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Wei Shi Liang
Intensive Care Unit
About me
Graduated from Shanxi Medical University with a degree in Clinical Medicine in 2006, and has been working in the field of Critical Care Medicine ever since.
Proficient in diseases
Treatment of severe infections, ARDS, severe trauma, MODS, and other diseases.
Voices
How long does the treatment for pulmonary embolism take?
The timing of pulmonary embolism treatment mainly depends on the severity of the pulmonary embolism. The main goals of pulmonary embolism treatment are to save lives by addressing life-threatening right heart dysfunction and obstructive shock caused by the pulmonary embolism, to re-establish pulmonary vascular patency, restore lung tissue perfusion, and prevent the recurrence of pulmonary embolism. Main treatment methods include: respiratory and circulatory support, anticoagulation, thrombolysis, interventional or surgical removal of blood clots, placement of inferior vena cava filters, etc. General management: Patients who are highly suspected or diagnosed with pulmonary embolism should be closely monitored, tracking changes in respiration, heart rate, blood pressure, venous pressure, electrocardiogram, and blood gases to prevent the dislodgement of clots again. Absolute bed rest is required, and care should be taken not to overly bend the lower limbs, maintain bowel regularity, and avoid straining. For patients experiencing anxiety and panic symptoms, reassurance should be provided, along with appropriate use of sedatives. If there is chest pain, analgesics may be administered. For symptoms like fever and cough, corresponding symptomatic treatments should be given. To prevent lung infections and treat phlebitis, antibiotics may be used. Additionally, support treatments for respiratory and circulatory functions, as well as anticoagulation therapy, should be provided.
The impact of hypokalemia on skeletal muscle
In clinical practice, hypokalemia can affect the muscular and nervous conduction systems. The most prominent symptoms of hypokalemia in the neuromuscular system are flaccid paralysis of the skeletal muscles, loss of tension in smooth muscles, and rhabdomyolysis. If the respiratory muscles are involved, it can lead to respiratory failure. Hypokalemia can also lead to insulin resistance, resulting in significantly abnormal glucose tolerance. If hypokalemia occurs clinically, it is crucial to actively treat the primary disease, appropriately supplement potassium, monitor during the supplementation process to avoid hyperkalemia, and closely monitor blood potassium levels with regular reviews.
Causes and Clinical Manifestations of Hypokalemia
Hypokalemia refers to a condition where blood potassium levels are below 3.5mmol/L. The causes can be due to inadequate intake of potassium, such as prolonged inability to eat without sufficient intravenous supplementation of potassium. It can also result from excessive loss of potassium, through external losses such as vomiting and diarrhea, or through renal losses due to the excessive use of diuretics and certain hormonal imbalances. A third cause involves the shift of potassium into cells, such as during episodes of alkalemia and periodic paralysis. Clinically, mild to moderate hypokalemia is characterized by symptoms like muscle weakness, fatigue, cramps, intestinal obstruction, and some abnormalities in electrocardiograms, including the presence of U waves and flattened T waves. Severe hypokalemia can lead to life-threatening arrhythmias, such as ventricular tachycardia and ventricular fibrillation, which require immediate treatment.
Can pulmonary embolism lead to pneumonia?
Pulmonary embolism itself does not cause pneumonia; however, during the treatment of pulmonary embolism, procedures such as oral tracheal intubation and the creation of an artificial airway might be employed. These can lead to nosocomial infections of iatrogenic origin, resulting in pneumonia. Pulmonary embolism often manifests as unexplained respiratory difficulty, pleuritic pain, tachycardia, and decreased oxygen saturation. Other high-risk factors include being over the age of 40, having a history of DVT (Deep Vein Thrombosis), obesity, prolonged immobilization, stroke, congestive heart failure, malignancy, lower limb fracture, anesthesia time exceeding 30 minutes during surgery, pregnancy and childbirth, use of estrogen, and a hypercoagulable state. These are all potential high-risk factors for pulmonary embolism.
Is acute severe pancreatitis serious?
Acute severe pancreatitis is a very serious disease in clinical practice, with a high mortality rate, often requiring comprehensive treatment in the ICU. Acute severe pancreatitis is a disease caused by multiple etiologies that results in localized inflammation, necrosis, and infection of the pancreas, accompanied by a systemic inflammatory response and persistent organ failure. It is divided into three phases. The first phase is the acute response phase, occurring from onset to about two weeks, characterized by systemic inflammatory response; the second phase is the systemic infection phase, occurring from two weeks to about two months, characterized by necrosis and infection of the pancreas or peripancreatic tissues; the third phase is the residual infection phase, occurring two to three months later, with clinical manifestations primarily of systemic malnutrition and persistent fistulas, accompanied by gastrointestinal fistulas.
What kind of urine occurs with hyperkalemia?
Primary hyperkalemia often coincides with metabolic acidosis, and in hyperkalemia-induced metabolic acidosis, paradoxical alkaline urine can occur. Once hyperkalemia occurs, it primarily affects the conduction of the heart and neuromuscular system. Typical clinical manifestations include severe bradycardia, atrioventricular conduction block, and even sinus arrest. In mild hyperkalemia, the electrocardiogram shows peaked T-waves; as potassium levels continue to rise, the PR interval prolongs, T-waves disappear, QRS complex widens, and ultimately, cardiac arrest occurs. Immediate treatment should be administered upon diagnosis to promote the excretion of potassium, maximizing the renal excretion capacity with diuretics. If drug-induced potassium excretion does not normalize levels and serum potassium exceeds 6.5 mmol/L, hemodialysis may be necessary. Additionally, some drugs can be used to shift potassium into the cells and protect cardiac function. (The use of any medication should be under the guidance of a doctor.)
Causes of Bronchial Asthma
The most common cause of bronchial asthma is inhalants, which are mainly found in daily life, such as dust mites, pollen, fungi, and some irritating and toxic gases, all of which may irritate the airways and cause asthma. Infections are closely related to the occurrence of asthma, and respiratory infections such as viruses, bacteria, and mycoplasma can all trigger asthma. Additionally, certain specific foods, such as fish, shrimp, crab, milk, and eggs, may cause asthma in certain groups of people. Factors such as the patient's mental state, changes in the climate, and intense exercise are also possible causes of bronchial asthma. These are the most common causes of bronchial asthma onset.
Causes of acute heart failure include
Most patients with acute heart failure have a history of heart disease, and the common causes mainly include: 1. Acute myocardial necrosis or damage, such as acute coronary syndrome, peripartum cardiomyopathy, and myocardial damage caused by drugs or toxins, including sepsis-induced myocardial damage. 2. Acute exacerbation of chronic heart failure due to infection or other stressful factors. 3. Acute hemodynamic changes, mainly including conditions like cardiac tamponade, hypertensive crisis, aortic dissection, and acute valvular regurgitation, all of which can lead to acute heart failure.
Causes of hypokalemia
Potassium is one of the essential electrolytes necessary for life. Its physiological functions mainly include maintaining cellular metabolism, regulating osmotic pressure and acid-base balance, and preserving cell stress response, etc. Daily potassium intake is about 100 millimoles, with 90% excreted through the kidneys and the remainder through the gastrointestinal tract. Common causes of hypokalemia include reduced intake, such as long-term inability to eat without timely potassium supplementation. Even though potassium intake decreases, the kidneys continue to excrete potassium, leading to potassium loss. The second cause is increased excretion, which includes losses through the gastrointestinal tract and the kidneys, both of which can lead to hypokalemia. The third cause is the movement of potassium from outside to inside the cells, which can occur during metabolic alkalosis or when glucose and insulin are administered, promoting the transfer of potassium ions into the cells, resulting in hypokalemia.
Causes of Acute Heart Failure
The main causes of acute heart failure include coronary heart disease, valvular disease, hypertension, and cardiomyopathies, such as toxic cardiomyopathy or hypothyroidism-related cardiomyopathy, as well as idiopathic cardiomyopathy. Myocarditis and arrhythmia-related causes can also lead to heart failure, but there are often triggers present clinically. Common triggers include poor treatment compliance, arrhythmias, anemia, infections, myocardial ischemia, excessive fluid intake, poor dietary control, and increased cardiac output, such as during strenuous activity and pregnancy, which can lead to increased cardiac output and cause heart failure. Conditions such as excessive fluid volume, hypertension, hyperthyroidism, and pulmonary embolism can also trigger heart failure.