Start From Emergency Doctor

Chapter 381

The situation was very critical at the time. A blood sugar level of 0.54 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 could not consider too much, and chose the conventional treatment of hypoglycemia, that is, oral glucose solution and intravenous drip were given immediately after admission.

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

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

3771 units are already classified as critical value, patients with more than 400 units can already have a 95% probability of confirming heart failure, and 3771 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 26 departments of cardiology and nephrology for consultation while stabilizing the blood pressure of the patient. Both doctors gave their own diagnosis plans and treatment methods. At the same time, the drugs were injected intravenously, intravenously, and instilled.

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

After the preliminary test results came out, although the doctors in the cardiology and nephrology department were invited for consultation, all the doctors were frightened by the patients’ alarming data. Treatment does not fully analyze the condition and cause of the disease, but only to deal with an abnormal test value and restore it to normal.

In the course of treatment, each doctor only considers the abnormal conditions that he needs to deal with. For example, the doctor in charge deals with hypoglycemia, the cardiology department deals with heart failure, and the correction of BNP, while the nephrology department prescribes the right medicine for abnormal kidney function, but …They ignored the patient’s capacity situation!

A person’s blood vessels are just that, and blood has a fixed volume. After a large amount of medicine is injected into the body, although various abnormal data is controlled, it has aggravated the condition!

After the condition became serious, the patient’s blood sugar changed again, from hypoglycemia to hyperglycemia, which exceeded 12 units at one time, which was much higher than normal. At the same time, the blood pressure dropped sharply. Hours.

If this patient is right in front of them, maybe everyone will panic, but at this time Zhou Yuan and Su Meng are only dealing with medical records, so they can analyze them calmly and have a clearer mind.

The reason for sudden high blood sugar is actually very easy to explain. The patient is hungry, blood sugar is low, blood potassium is very unstable, and the intracellular and extracellular are constantly changing, so the doctor in charge performed sugar supplementation. After that, the patient’s blood sugar increased , But insulin played a role responsively. The glucose in the blood entered the cells, and the potassium ions in the blood also changed accordingly, and severe potassium abnormalities appeared…

Abnormal blood potassium is a kind of electrolyte disorder.(Read more @ wuxiax.com)

The direct cause of the patient’s death was the infection that Sun Meng had previously speculated.

The infection is like a joke in the face of 0.54 blood sugar, 3771BNP, and renal failure. All doctors subconsciously ignore this. However, abnormal potassium levels, high blood pressure, and renal failure lead to further electrolyte imbalance in the body and high-risk blood picture. The combined stimulation eventually caused septic shock.

The septic shock also triggered the patient’s blood volume shock. Because of the rapid glucose supplementation, the patient’s blood sugar rose rapidly and the body blood pressure was extremely unstable. At the same time, the doctors quickly performed cardiopulmonary resuscitation and other rescue operations.

Bang, the blood vessels burst. The patient died on the spot.

It may be a bit convoluted. For example, the patient’s blood vessel is like a deflated balloon when it enters the hospital. Doctors try their best to restore the balloon to its normal inflated state.

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

But when the balloon was already very inflated, the patient had a sudden septic shock, causing a series of chain reactions. Seeing that the balloon was about to collapse, the doctor immediately performed a strong CPR, which was tantamount to stepping on a pump like crazy. Doesn’t explode?

Sun Meng’s expression also became serious.

She understood what Zhou Yuan meant.

Lin Hai is very similar to this elderly patient. A blood sugar level of 131 is a fatal threat in itself. It is very likely that abnormalities in cardiovascular, cerebrovascular, renal function, liver function, etc. will be discovered in the later stage.

The body is an organic whole. It is impossible to say that something is wrong in one place, while other places are unharmed. After the blood gas check is perfected, there will definitely be more problems and even life-threatening phenomena.

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

Whether it is blood sugar patients or other emergencies, they must always be aware of the whole body assessment of the patient. Many important examinations, such as arterial blood gas, electrolyte dynamic monitoring, chest X-ray and abdominal CT, etc., must be perfected.

For example, the patient who died had a significant drop in blood pressure one hour before he died, but no one paid attention to it and kept thinking about controlling blood pressure with conventional methods, so that he finally suffered shock and eventually died.

If the abnormality can occur early and the infection can be treated properly, at least no septic shock will occur, then a series of fatal diseases caused by septic shock will no longer exist. Although it is not guaranteed that the patient will survive, at least Eliminates a threat.

“Anyway, there is only one life, and we will do our best to be responsible for the patient’s life. Everyone is afraid of death and longs to live.” Zhou Yuan whispered.

Sun Meng nodded solemnly: “Thank you.”

Zhou Yuan didn’t say much, walked out of the office, and said again; “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 is not convenient, you can rest here.”

Just as Sun Meng wanted to thank, Zhou Yuan smiled and said, “I don’t have to go to work at night anyway.”

Sun Meng:? ?

You are killing people!

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

As usual, Zhou Yuan walked through the noisy street to go home. As a result, when passing by a shop, a familiar voice came from inside…