Start as an Emergency Physician

Zhou Yuan immediately prescribed in-depth examinations such as blood routine, kidney function test, blood sugar test, urine routine and so on.

"Oxygen, fluids, monitoring blood pressure, pulse, and ECG. Place the urinary catheter!"

The bedside ECG was also pushed over, and on the other side, the computer's blood sugar was also tested.

"Mistake one. "There is such a data on the computer blood glucose meter.

Zhou Yuan's brows furrowed.

The data is not measured, which means that the patient's blood sugar is too high. The upper limit of the instrumental measurement is 23.0mmo1/L, and once this blood glucose concentration is exceeded, it cannot be measured...

At this time, Zhou Yuan already had a rough answer in his heart, but he still needed further confirmation.

Zhang Ling had already returned, ready to start drawing blood, Zhou Yuan walked to Zhang Youwei's bedside, the latter lay quietly on the bed, there was no reaction, only occasionally let out a low snort in pain.

"Open another liquid and drip quickly. Zhou Yuan decisively gave the doctor's order.

Intravenous rapid infusions are large doses of injected fluids into the body by intravenous drips, and 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 touching porcelain, he should not be pretending this time. Zhang Ling's experience is relatively shallow, and he has only been in the hospital for three or four years, so he is not experienced and cannot judge what drugs to inject.

"Regular. 500 ml of 0.9% sodium chloride. Quick drip!" Zhou Yuan's speech sped up.

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

Zhang Youwei's blood routine has been marked as expedited, and ordinary blood routine needs to wait for half an hour or one or two hours.

However, in fact, the time of the blood routine is not long, the machine automatically analyzes, and it can be completed in about ten minutes, and the long waiting time is mainly due to the need to queue.

The blood routine in the emergency department was faster, not to mention urgent, and in two minutes, Zhang Ling ran back from the laboratory department.

Zhang Ling's face also became serious, and he hurriedly handed the results of the blood routine to Zhou Yuan.

Leukocytes 18.7×10^9L, neutral ratio 90, HB137gL, platelets 123×10^12L.

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

The blood glucose was 27.1 mmo1/L, the blood ketone body was 6 mmo1/L, and the urine ketone body was positive. Acetone has no renal threshold, creatinine and urea are normal, but renal function is abnormal. The plasma CO2 binding capacity was reduced by 30%, and the plasma pH was 16. Serum potassium and sodium are also above normal.

The blood sugar level of normal people is 3.9~6.1, and Zhang Youwei's blood sugar is as high as 27.1, which is obviously high blood sugar. On the side of blood ketone, the normal value should be about 1, but the patient reached 6.

High blood sugar – a symptom of diabetes.

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

Zhang Youwei himself had symptoms of dehydration and went into shock.

Zhou Yuan came to Zhang Youwei's bedside again, lowered his body, approached Zhang Youwei, and fanned him with his hand.

There is no smell in the breath...

In patients with ketoacidosis, the breath will have a keto odor similar to that of rotten apples. However, although there was no smell, the examination results, patient signs, etc., showed that the patient was indeed ketoacidosis.

"Ketoacidosis. Zhou Yuan issued the diagnosis.

Ketoacidosis is generally a disease in which patients are under the action of various triggers, resulting in obvious insulin insufficiency and inappropriate increase in glycogenic hormones, resulting in pathological changes such as hyperglycemia, hyperketones, ketonuria, dehydration, electrolyte disorders, and metabolic acidosis.

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

Acute abdominal pain, severe diarrhea, etc., many people do not have time to go to the internal medicine department to see, and go directly to the emergency department, which is also a relatively common emergency disease in the emergency department.

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

"Low-dose intravenous insulin, potassium supplementation. Zhou Yuandao.

Although it is an acute illness, ketoacidosis is not too serious. When it is too late to seek medical attention in an emergency, the patient can also be given more water, preferably light salt water, which can also be temporarily relieved by using the ratio of 1,000 ml of water to 9 grams of table salt.

Eventually, however, insulin injections are needed to lower the patient's high blood sugar.

"The day before yesterday, Sun Meng was sure that it wasn't a problem with food?" Zhou Yuan looked at Zhang Ling.

Zhang Ling nodded: "I'm also here." Determine if it's not the food's problem. "

Ketoacidosis has many triggers, 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 necessary to find the trigger and completely eliminate it, otherwise it will recur.

"Has the patient had any recent surgeries?" Zhou Yuan asked, "or was it an injury." "

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

"Hmm... Yes, I recently had a minor operation..."Zhang Youwei's wife looked a little stumped.

"What surgery?"

"It's a minor operation. "

Zhou Yuan was silent for two seconds, and his tone was aggravated: "Where was it done, what surgery?"

It's basically certain.

If it's not a dietary problem, it's usually an infection. I have recently undergone surgery, and it is very likely that there was an infection during the operation.

Ketoacidosis is most common with respiratory, urinary, and skin infections.

"A small clinic near my house, a circumcision..."Zhang Youwei's wife saw that Zhou Yuan's face became serious, and she didn't dare to hide it anymore.

Zhou Yuan nodded.

Zhou Yuan is not prejudiced against small clinics, but many small clinics are really not very good, and they can't even do basic disinfection and ensure a sterile environment.

For example, when Dr. Hu Zi used to be, there were not even complete suturing tools in that small clinic, and there were only so many kinds of sutures to choose from.

"It should be a circumcision infection. "

A lively voice came from the doorway.

Zhou Yuan looked up, and Sun Meng came.

It's been almost a month since I met Sun Meng.

In fact, it's not that they haven't met, they are all from the same hospital, Zhou Yuan and Sun Meng have both run to the inpatient department, and they can meet occasionally, but everyone's time is very urgent, so they just simply said hello.

This is the first time that Zhou Yuan and Sun Meng have officially met in the emergency department.

Sun Meng's eyes lit up and said, "Zhou Yuan, you're already off work, right?" "

Zhou Yuan nodded, "It's almost over, the rehydration has also been replenished, insulin or something is dripping, and then contact someone from the urology department to come over and help him deal with it again, it shouldn't recur." "

Sun Meng smiled and said, "Are you going back now, go to my consultation room and sit down?"

Zhou Yuan got up serious again: "What are you doing in your office, I'm not sick." "_

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