Start as an Emergency Physician

The popular sentence on the Internet, "Don't let him taste the sweetness of diabetes, don't let him taste the sweetness" does have a scientific basis.

Because the amount of glucose in the blood of diabetic patients increases, the urine will have a sweet taste, and most patients will appear colorless, but cloudy, and there are many bubbles.

Of course, the human senses are very wonderful, and in terms of taste, the feeling of sweetness does not depend entirely on the blood sugar concentration, so it is not rigorous to judge whether it is sweet or not simply according to the level of blood sugar.

However, the medical community has indeed proven that the urine of diabetic patients is sweet, and as for how it was proven, it is unknown...

According to this theory, this patient with high blood sugar of up to 13 has really become a sugar man, and if a vampire sucks him, he will be killed!

Such patients are already high-risk patients. Moreover, according to the family's account, the patient had dizziness, vomiting and other symptoms three days ago, and after treatment in the township hospital, the symptoms did not improve, and the symptoms worsened the next day.

Then, he began to have shortness of breath and couldn't urinate until he lost consciousness just now, so he hurriedly sent Yanjing Traditional Chinese Medicine.

Zhang Ling is responsible for finding a doctor, and for her, finding a doctor is equivalent to finding Zhou Yuan. Lin Wen went to take blood routine and other examination reports.

After a while, Zhou Yuan put on his white coat again and rushed over.

After a brief understanding of the situation, Zhou Yuan did a few simple inspections, and it was obvious that there was a smell of rotten apples.

This is an obvious symptom of diabetic ketoacidosis, which is one of the common emergencies in emergency medicine, such as hyperketones, ketonuria, dehydration, electrolyte imbalance, and metabolic acidosis.

Zhou Yuan had been exposed to ketoacidosis once, and that time the patient was suspected of touching porcelain, and he almost drove people out of the hospital and ignored it, but fortunately, Zhou Yuan was alert and rescued in time.

Soon, Lin Wen came back with the inspection report.

Patient Lin Hai, medical records show that the patient's past medical history includes fatty liver and chronic gastritis.

This made Zhou Yuan feel a little emotional, he was only twenty-five years old and actually got sick.

The results of the examination showed that there was no abnormality in the CT of the patient's head, and the blood gas analysis showed acid substitute, blood ketones 3.25 mmmo1/L, sodium 127 mmo1/L, potassium 3.9 mmo1/L, and plasma osmolality of 342.9 mOs.m/(kgH2O).

Other ancillary tests are even less encouraging.

For example, lipase, the range of normal people is 13~60, and the number of patients reaches 429. The normal amylase patient was 0~100, and the patient's value was 377.

Zhou Yuan's face gradually became heavy, this twenty-five-year-old patient was even more serious than the couple who had been on the night before!

"How can blood sugar be so high?"

Lin Hai lay on the hospital bed, all thoughts were lost, and he didn't say a word.

His tonnage is quite amazing, just 1.7 meters tall, it looks like he has more than 100 kilograms.

After inquiry, Zhou Yuan learned that Lin Hai's living habits were very poor, taking drinking water as an example, he rarely drank water when he was thirsty, and kept using drinks instead.

He had only finished drinking two large bottles of Coke before arriving at the hospital.

Based on the results of the examination, diabetic hyperosmolar state and ketoacidosis are diagnosed, and severe dehydration is diagnosed.

"Rapid rehydration. Supplementation is based on the actual dehydration of the patient's body. Zhou Yuan said.

Hyperglycemic hyperosmolar state, also known as hyperglycemic hyperosmolar syndrome, is a clinical syndrome characterized by plasma hyperosmolality, severe dehydration, and progressive impairment of consciousness due to hyperglycemia, coupled with ketoacidosis, which necessitates rapid hydration rather than high doses of insulin to control hyperglycemia.

The patient's family went to the pharmacy to get the medicine and handed it to Zhang Ling.

"There's no heart disease, right?" Zhou Yuan asked.

It is not written in the medical record, but it is always wrong to ask more.

"Nope. Lin Hai's father shook his head.

Zhou Yuan looked at Zhang Ling and said: "First fast and then slow, supplement 1,000 milliliters of normal saline in the first hour, and then adjust the speed according to the patient's dehydration status, the first eighteen to twenty-four hours to replenish the total amount of dehydration is average, and the remaining half will be completed in the next twenty-four hours." "

The normal saline configured in the pharmacy is hypertonic saline, and the clinical normal saline generally does not use hypotonic fluid, so as not to cause hemolysis and induce cerebral edema.

Of course, in addition to the injection of rehydration fluids, it is also a simple and effective way to supplement warm water through the gastrointestinal tract, and the specific steps are to inject about 200 ml of warm water from the gastric tube at a time, and then rehydrate through the nasogastric tube.

Zhang Ling began to quickly configure and prick the needle.

Lin Hai is relatively large, and the fat layer under the skin is very thick, so that the blood vessels can hardly be seen from the surface of the body.

I have tried methods such as patting, applying iodine solution, etc., and I have also tied the blood vessels with a tourniquet, generally speaking, the veins will bulge at this time, and the blood vessels will become obvious, but Lin Hai can't even see a trace of blood vessels on his hands...

Zhang Ling held the infusion needle in his hand and fell silent.

"Doctor Zhou, why don't you change it to a gastric tube rehydration?" Zhang Ling hesitated, not daring to take the needle.

The main reason is that you can't get a needle in this situation!

Zhou Yuan shook his head, for Lin Hai, injecting rehydration was the quickest and most suitable way, he walked up to Zhang Ling and said, "I'll come." "

Zhou Yuan took the needle, vented the needle again, and slowly slid his right index and middle fingers over the back of Lin Hai's hand.

He was trying to use his fingers to sense the pulsation of blood vessels, and there must have been a bulge caused by blood vessels on the surface of the skin, but it was impossible to see with the naked eye.

This method of searching for blood vessels is technically demanding and requires a keen sense of touch. Zhou Yuan himself has mastered the master-level intravenous injection, and various injection methods and ways to find blood vessels are handy.

Moreover, Zhou Yuan also has a perfect-level compression hemostasis method that specializes in dealing with blood vessels!

One of the essences of the compression hemostasis method is to find the bleeding point, that is, to find the bleeding blood vessels, and the perfect technique gives Zhou Yuan's fingers a strong perception of the pulse of blood vessels.

The two medical skills cooperated, and Zhou Yuan quickly found the position.

"Iodine complex. Mark it here. "

Zhang Ling immediately dipped a cotton swab in compound iodine and marked it along the direction of Zhou Yuan's fingers.

Lin Hai's blood vessels are relatively curved and not straight, and the marking is conducive to needle insertion and observation of the direction of blood vessels, and is conducive to parallel needle insertion after blood return.

Moreover, Lin Hai's blood vessels are relatively deep, and the fat layer is very thick, so the angle of needle insertion in ordinary people should be reduced as much as possible and kept below 20 degrees, but in order for the needle to enter Lin Hai's skin, the angle is about 25 degrees.

Zhang Ling held the cotton swab with a loveless expression.

Who am I and where am I?

Excuse me, nurses have been robbed of their jobs, is there any other good job you can recommend?

Nursing home nurses, nursing home convalescents, or physical health care and rehabilitation facilities?

I'm a nurse, I know more about the human body, otherwise I'll go to the massage, and I'll be able to find the sensitive points of the guests at once, and it's absolutely refreshing to press it..._

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