A stretcher trolley was pushing a middle-aged male patient. Like a stray dog that had been freed from its shackles, he ran straight to the resuscitation room.
He glanced at the System panel at the top right corner of his vision.
What a strange diagnosis.
Brain trauma, ketoacidosis!
In Zheng Ren's eyes, brain trauma was not important at all.
There was not even a subarachnoid hemorrhage. Would Zheng Ren care?
Brain trauma was similar to the concussion ten years ago, but there was no diagnosis of concussion anymore.
The patient did not have any organic lesions, but because of the impact on the head, symptoms such as dizziness, headache, nausea, vomiting, and other symptoms were collectively referred to as brain trauma.
Because there were no organic lesions, it became the best disease to cheat people in fights and car accidents.
None of that mattered. What mattered was ketoacidosis.
In terms of pathophysiology, ketone bodies are the intermediate metabolites of fatty acids in the liver.
Under normal circumstances, the body produces a small amount of ketone bodies, which are transported along with the blood to the heart, kidneys, skeletal muscles, and other tissues to be used as a source of energy. The concentration of ketone bodies in the blood is very low, generally not more than 1.0 mg/dL, and there is no detection of ketone bodies in the urine.
Patients with severe diabetes could detect ketones in their urine. Even more serious, when the body accumulates too much in the blood, it can make the blood acidic and cause acidosis, known as ketoacidosis.
Zheng Ren watched as the nurse performed ECG monitoring on the patient and set up an intravenous line while waiting for the doctor's next instructions.
He moved closer to the patient and sniffed. It smelled like rotten apples. This time, Zheng Ren had an idea in his heart. It was undoubtedly ketoacidosis.
"Take a blood sugar test," Zheng Ren said. "Call the endocrinology department immediately and get the chief resident for a consultation."
The nurse was slightly surprised. There was a bandage on the patient's head. It was obvious that it was a head injury. Why would Chief Zheng ask for an endocrine consultation?
However, due to the strict hierarchy between superiors and subordinates in the hospital, they did not express their opinions during the resuscitation. Instead, they chose to obey.
"Patient's family!" Zheng Ren shouted.
An eighteen or nineteen-year-old boy followed the first-aid ambulance. He came to Zheng Ren's side anxiously. "Doctor, is he in danger?"
At the same time, the sound of hurried footsteps came from the corridor.
Under normal circumstances, the first-aid ambulance would allow a family member to come up and help take care of the patient. Of course, the rules differed from place to place. This was the case in Sea City.
Other family members could take a taxi or follow the ambulance to the hospital.
Zheng Ren was a little unhappy when he saw that it was a young man.
The adults in this family were really magnanimous. Based on the patient's age, he guessed that he was in his sixties. This child could be his grandson or grandchild.
What were adults doing? How could they let a young man follow them in the car?
"Where are your parents?" Zheng Ren asked.
"…" The young man was stunned for a moment, then said, "I'm at work."
"Are there more adults coming?" Zheng Ren asked.
"Aunty Zhao and Uncle Li are with us."
This was more difficult to deal with. Zheng Ren was a little troubled.
The patient's fatal diagnosis was ketoacidosis, and he could die at any time. But the immediate family member who was in charge of the household was not there …
"Why don't you do it? Who are you to the patient?"
"I'm his neighbor."
"…" Zheng Ren was dumbfounded. What kind of messed up relationship was this?
"Chief Zheng, the blood sugar of the patient's fingertips is 54.2 mmol/L," the nurse said with admiration.
Such extreme blood sugar levels were rarely seen even in the emergency department. Perhaps the endocrinology department would have more?
This also proved that the patient's condition was critical.
Zheng Ren did not know how to treat ketoacidosis. It was not that he did not know how to do it, but at the very least, he was not a professional.
"10u of insulin subcutaneous injection, 500 saline. Blood gas analysis, ions, "Zheng Ren said immediately.
A small dose of insulin to correct the high blood sugar, coupled with fluid replacement to correct the loss of body fluids and ion imbalance, was the focus of the initial treatment.
There was only so much Zheng Ren could do.
The endocrinology department was not far from the emergency building. It was estimated that in a few minutes, the arterial blood might not even be able to be collected. They would have to push the patient to the endocrinology department for specialized treatment.
At this moment, a middle-aged man and a woman ran in, panting.
"Doctor, how is Uncle Wang?"
Zheng Ren glanced at them and asked, "It's very dangerous. Have you informed the patient's immediate family?"
"He has no immediate family. He's alone. We're all neighbors," the man said.
Uh …
Zheng Ren was in a dilemma.
However, it seemed that this man was quite popular. Nowadays, the relationship between neighbors was very cold. If he was slightly worse, he would die at home and only be discovered when his body was rotten.
"The patient's blood sugar is very high. The diagnosis is ketoacidosis. It's very dangerous. He'll have to go to the endocrinology department for hospitalization later." Zheng Ren looked at the three people who sent the patient over seriously, trying to find some clues from their eyes.
"It's hard to say if he can be saved," Zheng Ren said. "Who's going to pay the hospitalization fee later?"
"Doctor, do your best. Don't worry about the hospitalization fee. I'll pay it later, "the man said.
"Brother Li, your family is not well-off. The child is still young. Let me do it," the woman said.
Zheng Ren was a little surprised.
In the hospital and the emergency department, he was used to seeing people being cold. It was really rare for someone to fight to pay the hospitalization fee for a widowed and lonely old man.
The young man who came first said firmly, "Uncle, Aunt, stop arguing. I'll pay first. When I was in the car, I called my dad. He was rushing back and asked me to pay first. I still have red packets. It's fine. "
While they were arguing, a deputy director of the endocrinology department rushed over.
Feng Qing was in his forties. He was not tall and looked very honest. He stuttered a little.
Zheng Ren knew Feng Qing. Because the general surgery department involved surgery for elderly patients, most of the preoperative evaluations required endocrinology consultation.
The chronic consultation was handled by the deputy director, Feng Qing. The emergency consultation was handled by the chief resident.
Zheng Ren did not know why he came over today.
"Director Feng, the patient's blood sugar is above 50. We're considering ketoacidosis." Zheng Ren ignored the dispute between the neighbors and introduced the patient's condition to Director Feng. "We've already given him a small dose of insulin subcutaneous injection. We've checked his blood gas and ions."
"Okay." Feng Qing did not speak much. Because he had a stutter, his words were basically expressed in one or two words.
"Should we admit him to the hospital?" Zheng Ren respectfully asked for Feng Qing's opinion.
"Okay," Feng Qing said as he began to examine the patient.
The patient's reflex to light had problems. His condition had reached a certain level.
"Head CT. Should we do it now or when we go back?" Zheng Ren asked.
"Test … Considering that it's not a problem of external … trauma to the head. It should be caused by ketosis … Let's admit him to the hospital," Feng Qing said straightforwardly.
.。 m.
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