The inferior vena cava and part of the right atrial wall patch are also restored to their previous smooth state after widening.

Zhou Chao breathed a sigh of relief.

"Lin Yi, the operation was successful!"

Wang Qiaoya also said excitedly.

"The results of the surgery are obvious! The patient's upper and lower limb edema has improved significantly! ”

After the surgery, they did a CT of the upper and lower vena cava.

The CT results were also surprisingly ideal.

After walking out of the operating room and back in the consultation room.

Yin Liang found Lin Yi.

"Brother Yi, I received a patient here today, and the situation is a little strange. Why don't you show it? ”

Lin Yi nodded after listening, and then asked:

"What's the condition of the patient?"

"The patient is a 53-year-old male."

Yin Liang began to introduce the basic situation of the patient to Lin Yi.

"This patient had a stone on his left kidney, the size of a centimeter in diameter. Since he could not perform extracorporeal ultrasound lithotripsy, the local municipal hospital performed percutaneous kidney stone removal on him. Conventional surgical methods are used. ”

"This patient had the first two days of surgery, and there was nothing wrong, and his vital signs were relatively stable, which was today, that is, the fifth day after surgery. Sudden onset of abdominal pain, bloating, and fever with a decrease in oxygen saturation and a drop in blood pressure.

"The vital signs are very unstable."

"The local hospital couldn't control the vital signs, so they were transferred to our hospital."

"After this patient came, he did a blood routine, PCT, abdominal CT and abdominal color ultrasound."

"The blood routine white blood cells are relatively high, and the PCT is also very high. There was no major problem with the chest CT, but the abdominal CT did not show any obvious problems. ”

"The place where the kidney was operated on is not a big problem, and the color ultrasound only indicates cholecystitis. Now the most critical problem of this patient is that his blood pressure has not been maintained, and he can barely raise his blood pressure a little with vasopressors. ”

"As it stands, the patient is clearly in septic shock. The infection was very severe and caused shock, but one of the things I struggled with was, where is the source of the infection, and I can't find it? ”

"I did all the tests that should be done for him, but I couldn't find an obvious source of infection, which is strange when you say it."

Yin Liang finished the patient's current medical history in detail, still with a puzzled face.

After listening to the cause, Lin Yi also had a general judgment about this patient in his heart.

But what exactly is the cause of severe infection.

Where is the source of infection?

Of course, you still need to see the patient before you can be sure.

Lin Yi stood up and said, "Let's go and see the patient." ”

No matter how detailed the patient's medical history is, Lin Yi can't tell what kind of disease the patient is without seeing the patient in person.

Lin Yi and Yin Liang soon came to the emergency intensive care unit.

The patient was a man in his 50s with a very dull complexion and was in a coma.

He was intubated with an endotracheal tube and on a ventilator to assist breathing.

There is also a drainage tube in the left waist, which belongs to the drainage tube that was placed after the kidney stone removal was done at the local hospital.

Yin Liang pointed to the data on the ECG monitor and continued to introduce the patient's situation.

"Brother Yi, look at this patient, his blood pressure is extremely unstable now, and he has been using norepinephrine and metahydroxylamine bitartrate, and his blood pressure is still unstable."

"It goes down from time to time, and now the amount of vasopressor is already very large, and his procalcitonin is very high, reaching more than two hundred."

"And the lactate is also very high, lasting around 9.0mmol/L, this patient has poor microcirculation, and the infection is particularly serious, which is estimated to be very dangerous."

Calcitonin source is mainly a chemical indicator of the severity of infection.

Higher procalcitonin indicates more severe infection.

Normal procalcitonin is generally less than 0.5ug/L, and this patient has reached more than 200, which is very rare.

Lactate value is a biochemical indicator in blood gas analysis.

Lactate is present in small amounts in humans, but its clinical significance is particularly important.

Lactic acid can represent the body's circulatory state.

Lactic acid is produced in the absence of oxygen in the body, when oxygenation of tissues and organs has decreased.

If lactate is elevated, it represents the state of ischemia and hypoxia of the body, which means that the patient's circulatory state is not good.

Checking the patient's lactate is of great significance to determine whether the patient's circulatory status is good.

Some diseases can cause abnormal lactate metabolism, which causes lactic acid to accumulate in the body, which can lead to lactic acidosis in patients.

The clinical significance of lactate testing is a relatively reliable indicator.

The lactate concentration of normal people is 0.1-1.7mmol/L. If it exceeds 2.0 mmol/L, the patient should be considered to have insufficient tissue oxygenation.

The higher the lactate test value, the more severe the patient's circulatory disorder.

In general, if lactate continues to exceed 4.0 mmol/L, the risk of death is very high.

And now Yin Liang introduced that the lactate value of this patient is as high as 9.0mmol/L, which fully shows that this patient's condition is not optimistic.

If his lactate level can't be lowered, then the person will die.

Listening to Yin Liang's introduction, Lin Yi's brows furrowed slightly.

According to the results of blood tests, the infection of this patient was very serious.

However, according to the results of the patient's CT ultrasound and other examinations, the source of the infection was not found.

And all the manifestations of this patient's critical illness are all caused by severe infection.

Coma and shock are caused by infection.

If the source of the infection is not identified and disposed of, then the patient will not be able to be treated at all.

The patient's blood test results contradicted the radiological test results, so Yin Liang was puzzled and couldn't find the cause of the patient's illness.

Next, Lin Yi used a stethoscope to auscultate the patient's cardiopulmonary function in detail, and then palpated the patient's abdomen.

I have already come to a conclusion in my mind.

And Lin Yi's conclusion, that is, the root cause of the patient, was judged by Lin Yi completely based on his own experience.

Lin Yi repeatedly considered and came to the conclusion that the source of infection of this patient must be in the abdominal cavity.

Because once the abdominal cavity is infected, the symptoms of the whole body will be particularly severe, and it is difficult to treat, and the mortality rate of patients is high.

The most likely cause of severe abdominal infection in this patient is the rupture or perforation of the hollow organs.

The most likely is a perforation of the small intestine or large intestine, causing a serious infection caused by the flow of fecal water into the abdominal cavity.

Only in this way can the patient's condition be explained.

Lin Yi guessed that the patient's gallbladder was likely to have suppurated and gangrene, and it was swollen and unsightly.

And there may be a perforation in the sigmoid colon, and the fecal water in it is constantly flowing out and flowing into the abdominal cavity.

But because of this patient, he has been hospitalized for several days, and he has not eaten a drop of water and cannot eat.

So there wasn't much in his intestines, so there wasn't much fluid in his abdomen.