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10
Li Qiang
Intensive Care Unit
About me
Graduated from the Department of Clinical Medicine at Peking University Health Science Center in 1996 with a bachelor's degree. Appointed as an attending physician in the Beijing Health Bureau system in 2001. In 2011, became the chief physician and associate professor in the Critical Care Medicine Department at Peking University Third Hospital. Pursued a master's degree in Surgery at Peking Union Medical College from 2002 to 2005. Published over thirty papers as the lead author in domestic core journals, including three articles in SCI journals.
Proficient in diseases
Proficient in the diagnosis and treatment of critical illnesses such as severe cervical spinal cord injury, various types of shock, severe infections, multiple severe traumas, acute respiratory distress syndrome, acute severe pancreatitis, multiple organ dysfunction syndrome, and critical obstetrics and gynecology pathologies. Skilled in techniques such as cardiopulmonary resuscitation, tracheal intubation, tracheotomy, central venous catheterization, fiberoptic bronchoscopy, hemodynamic monitoring (Swan-Ganz catheter, PICCO hemodynamic monitoring), and blood purification. Able to proficiently handle the rescue and treatment of critically ill patients in departments such as general surgery, orthopedics, urology, obstetrics and gynecology, cardiovascular surgery, gastroenterology, neurology, hematology, and emergency medicine.
Voices
The difference between severe pancreatitis and mild pancreatitis
Generally speaking, mild pancreatitis is just a local inflammation of the pancreas, usually manifested as upper abdominal pain, nausea, vomiting, and bloating — symptoms of the gastrointestinal tract. Severe pancreatitis, however, is much more serious than mild pancreatitis. In severe pancreatitis, not only is the pain in the local pancreas area more intense and the abdominal bloating more pronounced, but there is also a lot of effusion accumulating in the abdomen. Severe pancreatitis can also affect many other organs, such as the lungs, which are most commonly affected. It can lead to patients developing acute respiratory distress syndrome, characterized by severe hypoxemia, with many patients requiring mechanical ventilation treatment. Another organ that is commonly affected is the kidney, with many patients with severe pancreatitis experiencing acute renal failure, reduced urine output, or even anuria. Severe pancreatitis can also affect the heart, brain, and other organs, leading to functional abnormalities in these organs. Therefore, besides affecting the local pancreas, severe pancreatitis can involve other important organs, resulting in multiple organ dysfunctions.
Is vomiting severe in brainstem hemorrhage?
Vomiting after brainstem hemorrhage is definitely a serious matter because if the vomiting is caused by a brain-related issue, it is due to increased intracranial pressure. This type of vomiting is characterized as projectile vomiting, which is one of the three major signs of increased intracranial pressure. If the brainstem hemorrhage is extensive, it may cause local stimulation leading to cerebral vascular spasm, or issues such as obstructed brain circulation resulting in increased intracranial pressure and hydrocephalus. This increase in intracranial pressure, especially if prolonged, can lead to brain herniation, which is particularly deadly if it compresses the brainstem. Therefore, this is a very urgent and serious condition that requires immediate attention. Of course, if the vomiting is solely due to other reasons such as gastric retention or improper feeding, that would be a different matter. Projectile vomiting caused by increased intracranial pressure is highly severe.
Which is more serious, liver failure or cirrhosis?
Liver failure refers to a functional impairment of the liver, which could be acute or chronic damage. For instance, it could be the end stage of chronic liver disease, or an acute condition such as hepatitis, or another acute liver lesion. Other common lesions may also cause a sudden abnormality in liver function, resulting in severe liver dysfunction. At this point, liver cirrhosis is a common cause of liver failure. For example, in the middle and late stages of liver cirrhosis, liver function is completely decompensated, meaning the liver can no longer maintain its basic normal functions, leading to liver failure. Therefore, liver failure is one of the major consequences of liver cirrhosis, but the two are distinct. Liver failure can also be caused by other reasons not related to cirrhosis. For example, acute ischemia in the liver, such as in shock patients, can lead to liver ischemia and subsequently liver failure. Liver cirrhosis is just one of the common causes thereof.
The difference between cardiogenic shock and sudden cardiac death
Cardiogenic shock is caused by a decrease in cardiac contractile function, leading to reduced ejection, lowered blood pressure, and resulting in ischemia and hypoxia of tissue cells. It is due to the reduced contractile function of the heart, which may be caused by coronary issues such as coronary ischemia, or by severe arrhythmias such as severe ventricular tachycardia or fibrillation, or by acute heart failure. Cardiogenic sudden death occurs when cardiogenic shock progresses further, leading to the cessation of the heartbeat. The main difference between cardiogenic sudden death and cardiogenic shock is that during cardiogenic sudden death, the heartbeat has definitely stopped completely, or there is only ventricular fibrillation, at which point it is called cardiogenic sudden death. During cardiogenic shock, the heart still retains some contractile function, meaning the heart still has some autonomous beating capability. Compared to cardiogenic sudden death, it is still an early, reversible stage of cardiogenic sudden death. Once it progresses to cardiogenic sudden death, immediate cardiopulmonary resuscitation is necessary, and at this point, the mortality rate greatly increases.
How to grade respiratory failure
Respiratory failure is generally not graded; instead, it is classified into types. There are two types, Type I and Type II. Type I is characterized by an oxygen tension lower than 60 mmHg, at which point, there is no increase in carbon dioxide, and the carbon dioxide level is normal. Type II respiratory failure is when the oxygen tension is below 60 mmHg, accompanied by an increase in carbon dioxide, which is then termed Type II respiratory failure. Regarding respiratory failure, it is classified by type and not by severity grade. This means that once it meets these criteria, it is referred to as respiratory failure, and at this point, some emergency treatments to improve low oxygen levels are necessary. Therefore, respiratory failure is generally not graded into mild, moderate, or severe degrees. It is only differentiated into different types. Of course, there are different severity levels in respiratory failure, but we generally do not apply a specific degree of severity.
What is acute severe pancreatitis?
Acute severe pancreatitis is caused by many reasons, including binge eating, especially consuming a large amount of high-fat diet, excessive drinking, obstruction of the pancreatic duct by gallstones in the bile duct, pregnancy, hyperlipidemia, etc. These lead to disorders in pancreatic secretion, resulting in pancreatic juices digesting the pancreas itself and leaking into the abdominal cavity, leading to symptoms such as abdominal effusion. It is classified as severe pancreatitis based on reaching a certain score in some assessments. Severe pancreatitis often accompanies dysfunction of organ systems, common examples include acute respiratory distress syndrome characterized by stubborn hypoxia and respiratory failure, acute renal failure shown by anuria or oliguria, and acute gastrointestinal failure, which manifests as high abdominal pressure and severe intestinal motility disorders, including abdominal distension.
Is it necessary to perform a tracheotomy in the late stages of ALS?
Patients in the late stages of amyotrophic lateral sclerosis (ALS) must undergo a tracheotomy because, by this stage, they have completely lost their motor abilities, including the muscle strength needed for breathing. Consequently, they lack the strength to breathe on their own, leaving them unable to survive without a ventilator. They must rely continuously on a ventilator to breathe as they cannot do it themselves. Therefore, if a ventilator is needed over the long term, a tracheotomy is necessary. This is because other methods, such as inserting tubes through the mouth or nose into the trachea to connect to the ventilator, are quite uncomfortable. Comparatively, tracheotomy offers a bit more comfort, making it a necessary procedure for connecting to a ventilator for long-term use and achieving greater comfort.
Why does pulmonary embolism cause cardiac arrest?
The mechanisms causing cardiac arrest due to acute pulmonary embolism mainly encompass several aspects. One is a large-scale acute extensive pulmonary embolism, which prevents the blood from being ejected from the right heart, potentially leading to acute right heart failure. At this time, the entire body's blood circulation will encounter issues. Another scenario is that following the pulmonary embolism, it causes severe hypoxia. This hypoxia can lead to oxygen deficiency in all organs of the body, including the heart. The coronary arteries that supply nutrients to the heart can also become ischemic. Both of these factors can cause the heartbeat to lead to sudden cardiac arrest. These are the primary mechanisms that can cause a sudden stop in the heartbeat.
What to do with respiratory failure in the late stage of amyotrophic lateral sclerosis?
Amyotrophic Lateral Sclerosis (ALS) is an irreversible disease, also known as motor neuron disease. Its motor function deteriorates progressively and irreversibly. Therefore, in the advanced stages, respiratory failure can only be managed with the help of a ventilator, which assists the patient's breathing mechanically. Consequently, patients typically require a tracheotomy in the late stages of the disease. Once connected to a ventilator via a tracheotomy, the ventilator becomes a permanent necessity. If at any point the ventilator is stopped, the patient would die due to lack of oxygen and the accumulation of carbon dioxide in the body. Therefore, they must wear the ventilator for life. Inevitably, this leads to respiratory-related complications, such as lung infections.
Can pulmonary embolism result in a vegetative state?
After a pulmonary embolism, if it is an acute and extensive embolism and not treated promptly, it can lead to severe hypoxemia. If hypoxemia is not addressed quickly and persists, it will affect the oxygen supply to vital organs throughout the body, including the brain. The brain is the organ most vulnerable to oxygen deprivation. If there is complete lack of oxygen for just four minutes, irreversible damage occurs to the cerebral cortex, and the patient will not wake up, leading to a vegetative state. Therefore, in cases of acute extensive pulmonary embolism, if treatment is delayed, there is a significant risk of the patient entering a vegetative state, and the mortality rate is also very high. Many patients may experience sudden death.