When Shibato asked, everyone was confused.

There are many drugs for the treatment of cerebral edema, but Jingye has found a different way and has to choose a highly toxic drug, why is this?

Jingye also knows that acetazolamide is toxic, but why did so many people buy it in the first place?

And not only that, but even after a few years of discontinuation, there are still people running around for acetazolamide, just to be able to buy it, why is this?

The reason is simple, it is because of the extremely high cost performance.

Acetazolamide is inexpensive, especially when it comes to treating glaucoma.

And Jingye wants to use acetazolamide for three reasons.

One:

After the effect of the previously injected glucose and mannitol has been completed, furosemide injection is undoubtedly the first, which can continue to prevent hyperkalemia and treat cerebral edema.

However, the drug is highly toxic to many other agents, several times more toxic than acetazolamide, and patients have been injected with a large number of different general anesthetics, and once furosemide injection is used, the patient will immediately develop orthostatic hypotension.

Hypotension is not terrible, what is terrible is that the patient has had an accidental pulsating hypotension during the operation, and the old injury has not healed, once the acute hypotension is caused again and causes the second shock, then the rescue time will be greatly reduced.

Two:

The effect of the dexamethasone injected by the patient half an hour ago has reached its peak, and the next use of dexamethasone must be given an hour apart.

Bumetanide was injected five minutes ago, but it is an auxiliary drug and must be combined with other drugs to exert its maximum effect after half an hour.

First, furosemide injection and bumetanide were excluded, and other agents were sought.

For example, glycerol fructose injection is contraindicated for people with intracranial hematoma, and the patient happens to have an intracranial epidural hematoma, so it is necessary to wait for the hematoma to clear before using this agent to rule out.

Another example is edaravone injection, which is contraindicated to be mixed with anti-epileptic drugs, and the patient not only happens to have epilepsy, but also has been injected with anti-epileptic drugs, so the will of God cannot be violated and ruled out again.

Another example......

After several rounds of elimination, on the whole, acetazolamide is undoubtedly the last choice.

Three:

According to Vice President Shibato, the disadvantage of acetazolamide is that it depletes potassium and blood in the body.

Therefore, Sedum feels that the disadvantages are also advantages, and the disadvantages of acetazolamide are used to reduce the patient's hyperkalemia.

Although acetazolamide can also reduce PaCO2, inhibition of carbonic anhydrase activity can immediately increase the concentration of plasma chloride, reduce intracellular H+ production, and weaken H+—Na+ exchange, thereby causing metabolic acidosis, which is also a disadvantage, but in fact, it is not.

It is important to know that hyperkalemia will first cause a decrease in effective circulating blood flow, and at present, the patient's cerebral blood flow is low, once the CBF is reduced to 8ml, the cell membrane ion pump will be inactivated, and the cell death will be directly announced, which is the most serious, so the patient is now very urgent to need normal cerebral blood flow and circulation.

Although metabolic acidosis can lead to increased intracranial pressure and dilatation of cerebral blood vessels, it can also lead to increased cerebral blood flow, which is undoubtedly another disadvantage to an advantage.

The disadvantages of decreased PaCO2, increased intracranial pressure, and dilatation of cerebral blood vessels in exchange for a life-saving cerebral blood flow are undoubtedly the most convenient option for patients to return cerebral blood flow to a normal state.

At the same time, acetazolamide also has a veritable advantage, that is, it can prevent and treat cerebral edema. In this way, acetazolamide can be called killing three birds with one stone, which is more practical than furosemide injection, and does not require any diuretics, hypothermia therapy, and osmotic dehydration therapy.

......

Therefore, based on these inferences, Jingye feels that acetazolamide is the most suitable drug for patients at present.

But it's not that acetazolamide is a miracle drug, it's just that the right medicine can be prescribed so that patients don't miss the time for the best treatment.

Hearing that acetazolamide was very effective, the hopeful eyes of the thirteen crows suddenly turned into boundless loss and resentment.

While the nurse injected acetazolamide, Jingye removed the ICP monitor to avoid the conflict of ischemic stroke in the cerebral hemispheres, and asked another nurse to inject a dose of dabigatran etexilate to enhance anticoagulation to prevent intracranial blood clotting and vascular embolism.

After completing the prevention and treatment measures for cerebral edema, Jing Ye asked the nurse to check whether the leukocytosis was caused by viral meningitis, the nurse shook her head and said no, Jing Ye shifted her attention to the location of the hypothalamic hamartoma again.

At this time, the doctor outside began to speculate again.

"Professor Jack has already had a craniotomy before, so I guess Jing Ye will not choose to open the door from the inferior temporal for the second time. ”

"I think that's the case, I guess he's going to use the wing point to open the knife this time. ”

"I don't think so, he won't go down the beaten path. Qi Xiuyuan shook his head, his eyes revealing the joy in his heart, "This night has only been in our hospital for a few days, but he can stand out in this major operation, and the equipment has not yet detected the symptoms, but he can be accurate one by one, and his observation is extraordinary, he is simply a prophet." And your guesses seem to have been wrong, so when I look at the next surgery, he will surprise us even more. ”

"The dean is right! The dean is right!" Shibato echoed.

Qi Xiuyuan turned his head to look at Chai Teng, and stopped talking, but finally he could only smile reluctantly, and continued to look back at Jingye.

Sure enough, Jing Ye's next move was guessed by Qi Xiuyuan.

Sedum did not choose to open the knife from the wing point, but transferred the gamma knife next to it to the side.

This is a head gamma knife, with many cobalt sources installed in a spherical helmet, which can form countless narrow beam ion rays, and these rays will gather at the same point of the brain tumor, which can be rotated and moved, and the tumor can be eliminated one by one according to the doctor's operation.

"I'm going, isn't it, this kid Jingye wants to use a gamma knife to remove a hamartoma? Are you sure he's going to listen to a good class in medical school?"

"Yes, we all know that this gamma knife is certainly a sharp weapon for removing tumors, but the preferred tumor diameter of gamma knife should be 2.5cm, and the maximum cannot exceed 3cm, but the diameter of the patient's hamartoma is as high as 3.3cm, once removed, no one dares to guarantee that there is no risk. ”

"If you don't die, you won't die, I think Jing Ye is doing this just to steal the limelight, otherwise who would be willing to take the risk of such an uncertain outcome, if a person dies in our hospital, who will be responsible? Shibato asked.

But before the dean could reply, Shibato beckoned the people behind him to dispatch and asked them to drag Jingye out immediately.