The diagnosis of lactic acidosis can be definitively based on several major test data.

It's really lactic acidosis, it's a bit inexplicable, and the anesthesiologist, Director Ouyang, and Dr. Jin haven't figured out how it can be lactic acidosis.

The anesthesiologist glanced at Yang Ping, and he said lightly: "Check lactic acid", and pointed out the direction in time, otherwise it would definitely be delayed.

There was no time to investigate the cause, so the anesthesiologist made a decision immediately, treated the symptoms first, and saved lives first.

"5% sodium bicarbonate 250ml, intravenous drip, check urine output, measure central venous pressure!"

Alkali and acid correction is a top priority, followed by fluid refill, and hemodialysis if necessary to filter out the lactic acid in the blood.

250ml of 5% sodium bicarbonate was hung, and the anesthesiologist began to use the formula to calculate the amount of alkali supplementation in mind.

The nurse begins to measure the central venous pressure, and the fluids are adjusted according to the central venous pressure at any time.

The urine output has been more than 600 ml since the beginning of the operation, and there is no water and sodium retention, so you can safely replenish alkali.

Director Ouyang has been engaged in orthopedics for 20 years, if it weren't for the pre-academic training, where would he still remember the calculation formula of acid-base balance.

Not to mention the acid-base balance calculation formula, it is estimated that lactic acidosis can be completely forgotten how to rescue.

The pre-conference training benefited a lot, which strengthened the shortcomings of knowledge, and now, he can keep up with the rhythm of anesthesiologists and know the significance of these measures.

Lactic acidosis, the mortality rate is 50%, when the blood lactate exceeds 25mmoll, it is rare to be successfully rescued, fortunately, it is only 8mmoll at present, not to the point of death.

"Send to ICU!"

The patient's vital signs were temporarily stabilized, and Director Ouyang made a decision.

"Quick, push the bed." The anesthesiologist followed the bedside, and the endotracheal tube had to be weaned, so he could only pinch the ball and go to the ICU.

Everything didn't go well, everything didn't go well, a good operation, the fracture was inserted into the muscle, and the special guide had to be urgently adjusted, and now the operation was successfully completed, I thought I could breathe a sigh of relief, and I had this kind of thing again, and I suddenly had lactic acid poisoning for some reason.

The manager of the equipment dealer is the most embarrassed at this time, the hotel private rooms have been booked, and now in this situation, people still have the heart to eat, he is standing next to him, it is not appropriate to stay, so he can only wait stupidly.

The manager was afraid that something would happen to this patient, and Director Ouyang would blame them, of course, no matter what, there was no way to let them take responsibility.

What he was afraid of was that Director Ouyang would stop using their equipment in a fit of anger, even if it was stopped for a period of time, there would be a lot of losses.

The patient was pushed out of the operating room door, and Dr. Jin shouted, "Wei Danian's family—"

A large family, two elderly couples, and a middle-aged couple immediately surrounded them.

looked at Wei Danian lying on the bed, with a tube in his mouth and breathing on a leather ball.

The patient's father, an obese middle-aged man, was shocked: "What's wrong? Doctor, why can't you do it? ”

The grandmother was dizzy and was about to collapse, but the patient's father immediately supported the old man.

"Big year, big year!" His mother shook his shoulders and wept silently.

"Usually in good health, you can eat and drink, how do you do the surgery, make people like this." Grandma patted the edge of the bed.

"Lactic acid poisoning, the condition is dangerous, I will be sent to the ICU for rescue immediately, and my life is in danger at any time, don't pull into bed." Dr. Jin pushed the bed, but it couldn't be pushed, and the family members all pulled the handrails and didn't let go.

"Lactic acidosis?"

The patient's father was very familiar with this word, and immediately calmed down, and his face turned from white to red: "Doctor, this happens to him every year, and he has to be admitted to the ICU at least once a year. ”

When the whole family heard it, they also stopped crying because of lactic acid poisoning, they may have experienced it too many times and become numb, or they may have been lucky every time and were rescued, so they are not so afraid.

"ICU, ICU, every seizure is sent to ICU, sometimes blood washing." My father is familiar with the road and already knows the process, and blood washing probably refers to hemodialysis.

"How many times have you asked about the medical history, why didn't you mention lactic acid poisoning?" The doctor in charge of the bed gritted his teeth in anger.

"The child is afraid of pain, and he is afraid to tell you about the situation, so he will postpone the operation, so-" Wei Danian's mother whispered.

"Confused, really confused, can you hide your illness?" Dr. King criticized fiercely, eager to kick it.

Besides, this young man is twenty-five years old, and he is still a child, so he coaxes when it hurts: "Good girl!" Obedient. ”

The hospital bed grunted and pushed to the ICU, the speed was too fast, and it was inevitable that there would be a little bump.

"Slow down, slow down, doctor, the child hurts." The grandparents and grandparents were anxious, for fear that the flat car would bump the children.

To save lives, you have to race against time, and you still care about the bumps in the speed of this hospital bed?

Dr. Kim got angry: "Don't pull it, let it go!"

After a few scoldings, he pulled back the few hands that helped him.

When the patient was finally taken to the ICU, the door barred the family and they slammed on the door.

"How high is the level of lactate?" The doctor on call asked.

"8mmoll" Dr. Kim breathed a sigh of relief.

That's okay, there is hope, it's higher than 25mmoll, and it's basically powerless.

In the final analysis, lactic acidosis is metabolic acidosis, the body's acid-base is balanced, the pH value is about 7.35 to 7.45, the increase or decrease of acid-base substances in the body, exceeding the body's ability to regulate, will cause changes in pH value, which is called acid-base imbalance, which will be life-threatening.

The causes of acid-base imbalance include respiratory factors and metabolic factors, and the increase in lactate is caused by metabolic factors.

"Put on the ventilator, draw blood and review blood routine, biochemistry, liver and kidney function, blood lactate, blood gas analysis, get on the ventilator, prepare the bedside blood filtration machine-" The ICU on-duty doctor has seen more critically ill patients, and as a professional in dealing with critically ill patients, he is better at handling these than orthopedic surgeons and anesthesiologists, and he is also fully equipped.

Even the use of magic lungs is commonplace, and what bedside blood filter machine is pediatric.

The ICU doctor listened to the heart and lungs, and handed over the condition to Dr. Jin and the anesthesiologist.

After completing the handover, anesthesiologist Lao Qin asked Yang Ping: "How do you know about lactic acid poisoning?"

"Alternatively, diabetic patients, with typical Kussmaul breathing, of course consider acidosis."

Kussmaul breathing, also known as acidosis breathing, is regular deep and fast breathing, which can remove more CO2, play a certain compensatory role in acidosis, and is a manifestation of the body's ability to compensate itself.

"The breath still smells of keto, those acidosis caused by salicylic acid, phosphoric acid, and sulfuric acid can be ruled out, the insulin is still hanging, and the pump speed is quite fast, so that blood sugar can also soar to ketoacidosis, it can only be said that insulin is fake, so lactic acidosis may be greater."

It's as simple as that, clear and rigorous logical reasoning, from symptoms to pathophysiology, peeling back the cocoon, and peeling off the answer in a few clicks.

The systematic super training program allows Yang Ping to compile the human anatomy, physiology, biochemistry, pathology, pathophysiology and clinical symptoms, as well as the results of the examination with logical relationships, and continuously train to train strong clinical logical thinking ability.

Devilish training, each training system can also correct errors on the light screen, so that with continuous strengthening, even in an emergency, Yang Ping can quickly go from symptoms to a deeper law along the logical chain.

There is a deep logic behind any appearance, but you just haven't discovered it, or medicine hasn't discovered it for the time being.

Anesthesiologist Lao Qin, carefully recalling Yang Ping's words, there is no fault, no loopholes, not blindness, and the reasoning process is the same as solving problems in high school, which is reasonable and well-founded.

An orthopedic surgeon has such a strong diagnostic thinking ability? Lao Qin was a little puzzled.

"How can this patient have repeated lactic acid poisoning, and now that phenformin has been eliminated, there is no reason, I have to find the reason." Yang Ping explained to Dr. Jin that the patients belonged to their group.

The levels of diagnosis include symptom diagnosis, pathophysiological diagnosis, case anatomical diagnosis, and etiological diagnosis.

Etiological diagnosis is at the highest level, but unfortunately, there are many diseases that do not have access to a causative diagnosis.

For example, the common hypertension and diabetes mellitus, these two diagnoses are only symptomatic diagnoses, and they are the lowest level of diagnosis in terms of diagnostic logic.

The lowest level of diagnosis means that the etiology is unknown, and the pathological anatomy and pathophysiology have not been thoroughly studied, so only symptomatic treatment can be made.

Lactic acidosis can only be regarded as a pathophysiological diagnosis, and treatment can only be started from the pathophysiological level.

It's okay this time, and I'll have a seizure next time, because the cause hasn't been found.

If the cause is to be treated, it is necessary to obtain a diagnosis of the cause, which is precisely the most difficult.

"I'll go back and look up the literature." Dr. King felt the need.

However, it is still unknown whether Wei Danian can be saved.