Start From Emergency Doctor

Chapter 380

Zhou Yuan was silent for a moment, then raised his finger to the door: “Please go out.”

What’s so special… There are still dozens of kilograms of free melon seeds to give away?

Sun Meng smiled triumphantly, clutching a handful of melon seeds and was about to leave.

The night shift is very tiring, and the night is no better than during the day. The entire emergency department is quiet. When there are no patients, it is boring to death. It happens to be able to kill time by eating melon seeds.

“and many more.”

Zhou Yuan suddenly remembered something and walked to the office to take out a medical record.

“This is the medical record I brought over from the teacher. This patient is similar to Lin Hai. Please pay attention.”

Zhou Yuan handles many medical records during office breaks.

In fact, writing medical records for interns is also a kind of training, which allows them to reach more types of patients, so that they can have evidence to follow when seeing a doctor. Zhou Yuan has improved too fast and missed this step.

However, the doctors have been able to fight steadily step by step. Zhou Yuan’s surgical skills can be improved, but the level of outpatient diagnosis requires his own efforts, and the system currently cannot improve Zhou Yuan’s diagnostic capabilities.

Sun Meng got up seriously, took the medical record, and looked at it.

The patient was a 61-year-old elderly man. He was admitted to the hospital at 3 a.m. for “vomiting and fatigue for two days” a month ago. On the morning of admission, he developed nausea and vomiting once, accompanied by severe abdominal pain in the upper body. She began to experience general weakness and semi-fainting.

Past medical history: 9 years of diabetes history, taking glimepiride at a dose of 4 mg/d and metformin at a dose of 3.0 g/d. He had a history of hypertension for two years, and had taken valsartan hydrochlorothiazide tablets at a dose of one tablet per day.

Glimepiride and metformin are both suitable for patients with type 2 diabetes. The former is mainly for patients with type 2 diabetes who cannot adequately control their blood sugar through diet control, exercise therapy, and weight loss. The latter is particularly suitable for obese type 2 diabetes. . Valsartan hydrochlorothiazide tablets are indicated for the treatment of mild or moderate essential hypertension, which is relatively stubborn hypertension, where a single drug cannot fully control blood pressure.

“Look at the diagnosis result directly.” Zhou Yuan reminded.

Sun Meng nodded, turned several pages, skipped a series of examinations, etc. The clinical diagnosis on the medical record showed: hypoglycemia, diabetes, and acute renal dysfunction.

“Low blood sugar? Lin Hai has high blood pressure…”

“Look carefully at how low his blood sugar is. Lin Hai has high blood sugar, as high as 130 millimoles, while this patient’s blood sugar is only 0.54, which is terribly low.” Zhou Yuan said.(Read more @ wuxiax.com)

This is like two extremes.

Sun Meng nodded and continued to watch, but was immediately stunned.

Near the end, there are a few lines of words “Brain death declared by invalid rescue.”

“The patient died?!”

Zhou Yuan nodded: “He died suddenly after correction. Can you guess the reason?”

Sun Meng closed the medical record book, did not read the death report and other records later, and thought about it by himself.

“I have a few questions…” Sun Meng said after thinking for a long time.

“The first one is renal failure. Is the patient’s renal failure acute or chronic?”

She turned a few pages forward, stared at the blood test, and said: “According to the hemoglobin, it may be chronic or chronic + acute. The patient has chronic renal failure drug accumulation poisoning after correcting blood sugar, or is sulphurous. Urea caused the second severe hypoglycemia and biguanide lactic acidosis?”

Zhou Yuan nodded. The points mentioned by Sun Meng are all possible causes of the patient’s death.

Sun Meng continued: “I am in charge of the emergency medical department. I previously encountered a patient with uremia who had hypoglycemia after taking sulfonylureas in other hospitals. As a result, he died immediately after he corrected his blood sugar. Cerebrovascular accident. Rapidly correcting hypoglycemia, the osmotic pressure inside and outside the brain cells changes sharply, which leads to the formation of brain herniation, which leads to death. Is this the reason?”

Before Zhou Yuan could answer, Sun Meng lowered his head and thought again: “The patient also showed a high blood picture… For such a high blood picture, infection must be considered first. The fever of the patient is unknown when he is admitted to the hospital. Other infection indicators such as hypersensitive CRP and hypersensitivity How about calcitonin? If there is an infection, it is not impossible to have septic shock.”

Zhou Yuan was a little surprised.

Only after reading a few pages of medical records, within three or four minutes before and after, he was able to analyze these things. Sure enough, it was not a joke that Sun Meng said before that he had to take the doctoral exam.

It’s not that doctors have the insight and judgment ability of Sun Meng. In fact, most medical doctors are not even as good as some experienced clinical undergraduates. Of course, in the short term, they can get a doctor of medicine. They have enough time, experience and insight to be able to keep up and surpass the latter…

“You are right. The patient has an infection. In addition, the patient is already old, has poor appetite, and the dental environment is also very worrying. Therefore, the lack of nutritional intake has caused Ah Hunzhe to be in the early stage of shock before admission. , The semi-fainting state can already be seen… and the patient’s body is in a severe metabolic imbalance and partial decompensation state, and a series of manifestations of hypoglycemia and abnormal heart, kidney and lung functions have appeared.”

“This is… the systemic blood vessels spasm in the pre-shock period, which caused the self-transfusion state?!”

Zhou Yuan smiled.

Sun Meng has probably guessed the cause of the sudden death of the patient.

“Look at the time log.”

“At 19:00, the blood pressure dropped to 127/64mmHg, and dropped more than 50mmHg. At this time, the patient entered the shock decompensation period. The doctor in charge immediately performed rapid fluid supplementation to increase blood pressure and try to control blood pressure.”

“At 21:00, the blood pressure slowly dropped to 90/55mmHg, and the blood sugar detected a sudden increase, which was 12.2mmol/L. At this time, the patient was expressionless, the body did not have any adverse reactions, and the state was normal.”

Sun Meng’s face was difficult to look.

The blood pressure has reached such a dangerous level, the body has not had any adverse reactions, and the state is normal? Everyone knows that this is only the surface calm, this is the glorious reflection before the dying, the tranquility before the storm…

Sure enough, the patient’s blood pressure has been irretrievable. After the control failed, the patient continued to drop, and the patient began to lose consciousness. On physical examination, the pupils were dilated and the light response was slow. One hour later, the patient’s blood pressure collapsed, and emergency resuscitation and other measures were taken, but the rescue failed in the end and the patient died quickly!

It looks like a simple hypoglycemia, but it took a life within a day of admission. The cause of the patient’s true death caused many doctors to be confused at the time.

Is there something wrong with the series of treatments after the consultation, or is there something hidden in the patient’s own disease, or is not discovered, or is it a rare allergy to a special drug? .