I Can See Health

Lu Chen was shocked.

This is the only patient with a life value below 60 that he has seen in the second endocrine zone so far.

He walked forward quickly and glanced at the bedside card.

This is a patient who was admitted this morning, a female, 56 years old.

The patient was lying semi-lying on the bed, with her eyes closed, pale and breathing rapidly.

The smell exhaled from her mouth seemed to be... the smell of rotten apples.

Yes, that's the smell!

The smell of rotten apples means diabetic ketoacidosis!

This is a common test point that all undergraduates know!

Diabetic ketoacidosis is the most common acute complication of diabetes and an acute complication of various types of diabetes. It is mainly manifested by hyperglycemia, ketosis and acidosis.

The patient has three more and one less, that is, more drinking, more urine, more food, and the symptoms of weight loss are gradually aggravated.

"Auntie, are you feeling okay now?" Lu Chen leaned over and asked softly.

The woman slowly opened her eyes, nodded weakly, and said, "Good."

"Compared to that, when you were admitted to the hospital?"

"Good."

It's actually better than when you were admitted to the hospital.

How bad was the situation when you were admitted to the hospital?

Beside the bed sat a woman in her twenties, with disheveled hair and a worried look between her eyebrows.

"Doctor, how is my mother's condition?"

Lu Chen shook his head slightly, but did not say it out loud.

The patient was present, so he could not directly tell her the condition.

The young woman frowned and said, "She has been talking nonsense just now. What's going on?"

"Talking nonsense?" A trace of suspicion flashed in Lu Chen's eyes.

"It wasn't like this at home before?"

"No." The young woman shook her head slightly, "It just started to happen today."

Lu Chen frowned, and he suddenly felt that the "good" in the patient's mouth might not be good!

"Auntie, do you know where you are?"

"Good."

"What's your name?"

"Good..."

It's completely irrelevant!

It's obvious that his mind has changed.

Lu Chen felt something was wrong and immediately examined the patient.

The patient had cyanosis of lips and fingertips, coarse breath sounds in both lungs, many moist rales, weak pulse, dull heart sounds, and cold and wet limbs.

Both lower limbs were swollen, and the left foot was obviously swollen. There were local skin damage, redness, swelling, and exudate.

On the ECG monitor at the bedside.

The patient's heart rate was 128 beats/minute and the breathing was 33 times/minute.

The last blood pressure measurement was an hour ago, and the blood pressure was Hg.

Lu Chen pressed the blood pressure measurement button on the ECG monitor.

Measure the blood pressure again.

Blood pressure 72/40mmHg!

Shock!

After the onset of diabetic ketoacidosis, the patient will be tired, have anorexia, nausea and vomiting, polyuria, dry mouth, headache, deep and rapid breathing, and the most characteristic is that the exhaled breath has the smell of rotten apples.

In the later stage, due to severe dehydration, decreased urine volume, dry skin, decreased blood pressure, increased heart rate, cold limbs, and different degrees of shock, impaired consciousness and coma may occur in the late stage.

Lu Chen determined that the patient was in a state of hypotension shock!

And at this moment.

The life value of 46 on the patient's head suddenly dropped again.

It became 42!

Lu Chen's eyelids jumped.

He hurriedly ran back to the duty room.

"Have you tested your blood sugar?" The female doctor on night shift asked with a smile when she saw Lu Chen coming back.

"Teacher Min, the patient in the emergency room is not doing well, blood pressure 72/40mmHg." Lu Chen said in a deep voice, "You go see her."

"Huh?" The smile on Min Ling's face froze, and she stood up quickly, "What's the matter? I remember this is a patient with diabetic ketoacidosis."

She grabbed the stethoscope and walked out of 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 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 room opposite the nurse station.

The nurse also heard the news and ran over with the rescue cart.

...

On the bed.

The patient was still breathing heavily and looked listless.

"Open another intravenous channel! Quickly replenish fluids!"

Min Ling ran to the emergency room and immediately saw that the patient's condition was not right.

Checked the body again and measured the blood pressure.

Min Ling confirmed that the patient was indeed in a state of hypotension and shock.

"Nurse, pump in norepinephrine immediately!"

"Received."

"Classmate, this patient has diabetic ketoacidosis combined with acute heart failure. Please consult the cardiology department and ICU immediately!" Min Ling turned around and said to Lu Chen.

"Okay."

Lu Chen nodded, and he hurried to the nurse station and found the phone numbers of the cardiology department and ICU.

Severe diabetic ketoacidosis is already very dangerous, and there is a risk of sudden death at any time.

What's more, there is now an acute heart failure!

Diabetic ketoacidosis requires a lot of fluid supplementation, but heart failure requires limited fluid supplementation!

This way, the treatment plan is contradictory.

Lu Chen quickly called the cardiology department and ICU for emergency consultation.

…

"It is recommended to transfer to the ICU for further treatment!"

Doctors from the cardiology department and IC ward came.

After seeing the patient, doctors from the two departments also recommended that he be transferred to ICU for treatment!

Staying in the original department and continuing to replenish fluids may aggravate heart failure!

But without rehydration, the patient's severe acidosis cannot be corrected!

At present, it is difficult for patients to recover using only ordinary treatment methods.

Only by being transferred to the intensive care unit and using bedside CRRT and higher-level antibiotics if necessary can there be a chance of improvement.

…

Fortunately, the patient's family members were more willing to receive treatment and signed the informed consent form before being transferred to the ICU.

Have rescue medicines and bedside monitors ready. UU reading www.uukanshu． net

Lu Chen and the nurse pushed the bed and sent the patient to the ICU.

While the patient is being wheeled into the ICU.

Lu Chen saw that the health value on her head had dropped again!

Only 39 left!

Lu Chen couldn't help but feel a little lucky that he discovered something was wrong with the patient in time.

Otherwise, if the treatment is delayed for a while, the patient will be in shock for a longer period of time, and all important organs will be ischemic and hypoxic, and it will be difficult to save the patient.

"Doctor, thank you."

The patient's family members stood at the door of the ICU and thanked him repeatedly.

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 told you this many times."

The patient's family members are not ignorant people.

Moreover, the patient has many basic diseases, such as hypertension, diabetes, and coronary heart disease for many years. They all know the patient's condition.

Lu Chen also learned about it from his family members.

This time, the patient suddenly caught a cold at home and interrupted his insulin treatment. He continued to have nausea and vomiting and stayed at home for four or five days.

It was not until today that I came to the hospital for treatment.

did not expect.

A small cold not only induces diabetic ketoacidosis, but also induces heart failure.

The two major diseases superimposed on each other caused a huge blow to the patient's body.

Back to the endocrinology ward.

Min Ling was not in the office. Lu Chen learned from the nurse that an emergency patient had come to the ward.

Lu Chen suddenly became confused. Who said that the night shift in the endocrinology department was easy?