Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

"Forget it, let's just let them go. As long as the temperature is controlled at 38.5 or 38 degrees by taking medicine properly, the problem will not be big."

Soon, a nightly episode passed.

……

the other side.

Jiangcheng Fifth Hospital.

The family came to the night emergency office of the Second Hospital.

The doctor who received the consultation was a doctor who was almost 40 years old, and he was much older than Lin Yi.

So the family members feel relieved when they see this age.

Great, finally it's not the young man who came to treat us.

"Doctor, my daughter has repeated fevers. The fever has reached more than 39 degrees. What should I do if it doesn't go down?"

The doctor asked while creating an inquiry record on the computer:
"How old is the child? Have you taken any medicine before? Runny nose, fever, vomiting?"

The family members glanced at the child in their arms and said:
"I took ibuprofen suspension, I had a little diarrhea, and then...a little cough.

Do you do me a favor, doctor, and quickly prescribe medicine infusion or take oral medicine?

My daughter has had a fever for two or three days. I'm really afraid that my brain will burn out! "

The young mother told a little lie.

In fact, her child didn't have a cough, but in order to prevent the recurrence of the situation where doctors in the city hospital did not prescribe medicine.

So the family members made the situation a little bit more serious.

The doctor waved his hand, glanced at the mercury thermometer that was taken out of the girl's pocket, and said:
"38.7 degrees, that's still quite high, let's see, there are many reasons for a cold and fever.

In addition, you have recurrent fevers, so take an X-ray first to check the inflammation of your lungs.

Then do a screening for mycoplasma and chlamydia. In addition, a small tube of blood should be drawn to see how the routine is.

However, the pediatric inpatient department of our hospital has no beds, and all of them are full.

After a while, you will have to infuse in the emergency department first. After the symptoms are milder, I can directly prescribe medicine for you to go home.

There are too many children with colds recently, and the hospital can't take them in. So we upstairs really can't take you who have a fever. "

The family members were not only not angry but also very happy when they heard it!
Look how good this doctor is!
As soon as he arrived, he gave the child infusion and medicine, and wanted to arrange hospitalization!
What a good doctor!
"Okay, okay, we can both, see the doctor for your arrangement."

There was a strange look in the doctor's eyes.

He glanced at the young couple.

What a wonderful thing!
How can you be so happy when your child is hospitalized for transfusion?

I'm afraid there is something wrong with my brain!

Soon, the family members took the child for an examination.

In the early morning inspection, almost no one lined up.

So the result came out after ten minutes.

The doctor took a look: "Well, there is no obvious shadow of inflammation in the lungs, it seems that your child is indeed mild.

How about this, I don’t recommend infusion for mild cases, I’ll just prescribe oral medicine for you. "

The family members nodded again and again: "Okay, okay, I need anti-inflammatory and anti-viral medicine, doctor, otherwise I'm afraid it won't work, so don't prescribe ibuprofen, I still have it at home."

The doctor nodded: "Don't worry, I will prescribe some anti-inflammatory and anti-viral medicine."

Then I saw the doctor filling in the name of the drug, dosage, time of taking it, etc. on the computer.

After printing out the medicine list, the family rushed to get the medicine again.

While walking, they discussed:

"Look at the medicines prescribed by this doctor, antiviral oral liquid, Shibao Litong tablets, children's paracetamol Huang Namin granules, and children's cough syrup!

What a responsible doctor!It's not much better than the surname Zhang in the city hospital! "

"That's right, Ibuprofen doesn't work and we insist on taking it, what a quack!

I don't understand why the level of the city hospital is so low now?To actually let a young man who doesn't understand anything work on the night shift? ? "

The couple took the medicine with the baby in their arms and went home.

…………

Jiangcheng Central Hospital.

It was already night, and a patient with severe diarrhea suddenly came to the emergency room.

It is said that he ate raw seafood, and he ate a lot.

It started to pull in the afternoon, but I never came to the hospital due to work reasons.

It got serious in the middle of the night, and I had diarrhea every half an hour, and was sent to the hospital by my colleagues only after I had diarrhea and vomiting.

When I came to the hospital, my whole face was pale, and I almost couldn't stand up straight when I held my stomach.

And there are shortness of breath and even difficulty breathing!
Check the electrolyte, serious disorder!
Serum potassium was as low as 2.8mmol/L!

2.8mmol/L!

Belongs to moderately low potassium!

Mild hypokalemia: within 3.5-3.0.

Moderately low potassium: within 3.0-2.5!

Severe low potassium: below 2.5!

The value of this patient is 2.8, but 2.8 is already a relatively dangerous value.

Potassium must be supplemented immediately!

If the diarrhea continues and falls below 2.2, you can only use a central venous catheter to supplement potassium.

But because the blood potassium is too low, some patients may not be able to save it even with this method.

(Central venous catheterization is a rapid potassium infusion method, but it also has advantages and disadvantages.

Lishi can quickly replenish potassium and raise blood potassium in patients.

But this is also the reason for the disadvantages. This method of rapid potassium supplementation can easily cause patients with sudden high potassium.

Potassium ions are elevated in a short period of time, and if hyperkalemia occurs without timely observation, it is also prone to sudden death.

Therefore, doctors in many small hospitals generally do not dare to take the risk of supplementing potassium in this way, but use a more conservative arm vein to supplement.

But the arm veins are relatively slow. For some patients with severe hypokalemia, if the potassium supplementation rate is too slow, the blood potassium cannot rise, it will not be effective, and it is easy to die suddenly.

Therefore, this method of potassium supplementation still depends on the specific hospital equipment or see a doctor. )
The element potassium is like a double-edged sword.

It must not be lacking. If it is lacking, it will lead to fatigue, muscle weakness, listlessness, and severe breathing difficulties, arrhythmia, and death from heart failure.

But it can't be too high, too high can also lead to arrhythmia and sudden death.

Potassium deficiency is generally seen in eating too little potassium food, hyperthyroidism, or like this patient, severe diarrhea, diarrhea and collapse.

High potassium is more common in kidney problems, as the filtering function of the kidneys is low, and potassium cannot be excreted and accumulates in the body, causing problems over time.

The doctor on duty did not dare to delay, and immediately gave the patient anti-inflammatory, balanced electrolyte and potassium supplementation treatment!

Infuse anti-inflammatory drugs first, and then immediately infuse electrolytes and potassium.

2.8mmol/L can slowly replenish potassium by controlling the drip rate through the arm vein.

Now the main thing is to observe the patient's blood potassium, abdominal pain, and diarrhea.

After waiting for hours.

At six o'clock in the morning, the patient's condition improved slightly.

After all, he is a young man, and his physical fitness is relatively good.

At least the frequency of diarrhea gradually decreased, and the symptoms of dyspnea disappeared.

But the blood potassium is still at the value of 3.1mol/L.

The blood potassium has risen a little, but it is still in a state of mild hypokalemia.

So the doctor on duty ordered another potassium infusion.

This time, it is supplemented slowly. 10% potassium chloride is 15 ml, containing about 1.5 grams of potassium, and it is mixed with 5 ml of [-]% sugar water for intravenous infusion.

The dripping speed is 40 drops/min.

The normal drip rate is generally within 40-60 drops.

The amount of potassium supplement for adults is between 3-6 grams per day, which can be increased according to the degree of potassium deficiency.

This patient has already supplemented 3 grams of potassium chloride. If the situation improves a little later, but the blood potassium is still between 3.3-3.5, then oral potassium supplementation can be used, such as slow-release potassium chloride. piece.

Under normal circumstances, as long as the potassium deficiency is not particularly severe, doctors recommend oral potassium supplementation for those with mild potassium deficiency, and intravenous potassium supplementation only when necessary.

After receiving the doctor's order, when the nurse dispensed the liquid and then changed the liquid for this guy, the guy looked at the big bag of transparent liquid and asked:

"Nurse... how long do I have to lose? I'll wait... I have to go to work at eight o'clock..."

The nurse glanced at him:
"Go to work? How can you go to work in this situation? You should ask for leave quickly, you still have a lot of fluid, and you have diarrhea like this. Do you still want to go to work when it is so serious?"

The nurse shook her head, not understanding what the young man was thinking.

After changing the fluid, the nurse continued:
"Remember, this bag of liquid must be infused slowly. It will take three or four hours to finish the infusion. If all the liquid is infused, it will probably be in the afternoon."

The boy frowned:
"Huh? I'm going to lose until the afternoon..."

He looked up at the clock on the wall of the emergency room, it would be seven o'clock.

It was already bright outside, and I had to go to work in an hour.

After transfusing fluids all night, the boy actually felt much better already.

I also have some strength on my body.

He asked: "Nurse, can you tell the doctor that I will not lose this bag of liquid? I feel much better."

The nurse said with a serious expression:
"Certainly not, this is a medicine for your treatment, it is to maintain your body's acid-base balance, otherwise you would have diarrhea and collapse, do you think you can get better just by infusing anti-inflammatory drugs?

All kinds of nutrients must be added, otherwise you can get better so quickly?

And you are not fully recovered yet, you still have to continue to replenish fluids, you know?
Lay down obediently and get an infusion. It’s okay to ask for a day off. Your body is the most important thing, you know? "

After speaking, the nurse took the infusion tray and left the ward.

But after just walking, I folded back and looked at the drop speed and then said:
"Remember, you have to lose slowly, otherwise... you will die!"

The nurse looked serious.

The boy had no choice but to nod his head.

After the nurse left, the colleague who sent the boy to the hospital also stood up and said:

"Then Chen Lei, you can lose here. I have to go to work too. I will help you ask for leave later."

The boy lying on the bed said with a troubled expression:
"Hey, it's so annoying. If I ask for leave, I will go to full attendance."

Full attendance is 600 yuan.

His monthly salary is barely enough to pay off the mortgage and car loan.

So [-] full attendance is a month's meal money for him.

Colleagues spread their hands and said:

"Hey, what can we do? You can't work while sick, right?"

The guy could only sigh silently.

Looking at the back of his colleague leaving, the guy named Chen Lei was full of regret at the moment.

I blame myself for being greedy.

The boss sent seafood as a reward to the employees, and Chen Lei usually didn't have the money to eat it, so he ate more because he thought it was something that didn't cost money anyway.

Unexpectedly!

Actually ate it and came to the hospital!

I don't know if I can ask the leader to compensate for this matter.

But if you want compensation, you worry about losing your job...

Hey!
Social animals are so difficult!
Chen Lei who was lying on the bed was still a little weak, but it was much better than when he just entered the hospital in the middle of the night.

After thinking about it for a long time, Chen Lei still wanted to go to work.

The main reason is that he doesn't want to lose the 600 yuan full attendance reward.

It would also be inappropriate to pull out the needle.

So Chen Lei took advantage of the nurse's inattention and accelerated the dripping speed.

He thought to himself, will the infusion kill people? ?I don't believe it!
I don't know whether the transfusion will kill or not, but I will die if I don't have money!
Mortgage, car loan...

He dare not rest for a moment!
Immediately, Chen Lei disregarded the nurse's instructions and completely opened the liquid to drip.

despair!despair!despair!
Looking at the transparent liquid quickly dripping into his body, Chen Lei was in a happy mood.

As long as the bag of liquid is transfused quickly, I can directly pull out the needle and go to work when the liquid is changed.

The big deal is to come back after get off work at night and continue to lose.

Thinking of this, Chen Lei closed his eyes happily and prepared to take a nap.

……

Half an hour later, it was close to 45:[-].

The nurse went to the bedside of each rescue patient to check the drip rate of the fluid and the condition of the patient.

suddenly!

When she walked to Chen Lei's bed, she couldn't help but exclaimed!
The nurse was shocked!
Immediately, while looking at the guardianship, he shouted to the office:
"Dr. Sun !!! Come and see this patient !!!"

The doctor on duty is surnamed Sun, and he has been working in the emergency department for almost ten years.

Then he heard the nurse's shout, and he stood up while writing the shift record in the office!
Then strode to the emergency room.

"What's the matter? What a fuss!"

Dr. Sun glanced at the nurse, then turned his gaze to the hospital bed.

Immediately!

He also gasped in fright!
"Damn it! Why is there no heartbeat!!" The heart rate monitor turned to '0'!
"Doctor Sun, I just touched...the femoral artery...has...no pulse!"

The nurse said nervously.

Then she looked up at the liquid in the infusion bag!
Immediately, the nurse screamed again in fright!
A big bag of sugar water with potassium! !
He lost so quickly! ! !
There will only be about thirty or forty milliliters left in the bag! !
"It's over, it's over! Medical accident! I... huh? No! I remember I adjusted the drip speed half an hour ago, which is a very slow 40 drops per minute! How could I lose so quickly?!"

Dr. Sun looked up at the infusion bag, and immediately knew the whole story!

"Are you sure you adjusted the drip rate to 40 drops per minute?"

The nurse nodded affirmatively: "Yes, the loss is potassium, how can I not know?"

Dr. Sun frowned and said, "That should be the rate he adjusted himself! Let's rescue him first, open the airway, and bring the first-aid medicine!"

Dr. Sun immediately guessed the reason.

Every time when potassium is supplemented, the nurse will explain to the patient and family members that they must not adjust the drip rate.

This medicine can be fatal if infused too quickly.

Therefore, those patients and their families would naturally be afraid of this medicine, even if they wanted to finish the infusion quickly, they would not dare to take the medicine at will.

But obviously, the young man in front of him is really not afraid of death!
Don't listen to the nurse!

Hey!
Sin!
The nurse will be panicked!
I'm afraid that this guy will really die.

but……

A large amount of potassium supplementation in a short period of time... Excessive extracellular potassium ions can cause arrhythmia and sudden death...