Most patients think that doctors are very hard-hearted and are only responsible for seeing patients and prescribing medicines, and do not care about the treatment effect of patients. In fact, doctors are very concerned about the results of the patient's treatment.

It is safe to say that the wishes of the doctors, and the wishes of the patients and their families, are highly aligned.

Because of this, doctors are not only subjected to irregular and heavy work, but also to bear tremendous pressure from the patient's family, the patient and the doctor themselves. These pressures can crush any doctor at any time!

These pains, even if understood by the patient and his family, are superficial. Only the doctors themselves understand the difficulty.

When the whole society regards doctors as "angels", doctors have embarked on the "road of no return" in life and career.

"I believe everyone has heard Dr. Liu's introduction just now. Such a patient is very dangerous and may die at any time. The other patients' shifts were suspended, and everyone focused on discussing the next steps for this patient. ”

Ling Xiaoyun interjected in time. This is actually a routine practice in neurology.

In such an era, Dr. Lau's treatment of such patients is correct and standard. If this kind of treatment is still uncontrollable, it seems that there is no better way.

Therefore, in the office, everyone, including Li Yun'e, did not dare to speak, and they did not know how to deal with it.

"Dr. Lin, it's up to you again." Obviously, Ling Xiaoyun didn't have a better way.

Lin Lin remembered that in his previous life, he also participated in the rescue of this patient. The difference is that Lin Lin in her previous life lacked experience in this area of rescue. Eventually, the patient's condition was uncontrollable, and the family chose to take the patient to "self-discharge".

After being reborn, Lin Lin has decades of experience and a solid foundation in dealing with such patients, although he does not dare to guarantee that he will be able to control the disease, but he has enough ways to think and implement.

"I will say a few words, I hope you will add to it later, and I hope you will point out the shortcomings of what I said."

"This patient, the treatment last night was effective, why did he start to have frequent attacks again this morning? In my opinion, there are several reasons to consider. ”

"First, this patient has been having seizures since yesterday afternoon and have not been under control until the emergency department of our hospital. Moreover, the patient's seizures have always been tonic-clonic seizures. ”

"Every time such an episode, the patient will experience a lack of oxygen. And the lack of oxygen will definitely cause hypoxic damage to brain cells. ”

"With frequent seizures, the damage to brain cells must be severe. After brain cell damage, cerebral edema slowly develops. Until cerebral edema is not controlled, the effectiveness of the drug will be greatly reduced. Therefore, the current treatment effect of patients is not good, which has a certain relationship with this. ”

"Second, the patient's seizure, which lasts for so long, every time there is a lack of oxygen, every time the muscles twitch violently, and every time the convulsions cause metabolic disorders, it is easy to cause acid-base imbalance in the patient's body."

"In general, in the case of acidosis, the effect of antiepileptic drugs is greatly diminished. So, this is another reason why the patient's current treatment is poor. ”

"The third possible reason, most likely related to the properties of the drugs themselves. Valium is a fat-soluble drug, and after entering the body, it quickly dissolves in fat, and the efficacy will quickly decrease. ”

"Lumina's intramuscular injection, which is slowly absorbed, has a limited effect. Phenytoin, on the other hand, is a good drug, but individual patients are not sensitive to it. ”

So, based on the above points, I recommend that you immediately use mannitol for dehydration, using half a dose of sodium bicarbonate, which is 125 ml of meridian infusion. Before taking the drug, the patient's acid-base status and electrolyte status are checked, and at the same time, the dressing is changed immediately. ”

"Dressing change? What kind of medicine to change? What medicine do you think? Is it really necessary to use anesthetics? Ling Xiaoyun asked a series of questions.

"You can't use anesthetics. Anesthetics may be effective, but the anesthetics themselves can also cause seizures. Besides, with anesthetics, you have to be on a ventilator, and we don't have that condition at all. ”

"When I change the dressing, I am changing to another benzodiazepine drug, clonazepam."

"Huh?! With chloronodiazepam? We haven't used this drug, and besides, isn't it also a benzodiazepine? What's the difference between that and what you just said? ”

Ling Xiaoyun is very realistic, if you don't understand, you don't understand. At this point, Lin Lin admired her very much.

"There is a difference. Clonitrodiapam is not a strong fat-soluble drug, and its fat solubility is much lower than that of diazepam, so it can maintain an effective concentration for a long time. ”

"I feel that patients are sensitive to benzodiazepine drugs, but the diazepam is too fat-soluble to maintain effective concentrations. Since other drugs have been used, you might as well use this, and combined with the method I just mentioned, it may be effective. ”

Lin Lin didn't dare to say too sure. After all, the individual differences of patients are too great, and no one dares to say which medicine each patient is sensitive to.

"I have a somewhat different opinion." Li Yun'e, who had been silent, finally spoke up.

Such an opportunity is difficult to find, Li Yun'e wants to take this opportunity to let out a bad breath, a bad breath of being "pressed on the ground and rubbed back and forth" by Lin Lin in the outpatient clinic.

"Although Dr. Lin said that there is a difference between diazepam and clonazepam, I don't think the difference is big."

"We must be vigilant about the inhibitory effect of chloronodiapam on respiration. I don't think it's worth the risk. ”

"Besides, we have never had experience with this drug. Patients are so young, and once they fail, the impact on our department is great. ”

Li Yun'e was in a hurry, and her speech was already incoherent. Since the patient is young, it is even more important not to let the patient die in the midst of continuous seizures. When she said this, didn't she slap herself in the face?

Dr. Li's concerns are not unreasonable. However, Dr. Li, if this patient does not take measures and continues to have seizures, he will definitely die. ”

"Since Dr. Li disagrees with Dr. Lin's opinion, I would like to hear Dr. Li's advice on the next steps for this patient." Ever since he knew the reason why Li Yun'e asked to go back to the ward, Ling Xiaoyun's heart was already very dissatisfied.

"There's nothing I can do." Li Yun'e's face showed an embarrassed expression.

"There's nothing Dr. Li can do, I can't do anything, and there's nothing you can do. The question now is, if you don't try Dr. Lin's method and let the patient wait for death, or take the risk of trying Dr. Lin's reasonable solution? ”