The person who was pushed into the rescue room this time was a middle-aged man in his forties and obese body.

I saw him lying on a stretcher, breathing irregularly. Chen Xia didn't respond no matter how he called. He was obviously unconscious. The key was that the patient had paroxysmal spasm on his left limb, which was thrusting one after another.

Chen Xia quickly asked, "What's going on with the patient?"

"Doctor, we don't know what's going on. Tonight we played mahjong together. Lao Qin touched a good card and shouted excitedly. Suddenly he shouted that he had a severe headache and vomited constantly. After a while, he fell into a coma. We immediately rushed over."

Chen Xia thought that this was usually a stroke, the most dangerous type of emergency room.

However, there is no neurosurgery or brain surgery department in Yuezhou Fourth Hospital, so it’s over.

"Hurry, then who? Wan Lu quickly monitors vital signs and opens venous channels. Wu Shaochen, you go to the third department of surgery to call the doctor on duty, and you say it may be a cerebral hemorrhage and ask for an emergency consultation."

After giving the instructions, Chen Xia immediately conducted a physical examination.

The patient is already in a coma, with the left pupil 2mm and the right pupil 3mm, varying in size, dull reflexes to light, clear lungs, clear heart rhythm, 120 times/minute, smooth rhythm, and Papistry sign is positive for right.

"Wan Lu, report blood pressure."

“Uppress 220, downward pressure 130.”

Chen Xia took a breath of air conditioning. What kind of evil did she do today? Why did she meet three hypertensive emergency patients in one night?

"Don't sprinkle the blood pressure monitor, measure it at any time."

Chen Xia was anxious now. He suspected that it was a cerebrovascular accident, but now there is no emergency CT and MRI, it is impossible to confirm, and ordinary X-rays do not work at all.

However, the patient's condition was very critical and entered a strange state. His breathing was faster and slower, but his heartbeat was getting slower and slower. The key was that his blood pressure was also damn. The second measurement returned to 140/100mmHg.

This manifestation of frequent highs and lows often indicates the formation of brain hernia. If it reaches this level, with current medical technology, the patient can no longer be saved.

"Lin Chenxing, hurry up and put mannitol on it. Where is the family? When will his family arrive?"

At this time, a few people rushed in from outside, one of whom was howling in.

As soon as he entered the emergency room, he directly slapped on the patient, "Old Qin, what's wrong with you, Lao Qin? Oh, Lao Qin, you can't die!"

Chen Xia didn't bother to say too much and asked hurriedly, "Are you a patient's family?"

A middle-aged man stood up and said, "Doctor, I am the patient's brother. How is my brother in the future?"

"It is very unoptimistic. The patient has cerebral hemorrhage now, and according to his symptoms, there should be a brain hernia. We have issued a critical illness notice, so you must be mentally prepared."

At this time, the doctor on duty in the third department of surgery also arrived. After some examination, he was also highly suspected of brain hernia.

Du Guobiao finally came out of the operating room and asked about the patient's condition. Chen Xia introduced it in the original form. He had another physical examination. The patient's eyeballs were oblique, his pupils were diffused on both sides, and his light reaction disappeared.

When Director Du looked up and saw the mannitol being dripped rapidly, a complex look flashed with lightly noticeable eyes.

The patient's wife was still howling, "Doctor, the doctor save my husband. He is only 40 years old and we still have three children."

Chen Xia opened her mouth but couldn't say anything. Several patients' families were called to the office by Director Du to explain the matter.

Brain hernia in a few decades may not be an incurable disease, and at least half of the hope is to survive.

But the premise is that once the disease is confirmed, a craniotomy must be performed quickly and the cause of the disease will be removed as soon as possible, such as removing intracranial hematoma or removing brain tumors.

If it is difficult to diagnose or the cause cannot be removed even though it is confirmed, palliative surgery can be used to reduce intracranial hypertension and rescue brain hernia.

But now there is no brain surgery department in the Fourth Hospital of Yuezhou. This kind of high-end surgery can be performed in the capital or Shanghai Stock Exchange. It is not possible in small cities like Yuezhou, and it does not have this technology or ability.

Chen Xia felt a little embarrassed, but he couldn't help it. He couldn't stand this kind of surgery either.

It was getting darker. After a night of struggle, the first two hypertensive patients finally recovered after emergency treatment. If nothing unexpected happens, they will be considered to have survived this time.

But there are always regrets in life. The third and youngest middle-aged man finally failed to get through and his breathing and heartbeat stopped.

Chen Xia and several young doctors rushed to rescue him. After half an hour, the electrocardiogram was still in a straight line.

In fact, this kind of rescue is also for the family to see. It is basically impossible for any miracle to happen. Even if the medical level in later generations is so developed, the mortality rate is also half.

After dawn, the patient was carried home while the patient's family was crying and shouting.

When the outpatient clinic started working in the morning, the emergency department was also empty. Du Guobiao called Chen Xia to the office and closed the door.

"Xiao Chen, you have some problems dealing with the third patient today. If you are considering cerebrovascular lesions, it is not recommended to lower your blood pressure too low. It is generally enough to maintain it at around 180mmhg.

If you use mannitol, the intracranial hematoma may further expand while the intracranial pressure is reduced, and it may also cause bleeding again. You should use nimodipine to lower the blood pressure first."

Chen Xia was a little confused and quickly explained:

"Director Du, I came from the textbook. It clearly stated that mannitol can be used to reduce intracranial pressure, reduce cerebral edema, and prevent brain hernia."

Du International continued: "Using mannitol to reduce blood pressure has always been controversial. If it is a cerebral infarction, your reduction will be too low and it will further reduce blood flow in the brain and aggravate the cerebral ischemia and hypoxia.

If it is cerebral hemorrhage, due to the increase in intracranial pressure, hypertension is a reflexive reaction, increasing intracranial blood flow. If the blood pressure is too low, the arterial pressure cannot fight intracranial blood pressure, which aggravates the occurrence of hypoxic encephalopathy and increases cerebral edema.

Another key point is that your previous diagnosis is speculation, there is no evidence, and cerebral hemorrhage does not equal intracranial hypertension, right? So where are the indications for the use of mannitol?"

Chen Xia was speechless when asked, and asked him, a surgical dog from his previous life, to answer such advanced internal medicine questions, which was indeed a bit embarrassing to him.

What followed was a sense of depression.

When Du Guobiao saw him like this, he smiled: "It's okay. In fact, the ending of this patient's use of medicine or not is the same. You have done a good job tonight. I am very satisfied. Don't have psychological burdens."

Chen Xia scratched her hair, "Old Du, why don't you let me go to the surgical team? I think my surgical level is better than internal medicine."

"Gongguanggu, this is surgery, not killing a chicken, don't think about it, kid."
Chapter completed!