NOVEL WEB I can see the status bar
Chapter 1127
Chapter 1127
All the other doctors had gone to lunch, but Sun Li'en didn't have much appetite for dinner.Well, actually have an appetite, and are very hungry.But the patient on hand has not yet been diagnosed, and he is still hungry.Sun Li'en was really embarrassed to just eat by himself and leave people alone.
Ma Yongfang also had the same idea as Sun Lien. She didn't go to eat at noon, but continued to wear protective clothing for follow-up consultations and examinations in the observation room.
There is a nurse in the entire observation room, and this nurse is so busy that she doesn't touch the ground.Sun Li'en was a little helpless, he would have brought Hu Jia, Zhong Yu and Xiao Guo with him if he knew about it.Even if you are not familiar with the new environment and can't find where the corresponding equipment is... At least it can make the nurses in the hospital a little easier, right?
The patient in Dr. Ma Yongfang's hands is quite strange.The course of the disease is short, the onset is fast, and the condition is severe.Stranger still, his onset was completely without warning.
Although he was in a coma when he was delivered, the patient had an admission record at the end of November.He developed diarrhea and was diagnosed and treated for bacterial enteritis.Examinations at the time showed that the patient had no other serious problems.The diarrhea caused an elevated heart rate and an electrolyte imbalance, but both were at a point where they could be corrected relatively easily.
How did he get himself into ketoacidosis in these few months?
Ma Yongfang's treatment plan for this patient is very conventional.In addition to using a large amount of saline-soluble insulin injections, vital signs detection and continuous monitoring of renal function were also carried out.In terms of electrolytes, oral potassium chloride supplementation was given, and CRRT was also added for intervention.
It is still uncertain whether the patient has type [-] diabetes or type [-] diabetes, but there will be no major problems in following the established direction in the treatment process.
"What happened to this patient?" After comforting Ding Huiguo, Sun Lien stopped by to see the patient under Ma Yongfang, and asked, "Ketosis?"
"Yes, ketoacidosis." Ma Yongfang nodded, "His blood sugar is 54.3mmol/L, and he is not in a hyperosmolar coma. This is outrageous."
Diabetic hyperosmolar coma is a relatively rare serious acute complication of diabetes.When the patient's blood sugar is often greater than 33mmol/L, and urine sugar becomes a strong positive reaction.Such coma is often seen in elderly patients without a history of diabetes or patients with mild type 2 diabetes.Elderly people tend to induce hyperosmotic coma due to the decreased sensitivity of the thirsty central nervous system that controls drinking water, resulting in insufficient water intake.Patients with mild type 2 diabetes may cause a rapid rise in blood sugar due to infection, stress response, etc., or have not been diagnosed because of mild type 2 diabetes, so they drink or consume a large amount of sugar-sweetened beverages and high-sugar foods by mistake, This induces hyperosmolar coma.
Ketoacidosis, on the other hand, is the result of a severe metabolic disorder that persists for a period of time.Normally, the body breaks down sugar as a source of energy.In some patients, because of the absolute lack of insulin secretion, or the relative lack of insulin but a large energy gap, the body cannot obtain enough energy by breaking down sugar.Then it turns to breaking down fat to provide energy for the body.
After breaking down fat, the human body uses the ketone bodies produced by breaking down fat for energy.However, the utilization efficiency of ketone bodies is low. In this case of "unable to decompose sugar for energy", the human body will tend to decompose a large amount of fat to provide energy for cells.After fatty acids are decomposed in large quantities by the liver, they cannot be consumed quickly, so ketone bodies will accumulate in the blood in large quantities.
After the blood ketones rise, the concentration of organic acids in the blood of the human body rises rapidly, which then leads to acidemia.When the blood pH value drops, the patient will subconsciously compensate by reducing the PCO2 in the body through hyperventilation.During this process, the patient's breath will have a typical ketone odor-this is why the breath of patients with ketoacidosis has the smell of rotten apples.
At present, the patient in Ma Yongfang's hands has appeared coma and Kussmalul`s respiration.When the patient has deep and long regular breathing, it often means that the patient's acidosis is already serious.
But ketosis is metabolic acidosis, which is different from respiratory acidosis caused by carbon dioxide retention, and it generally does not need to be corrected by intravenous sodium bicarbonate injection.Unless the acidosis has seriously affected the cardiovascular, respiratory, and nervous systems, it can be corrected only by supplementing body fluids, insulin, and electrolytes.
And this correction process may be relatively slow.In addition to assisting patients to quickly eliminate ketone bodies, it can only ensure the stability of the patient's vital signs.The healing process is important but not so fast.In the middle of this time, Ma Yongfang really had nothing else to do besides guarding the patient.
Sun Li'en looked at the case, and was going to ask Ma Yongfang to have lunch first.But Ma Yongfang didn't follow Sun Li'en's suggestion. She frowned and asked, "I think... should I give him an enhanced CT scan to see the islets?"
Sudden type [-] diabetes can be roughly divided into two types, one is insufficient insulin secretion caused by pancreatic islet tumors, and the other is a special type of type [-] diabetes.
As a new subtype of type 10 diabetes, fulminant type [-] diabetes mainly occurs in East Asia.The Japanese have the highest incidence rate, while in my country, about [-]% of patients with type [-] diabetes who start with ketosis or acidosis belong to fulminant type [-] diabetes.
The cause of this type of diabetes is unknown, and patients often lack specific symptoms.Diagnosis can only be confirmed with some laboratory tests.Its biggest feature is its rapid onset and critical condition.The patient's islet β cells were severely damaged in a short period of time, so the prognosis was extremely poor.
"Let's make sure he has type 37 diabetes first." Sun Li'en was not particularly impressed by this suggestion.After all, the status bar did not say whether he had fulminant diabetes or not, and this 15.2-year-old man named Huang Jiaming only had a reminder of "low serum insulin level" on the status bar, and now the handwriting has faded to almost invisible ——Continuous insulin pumping has caused his blood sugar level to drop rapidly, and it has now dropped to a level of 10mmol/L.According to the general treatment rules, it is time to start injecting [-]% glucose to prevent hypoglycemia in patients.
"The serum insulin level can't be measured now." Ma Yongfang was a little worried, "I asked Director Wu, and he said that the laboratory department will start the test in an hour, and the result will take another two hours at the earliest."
The detection method used by Beihu Hospital to detect serum insulin levels is the detection of enzyme-linked immunoassay kits. After separating the serum, the kit needs to dilute the reagent that has been equilibrated at room temperature for half an hour with distilled water, and then use the kit to start Serum was added to incubate at a constant temperature of 37 degrees Celsius for one hour, then the plate was washed and contrast agent was added, and finally put into a microplate reader with a light range of 450nm for data reading.
Determination of serum insulin levels is generally not an urgent investigation item.One of the reasons is that it is a relatively complex and time-consuming inspection method.At the same time, most of the kits used for the determination of indicators are 96 wells, and it is not economical to carry out the test without collecting a certain number of samples.
However, Sun Li'en's medical team is here to make an inspection tour, and they will leave Beihu Hospital after five o'clock this afternoon—if these problems cannot be solved now, they can only leave the patient in Beihu Hospital, and then ask the inpatient department to send someone to stay in Beihu Hospital. Observing the room to treat the patient - that's actually not very good.
Physicians at Beihu Hospital are almost desperately working in the red zone, and they are asked to draw out doctors and nurses just to take care of a patient with diabetic ketoacidosis... This will greatly affect the already tight shift sequence.If possible, Sun Lien and the others still hope that patients can complete the treatment as soon as possible, and then go home and continue to take medication.Although for patients after ketoacidosis, it is impossible to go home immediately.But at least it can reduce the work pressure of some medical staff - after a clear diagnosis, perhaps only need to have nurses responsible for continuous treatment and regular testing.
Therefore, Sun Lien decided to help Dr. Ma Yongfang and Beihu Hospital.
"I can't do the serum test now, so I can consider starting from other angles." Sun Lien thought for a while and suggested, "How about calling the family?"
·
·
·
Huang Jiaming is a programmer, but unlike the programmers in the stereotype of ordinary people, he is the kind of programmer with very good health.
At the age of 37, theoretically, he has reached the end of the life of a programmer.Most large companies will choose to expel programmers of this age group in various ways, such as the high-sounding reason of "regularly exporting experienced programmers to the society".
But Huang Jiaming's situation is different, he has fitness hobbies and habits.What's more valuable is that he has time for fitness.
Although it can't be compared with those fanatics who spend all day in the gym, Huang Jiaming has at least maintained a pretty good physical condition.And this kind of physical condition allows him to maintain a very good state in high-intensity work.In human terms, it means "can continue to roll".
But after Yunhe's epidemic swept the city, the special nature of the programmer's work made him have no chance to rest even in the closed city.Anyway, there is a network everywhere now, and in order to ensure that residents will not lose contact during the closed process, Yunhe provides services such as network and electricity to the highest level - even if the network is in arrears, it can continue to work normally use.
This guarantee directly gave Huang Jiaming no reason to refuse to work overtime.The company he works for... Anyway, that's the style - if DingTalk doesn't reply within 10 minutes to an email sent at [-] o'clock in the morning, the department manager will get angry and curse people to deduct bonuses.
In order to balance the "life" and work that have been almost completely squeezed out, Huang Jiaming made a decision after eating instant noodles for a week-he bought seven or eight boxes of fruit.
In Huang Jiaming's view, it is no problem to replace three meals with fruit.Fruit doesn't require pre-cooking, can be eaten quickly while sitting in front of the computer, and still provides a decent amount of calories.More importantly, this thing can be bought and put in the refrigerator as soon as it is bought-it is not easy to break.
Huang Jiaming was completely overwhelmed by his genius-like creativity.He even said to his parents, "I think I should consider starting a business. Just start a company that provides meals for programmers. I just ask them to provide a few easy-to-eat fruits every day!"
(End of this chapter)
All the other doctors had gone to lunch, but Sun Li'en didn't have much appetite for dinner.Well, actually have an appetite, and are very hungry.But the patient on hand has not yet been diagnosed, and he is still hungry.Sun Li'en was really embarrassed to just eat by himself and leave people alone.
Ma Yongfang also had the same idea as Sun Lien. She didn't go to eat at noon, but continued to wear protective clothing for follow-up consultations and examinations in the observation room.
There is a nurse in the entire observation room, and this nurse is so busy that she doesn't touch the ground.Sun Li'en was a little helpless, he would have brought Hu Jia, Zhong Yu and Xiao Guo with him if he knew about it.Even if you are not familiar with the new environment and can't find where the corresponding equipment is... At least it can make the nurses in the hospital a little easier, right?
The patient in Dr. Ma Yongfang's hands is quite strange.The course of the disease is short, the onset is fast, and the condition is severe.Stranger still, his onset was completely without warning.
Although he was in a coma when he was delivered, the patient had an admission record at the end of November.He developed diarrhea and was diagnosed and treated for bacterial enteritis.Examinations at the time showed that the patient had no other serious problems.The diarrhea caused an elevated heart rate and an electrolyte imbalance, but both were at a point where they could be corrected relatively easily.
How did he get himself into ketoacidosis in these few months?
Ma Yongfang's treatment plan for this patient is very conventional.In addition to using a large amount of saline-soluble insulin injections, vital signs detection and continuous monitoring of renal function were also carried out.In terms of electrolytes, oral potassium chloride supplementation was given, and CRRT was also added for intervention.
It is still uncertain whether the patient has type [-] diabetes or type [-] diabetes, but there will be no major problems in following the established direction in the treatment process.
"What happened to this patient?" After comforting Ding Huiguo, Sun Lien stopped by to see the patient under Ma Yongfang, and asked, "Ketosis?"
"Yes, ketoacidosis." Ma Yongfang nodded, "His blood sugar is 54.3mmol/L, and he is not in a hyperosmolar coma. This is outrageous."
Diabetic hyperosmolar coma is a relatively rare serious acute complication of diabetes.When the patient's blood sugar is often greater than 33mmol/L, and urine sugar becomes a strong positive reaction.Such coma is often seen in elderly patients without a history of diabetes or patients with mild type 2 diabetes.Elderly people tend to induce hyperosmotic coma due to the decreased sensitivity of the thirsty central nervous system that controls drinking water, resulting in insufficient water intake.Patients with mild type 2 diabetes may cause a rapid rise in blood sugar due to infection, stress response, etc., or have not been diagnosed because of mild type 2 diabetes, so they drink or consume a large amount of sugar-sweetened beverages and high-sugar foods by mistake, This induces hyperosmolar coma.
Ketoacidosis, on the other hand, is the result of a severe metabolic disorder that persists for a period of time.Normally, the body breaks down sugar as a source of energy.In some patients, because of the absolute lack of insulin secretion, or the relative lack of insulin but a large energy gap, the body cannot obtain enough energy by breaking down sugar.Then it turns to breaking down fat to provide energy for the body.
After breaking down fat, the human body uses the ketone bodies produced by breaking down fat for energy.However, the utilization efficiency of ketone bodies is low. In this case of "unable to decompose sugar for energy", the human body will tend to decompose a large amount of fat to provide energy for cells.After fatty acids are decomposed in large quantities by the liver, they cannot be consumed quickly, so ketone bodies will accumulate in the blood in large quantities.
After the blood ketones rise, the concentration of organic acids in the blood of the human body rises rapidly, which then leads to acidemia.When the blood pH value drops, the patient will subconsciously compensate by reducing the PCO2 in the body through hyperventilation.During this process, the patient's breath will have a typical ketone odor-this is why the breath of patients with ketoacidosis has the smell of rotten apples.
At present, the patient in Ma Yongfang's hands has appeared coma and Kussmalul`s respiration.When the patient has deep and long regular breathing, it often means that the patient's acidosis is already serious.
But ketosis is metabolic acidosis, which is different from respiratory acidosis caused by carbon dioxide retention, and it generally does not need to be corrected by intravenous sodium bicarbonate injection.Unless the acidosis has seriously affected the cardiovascular, respiratory, and nervous systems, it can be corrected only by supplementing body fluids, insulin, and electrolytes.
And this correction process may be relatively slow.In addition to assisting patients to quickly eliminate ketone bodies, it can only ensure the stability of the patient's vital signs.The healing process is important but not so fast.In the middle of this time, Ma Yongfang really had nothing else to do besides guarding the patient.
Sun Li'en looked at the case, and was going to ask Ma Yongfang to have lunch first.But Ma Yongfang didn't follow Sun Li'en's suggestion. She frowned and asked, "I think... should I give him an enhanced CT scan to see the islets?"
Sudden type [-] diabetes can be roughly divided into two types, one is insufficient insulin secretion caused by pancreatic islet tumors, and the other is a special type of type [-] diabetes.
As a new subtype of type 10 diabetes, fulminant type [-] diabetes mainly occurs in East Asia.The Japanese have the highest incidence rate, while in my country, about [-]% of patients with type [-] diabetes who start with ketosis or acidosis belong to fulminant type [-] diabetes.
The cause of this type of diabetes is unknown, and patients often lack specific symptoms.Diagnosis can only be confirmed with some laboratory tests.Its biggest feature is its rapid onset and critical condition.The patient's islet β cells were severely damaged in a short period of time, so the prognosis was extremely poor.
"Let's make sure he has type 37 diabetes first." Sun Li'en was not particularly impressed by this suggestion.After all, the status bar did not say whether he had fulminant diabetes or not, and this 15.2-year-old man named Huang Jiaming only had a reminder of "low serum insulin level" on the status bar, and now the handwriting has faded to almost invisible ——Continuous insulin pumping has caused his blood sugar level to drop rapidly, and it has now dropped to a level of 10mmol/L.According to the general treatment rules, it is time to start injecting [-]% glucose to prevent hypoglycemia in patients.
"The serum insulin level can't be measured now." Ma Yongfang was a little worried, "I asked Director Wu, and he said that the laboratory department will start the test in an hour, and the result will take another two hours at the earliest."
The detection method used by Beihu Hospital to detect serum insulin levels is the detection of enzyme-linked immunoassay kits. After separating the serum, the kit needs to dilute the reagent that has been equilibrated at room temperature for half an hour with distilled water, and then use the kit to start Serum was added to incubate at a constant temperature of 37 degrees Celsius for one hour, then the plate was washed and contrast agent was added, and finally put into a microplate reader with a light range of 450nm for data reading.
Determination of serum insulin levels is generally not an urgent investigation item.One of the reasons is that it is a relatively complex and time-consuming inspection method.At the same time, most of the kits used for the determination of indicators are 96 wells, and it is not economical to carry out the test without collecting a certain number of samples.
However, Sun Li'en's medical team is here to make an inspection tour, and they will leave Beihu Hospital after five o'clock this afternoon—if these problems cannot be solved now, they can only leave the patient in Beihu Hospital, and then ask the inpatient department to send someone to stay in Beihu Hospital. Observing the room to treat the patient - that's actually not very good.
Physicians at Beihu Hospital are almost desperately working in the red zone, and they are asked to draw out doctors and nurses just to take care of a patient with diabetic ketoacidosis... This will greatly affect the already tight shift sequence.If possible, Sun Lien and the others still hope that patients can complete the treatment as soon as possible, and then go home and continue to take medication.Although for patients after ketoacidosis, it is impossible to go home immediately.But at least it can reduce the work pressure of some medical staff - after a clear diagnosis, perhaps only need to have nurses responsible for continuous treatment and regular testing.
Therefore, Sun Lien decided to help Dr. Ma Yongfang and Beihu Hospital.
"I can't do the serum test now, so I can consider starting from other angles." Sun Lien thought for a while and suggested, "How about calling the family?"
·
·
·
Huang Jiaming is a programmer, but unlike the programmers in the stereotype of ordinary people, he is the kind of programmer with very good health.
At the age of 37, theoretically, he has reached the end of the life of a programmer.Most large companies will choose to expel programmers of this age group in various ways, such as the high-sounding reason of "regularly exporting experienced programmers to the society".
But Huang Jiaming's situation is different, he has fitness hobbies and habits.What's more valuable is that he has time for fitness.
Although it can't be compared with those fanatics who spend all day in the gym, Huang Jiaming has at least maintained a pretty good physical condition.And this kind of physical condition allows him to maintain a very good state in high-intensity work.In human terms, it means "can continue to roll".
But after Yunhe's epidemic swept the city, the special nature of the programmer's work made him have no chance to rest even in the closed city.Anyway, there is a network everywhere now, and in order to ensure that residents will not lose contact during the closed process, Yunhe provides services such as network and electricity to the highest level - even if the network is in arrears, it can continue to work normally use.
This guarantee directly gave Huang Jiaming no reason to refuse to work overtime.The company he works for... Anyway, that's the style - if DingTalk doesn't reply within 10 minutes to an email sent at [-] o'clock in the morning, the department manager will get angry and curse people to deduct bonuses.
In order to balance the "life" and work that have been almost completely squeezed out, Huang Jiaming made a decision after eating instant noodles for a week-he bought seven or eight boxes of fruit.
In Huang Jiaming's view, it is no problem to replace three meals with fruit.Fruit doesn't require pre-cooking, can be eaten quickly while sitting in front of the computer, and still provides a decent amount of calories.More importantly, this thing can be bought and put in the refrigerator as soon as it is bought-it is not easy to break.
Huang Jiaming was completely overwhelmed by his genius-like creativity.He even said to his parents, "I think I should consider starting a business. Just start a company that provides meals for programmers. I just ask them to provide a few easy-to-eat fruits every day!"
(End of this chapter)
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