Chapter 866: 850 Malignant Hyperthermia (Alliance Leader Joywong421 Bonus Chapter 5)

A newly arrived doctor helping out tried to lift the obstructing arm, but that arm wouldn't budge at all.

Zheng Ren suddenly thought of a disease; he entered the Shujian, stood behind, and took a look.

The system panel was bright red, and several diagnoses appeared before Zheng Ren.

Diagnoses like indirect inguinal hernia and gallstones, Zheng Ren ignored them outright; what he noted was a simple diagnosis—malignant hyperthermia!

This disease… can be called a disease, its incidence is extremely low, and it only appears when exposed to anesthesia.

It is one of the few hidden dangers most feared by the anesthesiology department.

Malignant hyperthermia is a hereditary disease characterized by high metabolism. It is triggered when patients come into contact with certain anesthetic drugs, and non-depolarizing muscle relaxants can delay its onset.

"Stop the anesthetic drugs!" Zheng Ren, upon seeing the system panel's diagnosis, immediately shouted in a low voice.

The doctors and nurses, in a flurry, had no idea; hearing someone speak, and the words full of authority and the unquestionable demeanor of a senior physician, they didn't think much why, and the anesthesiologist directly stopped the anesthetic drugs.

"Dantrolene, do we have it stocked?!" Zheng Ren almost shouted.

"..."

"..."

The operating room was utterly bewildered.

Dantrolene, what the hell is this?

"Is it malignant hyperthermia?" The head of the anesthesiology department ran in from outside; he was burly, like a bear, and even his silhouette gave a strong, fierce sense of oppression.

"Yes!" Zheng Ren, looking at the patient, said without hesitation.

Not only the system panel's diagnosis, the patient's violent twitching, convulsions, skeletal muscle rigidity, profuse sweating, and other symptoms are the most typical manifestations of malignant hyperthermia.

No temperature was taken, but Zheng Ren believed the patient's temperature was now at least 40 degrees Celsius.

The head of the anesthesiology department strode to the patient's side, and the doctors and nurses on both sides voluntarily made way.

After making a quick judgment, he hurriedly said: "The cooling blanket isn't cold enough; find something else to speed up cooling."

Having said that, he immediately took out his phone and placed a call.

"We need a helicopter, go to Xiehe, I need dantrolene, a patient has suddenly developed malignant hyperthermia!" The anesthesiology department chief's voice rang like a great bell, causing the entire operating area to tremble slightly.

As an extremely rare hereditary disease, malignant hyperthermia cannot be prevented. Moreover, domestically, the only hospital researching malignant hyperthermia is Xiehe.

The caffeine halothane contracture test has already been conducted in Xiehe's anesthesiology department. And the specific effective drug for malignant hyperthermia—dantrolene—is available only in Xiehe's anesthesiology department nationwide.

Zheng Ren had read several reports, mostly case summaries written by doctors from Di Du and Modu. When Modu's doctors encounter this situation, they can only watch helplessly as the patient dies.

For no other reason, just because there is no specific effective drug.

In Di Du, because Xiehe is present, there is still another option. (Note 1)

But even if a helicopter is dispatched, it's still uncertain whether the patient's life can be saved before dantrolene arrives.

"Increase oxygen flow, mask oxygen!" Zheng Ren shouted: "Raise the oxygen flow to over 10 L/min!!"

"Ice saline, sterile ice saline, give intravenously, as fast as possible!"

"Monitor temperature! Do not interrupt!"

"Two vials of sodium bicarbonate, push intravenously!"

"Hurry up, who's standing there dazed! Quickly push sodium bicarbonate intravenously!"

"Nurse, draw blood!"

"Instrument nurse, step down! No need for sterility now! Hurry and draw blood, electrolytes, blood gas; after drawing, rush to send it, tell the lab, emergency!"

Zheng Ren's loud shouts kept echoing in the operating room, and he forgot his own identity.

Although he had always avoided overstepping, causing resentment among the native doctors of 912 Hospital, when faced with this sudden critical illness of malignant hyperthermia, Zheng Ren cast everything aside.

Heaven and earth are vast, but can anything be more important than a human life?

"Call more people to help with physical cooling. Where's the circulating nurse! Head nurse! Hurry and check if the amount of frozen saline is enough!"

While Zheng Ren was shouting, appearing mad, he actually hadn't lost his reason. He continuously observed the ECG monitor calmly and steadily, watching the patient's vital signs.

The patient's ECG began to show a shortened QT interval, tall, peaked, symmetrical T waves, and a narrowed base forming a tent shape.

Soon, Zheng Ren noticed on the ECG that the P-wave amplitude decreased, the PR interval prolonged until the P-wave disappeared!

This is a manifestation of hyperkalemia; although the lab results aren't out yet, Zheng Ren can fairly confidently assert that the patient's potassium level may have exceeded 8 mmol/L, even reaching the lethal level of 10 mmol/L.

"Calcium gluconate, 5000 mg, push intravenously!" Zheng Ren's eyes narrowed as he fixed his gaze on the ECG monitor's waveform and shouted.

"5000..." a nurse who had just rushed to help was stunned.

In clinical use, the maximum dosage of calcium gluconate is 3 g, i. e., 3000 mg. 5000 mg—is this amount really okay?

The head of the anesthesiology department frowned, carefully looked at Zheng Ren, whom he did not know.

Whose doctor is this? How is he directing the rescue here? Nevertheless, every measure was timely, except for the excessive use of calcium gluconate.

He strode over to Zheng Ren's side and asked in a low voice: "Is the overdose okay?"

"The P-wave is gone!" Zheng Ren reached out, pointed his finger at the ECG monitor screen, and shouted: "The heart is about to arrest!"

Generally, cardiac arrest can still be rescued with a defibrillator, external chest compressions, etc.

But for malignant hyperthermia patients, the defibrillator is utterly useless. Moreover, the whole body is stiff as stone, making it impossible to move the chest wall.

Zheng Ren kept thinking: if the heart stopped, he would directly open the chest, perform direct-view external chest compressions, and add intravenous ice saline cooling; perhaps the effect would be a bit better.

But this measure is too extreme and violent; avoid it if possible. Furthermore, even if the chest were opened, the intercostal muscles inside and out are so tense that likely not even a hand could be inserted.

The anesthesiology department chief glanced at the ECG, knew Zheng Ren was right, and immediately had the nurse administer 5000 mg of calcium gluconate.

"How much urine output!"

"..." The operating room was already busy to the point of chaos, no one monitoring urine output. Zheng Ren stared intently at the ECG monitor; after he asked, the surroundings fell silent.

The anesthesiology department chief stared for a moment, then half-squatted, looked at the urine bag, and said: "About 20 ml."

"20…… no, 80 mg furosemide IV!" Zheng Ren said: "Monitor urine output, keep it at 50–100 ml per hour."

"Give hyperventilation!"

Yes, hyperventilate, definitely must hyperventilate!

Have the test results come back? If not, go push for them!

One after another orders, orderly, echoed in the operating room, surging.

More than ten doctors and nurses, feet off the ground, flew up.

And that arm, stiffly extended, like made of iron, only at its own frequency continuously spasming and twitching.

……

Note 1: Beijing Sanbo Yiyuan also seems to have sufficient reserves of the drug Dantrolene.