. Therefore, during the operation, only the head injury caused a certain degree of distress to the work of the anesthesiologists. Alcohol has little to no effect on treatment at this stage.

As the surgery continued, Zhang's vital signs gradually stabilized. And the large amount of plasma and blood products that were transfused allowed his body to regain a certain degree of balance. The narcotic drugs are gradually metabolized through the liver, the operation of the digestive tract is slowly restored, and the intestinal mucosal barrier is damaged to a certain extent due to the previous insufficient perfusion, which also accelerates the speed of alcohol entering the internal circulation through the intestine.

When the level of ethanol in a normal person's blood rises, the liver begins to metabolize it rapidly. But...... Zhang Junyi does not have this condition now.

More than 35% of his liver was removed, which basically means that his body's ability to metabolize ethanol has also decreased so much. What's worse is that the rest of the liver is very busy right now.

A large amount of sodium citrate injected into Zhang Junyi's body needs to be metabolized in the liver, the metabolites of cells damaged due to trauma need to be metabolized through the liver, the drugs used by anesthesiologists during surgery need to be metabolized by the liver, and even the antibiotics that are prophylactically transfused during treatment need to be metabolized by the liver.

Now for another ethanol ...... This is to throw two large bales of straw on the already overwhelmed camel. Zhang Junyi's body can bear it, it's a hell.

Sun Lien was a little confused, although he had dealt with many seriously drunk patients in the emergency department, but he was really a little unsure of how to deal with this kind of serious injury after acute alcohol poisoning.

But this was enough for Sun Lien to give a warning, and he dragged out Wu Faxian, the director of the intensive care medicine department, who was busy from the crowd, and whispered his "discovery". Of course, in order not to be too shocking, he used the reason that "I saw him drink a lot of wine before he fell from the building".

Director Wu glanced at the patient lying on the bed with tubes all over his body in disbelief, and then muttered two swear words in a low voice.

It's not that the ICU hasn't seen patients admitted to the hospital because they were drunk. However, such patients are generally admitted to the hospital due to cardiovascular and cerebrovascular accidents caused by drunkenness. The injury from a high-altitude fall was combined with alcohol poisoning, and even Director Wu was a little dazed for a while.

Drunkenness does not cause much direct damage to the human body, at least not immediately leading to serious consequences. It affects the patient's central nervous system, puts pressure on the digestive tract, and damages the liver in the process of metabolism. But in general, patients with acute alcohol poisoning are generally not in imminent life-threatening condition. The greatest risk for intoxicated patients is that when the central nervous system is suppressed, vomit may block the airway.

But Zhang Junyi, who is already receiving mechanical ventilation, obviously does not have this problem. Even if an opioid overdose suppressed breathing, mechanical ventilation would ensure that he did not suffocate himself. From Director Wu's point of view, the symptoms of acute alcoholism are at most a troublesome interference, and they are not enough to cause rapid death.

But just because it's not enough to kill quickly doesn't mean it can be as harmless as a two-month-old white sheep. For Zhang Junyi, who is still in the ghost gate with half a foot, acute alcohol poisoning is also a dangerous beast that can take his life. It's just that compared to other symptoms, the beast's activation is slightly slower.

"Please come up to the anesthesiology department for a consultation. Director Wu thought about it and decided to immediately ask for foreign aid to help. The conventional approach to drunkenness is not suitable for Zhang Junyi, a naloxone antagonist that targets central nervous system inhibition. It can quickly reverse the current situation of central nervous system suppression in drunk people, but it does not help to reduce the burden on the liver. Rather, it puts more stress on an already overwhelmed liver – naloxone itself is metabolically inactivated in the liver.

For the ICU, it is advantageous for Zhang Junyi to maintain anesthesia. His body has suffered too many serious wounds, and if he is brought to his senses now, Zhang Junyi will inevitably struggle because of the severe pain. This struggle can affect his vital sign support, and it can be even more fatal if two tubes are accidentally removed.

Treatment of acute alcoholism is generally symptomatic and pro-alcohol metabolism therapy. Liver damage and heavy load make Zhang Junyi's body unable to tolerate pro-alcohol metabolism therapy, so the only way left is symptomatic treatment.

This is why Director Wu asked the anesthesiology department for consultation - he is ready to perform liver replacement therapy for Zhang Junyi, and if the condition continues to deteriorate, he may even need to perform plasma replacement.

However, liver replacement therapy and plasmapheresis will cause Zhang Junyi to quickly be weaned out of anesthesia. This is clearly detrimental to further treatment. How to maintain anesthesia while treating without adding more other burdens to his body. This trade-off requires not only expertise, but also extensive experience in vital sign maintenance.

Biomages have a lot of experience in vital sign maintenance, but ...... They are not sensitive enough, or not sharp enough. Treatment in the ICU is relatively more brutal and straightforward than in the anesthesiology department. Dialysis on kidney failure, replacement on liver failure, ECMO on cardiopulmonary failure...... All in all, they have a lot of experience in dealing with the unexpected. But when it comes to avoiding these surprises, the ICU is much weaker than the anesthesiologists.

Dr. Li Tianfeng, deputy director of the Department of Anesthesiology, arrived at the scene three minutes after the request for consultation was issued. Then he shook and began to guide the rescue, Sun Lien saw that the situation here was basically stabilized, so he breathed a sigh of relief and returned to the operating room floor to find Hu Jia.

When waiting for his girlfriend at the door of the operating room, Sun Lien suddenly realized that Christmas had passed. It's December 26, 2:27 a.m.

When Hu Jia appeared outside the operating room, Sun Lien hugged his girlfriend with some distress, and then rubbed her head vigorously, "That patient has stabilized...... Well done, thank you. ”