I Can See Health: Chapter 81 Who says endocrine night shifts are better?
Chapter 81 Who said that the night shift in endocrinology is good?
Lu Chen was shocked.
This is the only patient with HP below 60 that he has seen so far in Endocrine Zone II.
He stepped forward quickly and glanced at the bedside card.
This is a patient admitted this morning, female, 56 years old.
The patient was lying half-recumbent on the bed, eyes closed, pale and short of breath.
The smell coming out of his mouth seems to be... the smell of rotten apples.
Yes, this is the taste!
The smell of rotten apples means diabetic ketoacidosis!
This is a common test site that undergraduates know!
Diabetic ketoacidosis is the most common acute complication of diabetes and an acute complication of various types of diabetes, with hyperglycemia, ketosis and acidosis as the main manifestations.
The patient has three more and one less, including polydipsia, polyuria, polyphagia, and the symptoms of weight loss gradually aggravated.
"Auntie, how are you feeling now?" Lu Chen leaned down and asked softly.
The woman slowly opened her eyes, nodded weakly, and said, "Okay."
"Compared to that, when you were admitted to the hospital?"
"it is good."
is actually better than when he was admitted to the hospital.
How bad was the situation when you were admitted to the hospital?
There was a woman in her twenties sitting beside the hospital bed, with disheveled hair and a sad look on her face.
"Doctor, how is my mother?"
Lu Chen shook his head slightly, but didn't say anything.
The patient is present, and he cannot directly inform him of his condition.
The young woman frowned and said, "She's been talking nonsense just now, what's going on?"
"Speak nonsense?" A hint of surprise flashed in Lu Chen's eyes.
"Isn't it like this at home before?"
"No." The young woman shook her head slightly, "This only happened today."
Lu Chen frowned, he suddenly felt that the "good" in the patient's mouth might not be good!
"Auntie, do you know where you are?"
"it is good."
"What is your name?"
"it is good……"
is completely unanswered!
It was obvious that his mind had changed.
Lu Chen felt that something was wrong and immediately checked the patient.
The patient's lips and fingertips were cyanotic, the breath sounds in both lungs were coarse, and many wet rales could be heard, the pulse was thin and blunt, the heart sounds were low and dull, and the limbs were clammy and cold.
Both lower extremities were swollen, the left foot was obviously swollen, and local skin was damaged, red and swollen, and there was exudate.
On the ECG monitor at the bedside.
The patient's heart rate was 128 beats/min and his breathing was 33 beats/min.
And the last blood pressure measurement was an hour ago, and the blood pressure was 93/65mmHg.
Lu Chen pressed the blood pressure measurement button on the ECG monitor.
Measure blood pressure again.
Blood pressure 72/40mmHg!
Shocked!
After the appearance of diabetic ketoacidosis, the patient suffers from fatigue, loss of appetite, nausea and vomiting, polyuria, dry mouth, headache, deep breathing, and the most characteristic is the smell of rotten apples in the breath.
In the later stage, due to severe dehydration, decreased urine output, dry skin, decreased blood pressure, increased heart rate, and cold limbs, in the late stage, there may be different degrees of shock, disturbance of consciousness and coma.
Lu Chen determined that the patient was in a state of hypotensive shock!
And right now.
The health value on the patient's head was 46, which suddenly dropped again.
becomes 42!
Lu Chen's eyelids twitched.
He quickly ran back to the duty room.
"Have you finished measuring your blood sugar?" The female doctor on the night shift asked with a smile when she saw Lu Chen coming back.
"Mr. Min, the patient in the emergency room is not very good. The blood pressure is 72/40mmHg." Lu Chen said in a deep voice, "Go and see her."
"Huh?" The smile on Min Ling's face froze, and she quickly stood up, "What's the matter? I remember this is a patient with diabetic ketoacidosis."
She grabbed the stethoscope and walked outside the office.
"I just went to the emergency room and found that the patient's mental state was not right. I took a blood pressure measurement and found that it was only 72/40mmHg!" Lu Chen replied immediately.
Min Ling's face was tense, and she quickly ran to the emergency ward opposite the nurse's station.
The nurse also moved at this time, pushing the ambulance and ran over.
…
Above the hospital bed.
The patient was still panting heavily, and his expression was sluggish.
"Open another venous channel! Quick rehydration!"
Min Ling ran to the emergency room and immediately saw that the patient's condition was wrong.
Physical examination again and blood pressure measurement.
Min Ling confirmed that the patient was indeed in a state of hypotensive shock.
"Nurse, pump norepinephrine now!"
"receive."
"Student, this patient is diabetic ketoacidosis complicated with acute heart failure, please ask the Cardiology Department and ICU for emergency consultation immediately!" Min Ling turned her head and said to Lu Chen.
"it is good."
Lu Chen nodded, and he hurried to the nurse station to find the cardiology department and the ICU phone number.
Severe diabetic ketoacidosis is already very dangerous, and there is a risk of sudden death at any time.
What's more, there is still an acute heart failure!
Diabetic ketoacid needs a lot of fluids, but heart failure needs to limit fluids!
In this way, the treatment plan can be contradictory.
Lu Chen quickly called the cardiology department and the ICU emergency consultation.
…
"It is recommended to transfer to ICU for further treatment!"
Doctors from Cardiology Department and IC Ward are here.
After seeing the patient, the doctors in the two departments suggested transferring to the ICU for treatment at the same time!
Staying in the original department and continuing to rehydrate may aggravate heart failure!
But without rehydration, the patient's severe acidosis cannot be corrected!
At present, only ordinary treatment methods are used, and it is difficult for patients to recover.
Only transfer to the intensive care unit, bedside CRRT and more advanced antibiotics if necessary, may there be a possibility of improvement.
…
Fortunately, the patient's family members were more willing to treat, and they signed the informed consent before being transferred to the ICU.
Get your rescue medicine and bedside monitor ready.
Lu Chen and the nurse pushed the bed and sent the patient to the ICU.
While the patient is being pushed into the ICU.
Lu Chen saw that the HP on her head dropped again!
Only 39 left!
Lu Chen couldn't help feeling a little fortunate. Fortunately, he found out what was wrong with the patient in time.
Otherwise, if it is delayed for a while, the time of shock of the patient will be prolonged, and major organs will be ischemia and hypoxia.
"Doctor, thank you."
The family members of the patients stood at the door of the ICU and thanked them continuously.
Lu Chen sighed slightly.
"Although he was admitted to the ICU in time, the patient's condition is still not very good. You have to be mentally prepared."
"Well, I know, your doctor has explained it many times."
Family members of patients are not ignorant people.
And the patients have many basic diseases, including hypertension, diabetes, coronary heart disease for many years, and they all know the patient's condition.
Lu Chen also learned from his family.
This time, after the patient suddenly caught a cold at home, he discontinued insulin treatment, and continued to suffer from nausea and vomiting, which dragged on for four or five days at home.
Until today, I came to the hospital for treatment.
did not expect.
A small cold not only induces diabetic ketoacidosis, but also induces heart failure.
The superposition of two major diseases caused a huge blow to the patient's body.
Back to the endocrine ward.
Min Ling was not in the office. Lu Chen learned from the nurse that there was an emergency patient in the ward.
Lu Chen was suddenly puzzled, who said that the night shift in the endocrinology department is very good?
Thank you for your reward.
(end of this chapter)