Diabetic ketoacidosis is due to the lack of insulin in the body and the inappropriate increase of the glycemic hormone, which causes sugar, protein, and fat metabolism disorder syndrome.
It is a common acute complication in diabetic patients.
If treated in time, the mortality rate is not high.
However, it is indeed a bit strange to appear in this girl who has no history of diabetes.
When he was in Jiangcheng, Qin Feng encountered a case of diabetic ketoacidosis, a man with type 3 diabetes, who almost died because of it.
So although the fatality rate is not high, it still needs to be taken seriously.
"Head Nurse Han, make a call to urge the laboratory department to expedite it. I want to see the test results as soon as possible."
Qin Feng turned his head and said to the short-haired middle-aged woman beside him.
"Okay, I'm going now."
Han Yu, a senior head nurse in the emergency department, worked in the emergency department with Dong Hao at that time.
Twenty years on, she is now one of the most important souls in the emergency department.
She is famous for her vigorous and diligent work, not to mention ordinary doctors and nurses, even Dong Hao is polite.
After all, in the emergency department, nurses work harder!
On the other hand, Zhang Qingquan's complexion was getting worse and worse, and panic flashed in his eyes.
But at this time, he had already reacted, and luckily he did not perform surgery on Zhang Jiajia.
If she really has diabetic ketoacidosis, once she is on the operating table, if something goes wrong, the consequences will be serious!
This is why it is necessary to do a comprehensive preoperative examination before the operation, and a second confirmation is necessary.
"Director Qin, what's going on? Is there something wrong with my daughter?"
Just when Qin Feng was about to speak to Zhang Qingquan, the child's father came over.
"That's right, we found that your daughter's blood sugar has some problems, which is several times higher than that of ordinary people. This shouldn't happen at her age.
Coupled with the fact that she had no previous history of diabetes, we initially suspected that she might have diabetic ketoacidosis. "
Qin Feng explained briefly.
"Diabetic...poisoned?
Will this be dangerous? "
Hearing his words, the girl's father frowned, but remained calm.
"Don't worry, if there is nothing wrong with our diagnosis, she should not need surgery."
Qin Feng comforted with a light smile.
"No need for surgery? Does that mean it's not serious?"
The girl's father's eyes lit up when he heard the words, and the next second he saw Zhang Qingquan next to him, and asked in surprise,
"That is to say, the previous diagnosis was wrong?"
As soon as the words fell, Zhang Qingquan's hand holding the checklist trembled subconsciously.
Diagnostic error!
This matter is big or small!
It's okay for the family members to understand. If there is a trouble, they will definitely be unlucky.
They have to apologize even if it is the least serious, and the department will come forward to solve it. If it is serious, they may even be punished if they go to the hospital.
After all, the situation in front of him is to advance into the operating room with one kick!
If Qin Feng hadn't stopped him in time, the consequences...
Thinking of this, cold sweat broke out on his back.
He has been an emergency doctor for so many years and has treated tens of thousands of patients!
Such a disease is rare and uncommon, but it is simple and simple.
The mistake was entirely caused by his prejudice against Qin Feng, which made him forcefully confirm his own point of view, and neglected it.
He almost might lead to a result that he would regret for the rest of his life.
"You can understand that your daughter's illness is indeed the same as the previously diagnosed intestinal obstruction. Because of the previous appendix surgery and the adhesion caused by this situation, the real onset time should be very early.
If surgery is performed, although the obstruction problem can be solved, follow-up treatment is still required.
This situation is rare.
Well, I still have a few questions to ask the patient himself, and I will take care of it. Can you please? "
After finishing speaking, Qin Feng looked at the girl's father with a faint smile.
The man was silent when he heard the words, and after glancing at Zhang Qingquan, his eyes moved to the nameplate on Qin Feng's chest.
"Okay, Director Qin, I believe in you."
"Okay, let's go in first."
Qin Feng nodded and said, turning his head to look at Zhang Qingquan,
"Bring it to me as soon as the test results come out."
"I see."
At this moment, Zhang Qingquan immediately nodded in response.
After about a few minutes,
Zhang Qingquan pushed the door in and handed over the report.
"Director Qin... the report is out."
Qin Feng took it and looked at it, sure enough!
PH7.8, metabolic acidosis~
The results of the blood ketone body test also came out, the increase was obvious, and the blood sugar was also 4+.
Diagnosed!
Qin Feng's heart was instantly diagnosed.
Diabetic ketoacidosis, yes!
"Jiajia, let me ask you, did you ever eat a lot before?"
Qin Feng looked at the girl on the hospital bed and asked.
"Well... Yes, about a month ago. During that time, because I was preparing for the monthly exam, I went to bed late every day, ate a lot, and lost a few pounds."
Zhang Jiajia thought for a while and said.
"Well, yes, this is one of the typical symptoms of diabetes."
Qin Feng nodded, everything is right.
If the direction is correct, some places that are forgotten by patients but important to doctors' judgment will naturally surface.
Therefore, no matter which hospital you are in, the patient's condition is beyond what you can see.
The most critical thing is whether the doctor can dig out the root cause behind the disease through some details, because the direction determines the diagnosis.
At the same time, it also determines the treatment and the safety of the patient's life.
"Doctor, what's wrong with my daughter? Do you need surgery?"
Mother was extremely anxious at the moment, and urged.
"Don't worry, it's confirmed, your daughter will be fine soon."
Qin Feng said with a smile.
…
Now that the symptoms have been identified, the treatment plan also needs to be changed.
Intestinal obstruction surgery changed to correct ketoacidosis, hypoglycemia, fluid replacement.
According to Qin Feng's judgment, as long as the ketoacidosis is eliminated and the intestinal physiology is restored, the obstruction will naturally disappear.
"Head nurse, take the patient to the consulting room and put on the monitor."
In the consultation room, the monitor was installed on Zhang Jiajia's body, and all the basic physiological indicators appeared on the screen.
Respiration 19 breaths/min
Heart rate 110/min
Blood pressure is 110/78
Blood oxygen 100%...
The data is all good, and Qin Feng has eased up a lot.
The rehydration instruction arranged by Zhang Qingquan before had an effect, and all indicators fell back to the normal range.
The next step is to lower blood sugar, continue to replenish fluids to maintain electrolysis, and at the same time fight infection to prevent intestinal obstruction and necrosis.
A tube is inserted to remove gas from the stomach and relieve pressure in the bowel.
Didi, Didi, Didi~
At this moment, less than 15 minutes after the hypoglycemia started, the monitor gave an alarm.
Zhang Jiajia suddenly developed shortness of breath, his expression was a little painful, and his heart rate began to soar.
"Director Qin."
"Shock! Prescribe another intravenous sodium supplement, and give it a quick drip."
Seeing this scene, Qin Feng's eyes suddenly became serious, and he said solemnly.
The heart rate above monitoring soared from 110, 120, 130, 140...
In just ten seconds, it has broken through 170/min and rushed towards 180.
The head nurse moved quickly, quickly opened the intravenous access, and began to drip.
After the rehydration fluid entered the body, in less than two minutes, the heartbeat began to drop rapidly.
Heart rate 135/min, basically normal.
"Okay, let's go back to normal speed and continue to lower blood sugar."
Qin Feng breathed a sigh of relief and commanded.
The pain on Zhang Jiajia's face also gradually disappeared, returning to normal.
An hour later, a second examination was conducted, and the blood sugar dropped significantly, and the abdominal distension also began to disappear.
Everything is going in the normal direction...
"Okay, send it to the ward, continue to pay attention, and have a blood test every 4 hours."
Qin Feng instructed.
The head nurse, Han Yu, nodded in response and arranged for the nurses to pay more attention.
…
In the director's office.
"Qingquan, what did I tell you yesterday?"
Dong Hao looked serious and asked in a deep voice.
"Director, I..."
Zhang Qingquan's face was a little ugly, but he didn't know what to say with complicated eyes.
"Okay, don't talk about it."
Dong Hao interrupted him angrily, "If you have any opinion on Qin Feng, the deputy director, you can appeal to the courtyard or report it.
But what I want to tell you is, don't put your dissatisfaction on every patient who comes! "
Boom!
Speaking of this, Dong Hao slammed the table.
"If it wasn't for Qin Feng today, think about the consequences yourself!"
"Maybe you think it's luck that he discovered the problem, maybe Qin Feng came a little later, and you can find the abnormality before the operation.
But what I want to say is, Zhang Qingquan, this is stupid!
If you really think it's luck, you're out of your mind!
Qin Feng is the deputy director hand-picked by the hospital. Let alone his surgical ability is well-known in the hospital, I believe everyone knows something about his resume.
An undergraduate who graduated from a second-tier medical school became the director of a double department in a third-tier hospital in a third-tier city in three years, and he established it himself. Go and find out what the level of the first hospital in Jiangcheng City is now?
The level 4 surgeries Qin Feng has undergone in three years add up to more than your ten years!
What is your objection? "
Dong Hao talked more and more, these words seemed to be held in his heart for a long time, and he had to spit them out quickly.
"Furthermore, in this disaster relief, mudslides blocked the road, and Qin Feng went into the disaster area alone with the army, and completed the diagnosis and treatment of the chaotic township hospital and countless patients in half a day.
Moreover, in the case of extremely scarce medical conditions, one person admitted and treated hundreds of patients until the rescue team arrived and went to work smoothly, almost seamlessly.
Can you do this? ! "
Speaking of this, Zhang Qingquan almost wanted to use his feet to dig a crack in the ground and get in.
For Qin Feng, his previous jealousy was greater than reality, and he was somewhat blinded.
He thought that the deputy director should be his own, so why should he give it to him?
In addition, Qin Feng didn't seem to take the initiative to provoke him, which made him feel angry and justified.
As a result, this happened on the first day!
If it wasn't for Qin Feng today, he might really be punished.
"Director, I know I was wrong."
Zhang Qingquan lowered his head and whispered.
"If you make a mistake, you must correct it!"
Dong Hao took a breath and said earnestly,
"Qingquan, I know that these years have not been easy for you. The emergency department is a thankless job. Not to mention the hard work, you also have to deal with different family members and patients, whether you hit back or scold you.
As for you, you have been trained and are the leader among the young attending doctors in our emergency department.
So you have to correct your attitude and don't affect yourself because of other things.
Lesson learned this time, you know? "
"I know, I won't do it next time."
Zhang Qingquan assured.
"What about Qin Feng?"
Dong Hao looked up at him and asked.
"I...follow the arrangement of the director and the hospital."
Zhang Qingquan still hesitated, but this time there was no objection.
After all, what just happened is still fresh in my memory!
"Well, you were brought out by me, so let me tell you the truth."
Dong Hao nodded and sighed,
"Actually, even if it's not Qin Feng this time, the deputy director is not in your turn."
"Director, why?"
Hearing this, Zhang Qingquan frowned and asked inexplicably.
"Your qualifications are not up to the hospital's requirements for the director of the emergency department office. Of course, Qin Feng is not enough either."
Dong Hao explained,
"But Qin Feng was always discussed and decided by the hospital affairs committee, and he bears a great responsibility. This is not only an emergency treatment, but also an attempt by Xiehe.
In the whole hospital, only he is the most suitable person! "