A middle-aged and elderly male patient was pushed by a flat cart, like a wild dog that had lost its stiffness, and ran straight to the emergency room.

Zheng Ren glanced at the system panel at the top right of his field of vision.

What a strange diagnosis.

Traumatic brain injury, ketoacidosis!

These two diagnoses, in Zheng Ren's eyes, traumatic brain injury is not important at all.

There is not even a subarachnoid hemorrhage, will Zheng Ren care?

Traumatic brain injury is similar to the concussion I spoke of ten years ago, but now there is no concussion diagnosis.

Patients who do not have organic lesions, but only have transient symptoms such as dizziness, headache, nausea, and vomiting due to a blow to the head are collectively referred to as traumatic brain injury.

Because there are no organic lesions, it has become the best symptom of fights and car accidents.

None of this matters, it's ketoacidosis that kills.

Pathophysiologically, ketone bodies are intermediate metabolites in the liver that break down fat into fatty acids.

Normally, the body produces a small amount of ketone, which is used as an energy source as it is transported to tissues such as the heart, kidneys, and skeletal muscle, and the concentration of ketones in the blood is very low, generally not exceeding 1.0 mg/dL, and ketones are not detectable in the urine.

In patients with severe diabetes, ketones can be detected in the urine. In more severe cases, when ketones accumulate too much in the blood, they can turn the blood acidic and cause acidosis, which is called ketoacidosis.

Zheng Ren watched the nurse busy, put the patient on ECG monitoring, indwelling intravenous access, and waiting for the doctor's next instructions.

He leaned over to the patient and sniffed the smell of rotten apples. Now Zheng Ren has a number in his heart, there should be ketoacidosis.

"Take your blood sugar. Zheng Ren said: "Call the endocrine immediately and find the inpatient to come for a consultation." ”

The nurse was a little surprised, the patient's head was bandaged, and the head was obviously traumatized, why did Mr. Zheng ask for an endocrine consultation?

However, the strict hierarchical difference between the upper and lower levels of the hospital made them not express their opinions during the rescue, but chose to obey.

"Patient's family!" Zheng Ren shouted.

The 120 ambulance was followed by an eighteen or nineteen-year-old boy, who eagerly came to Zheng Ren's side, "Doctor, is there any danger?"

At the same time, hurried footsteps could be heard in the hallway.

Generally, the 120 ambulance allows a family member to come up and help look after the patient. Of course, the rules are different in different places, and Haicheng is like this.

Other family members can take a taxi or follow the 120 ambulance to the hospital by car.

Zheng Ren saw that he was a young man and was a little unhappy.

The adults of this family are really big-hearted. He saw that the patient's age was probably in his sixties, and the child could be his grandson or grandson.

What do adults do to eat, how can a teenager be allowed to follow in the car?

"What about your parents?" asked Jung-in.

"......" The young man was stunned for a moment, and then said, "At work." ”

"Are there any other adults?" asked Jung-in.

Aunt Zhao and Uncle Li followed. ”

This is more difficult to deal with, and Zheng Ren is a little difficult to do.

The fatal diagnosis is ketoacidosis, and death can occur at any time. But the immediate family members of the head of the family are not there......

"Then you come on, who are you a patient?"

"I'm his neighbor. ”

"......" Zheng Ren was dumbfounded, what kind of messy relationship is this?

"Mr. Zheng, the patient's fingertip blood sugar is 54.2mmol/L. The nurse said with admiration.

This extreme blood glucose level is rarely encountered even in the emergency department. Maybe there will be a little more endocrinology?

This also proves from the side that the patient's condition is critical.

Ketoacidosis, Zheng Renke will not deal with it. Not at all, but at least not professionally.

"10u insulin subcutaneously, 500 saline. Blood gas analysis, ions. Zheng Ren said immediately.

Correction of hyperglycemia with low-dose insulin, plus hydration, corrects fluid loss and ionic disturbances, and is the focus of initial treatment.

There is only so much Zheng Ren can do.

The endocrinology department is not far from the emergency building, and it is estimated that in a few minutes, the arterial blood of blood gas may not be collected, so it will have to be pushed to endocrinology for specialized treatment.

At this time, two middle-aged people, a man and a woman, ran in, panting.

"Doctor, how is Uncle Wang?"

Zheng Ren glanced at them and asked, "It's dangerous, have the patient's immediate family members notified you?"

"He doesn't have any immediate family, he's alone, we're all neighbors. The man said.

Belch......

Zheng Ren was in trouble.

But it seems that this man's popularity is still good. How indifferent the neighborhood is now, if it were a little worse, if it died at home, everyone would be found out when they were rotten.

"The patient's blood sugar is very high, and now he is diagnosed with ketoacidosis, which is dangerous, and he will have to be hospitalized in the endocrinology department for a while. Zheng Ren looked at the three people who were there to send the patient, wanting to see some clues in their eyes.

"Whether it can be saved or not, it's hard to say. Zheng Ren said: "Who will pay the hospitalization fee in a while." ”

"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 rich, and the child is still young, so I'd better come. The woman said.

Zheng Ren was a little surprised.

In the hospital, in the emergency department, I am used to seeing indifference, like this kind of widowed and lonely old man, it is really rare for someone to compete to pay the hospitalization fee.

The young man who came at the beginning said firmly: "Uncle, aunt, don't fight, I'll pay first." While I was in the car, I called my dad, who was rushing back, and he asked me to pay the money first. I still have New Year's money, it's fine. ”

While this side was arguing, a deputy director of the endocrinology department rushed over.

Feng Qing, in his forties, is not tall, looks very honest, and speaks a little stammering.

Zheng Ren knew Feng Qing because general surgery involves the operation of elderly patients, and most of the preoperative evaluation requires endocrinology consultation.

Chronic diagnosis consultation is in charge of deputy director Feng Qing. Emergency consultation is the responsibility of the general inpatient.

I don't know how he came here today.

"Director Feng, if the patient's blood sugar is above 50, consider ketoacidosis. Zheng Ren ignored the argument between several neighbors, and instead introduced the condition to Director Feng: "A small dose of insulin has been given subcutaneously, and blood gases and ions have been checked. ”

"Good. Feng Qing didn't talk much, because he had a stuttering problem, so he basically used one or two words to express his speech.

"Admission to the hospital?" Zheng Ren respectfully asked for Feng Qing's opinion.

"Good. Feng Qing said as he began to check his body.

The patient has problems with light reflex and has become seriously ill to a certain extent.

"Head CT, do it now or go back and do it?" Zheng Ren asked.

"Test ...... Consider not cephalic ...... The problem of trauma is probably caused by ketosis...... Admission to the hospital. Feng Qing said "simply".

.。 m.