Gluttonous snakes

When the sick number comes, naturally there can be no slackness, not to mention that the situation of the two sick numbers is not an ordinary crisis.

Based on the treatment principle of first acute and then slow, first serious and then light, Chen Ling chose to see the elderly patient who had a heart attack first.

"Dr. Chen, it looks like the patient who swallowed the poisonous snake seems to be more serious!" Du Leixin reminded.

"No, this is more serious!" Chen Ling said without thinking, so he set about examining the elderly patient.

The patient is an elderly male who is already confused, mentally exhausted, dyspnea, palpitation, shortness of breath, paleness, cyanosis of the lips, cold limbs, and loss of urine...... and so on.

A quick physical examination of the patient revealed that the patient had a typical barrel chest, with only 10 breaths/minute, a pulse of 175/minute, a drop in blood pressure to 80/50mmHg, decreased breath sounds in both lungs on auscultation, generalized wheezing and wet rales, a heart murmur, extremely fast heart rate, irregular heartbeat, and percussion showed that the heart sound was dilated to the right.

This is a very typical chronic ischemic cor pulmonale, referred to as cor pulmonale.

Its cause is the increase in pulmonary circulatory resistance caused by chronic lesions of the lungs, thoracic or pulmonary arteries, to pulmonary hypertension and right ventricular hypertrophy, or accompanied by a type of heart disease without right heart failure, which is an extremely common and frequent disease, with a very high mortality rate, especially in the acute exacerbation period.

Now, the elderly patient is clearly in an acute exacerbation and is in the first stage of shock compensation, which is progressing to the advanced stage. Without emergency treatment, the patient will soon enter an advanced stage of irreversible shock.

Chen Ling's judgment was correct, this elderly patient was much heavier than the young man who swallowed the snake in his stomach.

After having a preliminary understanding of the patient's condition, it is too late to go for other examinations, so we should quickly carry out emergency symptomatic treatment, quickly replenish the blood volume, enhance myocardial contractility, and relieve peripheral vascular resistance!

In this way, it is necessary to establish intravenous infusion access and keep the respiratory tract open, the patient is an elderly man, the body is thin, the establishment of intravenous access is naturally not a problem, but the heart disease of the elderly is caused by pulmonary origin, the respiratory tract is blocked by phlegm, and it must be carried out by aeroenteric intubation.

Chen Ling was about to perform a tracheotomy for the patient and intubate it in parallel, but at this time, Yan Xinyue, who was dealing with the snake swallowing patient, screamed in surprise, Chen Ling handed the scalpel to Du Leixin who was standing aside, and then hurriedly rushed over to check. When I came back after temporarily solving the problem there, I found that the elderly patient's trachea had been cut open and connected to a ventilator.

With unobstructed venous access and respiratory tract, the following symptomatic treatment appears to be orderly, controlling respiratory tract infections, relieving bronchospasm, clearing sputum, hypoxic respiration, respiratory stimulants, and controlling heart failure......

After the situation here was temporarily stabilized, Chen Ling asked Wei Songliang to transfer the patient to the Department of Respiratory Medicine, and then came to Yan Xinyue's side by himself.

The snake, still in the belly of a young man.

Yan Xinyue estimated that the snake should still be in the stomach, and if it entered the intestines, the patient could not still be so comfortable, except for a slight discomfort, he did not feel anything else. It's just that although there is not much discomfort, it is not fun for anyone to have a snake in their stomach, and it is a poisonous snake, so this acrobat who is not very skilled but has a lot of courage has been scared to turn white at this time.

In order not to alarm the snake, Yan Xinyue did not dare to move it, but while doing psychological work for the patient, she asked about the shape, size, and species of the snake.

"What's the situation now?" asked Chen Ling as he walked over.

"The snake is still alive, and the patient can feel it moving inside!!" Yan Xinyue said.

Isn't this nonsense? Chen Ling really wanted to roll her eyes, but this expression was too girly, so forget it, "I'm asking about the size of the snake." ”

"About a finger and a half in size, forty centimeters in length, it's a bamboo leaf green!"

"Zhu Yeqing?" Chen Ling couldn't help but gasp, this guy is really not very brave but very big, just make a snake that is not poisonous, and actually make a highly poisonous Zhu Yeqing!

"He said that the snake's teeth had been pulled out by him!" Yan Xinyue said again.

"Isn't there no poison if you pull it out?" Chen Ling said disdainfully.

Zhu Yeqing, also known as Jiao Tail, is a highly venomous snake, with blood toxins, although the amount of detoxification when biting is small, and the blood oozing out is also less, but the pain is intense, it is burning, local redness and swelling, can be ulcerated, and develops rapidly. It is typically characterized by the presence of bloody blisters more often and earlier, and the general appearance of systemic symptoms is rare, with nausea, vomiting, dizziness, and abdominal distension and pain. Some patients have mucosal bleeding, vomiting blood, blood in the stool, and severe toxic shock, although the phenomenon of death is rare, but it is by no means impossible!

The young actor who swallowed the snake saw that after seeing it for so long, the doctor still didn't take out the snake for him, and couldn't help but say anxiously: "Doctor, don't worry about chatting, hurry up and help me take out the snake! I'm about to die of discomfort!"

Chen Ling and Yan Xinyue exchanged glances, and secretly sprayed him with a tacit understanding: Now that I know that I am uncomfortable, why did I go earlier?

"Don't worry, aren't we discussing a solution?" comforted Liu Shiya, the nurse who followed behind Chen Ling.

"Chen Ling, what do you think is the safest way to get the snake out?" Yan Xinyue asked.

"I think it's best to break his stomach open and take out the snake directly!" Chen Ling said with a bit of intentionality.

Sure enough, as soon as he heard this, the young actor's face turned even paler, and he said repeatedly: "No, no, no, this can't work!"

Who would have thought that Chen Ling's joke was recognized by Yan Xinyue, "I think this is the only way to be the safest and most reliable, because if you use other methods to get it, if the snake is frightened, it will be more troublesome to drill into it, so it is feasible to take the snake by opening its stomach!"

Frightened? I think you want to be fertilized, right? Chen Ling glanced at Yan Xinyue lovelessly, and that look was almost like asking: Teacher, you're not telling the truth, are you?

Yan Xinyue was a little embarrassed by Chen Ling, and couldn't help but be a little annoyed and asked, "Then what do you say is a better way?"

Chen Ling didn't answer her, just looked left and right into the corridor, and after a while, his new intern doctor, Chen Zhide, was out of breath and running back sweating profusely, still holding a bottle of wine in his hand.

"Doctor, give!" Chen Zhide handed the wine to Chen Ling.

Chen Ling took the wine and handed it to the young actor as soon as he turned around.

"Doctor, I don't like to drink!" said the young actor with a bitter face.

"Now is it a question of whether you like to drink or not, whether you can save your life!" Chen Ling said angrily.

"......" The young actor didn't dare to squeak.

"This is realgar wine!" Chen Ling looked at his aggrieved appearance, which was a little unbearable to explain, "Snakes are cold-blooded animals, not only afraid of heat, but also afraid of pungent smells of chemical mouths, if you enter your stomach and are not used to the irritability, through your stomach and into the intestines, then you can't think about it at that time." But if you drink it, it will soon get drunk, so not only do you have to drink it, but you have to drink as much as you can!

"Oh oh!" The young actor understood Chen Ling's hard work, and quickly took the realgar wine and poured himself a breath.

It didn't take long for him to pour more than half of the bottle of wine.

After more than ten minutes, the young actor told Chen Ling that the snake in his stomach didn't seem to move much.

Chen Ling: This asked people to prepare a gastroscopy.

Under the imaging probe of the gastroscope, the snake coiled in the stomach finally appeared in everyone's field of vision.

It is a bamboo-leaf green snake with a green body, golden eyes, and vertical pupils, with a large, triangular head, a thin neck, a short tail, small scales on the top of the head, grass green on the back of the body, white in the center of the outermost dorsal scales, a white lateral line from the back of the neck, and a pale yellow-green ventral surface.

Tightly coiled in the pylorus, it forms a sharp contrast with the flesh-colored stomach wall, coupled with the hideous shape of the snake, and the color is bright and weird, it looks extremely disgusting and terrifying.

Some of the more timid nurses couldn't help but cover their eyes, and they almost didn't vomit on the spot for Chinese New Year's Eve.

Although Chen Ling also felt nauseous, he still endured the churning in his stomach and observed it carefully.

The snake has indeed been drunk and unconscious by realgar wine at this time, except for a little inertia of the even, it basically doesn't move much!

After seeing the situation clearly, Chen Ling immediately began to give medical orders: "Give the patient general anesthesia, establish intravenous access and inhale oxygen!"

This surgery is naturally not an operation in the ordinary sense, because it does not require a knife!

After everything was ready, Chen Ling asked people to bring a snare, and in the field of vision of the endoscope, Chen Ling carefully put in the snare and used the snare to cover the snake's body and pull it from the dark door to the stomach!

However, when pulling, Chen Ling must not dare to exert force, because the snakehead canton is in the pylorus, and it is very likely to damage the stomach wall if he uses too much force, so he can only pull lightly, let it go, pull it lightly, and put it again......

This is a drudgery that requires absolute patience, just like fishing, you have to pull and loosen, slowly and slowly pull the snake out!

Half an hour later, the snakehead finally came out of the pylorus, and finally Chen Ling used a trap to fix the snake's head and pull it out of the cardia part!

The whole process was extremely thrilling, and it was quite disgusting, and two of the nurses who were present to help Chen Ling couldn't help but vomit, and the remaining one didn't vomit, because he didn't eat breakfast in the morning, and he couldn't vomit if he wanted to.

In the end, when the snake was finally taken out whole, the patient had half of his life left, and Chen Ling was also sweating profusely and embarrassed!

It's just that as soon as one wave stopped, another wave started......