Start as an Emergency Physician

Zhou Yuan was silent for a moment, then raised his hand and pointed to the door: "Please go out." "

What the hell... There are dozens of catties of free melon seeds?

Sun Meng smiled proudly, grabbed a large handful of melon seeds and was about to leave.

The night shift is very tiring, and the night is not as good as the day, the entire emergency department is quiet, and when there are no patients, I am bored to death, and I can pass the time with melon seeds.

"Wait. "

Zhou Yuan suddenly remembered something, walked to the side of the office and took out a medical record.

"This is the medical record I got from the teacher, this patient is somewhat similar to Lin Hai, you pay attention to it. "

Zhou Yuan takes care of many medical records during his office breaks.

Writing medical records for interns is actually a kind of training, which can allow them to come into contact with more kinds of patients, so that they can have evidence to follow when they see a doctor, Zhou Yuan improved too quickly and missed this step.

But the doctor is coming step by step, Zhou Yuan's surgical skills can be improved, but the level of outpatient diagnosis requires his own efforts, and the system cannot improve Zhou Yuan's diagnostic ability at present.

Sun Meng got up seriously, took the medical record, and opened it to look at it.

The patient, a 61-year-old man, was admitted to the hospital at 3 a.m. a month ago due to "vomiting and fatigue for two days", and developed nausea and vomiting once on the morning of admission, accompanied by severe abdominal distension and pain in the upper body, and then began to develop malaise and semi-syncope.

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

Both glimepiride and metformin are suitable for patients with type 2 diabetes, the former is mainly for patients with type 2 diabetes who are unable to adequately control their blood sugar through diet, exercise therapy, weight loss, etc., and the latter is especially suitable for obese type 2 diabetes. Valsartan hydrochlorothiazide tablets are indicated for the treatment of mild or moderate essential hypertension that cannot adequately control blood pressure with a single drug, that is, more refractory hypertension.

"You just look at the diagnosis. Zhou Yuan reminded.

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

"Low blood sugar? Lin Hai is high blood pressure..."

"You take a closer look at how low his blood sugar is. Lin Hai has high blood sugar, as high as 130 millimo, and this patient's blood sugar is only 0.54, which is terrifyingly low. Zhou Yuan said.

It's like two extremes.

Sun Meng nodded and continued to read, but froze.

Near the end, there are a few lines of the words "Declared dead after rescue failure"

"The patient died?!"

Zhou Yuan nodded: "Correct it and die." Can you guess what the reason is?"

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

"I have a few questions..."Sun Meng said after thinking for a long time.

"The first is kidney failure, is the patient's kidney failure acute or chronic?"

She flipped a few pages forward, stared at the blood routine a few times, and said: "According to hemoglobin, it may be chronic or slow + acute, and the patient has chronic renal failure drug accumulation poisoning after correcting blood sugar, or sulfonylureas have caused a second severe hypoglycemia and biguanide lactic acid poisoning??"

Zhou Yuan nodded, and the points raised by Sun Meng were all possible causes of the patient's death.

Sun Meng continued: "I am in charge of the emergency internal medicine department, and I have met a uremia patient who had hypoglycemia after taking sulfonylurea drugs in other hospitals, and died immediately after the blood sugar was corrected, and he was considered a cerebrovascular accident at that time. Rapid correction of hypoglycemia and sharp changes in osmotic pressure inside and outside brain cells, which led to the formation of brain herniation and thus death, is this the cause?"

Before Zhou Yuan could answer, Sun Meng lowered his head again and pondered again: "The patient also showed high blood signs... With such a high blood profile, infection needs to be considered first, the fever of the patient is unknown when he is admitted to the hospital, and what about other indicators of infection such as hypersensitive CRP and calcitonin? If there is an infection, it is not impossible to have septic shock. "

Zhou Yuan was a little surprised.

Just read a few pages of medical records, and it only took three or four minutes before and after, and he was able to analyze these things, and sure enough, Sun Meng said before that he was also going to take the doctorate exam was not a joke.

It's not that doctors have the insight and judgment ability of Sun Meng, in fact, most of the medical doctors are not even as good as some experienced clinical doctors, of course, this is in the short term, to be able to read the doctor of medicine, give them enough time, experience and insight can keep up with and surpass the latter.

"You guessed right, the patient had an infection, plus the patient is already old, his appetite is poor, and the dental environment is also very worrying, so the nutritional intake is insufficient, resulting in Ah Chao being in the early stage of shock before being admitted to the hospital, and the semi-fainting state can already be seen... In addition, the patient's body is in a state of severe metabolic imbalance and partial decompensation, and a series of manifestations of hypoglycemia and abnormal heart, kidney and lung function are present. "

"It's... In the early stage of shock, the blood vessels of the whole body spasm, causing a state of self-transfusion?!"

Zhou Yuan smiled.

Sun Meng had probably guessed the cause of the patient's sudden death.

"You look at the time log. "

"At 19:00, the blood pressure dropped to 127/64mmHg, a drop of more than 50mmHg, at this time, the patient entered the decompensated phase of shock, and the doctor in charge immediately carried out rapid fluid replenishment to increase blood pressure and try to control blood pressure. "

"At 21:00, blood pressure slowly dropped to 90/55 mmHg, and a sudden increase in blood sugar was detected, which showed 12.2 mmo1/L. At this time, the patient's face is expressionless, there are no adverse reactions in the body, and the state is normal. "

Sun Meng's face was difficult to look at.

Blood pressure has reached such a dangerous point, the body has no adverse reactions, and the state is normal? Everyone knows that this is just a superficial calm, this is the return to the light before checkmate, the calm before the storm...

Sure enough, the patient's blood pressure was irreversible, and after no control was successful, it continued to drop, and the patient began to lose consciousness. On examination, the pupils are dilated and the light response is obtuned. One hour later, the patient's blood pressure collapsed, and emergency resuscitation and rescue measures were carried out, but in the end, the rescue failed, and the patient died quickly!

What seemed like a simple hypoglycemia claimed a life within one day of being admitted to the hospital, and the real cause of the patient's death left many doctors confused at the time.

Is there a problem with a series of treatments after the consultation, or is there any illness of the patient that is hidden or undetected, or is it an allergy to a very rare special drug?_

Feilu reminds you: there are three things to read - collection, recommendation, and points