I Can See Health

Endocrine Zone II.

doctor's office.

"Dr. Min, we have an emergency patient."

As soon as Min Ling took over, the nurse ran into the doctor's office.

"okay, I get it."

Min Ling nodded, feeling very confused at the same time.

The recent night shift in endocrinology has been too difficult!

She remembers working a night shift, which was also very busy.

Why are there suddenly so many emergency room patients?

Have you been so "hot" recently?

Min Ling had deep doubts about herself.

…

On the other side, Lu Chen slowly walked into the endocrinology inpatient department with an uneasy mood.

This three hundred yuan is too hard to earn!

However, the endocrinology ward of Jinghua Second Hospital has four wards.

The patient will not necessarily receive the endocrinology area he went to.

but.

When Lu Chen came out of the elevator and came to the door of the second endocrinology area, he saw the flat car of the emergency department in front of him.

He could only silently accept the fact that he had a "black face".

The only good thing is that I don't need to check my blood sugar today.

As soon as he walked into the second endocrinology ward, Lu Chen met Min Ling.

Min Ling was about to go to the ward where the patient was, when she suddenly saw a familiar figure on the way.

"Are you... Lu... Chen?"

Min Ling's memory was very good and she immediately remembered Lu Chen.

Mainly because Lu Chen left such a deep impression on him!

This was the first time she had seen such an outstanding graduate student!

When encountering emergency situations, he remains calm and his clinical thinking is in order, even better than many residents who are already working.

"Hello, Teacher Min."

Lu Chen also saw Min Ling.

What a coincidence, I worked the night shift with her.

Now the day shift is still with her.

"Hurry and change into your white coat. Here are the emergency patients. They're in bed 18." Min Ling smiled.

With Lu Chen as a good helper, she would feel much more relaxed no matter how busy she was today.

Lu Chen nodded: "Okay."

I feel bitter in my heart, but I can't express it.

Lu Chen quickly walked into the duty room and put on his white coat.

Grab your stethoscope and carry a small medical flashlight in your pocket.

Came to the bedside of bed 18.

On the hospital bed, the patient still had his eyes closed and was in a coma.

However, his right hand occasionally waved involuntarily.

Lu Chen saw his health value, which was red at 45.

Surrounded by the bed were three middle-aged women, probably the patients' daughters.

At this time, Min Ling was already giving out medical orders.

"Enter ECG monitoring, inhale oxygen through the nasal cannula, check fingertip blood sugar, and then urgently check blood routine, biochemistry, ions, coagulation items, cardiac enzymes, and blood gas analysis."

"receive."

One nurse brought the ECG monitor and another nurse started taking blood from the patient.

The fingertip blood sugar value comes out quickly.

"Dr. Min, the fingertip blood sugar is 1.8mmol/L." After measuring the blood sugar, the nurse immediately replied.

"So low?" Min Ling frowned, "Immediately inject two high-sugar injections, then add a 500ml bag of sugar, and adjust the liquid speed faster."

"receive."

Min Ling then looked at Lu Chen who was standing aside: "The emergency department considered that the patient was in a hypoglycemic coma, so they did a head CT and sent him to our department."

Lu Chen frowned and said, "Teacher Min, do you still need to identify cerebral infarction?"

"Yes." Min Ling nodded slightly, "Although all the current evidence points to hypoglycemic coma, we must not forget to rule out cerebral infarction. Because the treatment of cerebral infarction and hypoglycemic coma are very different."

Not only hypoglycemic coma patients, but also all delirious patients must rule out acute cerebrovascular accidents.

Later, Lu Chen asked a family member about the patient's illness.

The patient has a history of diabetes for more than 20 years and has been taking insulin at home.

I don’t know why recently, my appetite is not very good and I eat less, but I still take the same amount of insulin as before.

"Do you know how to do a neurological examination?" Min Ling continued.

For delirious patients, in addition to routine physical examination, there is also a complete neurological examination.

Physical examination of the nervous system is more cumbersome.

If it is not used frequently in clinical practice, it can easily be forgotten.

Except for doctors in neurology, many doctors from other departments will ignore the physical examination of the nervous system.

Doctors in certain departments don’t even know how to conduct neurological examinations at all.

"I know a little bit," Lu Chen said.

Min Ling nodded; "Then you start."

Lu Chen walked to the right side of the hospital bed.

The first step in a physical examination of the nervous system is to determine consciousness.

Obviously, the patient in front of him is in a coma, but it still needs to be distinguished whether it is a deep coma or a shallow coma.

Next is the examination of the cranial nerves.

Focus on the examination of the oculomotor nerve, trochlear nerve, and abducens nerve, observe whether there is diplopia, whether the eyeball movement is in place, observe whether the corners of the mouth are deflected, and determine whether it is central facial paralysis or peripheral facial paralysis.

Then the muscle strength and muscle tone of the patient's limbs are examined to determine the level of muscle strength and whether there are extrapyramidal symptoms.

Finally, there is the examination of the sensory system, physiological reflexes, pathological reflexes, meningeal irritation signs, and autonomic nervous system.

A complete physical examination of the nervous system takes a lot of time.

Min Ling looked at Lu Chen's physical examination and nodded with satisfaction.

This is not just a little bit, but quite a bit!

The more she looked at the student in front of her, the more she liked him.

Check completed.

Lu Chen was already a little tired. He breathed out gently and said, "The patient is in a shallow coma... There was no contraction of the left nasolabial fold during orbital stimulation, there was no spontaneous movement of the left limb, and there was avoidance of the right limb. Movement, no pathological signs were elicited on the left side..."

"In general, the patient currently has signs of left limb hemiplegia and needs to be differentiated from cerebral infarction."

"Okay." Min Ling nodded, and then said to the family members on the side, "Which of your family members can make the decision, come to the office with me."

The three family members and three middle-aged women present looked at each other, but no one spoke for a while.

Min Ling frowned: "Who are you patients?"

At this time, one of the short, dark-skinned middle-aged women stood up.

"I am the patient's daughter, I will come with you."

"Okay." Min Ling nodded, glanced at the other family members, and then walked out of the ward.

Middle-aged women followed.

…

doctor's office.

Min Ling sat in front of the computer, and Lu Chen stood beside her.

The middle-aged woman was sitting aside, looking reserved and a little restless.

"The patient is currently in a coma, and UU Reading www.uukｎshu.net is in a relatively dangerous situation. We must first consider hypoglycemic coma, and secondly, acute cerebrovascular accidents, which we often call cerebral infarction."

"Yes, I understand." The middle-aged woman nodded, "The doctor in the emergency department told us."

Min Ling continued: "That's good. Although we have given corresponding treatment measures, in order to rule out cerebral infarction, we still need to go out for an examination."

"A checkup?" the middle-aged woman asked nervously, "Didn't you already do a head CT scan during the emergency room?"

"Head CT is to rule out trauma and cerebral hemorrhage." Min Ling explained, "Only magnetic resonance imaging can rule out cerebral infarction!"

The middle-aged woman frowned, her eyes flickered, bit her lower lip, and said, "Doctor, I, my brother haven't come yet. When he comes, we will discuss it with him and give you an answer later."

"Okay, but you have to hurry up. The patient's condition is now serious. If the diagnosis is not made as soon as possible, the best opportunity for treatment may be delayed," Min Ling said.

"Okay, thank you doctor."

The middle-aged woman nodded and left the ward.

Looking at the middle-aged woman's leaving figure, Lu Chen frowned and whispered: "Looking at the clothes of the patient's children, it doesn't look like they are in particularly poor economic conditions. How to do an examination will take a long time to discuss... …”

Min Ling smiled helplessly: "Xiao Lu, as the saying goes, one monk carries water to drink, two monks carry water to drink, and three monks have no water to drink."

"This person, the more the better, and in our place in Jinghua, the patriarchal mentality is quite serious. Generally, the family's property will not keep daughters."

"After you come to the hospital, who pays the medical bills will make the decision."