MTL - Since 1981 Health School-Chapter 414 neonatal chylothorax

  Chapter 414 Neonatal chylothorax

  In the pediatric ward.

  Shen Lifen was looking at the child in his arms with tears in his eyes. Seeing his son's breathing sound like a bellows, and his face flushed because of dyspnea, let alone how distressed he was, tears flowed down again.

   "Baby, baby, don't scare mom, get better soon, mom please, woo woo woo~~~"

  The child’s mother was crying, and the child’s grandmother, aunts, and aunts were also wiping away their tears.

  The child's grandma just sat on the ground and howled:

   "My poor grandson~~Why did you get so seriously ill~~How can I explain to your father~~Why is my life so miserable~~"

  The child's grandpa was even more annoyed when he heard this: "What are you howling, you have to howl, it's bad luck!"

  In the ward, the nurses came in and out, suctioning the child's sputum, changing the medicine, and observing the condition, all of them were extremely nervous.

  Outside the ward, many people gathered around the door and pointed.

  Hospitals in this era, because of their limited capabilities, cannot keep up with the treatment. Deaths in hospitals are also a daily phenomenon, and many people are sent to the morgue every day.

   Now the patient is a 2-month-old baby, and his father is still a soldier, which makes many family members who are onlookers sigh.

   "It's over, it's over, this child can't be kept..."

   "Yeah, this condition is getting worse every day, and the doctors can't help it. I heard that I'm going to invite experts from other hospitals..."

   "Poor thing, this child's father probably doesn't even know that his son is going to die. If he knew this, how distressed he is..."

   "I heard that Dad is still an officer guarding the frontier, but he is a great hero of our country..."

   "It's really a good man who doesn't get rewarded..."

  Whether it was Shen Lifen in the ward, or the family members, or the crowd of onlookers, everyone already knew in their hearts that this little baby might not be able to keep.

   Judging from the old experience of the common people, the air intake is less and the air output is more, which is almost in a dying state.

  Chen Qi came to the ward in this low-pressure atmosphere.

  President Gai personally accompanied Chen Qi to walk in front, chatting about his condition, and walked into the ward, followed by a lot of directors, and finally a little doctor like Qi Zhiyi.

  The onlookers outside the ward were full of question marks. It was agreed to invite experts, but how could a young man go in?

  Experts, shouldn’t they be white-haired and bearded?

   There are also doubts about Shen Lifen and other family members. They never dreamed that the person who came to participate in the consultation would be such a young doctor?

   It seems that he is not even 30 years old, and he is about the same as an intern.

   "Dean Gai, this, this is..."

  Dean Gai immediately realized what was going on, and hurriedly introduced:

   "Mr. Shen, this is Comrade Chen Qi, the dean of the Fourth Hospital of Yuezhong University. He is a double director of the International Medical Association and the only international expert in our country. He sacrificed his personal rest time to come here for consultation."

  Dean Gai also played a game of words, did not say what double directors were, and did not say what kind of professional directors they were.

  Older people may not know it, but young people like Shen Lifen who often read newspapers immediately realized who Chen Qi was.

   "So you are Comrade Chen Qi, that's great, please save my child, woo woo woo~~~"

  The family members next to him were also sincere. Only the grandma and grandma of the child were a little dissatisfied with Chen Qi's age.

  Chen Qi quickly comforted:

   "Don't worry, don't worry, you see everyone is helping your child find a way, don't lose confidence first, let me check first, now that medicine is so advanced, there must be more solutions than difficulties."

  Time was running out, and Chen Qi didn't have time to say anything, so he began to unbutton the baby's clothes.

  The premature baby who is only 2 months old is as weak as a kitten, which makes people feel pitiful.

As soon as he opened the clothes, Chen Qi keenly found that the suprasternal fossa, supraclavicular fossa, and intercostal space had obvious depressions. An experienced doctor could tell at a glance that this was due to partial obstruction of the upper airway. Difficulty breathing.

  Children have shallow and fast breathing, so the three concave signs will be more obvious, which is also an important criterion for diagnosing severe illness.

   It also indicates that the child is already suffering from respiratory failure, and the situation is more serious than he imagined.

  Chen Qi tapped the chest with his fingers again, and his voice was obviously dull. Combined with the chest X-ray, the pleural effusion may be clear. Now the most troublesome thing is what is the nature of the effusion? Source of interstitial fluid?

   Is this exudate and transudate? Is it infectious, neoplastic or traumatic?

  If in future generations, CT films can provide doctors with very valuable evidence, the problem is that there is none now, which makes Chen Qi a little headache.

   "Dean Gai, let's do a B-ultrasound for the baby first."

   "Oh, B-ultrasound was done just now, and the report only said that there was effusion, and could not provide more useful information."

  The B-ultrasound machine in the second hospital is the same as the fourth hospital, which is black and white, and the screen is not clear enough, which also affects the doctor's judgment.

  Doctors in this era are so helpless when they see a doctor. They want to check but don’t check, and they want medicine but no medicine. Therefore, the mortality rate of patients is much higher than that of later generations.

  Chen Qi thought of the most advanced notebook-type color ultrasound machine in his own space. He had never taken this thing out in front of others, and only used it secretly in Huangtan.

  The situation is critical now, seeing that the child can't survive and may die at any time, he can't remain indifferent.

   Having made up his mind, Chen Qi said to the surrounding doctors:

   "Wait a minute, my friend in a foreign country gave me a color B-ultrasound machine, which happened to be in my home, I'll go get it."

  As soon as Qi Zhiyi heard it, he shouted from behind: "Chen Qi, let's go, let's go faster by bicycle."

   The two returned within 15 minutes, and Chen Qi said anxiously: "Dean Gai, now I need a room with curtains, preferably without light."

  The director of pediatrics Yao Qingju shouted: "Go, go to our small warehouse, there are no windows."

  As soon as Chen Qi came up with advanced foreign gadgets, everyone wanted to see them. Chen Qi thought to himself that he was lucky to be able to pull the banner of foreign countries, otherwise it would be really hard to explain.

   But he is someone who doesn’t want a large group of people to watch. He has two mouths, and it’s hard to tell if some “black technology” is publicized.

   "Sorry, sorry, because this machine is still in the experimental stage, there are confidentiality requirements, so please forgive me for not being able to watch, but don't worry, I will tell you the results as soon as possible."

   Everyone was disappointed when they heard it, but when they thought about Chen Qi's identity, it was not easy to force them, so they could only shake their heads and wait outside the house.

  Chen Qi put the baby on the hospital bed, locked the door, and then opened the color Doppler ultrasound machine, and began to apply gel on the probe.

   "Mr. Shen, hold on to the child's hands and feet later, try not to move, and I will check as soon as possible."

   Young babies are the most troublesome to check, because they will keep moving, which will cause image distortion and make it difficult to locate.

  B-ultrasound is okay. For example, CT and other examinations can only be performed because the patient is immobile, so some sedatives have to be used to make the child fall asleep.

  Shen Lifen looked at the thin machine in front of him, which was as strange as a TV screen, and he was full of curiosity, thinking that foreign things were good, maybe his child could really be saved.

  Chen Qi quickly placed the probe on the baby's chest, close to the skin, and stared at the screen carefully while swiping.

   It didn't take long to see something was wrong.

  Originally, the pleural effusion is generally relatively clear, so the B-ultrasound shows a liquid dark area with good light transmission.

  But the pleural effusion of this patient can clearly see tiny dot echoes, which suggests that there are sediments in the pleural effusion, which is relatively turbid in layman's terms.

  The pleural effusion is not only cloudy, but there is still pleural effusion even when the probe reaches the sixth rib. This is a large amount of pleural effusion, and the situation is more serious than imagined.

  Seeing the doctor's silence, Shen Lifen became more and more nervous, "Dr. Chen, what's wrong with my son? Is it serious?"

  Chen Qi packed up the machine, and replied: "It's serious, I have a guess, and further inspection is needed."

   "Okay, listen to you, check whatever you say."

   "Let's go out and say, this needs the consent of your family members to proceed."

  In the ward.

  The child’s grandma became anxious when she heard this:

   "What? You said you were going to take such a long needle and stab it into my grandson's chest? Isn't this going to kill him? No, no, no."

  The grandma of the child also shook her head like a rattle:

   "Our baby is only less than 2 months old, how can he bear this suffering, just follow Guning, it will kill someone."

  Chen Qi was also speechless, and explained:

   "I didn't **** him with a needle. I wanted to send the needle to the pleural effusion and take out the pleural effusion for testing. Only when we know what kind of effusion is in it can we prescribe the right medicine."

   "No, no, I've never heard of such a cure."

   "That's right, it's scary to hear."

  The family members objected repeatedly, and even Dean Gai was uncertain.

   "Chen Qi, pumping pleural effusion is also a painful thing for adults. This little baby is so thin, and his vital signs are not stable. Is it too dangerous to have pleural effusion?"

  Surgery Director Lu Yue also persuaded: "That's right, I'm so young, I don't dare to ask me to do a chest puncture. By the way, what judgment did you just have with the B-ultrasound?"

  Chen Qi replied without hesitation:

"I judge that the possibility of chylothorax is very high, because the pleural effusion is full of punctate echoes, and the age of the child was < 28 days when symptoms appeared, and the age at admission was < 2 months, combined with a large amount of pleural effusion This is consistent with the diagnosis of congenital chylothorax."

"what?"

   "Cylothorax?"

   Hiss~~~~

  In the ward, from Dean Gai to the directors of the department, everyone gasped, while the little doctors who followed looked confused? Then ask the colleagues next to each other, what is chylothorax?

  Lu Yue hesitated to speak, "Chen, Dean Chen, chylothorax is terrible, this, this..."

  Yao Qingju's expression also changed, looking at the little baby on the hospital bed, she also muttered to herself: "What's wrong with this, what should I do?"

   With the development of diagnosis and treatment technology, chylothorax is still often encountered in thoracic surgery, but in the 1980s, it was definitely a rare disease, and it was normal for young doctors not to have heard of it.

   Let’s put it this way, after the occurrence of chylothorax, chyle fluid in the chest cavity can accumulate in the chest cavity, which will cause compression on the heart and lungs, causing problems such as dyspnea, and affecting the function of the heart and lungs.

  In addition, because a large amount of chyle loss can cause electrolyte imbalance, malnutrition, and infection symptoms in the human body, the mortality rate of adult chylothorax was very high before 2000, reaching more than 80%.

  As for the chylothorax of newborns and young babies, it was a key problem in 1985.

   The first one is the difficulty of diagnosis and the lack of relevant instruments;

  The second is that conservative treatment is not effective, there is a lack of drugs, and there is a lack of diagnosis and treatment guidelines. There is not even the simplest ventilator. Doctors can only do nothing when they encounter it.

  The third newborn and infant require higher surgical skills, and ordinary general surgeons simply can’t bear it, so even if the diagnosis is made, they can only watch.

   In terms of probability, the neonatal mortality rate can reach almost 100%.

  That's why when Chen Qi said that the little patient might have chylothorax, those veteran doctors were shocked.

  Because this indicates that the treatment of children is almost impossible, unless they are transferred to children's hospitals in Shanghai or the capital, and there is still a possibility of treatment, at least in Vietnam and China.

  But in the absence of a professional ambulance, it would not be so easy to transfer to another hospital in a day, and it is possible that half-passers would simply disappear.

   Shen Lifen saw that the doctors in the ward looked nervous, and knew that chylothorax was definitely not a good disease, and it might have killed her child.

  At the critical moment, being a mother is just being strong.

  She saw her son on the hospital bed struggling to breathe, "cool couple cool couple", knowing that it was a critical moment and there was not much time to hesitate, so she gritted her teeth and said:

   "Okay, Dr. Chen, I believe you, if you say you want to do the puncture, just do it."

  The grandma of the child was anxious when she heard this: "You son of a bitch, how can you just stab the baby? What if the baby is stabbed to death?"

   "Mom, if the baby dies, it will be too late. As long as there is a glimmer of hope, I will try. Otherwise, I will be sorry for Weimin, and I will save our son."

  The child's grandma is about to howl again, and the grandpa next to him quits:

   "Why howling? Are you a doctor or are they a doctor? Just listen to the doctor if you don't understand. Can the doctor still harm us?"

  The grandfather of the child turned to Chen Qi again, and said sincerely: "Doctor, you can do whatever you think is good, we all agree!"

  Shen Lifen also wiped away tears: "Doctor Chen, you are a miracle doctor, my child's life is in your hands."

  Chen Qi felt emotional after hearing this, thinking that the current patients are really sympathetic and courteous, and at the same time, it is also the fastest way to diagnose, treat and save a life for a baby.

  Dean Gai wanted to persuade a few words, but he swallowed the words of dissuasion. He invited Chen Qi. Now that he has a new way of thinking about diagnosis, is it because he is afraid of the risk that he doesn't do it?

   "Chen Qi, since you have made a decision, follow your ideas, and I will be responsible for any accidents!"

  As soon as Chen Qi heard that everyone had unified their thinking, he directly ordered:

"Okay, let's stop talking about the polite words, head nurse, prepare the debridement room and puncture kit immediately; Zhiyi, prepare the pre-puncture talk and ask the family members to sign and agree; the other directors, you are troubled, help me , fix the child."

   Chest puncture, bone puncture, and lumbar puncture are all invasive. Although anesthesia will also be administered, the whole process is quite cruel.

  Children will struggle and cry desperately because of the pain, and older children will keep calling for help. Ordinary parents can't watch it at all, and they will burst into tears when they see it. They probably want to hold their children and run away instead of checking.

  So the parents were cleared during the examination, and a large group of doctors were needed to fix the baby's hands, feet and head.

  Chen Qi applied the anesthetic layer by layer. Amidst the child's heart-piercing cries, he ruthlessly plunged a puncture needle about 6cm into the baby's chest cavity.

   Frightened, the scalps of the nurses next to me were numb and they swallowed.

  As the resistance of the needle disappeared, Chen Qi knew that he had reached the area of ​​pleural effusion, so he immediately connected the needle and slowly sucked out the fluid inside.

  At that moment, Dean Gai, Director Lu, Director Yao, Director Ge and other senior doctors, as well as the specially approved little doctor Qi Zhiyi, all stared at the syringe nervously.

  Qi Zhiyi suddenly shouted: "Ah, it's white, milky white pleural fluid."

  General pleural effusion is colorless, transparent, or translucent. When sick, it may be light yellow or light green. Trauma may produce **** pleural effusion.

  But the pleural effusion of chylothorax is different. If I insist on describing it, let’s put it this way, it’s exactly the same color as pearl milk tea.

   Either milky white or creamy yellow.

  If it is milk tea, it looks very attractive, but if it is the pumped pleural fluid, it will make the scalp tingle, which further confirms the possibility of chylothorax.

   Several senior doctors thought to themselves, it is almost the same.

  But doctors can't patronize guesses when seeing a doctor, that requires definite evidence, so for young doctors, there are still doubts.

  Qi Zhiyi was very active today, because Chen Qi is his classmate, and the two are still good friends, so he didn't hide any doubts in his heart, and asked directly:

   "Chen Qi, quickly see if this is chyle fluid?"

  Chen Qi looked at the milky white liquid in the glass bottle and was not 100% sure.

"Whether it is chyle fluid or not needs to be tested, after all, tuberculous pleural effusion will also be the same. In this way, the pleural effusion is divided into two parts, and the part is rushed to the laboratory for emergency biochemical tests, focusing on protein, triglyceride content and lymphocytes. How many."

  Qi Zhiyi is like a curious baby at this time, thinking of getting the result quickly:

   "Ah, these biochemical tests take a long time to come out with a report. Is there a simpler and quicker test now? What if the baby's condition continues to worsen tonight?"

   Chess Chen clicked on the little patient who was still on the hospital bed:

   "Don't worry, I have just pumped 100ml of pleural fluid, and it won't oppress the heart and lungs anymore. It will definitely slow down tonight. As for the simpler detection method, it really does exist."

  (end of this chapter)