Emergency Department Observation of Medical Records

When the shift was over at 17:07 in the morning, the doctor on duty reported that the 30-year-old girl who was accepted for examination yesterday was found unconscious at [-]:[-] in the morning.

After Zhao Bin finished his shift, he hurried to see the patient. The doctor on duty went with him and explained his condition in detail: "At 07:30, the nurse went to draw fasting blood, but she couldn't wake her up. The body is in a light coma state. The breathing and heart rate are normal, the blood pressure is slightly lower, 90/54mmHg, and the blood oxygen saturation is normal. My sister said that it was normal last night, eating and sleeping were normal, and there was no problem at all before going to bed. In the ward Others also said that the patient was still very energetic yesterday, and the two sisters quarreled all night."

"Did all your fasting blood be drawn this morning?" Zhao Bin asked.

"It was done," the doctor on duty nodded, "I sent it over for an urgent checkup. The blood was drawn for maybe 20 minutes, and the results won't come out until a while later. I also added a blood gas."

"Didn't you have time to check your blood sugar?" Zhao Bin asked, looking at the patient.

"No, the shift was about to be over at that time. I think they had already drawn blood, so they didn't rush to check their blood sugar." The doctor on duty said.

"Okay, I'll let them check one now." Zhao Bin said and went out to call the nurse over.

After a while, the finger blood sugar came out, 1.3mmol/L.The two doctors and one nurse in the ward were stunned.

"Is there... something wrong?" The nurse still couldn't believe it.

"The venous blood will come out in a while, let's infuse the sugar water first. Hurry up!" Zhao Bin didn't dare to speak too loudly, as other patients in the ward were still watching.

Both he and the doctor on duty were a little scared, because they underestimated the condition, preconceived that the two sisters were arguing, and the sister's dizziness and fatigue were manifestations of hysteria.Unexpectedly, it was such a severe hypoglycemia that even led to coma.

"She doesn't have the foundation of diabetes, and she has no heart problems, and her heart function is normal," Zhao Bin said in a low voice. "The sugar can go in faster. I'm calling the endocrinology department for consultation. I think there is something wrong with this girl. There's still trouble. Where's her sister?"

"I said I went out to buy food in the morning." The head nurse also came to see the patient, and after knowing about the blood sugar, she was also very nervous, "Our nurse on the night shift heard my sister say that it will be fine after eating, so I went out to buy food .”

"I ignored it," Zhao Bin sighed, "dizziness, fatigue, and recovery after eating, this is a hypoglycemic reaction."

"Let's not talk about that now," the doctor on duty patted him, "First find out what caused such a low blood sugar."

Zhao Bin nodded, and explained to the nurse as he walked out: "When her sister comes back, tell her to come to me quickly."

Zhao Bin called and asked the head of the endocrinology department to come down for consultation.When the boss of endocrine arrived, it happened that my sister came back with breakfast.The two of them went to see the patient again. After the glucose was supplemented, the patient was already awake. Now he said that he was a little bored in bed, but he felt fine otherwise.The boss of endocrinology asked about the condition carefully again, and the two came out to discuss.

"Such a low blood sugar," Zhao Bin asked, "do you consider pancreatic tumors?"

"It must be considered." Wu Wenni said, "But pancreatic tumors can't explain why the onset occurs in the morning. The adrenal gland problem may be rhythmic. In short, let's do a full abdominal CT first, and then look at the blood results. Check it out. A tumor marker. I contacted the nurse station of our department and reserved a bed for her at that time, and transferred in if there was a bed. I have to tell them that this is not a simple disease anyway, and the examination and treatment may cost a lot of money ..."

"Okay, I'll tell them. I'm sorry to trouble you." Zhao Bin said.

By the afternoon, the patient had no other discomfort.After listening to Zhao Bin's explanation, the elder sister became silent for a long time, and the younger sister also felt her uneasiness sensitively. The two of them were very quiet all morning. At noon, the elder sister went out to buy food and brought a few boxes of milk when she came back.As soon as the CT report and films were retrieved in the afternoon, my sister rushed back to look for Zhao Bin.

Zhao Bin read the report first. The first line of the CT reads: Multiple solid masses in the liver, considering the possibility of liver metastasis of the tumor, please combine it with the clinic.He picked up the film and looked at it. There were densely packed tumors of different sizes on the liver.Since he entered clinical work, he has never seen such a severe liver metastases.He even suspected that he had read the wrong film, so he picked it up and checked the patient information on the film.The performance of this film really made him feel unbelievable, so he brought the film and his family to his superiors.Everyone in the department watched the film and discussed the situation together.Director Zhou of the emergency department called and directly invited the directors of the Department of Hepatobiliary Surgery and Gastroenterology to watch the film.The director of the Department of Hepatobiliary Surgery said that he had seen similar cases. Judging from the imaging features of the metastases, it was considered to be liver metastasis from cholangiocarcinoma, but a biopsy was definitely needed for diagnosis.

"How old is the patient?" asked the director of the hepatobiliary surgery department.

"17 years old..." Zhao Bin replied.

There was a heavy sigh in the office, and no one spoke for a while.

"The prognosis is very bad," said the director of the Department of Hepatobiliary Surgery. "For cholangiocarcinoma, according to the articles published by our hospital in the past two years, the average survival time of palliative treatment is 9 months, and the latest reports from foreign magazines have no average survival time." More than 1 year. After the radical operation, no more than two years. Her liver metastases are so severe, and other organs other than the liver have not been checked. Radiotherapy and chemotherapy can be tried, but it depends on their wishes, and there is no guarantee that they can prolong survival ..."

Zhao Bin took the film back to explain the illness to the two sisters. After leaving the office, the interns brought by Zhao Bin dared to speak without the pressure of the three department directors: "Mr. Cancer, but is her symptom low blood sugar? Or low blood sugar at this fixed time in the morning?"

Zhao Bin said: "Remember the functions of the liver. What is related to blood sugar is the storage of glycogen in the liver. Her liver has been fully occupied by metastatic tumors, and there is less liver tissue with normal functions. Such a liver can The stored liver glycogen is less, and the time interval between eating during the day is not long, so there will be no obvious symptoms of hypoglycemia. The liver glycogen stored during sleep at night is consumed, and hypoglycemia will occur when you wake up in the morning."

"It's a good thing I was hospitalized that day, otherwise, if I was outside, unconscious and unable to eat, I might have died..." the intern sighed.

Zhao Bin didn't speak anymore, he just felt lingering fear.In this matter, his judgment was too preconceived. He even let go of hypoglycemia and simply thought of the patient's symptoms as hysteria related to psychological factors.As the intern said, if the patient's family hadn't strongly requested to be hospitalized that day, perhaps the patient might have an accident outside the hospital.He asked himself, if there was an accident, he would have to bear most of the responsibility, which was a missed diagnosis.He felt that he was indeed a little irritable recently, and he didn't take it too seriously when seeing patients.This state is not good... he thought with a sullen face.

At the door of the ward, the patient's sister was waiting for him.Her eyes were red, as if she had just cried, and her expression was tense.

"Doctor, come in, let us talk together." My sister said with a choked voice.

Zhao Bin nodded and walked into the ward. The 17-year-old girl is at a loss. She is still not very clear about her illness, and she doesn't know that her future has been sentenced to death with a reprieve.

"The most promising treatment now may be liver transplantation." Zhao Bin said, "There are too many metastatic tumors on the liver, it is impossible to cut out the tumors one by one, and there is no way to accurately separate the normal liver tissue from the tumor. The cells are separated. The only hope is to find a suitable donor and replace the entire liver while undergoing radical surgery. Another is to try to do radiotherapy and chemotherapy for the tumor.”

"How much does it cost?" My sister took a breath, suppressing the tremor in her voice, and asked.

"Hundreds of thousands." Zhao Bin said, "We still have to wait for a suitable donor."

"Hundreds of thousands..." My sister lowered her head, "The two of us, without eating or drinking, can save so much money in decades..."

"There is social assistance now..." Zhao Bin comforted her weakly.

"Even if we have the money for the rescue, can we wait for this liver?" My sister wiped her tears with her hand, "It is said that the tumor will get heavier every day. It’s worn out. Besides chemotherapy and radiotherapy, you can’t even guarantee that it will be effective, and the two of us have spent money, so we can only suffer.”

"It's always a way." Zhao Bin said.

"Apart from waiting, what should we do now?" My sister said calmly, "According to what you said, the liver is already like this, and it may be as unconscious as it was this morning at any time in the future. We will continue to live. , I can't leave her alone and let her die like this. What should we do now?"

"Now we can only observe, and supplement sugar in time when there is a hypoglycemia reaction." Zhao Bin had to explain again.

"Okay." My sister said, "Days are getting worse... I didn't even know that God had prepared such a big 'surprise' for the two of us." As she spoke, her tears couldn't stop flowing again down.

On the contrary, it was the younger sister lying on the bed with a numb and calm expression, as if all this had nothing to do with her.

The two sisters packed up in the afternoon and were discharged from the hospital.When they left, the two sisters held hands and were very close to each other.My sister said something, and my sister laughed.On their faces, the despair when they learned of the diagnosis and prognosis could not be found for the time being.The two are so close, like the best pair of sisters in the world.

What are all the grievances and grievances, big and small, in the face of life and death?

The midsummer cicadas cover up the hustle and bustle of the world.

Luo Mingyao hasn't been to the laboratory for the past two days.At the end of August, the Endocrinology Department of the Affiliated Hospital of C University will hold a class on type 2 diabetes, and invited several well-known domestic professors to give lectures.Luo Mingyao and other graduate students in the department who are not in clinical practice have to do chores for the department.A prospective first-year graduate student like him is not responsible for many things, mainly registering, organizing schedules, and moving things.Other brothers and sisters are responsible for the reception of the professors and even the handover of the sponsored manufacturers.

The study class held this time is relatively large, and there are three or four sponsors.Every day, there are many people lined up at the door of the Office of the Director of Endocrinology, waiting to come in to discuss the next steps, needs and so on.Luo Mingyao's elder brother, Song Chenggang, is now also in charge of the handover of the manufacturer. Luo Mingyao also helps his elder brother with chores. Sometimes Song Chenggang is too busy, so he also helps a lot with making calls and sending and receiving text messages.One of them made domestically produced metformin sustained-release tablets, and even added him as a friend on WeChat.Luo Mingyao sent him a message asking him to come to the director's office for a meeting this afternoon.

Probably a newcomer, he took the elevator at the back door on the day he came, and was directly stuck in the corridor by the access control.

The inpatient department of the Affiliated Hospital of C University is relatively large, and there are too many people coming in and out. Patients, family members, medical staff, and other hospital staff come and go, and the eight elevators on the [-]th floor are not crowded enough.In order to ensure that the hospital staff can go up and down the stairs smoothly, patients and other outsiders arrange the elevators at the main entrance to go up and down.The manufacturer's representative probably saw that there were few people on the elevator at the back door, so he took it for granted and walked through the back door, but when he came up, he found that he couldn't get in, so he had to call Luo Mingyao for help.

Fortunately, Luo Mingyao was in the department. He went to help someone open the door, and the two of them were stunned when they met each other.

"Luo Mingyao!" The other party called out first, "Remember me, I'm Xu Maohua!"

"Of course I remember." Luo Mingyao was also a little excited.Still wanting to say something more, Xu Maohua hurriedly said that he would look for him later, he had to go to the director for a meeting, and he was almost late.

Xu Maohua called him after a meeting, and he shook Luo Mingyao's hand enthusiastically: "I didn't expect to see each other for so many years after graduation, but I met here."

"Yeah..." Luo Mingyao couldn't help but sigh with emotion, "When we were in the freshman reunion, that was the last time we met, right?"

Xu Maohua nodded: "We got together in the senior year, but you didn't come. The class monitor said you were an intern? Your medical university internship is too strict. I heard that you stayed at home for a week during the summer vacation?"

"Yes," Luo Mingyao said, "Internships are never fake. We were lucky enough to invite them for a week."

"Then you graduated this year, right? Didn't you go back this year?" Xu Maohua said.

"That's right. The graduate students in the headquarters didn't go back this year, and they all started working directly." Luo Mingyao said.

"Fortunately, I didn't study medicine back then!" Xu Maohua said with a smile, "My grades were not as good as yours. At that time, I was not admitted to the clinical medicine of F University. Later, I was transferred to pharmacy. I graduated last year and started working. It was a pity that I didn't study clinical medicine at first. , I’ve been working for a year, and I’ve met a lot of your clinicians. I’m glad that it’s too hard to learn the clinic. Although we run a lot, I don’t think I’m tired compared to you.” He patted Luo Mingyao's shoulder, "Old classmate, let's come out to have a meal. I just came out today to help my senior run this matter. I don't have to go back to the company in the afternoon. I will treat you to dinner in the evening?"

"This, please don't ask me." Luo Mingyao was a little unaccustomed to his enthusiasm and tact, and said, "I have nothing to do at night, but there are many things in the department recently, and I am afraid that the senior brother will find me at any time. We will not go far. There are delicious food nearby. Yes, let me take you to eat."

"You choose a place," Xu Maohua said, "You haven't graduated yet to earn money, so I'm sure I'll invite you!"

Luo Mingyao really couldn't talk to him, so he decided on a time and place for dinner.Luo Mingyao went back to continue doing things for a while, and went to find someone to eat after six o'clock.