There are two categories of acute pancreatitis in terms of degree: mild and severe. Although the symptoms are similar to the same severe pain, mild acute pancreatitis generally does not die - or even develops to the point of death. However, the severe symptoms are different, and its prognosis is very poor. And it progresses very quickly. What is more troublesome is that the development of severe pancreatitis always does not play according to common sense. It does not have a strict order of onset. It may cause multiple organ failure just now, and it may also be done step by step, digesting the pancreas itself bit by bit, and then eroding other organs and tissues.

The pathogenic mechanism of acute pancreatitis is basically the same - except for the acute pancreatitis caused by hyperlipidemia, alcoholic acute pancreatitis and biliary acute pancreatitis are both because the pancreas cannot discharge pancreatic juice smoothly, which leads to inflammatory reactions such as edema, bleeding, and even necrosis caused by the pancreas self-digestion from the inside. At the same time, factors that cause this sterile inflammatory reaction include oxidative stress, bacterial displacement, circulation disorders, etc. The mechanism is complex, but in general, the pathogenic mechanism is consistent - under the influence of alcohol, the pancreas secrete more pancreatic juice, and the Oddi sphincter at the end of the pancreatic duct may have spasms, which leads to pancreatic duct obstruction. The gallbladder is because gallstones block the channel from the ampulla of the hepatopancreatic ampulla to the head of the duodenum.

If you are a mild patient, you usually have pancreatic edema. The condition is generally self-limiting - even if you do not apply drugs or surgical treatment, you can recover on your own after a period of time. However, severe cases are different. Whether it is edema or hemorrhagic necrosis, severe acute pancreatitis has a very high mortality rate. According to domestic statistics, the mortality rate of severe acute pancreatitis is between 10% and 30%. It is considered a type of highly mortality rate in acute abdominal diseases.

For emergency doctors, it is very important to distinguish the patient's "urgent" and "severe" situation. For diseases that are unbearable for pain such as ureteral stones, but have low mortality rates, they can be regarded as "urgent but not serious". It is advocated to relieve the patient's pain first, and then seek treatment methods. However, if the patient's family clearly knows the consequences of the disease, and after being sent to the emergency department, they choose to treat conservatively or even give up treatment, it is considered "severe but not urgent".

However, diseases such as myocardial infarction, cerebral infarction, severe trauma, severe burns, poisoning, etc. that progress rapidly and may directly lead to death of patients fall into the category of "urgent and severe".

And now, lying on the rescue bed and not very clear-minded, what type does Tian Xinghua belong to?

The person who sent Tian Xinghua to the hospital was his 12-year-old son. The hospital could not accept the signature of a person with limited civil capacity for rescue. If Tian Xinghua was to be rescued, the medical department must sign and authorize it.

However, it is not something that Sun Lien can get by just calling. If you want to sign, it must be proved that the patient's condition is so urgent that he needs rescue. In other words, unless it is clear that Tian Xinghua is indeed suffering from severe acute pancreatitis, the Medical Department will not give permission at the risk of being complained or even prosecuted by the patient's family.

Sun Lien glanced at the status bar above Tian Xinghua's head, and then sighed slightly.

"Tian Xinghua, male, 44 years old, pancreatic edema (03.25.33), hypoxia (01.41.22), blood sugar 11.7mmol/L, (01.31.41), high serum amylase content (00.44.41).

In terms of time maintenance, Sun Lien only took a look at his blood sugar, which lasted no more than two hours. From the perspective of time, the occurrence of this symptom lags behind pancreatic edema. It can be basically confirmed that his hyperglycemia is caused by acute pancreatitis.

If the blood sugar of patients with acute pancreatitis is higher than 10mmol/L, it can be directly considered as acute severe pancreatitis. Although clinically speaking, serum amylase or other organ examinations are required to be confirmed as severe, Sun Lien is very sure that Tian Xinghua's condition is very dangerous.

"Give him oxygen, has the blood sugar level come out?" Sun Lien decided to urge him to check the progress of the examination, at least get direct evidence of high blood sugar first, and then ask the medical office for authorization. Although it is considered a serious illness, Tian Xinghua's symptoms are not too bad, at least not too bad now. If it is delayed until organ failure or respiratory distress syndrome (ARDS) and systemic inflammatory response syndrome (SIRS), it will be troublesome.

"Blood sugar is 11.8mmol/L. Brother Sun, is this person suffering from diabetes?" Nurse Xiao Guo was fiddling with a blood sugar meter. The equipment used in the emergency room for preliminary blood sugar measurement is a small machine that can be used for home testing of blood sugar. The mini size is really a bit unbearable to see.

Sun Lien sighed, "If he has diabetes, I don't have to worry so much." This is also one of the reasons why Sun Lien cannot directly rely on high blood sugar to authorize - he cannot provide evidence to prove that Tian Xinghua has no diabetes. If he is a diabetic patient, although the blood sugar level of 11.8mmol/L is very high, it will not become evidence that severe acute pancreatitis.

"Children, what medicine does your father usually take?" Sun Lien thought for a while and decided to ask the patient's family first. Although the twelve-year-old child was a bit difficult to carry his father to the hospital, he could still answer some questions accurately.

"Take medicine?" Tian Yu shook his head without hesitation, "My father doesn't even have a headache or fever, and I've never seen him take medicine."

Although Tian Xinghua still cannot be ruled out that he has diabetes, the amount of this evidence is still there. After letting Xiao Guo use the routine blood induced and serum amylase data again, Sun Lien led Tian Yu out of the rescue room.

"You just wait here." Sun Lien pointed to the seat in the rescue hall and said to Tian Yu, "Look at the door. If your uncle comes, take him to the rescue room first. Register and other items can wait a little." Sun Lien's plan is very simple. He first thought of a way to send Tian Xinghua to the operating table, and the pancreas clearance and drainage as soon as possible is the only way to save his life.

Returning to the rescue room, Sun Lien continued to direct the treatment, "Give him wustaldehyde, 100,000 units to get normal saline, and monitor blood pressure..." He thought for a while, "After the CT results come out, ask doctors from outside the liver and gallbladder to consult."

According to the consultation order of surgery first and then internal medicine, Sun Lien decided to wait for doctors from extrahepatobiliary to see the patient's condition before asking about the opinions of the gastroenterology department.

Tian Xinghua, who was lying on the hospital bed, vomited again. He was restless on the hospital bed. He was obviously in a state of pain, but he still struggled. Seeing this, Sun Lien hurried over to comfort the patient, but the results were very little. Tian Xinghua is now drunk and cannot give him painkillers or sedatives, which is really a bit troublesome. Sun Lien held Tian Xinghua's hand that wanted to push away his oxygen tube for the third time and shouted to Guo Yu helplessly, "Xiao Guo, bring it here with constraints!"

Tian Xinghua was tied to the bed. Sun Lien quickly arranged a CT scan while there were too many people. There were no restraint belts on the CT scan bed. It would be better to ask a few more doctors to wear lead clothes while there were too many people and finish the examination by Tian Xinghua.

After the CT scan results are released, you should be able to go to the medical office to authorize it based on the results. Sun Lien went through the examination order in his mind and confirmed that there were no missing places, and breathed a sigh of relief.

Although Tian Xinghua may not be able to save his life after going to the operating table, that is not something he can handle. Sun Lien and nurse Xiao Guo and others pushed the hospital bed to the imaging department together.
Chapter completed!