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Wang Li Bing
Intensive Care Medicine Department
About me
Loudi Central Hospital, ICU, attending physician, has been engaged in ICU clinical work for many years, with rich clinical experience in the treatment of emergency patients.
Proficient in diseases
Proficient in using equipment such as continuous electrocardiogram monitoring, oxygen saturation detection, blood pressure monitoring, and disease monitoring.
Voices
Upper gastrointestinal bleeding includes which areas?
In clinical practice, bleeding in the digestive system above the ligament of Treitz is referred to as upper gastrointestinal bleeding. It primarily includes the following areas: The first major category is esophageal diseases, such as esophagitis, esophageal trauma, and other causes of bleeding. The second category is duodenal diseases, such as peptic ulcers, acute erosive hemorrhagic gastritis, stomach cancer, etc. Another cause is liver cirrhosis leading to portal hypertension, which can cause rupture and bleeding in esophageal and gastric varices. The fourth category includes biliary system and pancreatic diseases involving the duodenum, such as pancreatic cancer, which can also lead to bleeding.
What tests are done for arrhythmia?
Arrhythmia is also relatively common in clinical practice, and its common detection method is mainly the electrocardiogram (ECG). ECG is a simple and non-invasive operation that helps to identify the type of arrhythmia. Another method is the 24-hour Holter monitor, which can record all heart rate changes occurring within 24 hours. If an arrhythmia occurs, it is crucial to seek medical attention promptly, visiting a cardiology department. Treatment may involve antiarrhythmic medications, and if possible, a complete electrophysiological examination can be performed.
What is a cerebral infarction?
Brain infarction is also relatively common in clinical practice, mainly seen in elderly people, generally accompanied by underlying diseases such as hypertension, hyperlipidemia, and diabetes. Brain infarction is primarily caused by the blockage of cerebral blood vessels, leading to necrosis of brain tissue due to ischemia and hypoxia. After a brain infarction occurs, patients should seek medical attention in a timely manner and be admitted to the department of neurology or neurosurgery for systematic drug treatment. If the infarction area is large or a brain herniation has formed, surgical intervention should be considered, such as decompressive craniectomy and lowering intracranial pressure.
Which department should I go to for a cerebral infarction?
Stroke is caused by blockage or narrowing of blood vessels within the skull, leading to ischemic necrosis of brain tissue and a range of symptoms. Typically, patients with strokes are seen in neurology departments. Of course, the location of the stroke varies, and each patient's clinical presentation is different. If a stroke occurs, a cranial CT scan can provide a clear diagnosis. Clinically, treatment primarily involves dehydration, lowering intracranial pressure, brain protection, and nutritional support. If the patient has a large area of cerebral infarction and high intracranial pressure, they can be seen in neurosurgery, where procedures such as craniotomy decompression may be used to reduce intracranial pressure.
What should be done if the area of cerebral infarction is large?
If a large cerebral infarction occurs, brain edema often peaks within two to three days, and the mortality rate is extremely high. If medical attention is sought within six hours of onset, thrombolytic therapy can be considered. If emergency thrombolysis is exceeded, then only conservative drug treatment is available. For example, mannitol dehydration to reduce intracranial pressure, nourish neurons, protect brain cells, provide nutritional support, etc. After a stroke, it is essential to monitor changes in the patient's consciousness and pupils, dynamically assess the patient’s Glasgow Coma Score, and be aware of various potential complications. Family members should be well-informed about the patient's condition, etc. (Specific medications should be administered under the guidance of a doctor.)
Common causes of heart failure
Heart failure is a syndrome that occurs when various structural or functional cardiac diseases impair ventricular filling or ejection function. Once heart failure occurs, medical treatment should be sought promptly. Common causes of heart failure mainly include the following points. The first category is primary myocardial damage, which mainly includes coronary heart disease, myocardial infarction, myocarditis, cardiomyopathy, and diabetic cardiomyopathy, among others. The second major category is cardiac load, such as excessive pressure load, commonly seen in hypertension, aortic valve stenosis, pulmonary hypertension, etc.; and excessive volume load, mainly found in cardiac valve insufficiency and congenital heart disease, among others.
What is ventricular arrhythmia?
Ventricular arrhythmias mainly refer to disorders of the ventricular rhythm and are relatively common clinically, including premature ventricular contractions, ventricular tachycardia, ventricular flutter, and ventricular fibrillation. Premature ventricular contractions generally do not cause noticeable clinical symptoms, while ventricular flutter and ventricular fibrillation are very dangerous clinically and must be treated promptly with defibrillation. Therefore, ventricular arrhythmias must be treated promptly, actively treating the underlying disease, and managing the arrhythmia to prevent sudden death.
How to supplement potassium for hypokalemia
Hypokalemia generally has two common methods of potassium supplementation. The first is oral potassium supplementation, and the second is intravenous potassium supplementation. Oral potassium supplementation is the safest method, for example, taking potassium chloride sustained-release tablets orally, as well as potassium chloride injection solution orally, and eating more potassium-rich vegetables and fruits. The second method is intravenous potassium supplementation. For intravenous potassium supplementation, it is important to pay attention to the patient's urine output. If the patient's urine output is adequate, intravenous potassium supplementation can be appropriately performed, and the concentration of intravenous potassium supplementation should not exceed 0.3% to prevent arrhythmias caused by hyperkalemia. (Please use medications under the guidance of a doctor.)
How is hypokalemia diagnosed?
Hypokalemia refers to a blood potassium level below 3.5mmol/L. Clinically, it is mainly diagnosed through electrolyte tests and arterial blood gas analysis, which can confirm whether a patient has low potassium. After developing hypokalemia, patients may experience symptoms such as fatigue and limb weakness. At this point, treatment should include the oral administration of sustained-release potassium chloride tablets or intravenous infusion of potassium chloride, as well as advising the patient to consume potassium-rich vegetables and fruits to correct hypokalemia. Prolonged hypokalemia can lead to arrhythmia and even endanger the patient’s life. (Medications should be used under the guidance of a clinical doctor, according to the specific situation.)
Preferred examination method for upper gastrointestinal bleeding
Upper gastrointestinal bleeding is very common clinically. If the patient's respiratory and circulatory systems are stable, an esophagogastroduodenoscopy can be performed to further identify the bleeding site. Of course, it is also necessary to dynamically monitor blood tests and coagulation function, and pay attention to the patient's vomiting and rectal bleeding. The clinical treatment of upper gastrointestinal bleeding mainly involves transfusions to replenish blood volume and conservative medical treatment for hemostasis. If conservative medical treatment is not effective, surgical intervention can be considered.