Chapter 1491 Solid Basic Skills

The two exchanged only a few words in a low voice, and did not continue to speak.

The surroundings are messy, who knows if there are any family members of the patients. And just listening to the 120 emergency doctor, there is no way to judge the specific situation at that time.

It's all guesswork, nothing to do. But you have to be self-righteous, and the family of the patient will listen to the propaganda, and the doctors below will be in trouble.

Do your own thing, don't cause trouble for others, this is the most basic doctor's creed.

Fortunately, the patient has woken up, and there is nothing to worry about.

Zhou Litao called the patient's family to ask about the situation, and asked carefully. Zheng Ren listened for 2 minutes, then leaned over and asked, "What medicine did the patient take last night?"

"Uh..." The patient's family was stunned, thinking hard.

"Boss Zheng, what do you suspect?"

Zheng Ren said in a low voice when his family members went to the luggage to find the medicine box, "Patients with hyperthyroidism generally have a fast heart rate, and oral propranolol reduces the heart rate. It is recommended in major guidelines, which can inhibit the conversion of T4 to T3, and is the first choice drug.

However, high-dose β-blockers can weaken the effect of catecholamines, inhibit the decomposition of hepatic glycogen, reduce hepatic glucose output and gluconeogenesis, and also inhibit fatty acids, lower blood glucagon levels, and reduce blood sugar production. "

That is to say, taking too much of this drug will cause the blood sugar to drop.

"I see." Zhou Litao said immediately.

In fact, just as Zheng Ren started, Zhou Litao thought of this.

After all, he is not an endocrinologist. Zhou Litao is not very familiar with the fact that β-blockers can cause hypoglycemia.

But if Zheng Ren was not there, he probably wouldn't miss it. Zheng Renzai, reminded the direction, and accelerated the process of asking the medical history.

Sure enough, the family members came with the propranolol pill box.

Because the patient's condition is not serious and his activities are normal, there is no family to accompany him. This morning, I heard from a clinician that the patient's heart rate was fast last night, and there was no obvious relief after 30 minutes of taking the drug, so he increased the dose.

Seeing that the patient was fine, Zhou Litao asked the emergency physician to issue an order and stay in the hospital for observation.

Observe for a while.

It's just hyperthyroidism, but I can't be admitted to the hospital.

When he was done, Zhou Litao called Zheng Ren to his duty room.

"Boss Zheng, your eyes are so bright, have you ever done endocrinology?" Zhou Litao took out a box of Ziyun and was despised by Su Yun.

"No, I met a similar patient in Xiangjiang a while ago, but it wasn't hyperthyroidism." Zheng Ren said casually.

Su Yun glanced at Zheng Ren, this answer was too careless.

Hypoglycemia refers to the symptoms and signs of decreased glucose concentration in the blood, which ultimately leads to impaired brain function.

Clinical manifestations range from behavioral changes, fatigue, and confusion to seizures and loss of consciousness, known as functional brain failure.

Therefore, many patients with hypoglycemia are often misdiagnosed as epilepsy or even depression and mania.

Qin Lu's illness, mania or something, was related to low blood sugar, but he seemed to have seen it at a glance.

This guy, sneaky, looks really unpleasant.

It's a pity that he couldn't catch up with him. I really wanted to find a chance to slap him once, Su Yun was smoking a cigarette and thought to himself.

"By the way, Mr. Zhou, how did you judge the low blood sugar?" Zheng Ren asked.

"When the patient came, I felt something was wrong." Zhou Litao smiled and said, "If you want to sleep with the nurse on duty, and you don't take the girl with you in the ward in front of others, there must be something wrong."

"Well, yes." Su Yun said: "I met a patient before, who suffered from a car accident, multiple rib fractures on both sides, bilateral hemopneumothorax, ruptured lung, traumatic wet lung, and head trauma. After the operation, he was in the ICU. It was assisted by a ventilator with a tube inserted for 3 days. Later, the tube was extubated. Guess what the first sentence is?"

Zheng Ren smiled and said nothing.

Zhou Litao asked suspiciously: "It doesn't have to do with the nurse, right?"

"He took the ICU head nurse's hand and said that he was going to drink flower wine together at night." Su Yun laughed.

"What happened later?" Zhou Litao also had a lot of gossip.

Being the chief inpatient in the emergency department, listening to some gossip is like having fun in the midst of suffering.

"Afterwards, his condition stabilized a little, and he was kicked out of the ICU." Su Yun said with a smile.

The symptoms are different, but the symptoms are similar.

"Boss Zheng, what happened to the patients in Xiangjiang you said?"

"The pancreas has a feeding artery with plaque, and the intermittent flow rate changes lead to abnormal insulin secretion. He is a bit more advanced than these two patients. It's not nonsense, but what he has experienced in a virtual way." Zheng Ren briefly described Qin Lu disease.

"Tsk tsk." Zhou Litao secretly wrote down the case mentioned by Zheng Ren.

Although you may not meet similar patients in your life, if you do, you will have a shadow and a little impression in your heart, at least it will reduce the chance of misdiagnosis and missed diagnosis.

"Mr. Zhou, if the patient's blood sugar is not low, what are you going to check?" Zheng Ren continued to ask.

"Mental symptoms in patients with hyperthyroidism are generally due to electrolyte imbalance, pre-hyperthyroid crisis, hypoglycemia, or autoimmune encephalitis. It is the most convenient to check blood sugar, and the symptoms of patients who are asleep are similar. If not, check them one by one."

Zhou Litao has a solid foundation, and Zheng Ren just finished asking about it, he said casually.

Zheng Ren thought to himself, 912 is profound. The total hospitalization of an emergency department is so terrible.

It is difficult for doctors in other departments except gland surgery and endocrinology to know the details of these things about hyperthyroidism.

The role of a specialist is here, but good things have bad things. The more you study a certain direction, the less you know about diseases in other departments.

"Boss Zheng, you are really versatile and powerful." Zhou Litao said with a smile, "Is there anything I should pay attention to this patient?"

"It's nothing, you can treat it." Zheng Ren smiled. "After two days of observation, let me go to the specialist outpatient clinic. You can go to the emergency department and solve the hypoglycemia. By the way, tell the patient that the medicine can't be taken casually. "

"Yeah, eat as much as you want, it's really terrible." Zhou Litao said, "Boss Zheng, a patient with Gaucher's disease, when are you going to do a live broadcast of the surgery?"

"I don't know, if there are no problems, the sooner the better." Zheng Ren said.

"I've seen the surgery you performed live, and it was really good." Zhou Litao was a little envious.

Can go to surgery, be a surgeon, no one wants to be in the emergency department.

But at that time, a mistake became an eternal hatred, young, ignorant and ignorant, and was tricked into the emergency department.

Today's children are better than each other, and there are not many people who are engaged in the medical industry after graduation, let alone emergency care.

The more Zhou Litao thought about it, the more he felt that his future was bleak.

How nice to be like Boss Zheng.

These are still bearable, the key is that Boss Zheng has a high level and has a girlfriend!

It doesn't count if you have a girlfriend, and you can hand him instruments when you can still operate.

Alas... Zhou Litao let out a long sigh.

Zheng Ren and Su Yun were about to leave when they suddenly heard a series of hurried footsteps in the corridor.