socalfunplaces Chapter 623
Chapter 623
Lin Feng returned to the emergency room from the director's office,
Start seeing the patient.
outcome
I saw 10 patients.
"Dr. Lin, the Department of Obstetrics and Gynecology is looking for you to come and consult!"
The nurse at the nurse's station ran over and asked Lin Feng.
Lin Feng: ".................."
What's going on today?
So many things?
"Okay, tell the obstetrics and gynecology department, I'll go over now..."
Lin Feng quickly finished looking at the patient, then got up and left the consultation room, Xiaoru quickly followed.
Not far away,
When Dr. Jiang Yue saw it, he couldn't help muttering.
"This Lin Feng, it's quite popular..."
She actually wondered, why is this Lin Feng so powerful?
I heard that I am only a graduate student, not even a doctorate.
The doctor next to her heard her muttering and smiled without speaking. Although this Jiang Yue returned from abroad, he was very ungrounded and a little arrogant, and his treatment of people made people have a feeling of 'I'm so cold, don't get close'.
He even said, "What? Sold so fast at home and abroad? "What? Domestic online shopping delivery so fast? " and so on.
She is quite distant from any doctor or nurse.
And one more question,
Jiang Yue is abroad, when he is interning, a patient has a team (doctors, nurses, life support, psychology, cleaning, miscellaneous)...
The division of labor is particularly numerous.
And a doctor only needs to be in charge of one patient.
And what about the harmony side?
My God, one doctor is in charge of dozens of patients.
Lose your marbles!
Therefore, Jiang Yue is very unsuitable for life in China.
She didn't even realize that she had been faintly isolated.
......
Lin Feng's side.
Came to the Department of Obstetrics and Gynecology.
"Doctor Lin..."
"Dr. Lin is here."
Soon, a nurse led Lin Feng to one of the wards.
Separate ward.
There are several doctors, but it seems that the director-level doctor is not there.
All are the following main treatment.
"Doctor Lin, help take a look at this baby..."
Lin Feng looked over.
The newborn, hair was still wet and sticky together, apparently not bathed yet.
Obviously, I was born today, so I didn't bathe.
Harmony Hospital, Department of Obstetrics and Gynecology, all bathe the baby every morning, and will not bathe the baby additionally. Of course, newborns are just born, they will be more afraid of cold, and generally have a higher temperature than ordinary people to keep warm. (Children are less afraid of cold than adults.) ）
The baby in front of you,
Lin Feng saw the problem at a glance.
Pale all around!!
"Tell me about the situation..."
"Okay, this baby, female, was born by cesarean section, gestational age 38 weeks, birth weight 3110g. Mother 22 years old, pregnant 2 times and gave birth 2 times (G2P2), O, Rh positive blood type..."
"When you are born, you can't breathe on your own. spontaneous breathing occurs after 30 seconds of positive pressure ventilation..."
"Physical examination at birth: heart rate 178 beats/minute, breathing 64 breaths/minute, body temperature 36.9°C, blood pressure 59/35mmHg."
"After successful oxygen resuscitation, the baby is still pale, no jaundice, no edema, accompanied by respiratory distress, oxygen concentration of 30% under nasal cannula oxygen, normal blood oxygen saturation, clear breath sounds in both lungs, no murmur in the heart, liver touches 3cm under the ribs, the spleen is not reached, and the muscle tone of the limbs is low."
soon
The obstetrician explained the situation clearly.
"Okay!"
Lin Feng nodded and began to think.
Lin Feng thought of a string of diseases at this time:
Perinatal asphyxia, septic shock due to early-onset sepsis, acute bleeding, neonatal hemolytic disease, congenital heart disease... Wait a minute
These diagnoses may present with the clinical manifestations described above.
Obviously,
Suffocation is definitely there.
But what is the reason why you are still pale after nourishing your qi?
Filtered it,
In this case, there are three possibilities:
Severe acute ischemia... (Heavy bleeding in the body)
Hemolysis...
Lin Feng: "Is there a blood routine and blood gas analysis?" And Tsuen cell analysis..."
Doctor: "Yes, it's anemia." "
Lin Feng: "Report to me..."
Hematocrit 16%, hemoglobin 56g/L;
Arterial blood gas analysis PH7.20, HCO3-10mmol/L, BE-14mmol/L→
The conclusion is:
Severe anemia!
Anemia metabolic acidosis!!
So, where does the baby's blood go?
The causes of anemia in newborns can be divided into:
Decreased red blood cell production: such as pure red blood cell aplastic anemia, congenital leukemia, etc.;
Excessive loss of red blood cells: including various diseases that cause blood loss in newborns before, during, and after birth;
Increased destruction of red blood cells: mainly refers to various hemolytic diseases and infections.
Consider that the mother has type O blood and there is a possibility of hemolysis. (If one of the couple has type O blood, the newborn is more likely to have hemolysis.) Another cause of jaundice is hemolysis. ）
Of course, blood loss before birth cannot be ruled out.
Lin Feng came to his mother.
After a 10-minute question, I learned something suspicious:
Mothers feel a decrease in fetal movements 2 days before the birth of the child, and fetal heart rate monitoring shows a decrease in baseline fetal heart rate variability and late deceleration.
• No history of abdominal trauma and no amniocentesis.
Lin Feng: "This fetal movement is reduced, there may be a problem... And I watched the ultrasound of the prenatal admission, and the fetal heart rate also felt a little problematic..."
"My consideration, there are two."
"First: hemolysis."
"Second: fetomaternal transfusion syndrome."
The doctors were shocked.
"Blood transfusion for the fetus?"
"What is it?"
"I've heard this, but I haven't seen it..."
Medical knowledge is vast, many doctors have worked for decades, and there may be many diseases that they do not know and have not been exposed to.
This is a normal thing.
"We only thought about hemolysis..."
"However, we have already done the "neonatal hemolytic disease test and antibody screening test" to rule out hemolysis."
Lin Feng: "Since the hemolysis test has been done and hemolysis has been ruled out, then do the "fetal red blood cells in the mother's blood circulation (KB test)" to diagnose the fetal mother blood transfusion..."
Fetomatemalhemorrhage (FMH)
It is a very rare obstetric disease, which refers to a certain amount of fetal blood entering the maternal blood circulation through the damaged placental villi, causing fetal blood loss and hemolytic reactions of the mother and fetus.
Because of its insidious clinical manifestations, and the mother's hemolytic anemia symptoms are rare, there are almost no specific clinical manifestations, often there are no obvious precipitating factors, mostly acute, prenatal is more difficult to diagnose.
Therefore, it leads to a high perinatal mortality rate!
Moreover, even if it is saved, it may be saved too late, resulting in a very poor prognosis.
As for
Causes of fetomaternal blood transfusion.
It may be that due to the pressure difference between the umbilical artery and the villus space of the fetus, the water and metabolites in the fetal blood circulation can reach the mother, so the blood of the fetus can also enter the mother through this pathway.
Especially when the villi are damaged, fetal blood can directly enter the mother's body.
。