I’m a doctor, but I’m afraid of a man pulling his teeth, because I’ve met a patient who’s been through life and death since I pulled his teeth.
I was on duty that day at the E.R., and I got a phone call from the dentist saying that a patient was in bad condition and had to be brought to E.R. for rescue. I rarely get a distress call from the dentist, for the first time in my life.
The patient arrived at the door of the rescue room in less than a minute.
I knew something was wrong.
The patient was a young woman, with blood on her mouth, lying in a transhipment bed in a state of panic, and with words in her mouth that she could not hear.
Several dental nurses were busy looking for blood vessels, needles and fluids.
Oral surgeons and family members (the patient ‘ s husband) were nervous and gave me an overview of the situation.
The patient was 29 years old and had intended to do so at a dental clinic because of the lack of teeth and the need to remove intellectual teeth.
The doctor probably didn’t feel good about it, so she came to the general hospital, so recently we were in the hospital.
At first, it went well, but when the lower teeth were ready to pull hard, the patient suddenly said no, it was painful, and people started to twitch.
The dentist got cold sweaty, stopped working on his hands and called for no response from the patient, his heart beats fast and his blood pressure cannot be measured.
Considered shock, which was a neurogenic shock, he put half an adrenaline in his muscles and tried to refill it.
But the patient’s veins are difficult to find, he didn’t get a shot and he rushed to the emergency room.
Patients stopped convulsions on their way here and their eyes opened, but their mental state was not good.
Our nurse quickly placed the patient in a rescue room, oxygen-absorption, electrical surveillance, an intravenous tunnel, etc.
Patients are in shock, blood vessels are hard to find, sweaty and wet, and several young nurses will be unable to find them for a while.
Then the guard came over for a while and finally got the needle.
I asked the nurse to fill the patient with liquid, the patient was in shock, the blood capacity in the veins was mostly inadequate, and rapid rehydration was always right, except for heart-borne shock.
However, the patient was so young and had not heard of a heart attack and had little chance of a heart attack.
The vitals were measured, the heart rate went up to 160 times (normal human heart rate 60-100 times/min), and there was a marked excess of heart movement.
Either the patient’s heart rate was high, or the side effects of the half adrenaline from the dentist, I guess, both.
Blood pressure was no good either, only 80/40 mm/Hg, but according to the dentist, it was better than just before, when it was not measured in the oral clinic, which scared the piss.
Several nurses helped the patient clean up the blood from his mouth, and very little blood came out, but it seemed scary.
The patient’s husband can’t cry anymore. Ask us what’s going on.
I can’t explain so much to him right now. I’m going to have to concentrate on stabilizing the patient.
On the one hand, there is resistance to shock and, on the other, an end to the bleeding.
The nurse opened a two-way vein to the patient and used a pressurized bag, and a bottle of 500ml of physio-saline quickly dried up, to my surprise.
I thought the exterior ecstasy might not have been smooth, and I was going to give her a DIAC quick refill, which would seem to hold.
Dr. Pepe reported that the patient’s blood sugar was detected.
The temperature was measured, 38.8 degrees C.
The patient’s getting hot.
Is this a nervous shock? I questioned this diagnosis.
A small number of patients suffer severe pain, trauma, etc., leading to vascular constrictions and pathological changes such as vascular expansion.
This leads to a relative lack of blood capacity, with the result that all organs of the whole body suffer from anaesthesia and a state of shock.
The brain, in particular, can convulsion and coma once it has an ischaemic oxygen.
As this shock is mainly due to a nervous adjustment problem, it is called neurogenetic shock.
But there should be no heat in a nervous shock!
What does heat often mean? Dr. Frepe knows that in most cases it means that the patient is infected.
Of course, severe stress can also heat up, and it is inevitable that the patient has gone through so much as just now.
After pacifying the patient ‘ s family, the dentist brought in external blood meds and gauze, and provided the patient with a partial oral stopper, which was effective and reduced bleeding.
However, the heart rate of the patients has remained high, the blood pressure has risen unsatisfactory and the mental state is still poor.
This is obviously wrong.
Oral surgeons also told me that he had dealt with neurotic shock patients before and that he had problems with his teeth.
But it’s coming back soon, unlike today’s, to the emergency room.
I commend him for the timeliness of his response, which, if done at the dental clinic, would have left the real people, and the yellow cabbage would have been cold when the hospital was rescued.
No wonder the dental clinic is reluctant to accept it.
The dental clinic is thus self-aware.
The dentist laughed and told me in private that he had no idea what would happen.
In the case of teeth alone, it is not too complicated, and it may be that the patient is too sensitive, not to rule out the insemination of his or her own, but also the pain.
And it was this unpleasant thing that happened when the patient was scared.
Now, think about it.
At the end of the day, however, the rescue was timely, and the patient did not suffer from a cardiac arrest, otherwise the consequences could not have been envisaged.
The exit cavity doctor was relaxed, after all, and the patient came to the emergency clinic.
But I had to hit him, saying that the patient’s condition was not stable and could explode again at any time, even more.
“Is the patient bleeding a lot? I asked the dentist.
He told me that the hemorrhage was not so much, that it looked scary at the time of the patient’s convulsion, but it certainly didn’t go into haemorrhagic shock.
The dentist knows what I mean.
The patient’s blood pressure is low, rehydration is resistant to shock, and half an adrenalin has just been used in the oral cavity, but the blood pressure is not ideal, and I have to rule out other reasons for not meeting the diagnosis of neurogenetic shock.
If there is a large hemorrhage in the sick body cavity, it can lead to haemorrhaging, which has limited effect on other than effective stoppages and transfusions.
I asked the dentist whether he had a blood test before he pulled his teeth and if there was any problem with his coagulation.
If the patient suffers from bad blood, it can cause a large amount of bleeding. Although there appears to be a small amount of bleeding outside, in case the blood flows into the stomach, in case the patient swallows it.
I don’t believe in dentists. I really want to rule out everything.
The dentists said that they rarely used to draw blood.
I can’t believe it. You don’t need a routine test for a denture like that?
Really.
Not really.
Not even blood.
Oral surgeons told me that tooth pulling seemed violent, that it was a plier and a hammer, but that the vast majority of people were successful and had few accidents.
No hospital has ever heard of a regular blood test for patients before pulling out their teeth.
I sort of got to Cope.
But anyway, the patient now has to take a blood test.
I told the nurses early in the morning that the usual set of indicators, especially those on condensation, must be checked, as well as those on infection.
I gave patients regular CPRs, and I didn’t find any other problems except for the high CPR.
But she’s sweaty. It’s shock, it’s heat.
I instructed the nurse to continue to fill her with liquid and to remediate the lost sweat.
In addition to an angiogenesis, which is the most powerful angiogenesis, timely refilling of blood capacity is also important for patients with this neurogenic shock.
The dental doctor again examined the patient ‘ s oral condition, confirming that the haemorrhage had not increased and that he was ready to leave.
I asked him how he talked to his family, and he said that the patient’s husband generally understood that as long as the patient could recover, everything could be said.
That’s when the nurse came to me and told me that the patient was 40°C.
What?
Wasn’t that 38.8°C? There’s been a mistake.
The nurse said two of the thermostats, all 40°C, were being remeasured using a silver thermometer.
The nurse also thought it was a little bit weird that it was barely 39°C, and now it’s going to be 40°C, too fast.
I touched the patient’s hands and feet, and it was really hot. Give her a physical cooling.
Mercury thermometers show higher results than body thermometers, 40.3°C.
Holy shit.
This is really not a neurotic shock. I whispered to the dentist.
That’s the second time I’ve doubted this.
There’s no neuro-induced shock so hot.
But infectious shock! The shock caused by a severe infection will increase significantly the temperature!
The dentist was also puzzled by the fact that the patient was in a good state before pulling his teeth and had not heard of the infection.
He would never pull his teeth if his teeth were inflammated, sept, etc.
When I was actually worried about pulling his teeth, he was acting too rudely, causing severe tissue damage to his teeth, followed by a lot of bacteria.
As you know, there’s a lot of microbes in the mouth, bacteria, viruses, fungus, especially rotten teeth, dirty, dirty.
If a large number of micro-organisms were to bleed through damaged tissue for short periods of time, wouldn’t that lead to serious infections and sepsis?
Infectious shock is possible.
The oral surgeon did not look good, and I stressed that the tooth extraction process was generally smooth and did not result in very serious damage to the surrounding tissue, and that it could lead to a large amount of bacterial blood.
I’m just worried. I don’t have any evidence.
I know it would upset him, and it would be uncomfortable to be questioned about the professionalism of his work.
If that’s not the case, how do you explain the heat?
How do you explain the delay in correcting the patients’ state of shock?
Of course I trust my colleagues, and the dentist will certainly not lie to me, and he says that there is no serious injury, and there is no fake.
Otherwise, I’ll open my mouth to the patient, and he won’t have to lie to me.
At that point, Dr. Fupé obtained the patient ‘ s blood test results.
The patient’s blood count is high, and the rest is not very unusual.
Hemoglobins, plateboards, coagulation indicators are normal, as are sodium brain (an indicator of the reactionary function) and myocardial lesions.
I can’t understand.
Patients are in shock, and the type of shock is low blood capacity, heart source, allergy, neurogenetic, infectious, obstructive.
In the case of the patient, there is no evidence of a heart-borne shock, the least likely, after all, and the family has said that there is no history of heart disease.
The possibility of low-capacity shock (e.g. due to haemorrhage) is also ruled out, as haemoglobin is normal and there is no blood loss.
The slabs and coagulation indicators are also normal, proving that there will be no significant haemorrhage.
An allergy shock must be vigilant, but the patient has no history of allergies, and the food drugs have no allergies, which her husband made clear to us.
Also, allergy patients tend to have visible allergies, such as skin itching, red spots, etc., and none of these patients.
Moreover, even in case of allergy, this half of adrenaline, combined with a large amount of rehydration resistance to shock, should be a quick relief.
But the heart rate is still high, blood pressure is still less than 90/50 mmHg, and the mental state of the whole person is not very good, so it’s really not an allergic shock.
Neural shock may happen, but it is definitely not just there, but it can’t be explained by a single patient’s fever.
The most common causes of obstructive shock are pulmonary embolism, cardiac pressure, etc., which are fatal, but patients do not have a similar history or behaviour and do not support it.
Besides, there’s no heat in obstructive shock.
High heat, that’s a very big characteristic of the patient.
Plus the patient’s albino count is elevated, which points to the patient as an infection and one of the worst, an infectious shock.
Whether the dentist agrees or not, I’m going to have to give her antibiotics and cover anaerobic infections because the teeth contain a lot of anaerobics.
And before I use antibiotics, I have to give the patient blood.
If the patient actually had bacterial blood, the blood would have been positive, and the evidence was conclusive.
I do not trust the dentist, but I am trying to find a solution to the patient’s problems.
Of course, I’ve got the patient. I don’t need to talk to the dentist about anything.
The dentist went home, but I had to talk to my family.
The patient’s husband was already in shock, but he said he had to find a way to save his wife. If something goes wrong, nobody’s gonna get better.
What does he mean, of course I know.
Nor did I make it clear to him that the tooth extraction caused tissue damage, bacterial blood, sepsis and infectious shock, but that it did not exclude infection and that it was first treated for infectious shock.
It’s serious, but we’ll do our best.
He was also notified of his illness.
I was wondering if I could get Dr. ICU to come down and see if ICU treatments, since they’re all about infectious shock, it’s definitely not for three or two days.
That’s when the nurse came out and yelled at me.
The patient threw up and said nonsense.
I pulled my leg and ran to the rescue room. There was vomit by the patient’s bed, and there was blankets on the bed.
The patient then danced and said something to the detriment of him, as if he were in a state of weakness.
She’s so pretentious!
This is my first judgment.
It is a manifestation of a mental disorder, i.e. the patient’s nonsense, insanity, and the fact that she’s going to climb up from her bed and pull out her needles.
I quickly asked the nurse to push her a fluorine, an anti-fouling drug.
Whatever the cause, it was imperative to stabilize her, or she could rip off all the needles.
The patient gradually stabilized and his eyes closed.
Blood pressure has been further reduced.
This, as I expected, has a side effect on anti-fascist and tranquillizers, which leads to lower blood pressure.
In addition, the patient would have been in shock, which would have been even lower when the whole person had quieted down.
In addition to rapid refilling of shock and the use of angiogenesis, I made a new decision, which is to put her in the ventilator.
Patients are in a state of infective shock, are in critical condition, may lack oxygen in all organs of the body and simply cannot meet their needs.
Plus the patient’s vomiting, and I’m afraid that if you throw up again, you’ll get the wrong inhaled airways, which is more troublesome, so you can put the air intubate on the respirator, first, to secure the oxygen supply, and second, to protect the respiratory tract.
I asked Dr. Pepe to call Dr. ICT.
He then spoke to his family briefly and agreed to all treatments, and signed them.
I put a tube in the patient and put it on the respirator.
Dr. ICTU came in, learned and generally agreed with the diagnosis of an infectious shock.
After all, the patient’s heat is high, hemorrhagic cell count is high, and he’s in shock.
He added that he had seen a pneumocococcal sepsis, an infectious shock, and that the outbreak had been very rapid and dangerous.
But he has a question. Where’s the infected stove?
In the case of soft tissue damage and vascular damage in the area of teeth, oral surgery is required to deal with this predisposition, not with antibiotics alone.
Let’s just think about it, get paid for ICU, under infectious shock. At the same time, dental consultations are conducted, so that they can see the oral situation and deal with it as appropriate.
But the problem now is, ICU doesn’t have a bed anymore.
No, we have to find a way to move a bed. We can’t put this in E.R.
Dr. ICTU called their director to see if there were any other options.
The director said that if the patient was serious and had to live with ICU, then ICU would have to transfer a patient and make a bed for her.
The director said one last thing, because I was next to Dr. ICT, and I heard it.
He said that the patient was moving so fast in less than an hour, so don’t just think about an infectious shock.
Have you ever seen a bacterial infection so fast?
It’s like lightning, hitting deep inside me.
That’s what I’m worried about. I can’t find any other explanation.
Allergies and neurogenic shocks are not the same, at least they cannot be explained in isolation.
There’s no evidence of any other shock.
“Does the patient have a thyroid problem? The director of ICU said another word on the phone.
Dr. ICTU said there wasn’t, and then he looked at me and wanted me to give an answer.
But it’s really like being struck by lightning, and I can’t talk or move.
My back was cold and my pores were up.
Dr. ICTU saw me differently and was confused, and I spoke to him for a long time, and the patient’s thyroid, as if it was swollen.
Dr. ICTU can’t believe it, because I just didn’t tell him about it, and the family didn’t provide it.
I didn’t forget to tell Dr. ICT, but I just found out.
If it wasn’t for the director of ICU, I didn’t even know that the patient’s thyroid was swelling.
Before Dr. ICTU came, I made a trachea for the patient.
When the catheter was intubated, it seemed to me that the patient’s neck was a little thick, and the thyroid appeared to be swollen.
But because of the urgency of the situation, I was not able to take care of so much, especially the slight swelling of the thyroid, which did not affect the situation, so I did not study it.
I don’t think I’m gonna talk about this anymore.
It wasn’t until the director of ICU on the phone that I woke up in my head.
After dropping the phone, Dr. ICTU and I went up and examined the patient’s neck and thyroid, and found that the patient’s thyroid was really swollen, but it wasn’t particularly obvious and could not be noticed without notice.
What does it mean to be entropy? What does it have to do with the patient’s life and death?
Dr. Frepe can’t touch his head.
Doctors I.C.U. and I counted the patient’s condition, the sudden heat, the marked hysteria, the sweat, the mental symptoms, the vomiting, the shock all of which pointed to a possible thyroid threat.
When I think of the thyroid crisis, I can feel my hands getting cold, and my heart speaks of my voice.
Yeah! How can infectious shock go so fast?
Even if there are visible openings around the teeth, bacteria can bleed, but how can it change in one hour?
How can a patient, a good man, a good young man, be nearly killed in the middle of an infection?
But there is a disease, like severe infection, sepsis, infectious shock, which can have heat, sweat, heart rate, nausea, vomiting, mental abnormalities, shock and even coma.
It’s quite explosive, and it can mess up the patient’s body in a very short time, and it’s getting us a lot of trouble.
That’s a thyroid hazard!
When a patient is suffering from thyroid hyperactivity (hysteria), especially when there is no timely and effective treatment, any surgery, including tooth extraction, combined with mental stress (e.g. pain, stress, etc.), can lead to an increase in the macetosis.
The thyroid can release large amounts of thyroid hormones into the blood cycle in a short period of time, and these thyroid hormones are packed with blood vessels, and they tend to drift around, making the thyroid symptoms that patients are already experiencing more visible and extreme.
Like this patient, there’s a sudden shock, heat (often > 40°C), hysteria (often > 160°C), sweat all over the body, nausea, vomiting, consciousness disorder, and so on.
If rescue is not timely, the thyroid mortality rate is 20% or more.
Thinking of this level, I feel terrible and afraid.
If I’ve been in an infectious shock, and I haven’t been able to contact Dr. ICT, and I haven’t heard from the director of ICU, the consequences are really fucked up.
Because I was wrong at the beginning of the diagnosis, the patient, though infected, was not an infectious shock, but a thyroid hazard.
I began to blame myself for what I had just accused the dentist of, and if it really was a thyroid crisis, it really wouldn’t be able to blame anyone, not the mouth, but the thyroid.
Dr. ICTU said that the dental doctor was still responsible and that the little girl had a goitre. There must have been no accidents.
I didn’t see it at first.
Moreover, the dentists said that they were largely uninspected in their teeth, that they were generally in good condition, and that it was too much of a blood test.
In addition, the fact that the patient is enthroned, although it is only in our hands, is not confirmed by the colours, is still unknown, and is subject to blood sampling.
As for the consideration of the current dilemma caused by the thyroid threat, it’s just speculation and analysis by the three of us.
Let the Endocrinology show up, too.
If it’s a thyroid hazard, it’s good to let them guide the treatment.
That’s what I thought.
The endocrinologist arrived soon, but, because he was a young resident and was unable to obtain it, he reported to the director.
After listening, the Director felt that he could not rule out the thyroid threat, or it was similar to it, which was delayed and could be dealt with directly first.
Otherwise, patients may die from high fever, heart failure, pulmonary oedema, etc.
I told the patient’s husband about the outcome, and he probably didn’t understand what the thyroid threat was, but he knew that the disease was dangerous and that he might lose his life at any time.
ICU still gotta go.
While waiting for the ICU bed, we put a stomach tube in the patient and fed a large dose of propylazine (PTU).
This is a very common methic drug, which is usually used at a small dose, but to save the thyroid hazard at a large dose.
It is also used in Plull, a beta adrenaline receptor retardant, which significantly strains the sense of contact and reduces the heart rate.
Hydrogenized pines (a hormone) are also used, hormonals are powerful anti-inflammation, anti-convulsive drugs and the rescue of thyroid hazards is essential.
Dr. ICTU told the patient ‘ s husband that if the medications were not able to alleviate the condition, they might have to be purified with blood.
It would be helpful to have a tube in the patient ‘ s veins, to pull out the blood, to remove too many thyroid hormones, inflammation media, etc., and then to transfer the blood back into the body.
The families agree.
The patient earned ICU the same day and the examination was improved later.
The next day I called Dr. ICU, and he told me that the blood was in return, that the thyroid hormones in the patient’s blood were elevated, that the color had seen the thyroid swelling, that the diagnosis of the thyroid was conclusive, and that the thyroid threat existed.
The Director of Endocrinology has also visited and directed treatment.
It’s not an infectious shock, it’s not an ordinary neurotic shock, it’s a blood loss, it’s a thyroid hazard!
This disease that almost caught me in an accident and burned my heart forever.
If it wasn’t for the ICU director, the patient and I would be in trouble.
The patient subsequently recovered without significant after-effects.
Discussions were also said to have taken place within the dentist, and I was not aware of their content.
I also asked some dentists in other hospitals who gave me feedback that they really didn’t have to do any pre-operative blood tests, and that usually nothing was wrong.
The problem was due to the fact that the patient himself had the acetic acid, but because the symptoms were not so obvious, she had not noticed herself that she had not gone to the hospital, so she did not find out and did not inform the dentist.
The dentist did not find her goitre swollen, nor did she find her pre-operative eccentricity, and thought that it was a result of stress, which in fact was her muscular.
It’s a long story.
And I’ve been thinking about what I do, and it’s easy to pre-empt the disease.
Every heart doctor sees a heart attack is myocardial infarction, every stomach abdominal pain is removed from his stomach. I see an infectious shock.
It’s like you have a hammer and everything looks like nails.
We have to open our eyes.
Cope classes: What are the concerns before pulling out?
Is the dental extraction safe?
Overall, it’s safe. Do not be afraid to do so because of an example of denial. Oral studies have existed for many years, and similar cases are rare.
What’s taboo about tooth extraction?
In general, there are diseases of the blood system that are not suitable for tooth extraction, such as severe anaemia, leukaemia and haemorrhagic diseases, which may not stop with bleeding and which may already cause serious infections.
There are also serious cardiovascular diseases, such as severe heart failure and arrhythmia, which are not suitable for tooth extraction.
Diabetes is also susceptible to infection if it is not controlled. Hepatitis is also not suitable for tooth extraction, and hepatitis is first controlled for fear of bleeding.
Female patients, whose menstruation and gestation periods are less suitable for tooth extraction, are prone to miscarriages and premature births, and are safer in the middle of pregnancy (four, five, six months).
Teether is also not suitable for tooth extraction, and it must be controlled first, whether for medical or surgical treatment, and then stabilized, or it may cause thyroid distress, of course, only possible, not necessarily.
How many types of shock?
Ordinary people know only shock, and there are many types of shock, and different methods of shock rescue.
The most common types of shock are infectious shock, low blood-capacity shock (including haemorrhagic shock), heart-borne shock, obstructive shock, neurogenetic shock, allergic shock, etc.
What do you expect to be clinical?
Tetraphtheria, which refers to thyroid hyperplasia, or amphibolism.
The thyroid is an endocrine organ in the human body, and it is capable of distilling thyroid hormones, which are very useful to the human body, and which contribute to the growth and development of the human body, as well as to all physical activities, but which are not good.
If a certain factor leads to an increase in thyroid hormones, it is an amputation, where patients are susceptible to agitation, agitated insomnia, heart palpitation, inactivity, fear of heat, sweatiness, wasting, high appetite, and an increase in the number of urinals, and where women are likely to have fewer menstruals.
But not all patients behave like this.
What’s the thyroid threat?
When thyroid hormones suddenly increase strongly, a manifestation of an acute increase in thyroid toxicity, the cause of occurrence is related to the influx of thyroid hormones into the blood cycle. There are more cases of untreated or insufficiently treated patients with more severe acetylene.
Clinical performances include high heat, sweat, hypervelocity, irritation, anxiety, paranoia, nausea, vomiting, diarrhoea, shock, heart failure, coma, etc., and mortality rates of over 20%. Case number: YXA1ogBklmH5DMkp1sdPdj
I don’t know.
Keep your eyes on the road.
