I Can See Health

   Chapter 107 The three monks have no water to drink

   Endocrine Zone II.

doctor's office.

   "Doctor Min, here is the emergency patient."

   As soon as Min Ling took over, the nurse ran into the doctor's room.

"okay, I get it."

  Min Ling nodded, and at the same time was very puzzled.

   The night shift for endocrinology recently is too bad!

   She remembered working a night shift and was very busy.

  Why are there so many emergency patients suddenly?

   Have you been so "hot" recently?

  Min Ling had deep doubts about herself.

  …

   On the other side, Lu Chen slowly walked into the endocrine inpatient department with an uneasy mood.

   These three hundred dollars are too hard to earn!

   However, there are four endocrine wards in this Jinghua Second Hospital.

   The patient will not necessarily receive the endocrine zone he went to.

but.

   When Lu Chen got out of the elevator and came to the door of the second endocrine area, he saw the flat car in the emergency department in front of him.

   He could only silently accept the fact that he was "black-faced".

  The only good thing is that there is no need to test your blood sugar today.

   As soon as he entered the second endocrinology ward, Lu Chen met Min Ling head-on.

  Min Ling was about to go to the ward where the patient was, but suddenly saw a somewhat familiar figure on the way.

   "You are... Lu... Chen?"

  Min Ling's memory is very good, she remembered Lu Chen at once.

   Mainly because Lu Chen left a deep impression on him!

   It was the first time she had seen such an outstanding graduate student!

   In the face of emergency rescue, he is calm, and his clinical thinking is in order, even better than many resident physicians who have already worked.

   "Hello Mr. Min."

  Lu Chen also saw Min Ling.

   This is really a coincidence, I worked with her on the last night shift.

   Now the day shift is still with her.

   "Go and change your white coat. I'm here for an emergency patient. It's bed 18." Min Ling smiled.

   With Lu Chen as a good helper, even if she is busy today, she will feel a lot more relaxed.

  Lu Chen nodded: "Okay."

   I have bitterness in my heart, I can’t say it.

  Lu Chen walked quickly into the duty room and put on his white lab coat.

   Grab a stethoscope and a small medical flashlight in your pocket.

   came to the bedside of the 18th bed.

   On the hospital bed, the patient was still in a coma with his eyes closed.

   However, his right hand occasionally waved involuntarily.

  Lu Chen saw that his health was 45 in red.

   Surrounded by the bed were three middle-aged women, all of whom were supposed to be the daughters of the patient.

   At this time, Min Ling was already issuing medical orders.

   "Go on ECG monitoring, inhale oxygen through nasal cannula, check fingertip blood sugar, and then urgently check blood routine, biochemistry, ions, coagulation items, myocardial enzymes, and blood gas analysis."

"receive."

   One nurse brought in an ECG monitor, and another nurse started taking blood from the patient.

   The value of fingertip blood sugar came out soon.

   "Doctor Min, fingertip blood sugar is 1.8mmol/L." After measuring blood sugar, the nurse replied immediately.

   "So low?" Min Ling frowned, "Immediately inject two high sugar boluses, then hang a 500ml bag of sugar, and adjust the liquid speed faster."

"receive."

  Min Ling then looked at Lu Chen next to him: "The emergency department considered this patient to be in a coma due to hypoglycemia, so a CT scan was done and sent to our department."

  Lu Chen frowned and said, "Mr. Min, do you still need to identify it with cerebral infarction?"

   "Yeah." Min Ling nodded slightly, "Although all the current evidence points to hypoglycemia coma, we must not forget that cerebral infarction must be ruled out. Because the treatment of cerebral infarction and hypoglycemia coma are very different."

   Not only hypoglycemic coma patients, but all delirious patients, acute cerebrovascular accidents must be ruled out.

   Then, Lu Chen asked the family members on the side of the patient's illness.

   The patient has a history of diabetes for more than 20 years and has been taking insulin therapy at home.

   I don’t know what happened recently. I have a bad appetite and eat less, but the amount of insulin I used is still the same as before.

   "Will you have a nervous system examination?" Min Ling continued.

   For delirious patients, in addition to routine physical examination, there is a complete set of neurological examination.

   Examination of the nervous system is cumbersome.

  If it is not used frequently in clinical practice, it is easy to forget.

  In addition to the doctors of neurology, doctors of many other departments will ignore the examination of the nervous system.

   Doctors with departments do not even know how to examine the nervous system at all.

   "A little bit." Lu Chen said.

  Min Ling nodded; "Then let's start."

  Lu Chen walked to the right side of the hospital bed.

The first step in the physical examination of the nervous system is to judge consciousness.

   Obviously, the patient in front of him is in a coma, but it is necessary to distinguish whether it is a deep coma or a light coma.

   Next is the examination of the cranial nerves.

   Focus on the examination of the oculomotor nerve, trochlear nerve, and abducens nerve, observe whether there is diplopia, whether the eye movement is in place, whether the angle of the mouth is skewed, and determine whether it is central facial paralysis or peripheral facial paralysis.

   Then check the muscle strength and muscle tension of the patient's limbs to determine the level of muscle strength and whether there are extrapyramidal symptoms.

   Finally, it is the examination of the sensory system, physiological reflex, pathological reflex, as well as meningeal irritation and autonomic nervous system.

   It took a lot of time to examine the whole nervous system.

  Min Ling looked at Lu Chen's physical examination and nodded with satisfaction.

   This is not a little bit, but quite a bit!

   For the student in front of her, she liked it more and more.

   Inspection completed.

Lu Chen was a little tired, let out a breath, and said, "The patient is in a coma... The left nasolabial fold did not shrink during the orbital pressure stimulation, the left limb did not move spontaneously, and the right limb avoided Movement, left pathological signs are not elicited..."

   "In general, the patient currently has signs of hemiplegia of the left limb, which needs to be differentiated from cerebral infarction."

   "Okay." Min Ling nodded, and then said to the family members on the side, "Which of your family members can call the shots, come with me to the office."

   The three family members present, three middle-aged women, looked at each other, but no one spoke for a while.

  Min Ling frowned: "Who are you all from the patient?"

   At this time, one of the middle-aged women with short stature and dark skin stood up.

   "I'm the patient's daughter, I'll come with you."

   "Okay." Min Ling nodded, glanced at the other family members, and walked out of the ward.

   Middle-aged women followed.

  …

doctor's office.

  Min Ling was sitting in front of the computer, and Lu Chen was standing beside her.

  The middle-aged woman sat aside, her expression restrained and a little restless.

   "At present, the patient is in a coma and is in a relatively dangerous situation. We must first consider hypoglycemia coma, and secondly do not exclude acute cerebrovascular accident, which is what we often call cerebral infarction."

   "Well, I understand." The middle-aged woman nodded, "The doctor in the emergency department told us."

  Min Ling continued: "That's good. Although we have given corresponding treatment measures, in order to rule out cerebral infarction, we still need to go out for an examination."

   "Check?" The middle-aged woman asked nervously, "Didn't you already have a CT scan in the emergency room?"

   "Head CT is to rule out trauma and cerebral hemorrhage." Min Ling explained, "Only by doing MRI, can cerebral infarction be ruled out!"

   The middle-aged woman frowned and her eyes flickered. She bit her lower lip and said, "Doctor, I, my brother hasn't come yet. When he comes, let's discuss it with him and give you an answer later."

   "Okay, but you have to hurry up. The patient is now in a serious condition. If it is not clear as soon as possible, it may delay the best time for treatment." Min Ling said.

   "Okay, thank you doctor."

   The middle-aged woman nodded and left the ward.

Looking at the back of the middle-aged woman leaving, Lu Chen frowned and whispered, "Looking at the clothes of the patient's children, it doesn't seem like the financial conditions are particularly poor. It takes a long time to discuss how to do an examination... …”

  Min Ling smiled helplessly: "Little Lu, as the saying goes, one monk carries water to drink, two monks carry water to drink, and three monks have no water to drink."

   "This person, it's not that the more the better, and in this place in Jinghua, the idea of ​​​​priority of sons and daughters is more serious. Generally, the family's property will not keep a daughter."

   "After you come to the hospital, whoever pays the medical bills will make the decision."

   Thank you Jiulu Adviser and Fujisawataka for your reward.

   (end of this chapter)