Start From Emergency Doctor

Chapter 333

Zhou Yuan immediately opened blood test, kidney function test, blood sugar test, urine test and other in-depth tests.

“Oxygen, fluid replacement, blood pressure, pulse and ECG monitoring. Place the urinary tube!”

The bedside electrocardiogram was also pushed over, and on the other side, the computer blood glucose was also tested.

“Error one.” Such a data appeared on the computer blood glucose meter.

Zhou Yuan frowned.

No data can be measured, which means that the patient’s blood sugar is too high. The upper limit of the instrument measurement is 23.0mmol/L, once the blood glucose concentration is exceeded, it cannot be measured…

At this time, Zhou Yuan already had a general answer in his mind, but he needed further confirmation.

Zhang Ling had already returned and was about to start drawing blood. Zhou Yuan walked to the bedside of Zhang Youwei. The latter lay quietly on the bed without any response, just occasionally humming in pain.

“One more way of liquid, a quick drip.” Zhou Yuan decisively reached the doctor’s order.

Rapid intravenous drip is an intravenous infusion of large-dose injections into the body, the main purpose is to replenish body fluids, electrolytes or provide nutrients.

“What kind of liquid?” Zhang Ling was a little confused.

By now, she has realized the seriousness of the problem.

Although Zhang Youwei has a history of clashing with porcelain, this time it shouldn’t be a pretender. Zhang Ling’s experience is relatively shallow, and she has only been in the hospital 030 for three or four years, so she is not experienced enough to judge what medicine to instill.

“Regular. Five hundred milliliters of 0.9% sodium chloride. Quick drip!” Zhou Yuan’s speech speeded up.

After opening the intravenous access the next day, Zhou Yuan waited for the report of blood routine.

Zhang Youwei’s blood test has been marked as urgent, and ordinary blood test needs to wait half an hour, one or two hours.

However, in fact, the blood routine does not take long. The automatic analysis by the machine can be completed in about ten minutes. The long waiting time is mainly due to the need to queue.

The blood test in the emergency department was faster, not to mention the urgency. In two minutes, Zhang Ling ran back from the laboratory.

Zhang Ling’s expression also became serious, and she hurriedly passed the blood test results to Zhou Yuan.

White blood cells 18.7×10^9/L, neutral ratio 90%, HB137g/L, platelets 123×10^12/L.

Soon, Lin Wen came back with all the test results.

Blood glucose was 27.1mmol/L, blood ketone body was 6mmol/L, urine ketone body was positive. Acetone has no renal threshold, creatinine and urea are normal, but renal function is abnormal. Plasma CO2 binding capacity is reduced by 30%, and plasma pH value is 16. Serum potassium and sodium also exceeded the normal value.

Normal people’s blood sugar level is ~6.1, and Zhang Youwei’s blood sugar is as high as 27.1, which is obviously hyperglycemia. On the blood ketone body side, the normal value should be about 1, but the patient has reached 6.

High blood sugar-a symptom of diabetes.(Read more @ wuxiax.com)

And accompanied by normal gastrointestinal tract, vomiting, diarrhea and so on.

Zhang Youwei has symptoms of dehydration and is now accompanied by shock.

Zhou Yuan reached the bedside of Zhang Youwei again, lowered his body, got close to Zhang Youwei’s mouth and nose, and slapped it with his hand.

No smell…

In patients with ketoacidosis, some people have a ketone odor similar to rotten apples in their breath. However, although there is no smell, test results, patient signs, etc., all show that the patient is indeed ketoacidosis.

“Ketonic acidosis.” Zhou Yuan issued the diagnosis result.

Ketoacidosis is generally caused by patients with various inducements, resulting in obvious insufficient insulin and improper increase of glycogen hormones, resulting in hyperglycemia, hyperketones, ketonuria, dehydration, electrolyte disorders, and metabolic acidosis A disease with pathological changes.

This is one of the common emergencies in internal medicine. Of course, it is also seen in the emergency department.

Acute abdominal pain, severe diarrhea, etc., many people don’t have time to go to the internal medicine department, so they rush to the emergency department, which can be regarded as a relatively common emergency in the emergency department.

Fortunately, Zhou Yuan predicted it in advance and provided Zhang Youwei with physiological saline in time to alleviate the abnormal problems of various values ​​in the body.

“Small dose of intravenous insulin and potassium supplementation.” Zhou Yuan said.

Although it is a sudden illness, ketoacidosis is not too serious. When there is no time to seek medical treatment in an emergency, you can also give the patient plenty of water, preferably light saline. The ratio of 1,000 ml of water to 9 grams of table salt can also be temporarily relieved.

However, in the end, insulin injections are needed to lower the patient’s hyperglycemia.

“The day before yesterday, Sun Meng was sure that it was not the food problem?” Zhou Yuan looked at Zhang Ling.

Zhang Ling nodded: “I’m also there. I’m sure it’s not the food.”

There are many causes of ketoacidosis, such as infection, food poisoning, improper treatment, etc., as well as various stress factors.

In order to solve ketoacidosis, in addition to temporarily controlling the symptoms, it is also necessary to find the predisposing factors and eliminate them completely, otherwise it will still recur.

“Have the patient had any surgery recently?” Zhou Yuan asked, “Or was injured.”

Postoperative infections and wound infections are relatively common, and they are high-frequency factors that induce ketoacidosis.

“Hmm…Yes, I had a minor operation recently…” Zhang Youwei’s wife seemed to hesitate.

“What surgery?”

“It’s a minor operation.”

Zhou Yuan was silent for two seconds, adding to his tone, “Where did it go and what kind of surgery?”

Basically it can be determined.

If it is not a diet problem, it is usually an infection. I have had surgery recently, and it is very likely that infection occurred during the operation.

Ketoacidosis is the most common infection of the respiratory system, urinary system and skin.

“The circumcision performed at the small clinic near my home…” Zhang Youwei’s wife saw Zhou Yuan’s face become serious, and she didn’t dare to hide it anymore.

Zhou Yuan nodded.

Zhou Yuan is not biased against small clinics, but many small clinics are really not so good. They can’t even perform basic disinfection and ensure a sterile environment.

For example, in the case of Dr. Beard before, the small clinic didn’t even have a complete set of suture tools, and there were only so many sutures to choose from.

“It should be the infection of the circumcision.”

A lively voice came from the door.

Zhou Yuan looked up and Sun Meng came.

It’s been almost a month since I saw Sun Meng.

Actually, it was not that they didn’t meet each other. They were both in the same hospital. Zhou Yuan and Sun Meng both ran to the inpatient department, and occasionally met, but everyone was in a hurry, so they just said hello.

This is the first official meeting between Zhou Yuan and Sun Meng in the emergency department.

Sun Meng’s eyes were bright, and said, “Zhou Yuan, are you off work? Let me take care of it next.”

Zhou Yuan nodded, “It’s almost done, the fluids have been supplemented, insulin and everything are instilled, and then contact the urology department to help him deal with it, and there should be no recurrence.”

Sun Meng smiled and said, “Are you going back now, go to my clinic and sit down?”

Zhou Yuan was not serious again: “Why are you going to your clinic, I’m not sick.”.