Start as an Emergency Physician

The situation was critical, and 0.54 blood sugar was not a small problem, enough to keep the entire emergency department busy, because it was a high-risk emergency!

Therefore, the doctor in charge did not think too much about it, and chose the conventional treatment of hypoglycemia, that is, oral and intravenous infusion of glucose solution immediately after admission.

Subsequently, the auxiliary examination showed that the elderly patient's BNP was as high as 3771 units!

The so-called BNP is a quantitative marker of heart failure, which can reflect left ventricular systolic dysfunction, left ventricular diastolic dysfunction, valvular dysfunction and right ventricular dysfunction, in short, it can reflect heart failure, heart failure, lung disease, etc., and is also the most powerful predictor of death in patients with acute coronary syndrome!

3,771 units are already in critical condition, and patients with more than 400 units can have a 95% probability of confirming that they also have heart failure, and 3,771 units are simply more reliable than 99.99% in the paternity test!

It is precisely because of the emergence of two important life-threatening indicators that the chief doctor quickly invited the cardiology and nephrology departments to consult while stabilizing the patient's blood pressure, and both doctors gave their respective diagnostic plans and treatment methods, and at the same time gave drugs for intravenous injection, intravenous thrust and infusion.

In fact, there is no sudden change in the condition clinically, and the change in the condition of the vomiting has not been noticed, even if it is a sudden death, there must have been a lot of signals before, but it was not noticed.

After the preliminary test results came out, although doctors from the cardiology department and nephrology department were invited for consultation, all the doctors were frightened by the patient's frightening data, and all of them were treating the "headache and foot pain", without a comprehensive analysis of the condition and cause, but only to deal with a certain abnormal test value and make it return to normal.

In the course of treatment, each doctor only takes into account the abnormalities that he needs to deal with, such as the doctor in charge dealing with hypoglycemia, the cardiology department dealing with heart failure and correcting BNP, and the nephrology department prescribes the right medicine for the abnormal kidney function, but... They ignore the volume situation of the patient!

A person's blood vessels are just a little bit, and the blood is also a fixed volume, after a large amount of medicine is injected into the body, although the abnormal data is controlled, but the condition is aggravated!

After the condition became severe, the patient's blood sugar changed again, from low blood sugar to high blood sugar, which once exceeded 12 units, which was much higher than normal, and at the same time, the blood pressure dropped sharply, and the patient was two hours before death.

If this patient was in front of them, maybe everyone would panic, but at this time, Zhou Yuan and Su Meng were only facing medical records, so they could analyze calmly and their minds were much clearer.

The reason for the sudden hyperglycemia is actually very easy to explain, the patient is in a state of starvation, the blood sugar is low, the blood potassium is very unstable, and the intracellular and extracellular are constantly changing, so the doctor in charge of the sugar supplement, after which the patient's blood sugar rises, but the insulin reactive effect, the glucose in the blood enters the cell, and the potassium ion in the blood also changes, and there is a serious abnormal blood potassium...

Abnormal blood potassium is a chaotic situation.

The direct cause of the patient's death was guessed by Sun Meng before.

The infection was like a joke in the face of 0.54 blood sugar and 3771BNP and energy failure, and all doctors subconsciously ignored this, but under the combined stimulation of abnormal blood potassium, hypertension, renal failure and further electrolyte imbalance in the body, and high-risk blood picture, septic shock was finally achieved.

Septic shock has caused the patient's drip volume shock, and because of the rapid replenishment of glucose, the blood sugar in the patient's body rises rapidly, and the body's blood pressure is extremely unstable.

Bang, the veins burst. The patient died at the scene.

It may be a bit tongue-twisting, but for example, a patient's blood vessels are like a deflated balloon when they enter the hospital, and doctors try to restore the balloon to its normal inflated state.

This balloon has multiple mouths, some doctors are using pumps, some doctors are blowing through their mouths, these are understandable, abnormal blood sugar and BNP must be corrected immediately, otherwise the patient will still die, so it is no problem for them to treat at the same time.

But when the balloon is already very inflated, the patient suddenly has septic shock, causing a series of chain reactions, seeing that the balloon is about to deflat, the doctor immediately carries out strong stimulation of cardiopulmonary resuscitation, which is equivalent to frantically stepping on the airbag, can it not explode?

Sun Meng's expression also became solemn.

She understood what Zhou Yuan meant.

Lin Hai is very similar to this elderly patient, with a blood sugar level of 131, which is a fatal threat in itself, and it is very likely that abnormalities in cardiovascular and cerebrovascular, renal function, and liver function will be found in the later stage.

The organism is an organic whole, it is impossible to say that something is wrong in one place and that there is nothing wrong in other places, and after the blood gas test is perfected, there will definitely be more problems, even life-threatening phenomena.

Zhou Yuan is reminding Sun Meng to always pay attention to it, and not to ignore the whole in order to correct a certain abnormal data.

Whether it is a blood glucose patient or other emergency, it is necessary to always have the awareness of the whole body assessment of the patient, and many important examinations, such as arterial blood gases, electrolyte dynamic monitoring, chest X-ray and abdominal CT, etc., must be improved.

For example, in this case, the blood pressure of the patient who died had dropped significantly an hour before he died, but no one paid attention to it, and he kept thinking about using conventional methods to control his blood pressure, so that he finally went into shock and eventually died.

If the abnormality can occur early and the infection is properly managed, at least septic shock will not occur, then a series of fatal illnesses caused by septic shock will no longer exist, although it will not guarantee that the patient will survive, but at least eliminate a threat.

"In any case, you only have one life, and we do our best to take responsibility for the lives of patients. Everyone is afraid in the face of death and longs to live. Zhou Yuan said in a low voice.

Sun Meng nodded solemnly: "Thank you." "

Zhou Yuan didn't say anything, walked out of the office, and said, "The spare key is on the desk, you don't have an office now, you have to go back to the public office to rest, if it's not convenient, you can rest here." "

Sun Meng was just about to thank him, but Zhou Yuan said with a smile: "Anyway, I don't have to go to work at night." "

Sun Meng: ??

You're murderous!

When Zhou Yuan left Yanjing Traditional Chinese Medicine, it was already ten o'clock in the evening, and night fell on this bustling city again.

As usual, Zhou Yuan walked through the noisy street to go home, but when he passed by a shop, a familiar voice came from inside..._

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