Although he really wanted to help, Sun Lien was just an emergency physician who had a cheat. He could influence and master very little about the things on the other side of the ocean - he was not even as good as Xu Yourong, who had lived in the United States for several years.

Although Sun Lien himself had the idea of ​​helping, it was obviously more important to know himself than this idea. Xu Yourong had just arrived in the United States and his lover was locked in a mental hospital and suffered a lot. Now he was afraid that his mind would be full of lawsuits. In this case, it was obviously not a clever move to call him to ask about the situation.

Sun Lien no longer knew how many sighs he sighed today. But he still restrained his emotions. Although the hospital is a place where science and technology occupy the main guiding factors, the emotions of the doctors are actually equally important. Even if the treatment plan prescribed by a confident doctor and a dejected doctor is completely consistent, the effect will sometimes be a little different when the patient keenly realizes that the doctor has no confidence.

Since it's a job, you have to be worthy of your responsibilities. Sun Lien rubbed his face, stood up and prepared to complete the final rounds. Wang Ge's condition has improved now, but he is still a long way from being discharged from the hospital. His personality seems to have begun to change, at least he is not as frequent as before.

"Doctor Sun, I'm looking for you." As soon as he walked out of the office, Sun Lien was stopped by Professor Zhang. Professor Zhang Zhifu walked over with his legs and happily patted Sun Lien's arm and said, "I just answered a call. Dean Liu said that I asked me to go to the ICU to see if there are any patients who need to be diagnosed."

The intensive care medicine department of the Fourth Hospital is basically the busiest department in the entire hospital except for pediatrics and emergency departments. Intensive care departments such as u and picu are directly managed by cardiac and pediatrics, otherwise a few doctors in the intensive care medicine department would have to die on the spot to protest.

Get more departments and departments to generate income? If it doesn’t exist, no matter how delicious the money is, you have to have the life to spend it.

From the perspective of critical care medicine doctors, their attitude towards Sun Lien and the Comprehensive Diagnostic Center is very complicated. On the one hand, Sun Lien and the Comprehensive Diagnostic Center have taken action many times in the past and found the cause of the patients in time to stabilize their condition. Except for a small number of patients who can directly enter the Comprehensive Diagnostic Center for hospitalization or transfer it to other specialized hospitalization departments, the rest were stuffed into the ICU.

In the past year, ICU's workload has increased by at least 12% year-on-year, and these books are all due to Sun Lien.

Although I hate a lot of work, the doctors at the ICU have to admit that Sun Lien and the patients sent to the Diagnostic Center have all been diagnosed with clear diagnosis. They don’t even need to do additional tests, just treat them according to the Diagnostic Center’s opinions.

Therefore, the entire critical care medicine department has a very disagreement towards the comprehensive diagnosis center. Most hospitalized and attending people think that the diagnosis center is in trouble, while the above-mentioned hospitalizations have a strong likes for the diagnosis center - diagnosis in the field of critical care medicine is also a very important part. Many times, after finding the cause, doctors in the critical care medicine department can even start targeted treatment before the disease further develops. This "leading step" treatment model greatly increases the survival probability of patients transferred.

However, not all patients who stay in the ICU can enjoy this kind of "leading" treatment. Although the emergency department of the Fourth Hospital is strong, it is only an emergency department after all. There are not many patients who can obtain complete and accurate diagnosis in the emergency department. Especially when the patients are already in danger of life, the requirements for diagnosis in the emergency department should naturally be relaxed a little more - unless it is a monster like Sun Lien who can save and diagnose while doing a diagnosis, other emergency doctors will first stabilize the situation of critically ill patients, then make a preliminary diagnosis and judgment based on the current information, and finally send the person to the ICU and be finished.

After other examinations were improved in ICU, patients with stable vital signs and basically clear diagnosis would be sent to the corresponding specialist for further hospitalization.

This also leads to many patients in ICU who need to be diagnosed every day, and the general disease is not very mild. In the past, it was almost impossible to completely cover these patients who need to be diagnosed by only Sun Lien's team. But now with Professor Zhang's team, the critical care medicine department suddenly became energetic. Before Professor Zhang Zhifu could contact them on his own initiative, the critical care medicine department found Liu Tangchun, "Director Liu, can you ask Professor Zhang to come to us for a diagnosis?"

There are several more troublesome patients in the ICU. Especially a diabetic patient who has been living in the ICU for three days is particularly troublesome.

"Diabetes? Is it ketosis coma?" Sun Lien and Professor Zhang Zhifu sat together in the small office of the Critical Care Medicine Department looking at the information. Sun Lien originally planned to remain silent throughout the whole process, but just came over to show his face. But when he heard that the patient who was currently thinking that the most difficult in the Critical Care Medicine Department was actually diabetes, Sun Lien couldn't help it now.

Most diabetic patients can be divided into two categories according to their classification - type 1 diabetes or type 2 diabetes. Patients with type 1 diabetes cannot produce enough insulin, so they will have symptoms of hyperglycemia. Most patients with type 2 diabetes have symptoms of insulin resistance, and their bodies have poor response to insulin. Therefore, they obviously produce enough insulin, but the blood sugar content in the body still cannot be reduced.

When the blood sugar content is always at an extremely high level, the human body will experience serious metabolic disorders. This metabolic disorder will cause the human body to be unable to use the glucose in the blood to supply energy, thereby turning it into fat consumption.

Fats first need to be converted into ketone bodies, so that the human body can use them. However, when the ketone bodies are produced too much and exceed the extent that the tissue can use, the patient will experience ketoneemia and ketouria. The most direct consequence of ketone accumulation is diabetic ketoacidosis.

Ketoacidosis is a common emergency in internal medicine, but... from Sun Lien's perspective, it is far from the point of diagnosis. Ketopathy has very clear indications, with random blood sugar content greater than 16.7 mmol/l, blood ketone bodies greater than 4 mmol/l, and patients with unclear consciousness and reduced plasma carbon dioxide binding capacity.

Although ketoacidosis is an acute disease or even a severe disease, its diagnosis is not difficult. Sun Lien can't understand why ICU treats this patient as a case that "needs a diagnosis center."

"It's not acidosis." Sun Lien's doubts were quickly answered to a certain extent, "This is a patient with hyperosmotic coma."

The full name of hyperosmotic coma is "hyperosmotic non-ketopathy diabetic coma". As its name suggests, this is a non-ketopathy coma caused by diabetes. Patients mainly suffer from aggravated glucose metabolism disorders, resulting in hyperosmotic dehydration of the extracellular fluid, which causes hypovolemia and hyperosmotic dehydration caused by hypovolemia. This dehydration manifests in the patient and becomes "coma".

"The patient is 29 years old. The family said that the patient has obvious polyphonic and polyuria in the past two years, and the daily water consumption is greater than 2,000ml." Wu Faxian, director of the Department of Critical Care Medicine, told Sun Lien and Professor Zhang, "And this is a heavy lover of Coke, drinking at least three bottles of Coke every day. Because his weight has been declining for two years, his family did not think there would be any problems with his body."

Drinking cola generally makes people gain weight, which is the main reason why many people love and hate carbonated beverages. But compared to gaining weight, what is more terrifying is that "it obviously drinks a lot of cola every day, but the weight decreases." Generally speaking, this means that patients are very likely to suffer from diabetes - drinking more and urinating more, and losing weight when eating too much is the main early signal of diabetes.

"Good guy...1,000 ml per day." Professor Zhang was also shocked by this data, but he quickly focused on other contents. "It's a bit early to start the disease at the age of 29."

"We also suspected that it might be type 1 diabetes, but the patient's condition did not support this judgment." Director Wu continued, "He was found to be drowsy at 7:00 am on the morning of the day of his admission, but he could simply answer the questions. At 12:30 noon, he began to feel refractory, restlessness and shortness of breath. The patient's family handed 120 and urgently checked his blood sugar in the emergency room. The blood sugar content was 79.42 mmol/l, ph6.98, and urinary ketone body 2."

Good guy... Sun Lien was shocked by this data. With such high blood sugar, the blood of this patient might taste sweet.

"The emergency department checked him for CT, which indicated that there were multiple infections in both lungs, pulmonary edema and cerebral edema." Director Wu continued to introduce, "The emergency department added 8,000 ml of crystal liquid, and 3,000 ml of urine. 160 units of insulin were used, and blood sugar dropped to 22 mmol/l. At the same time, the cephalosporin was also given anti-infection, and 5% sodium bicarbonate was used in total. "

Sun Lien vaguely saw from this series of numbers the appearance of the chaotic emergency department at that time. 5% sodium bicarbonate is a first-line clinical drug used in clinical treatment of metabolic acidosis. However, this injection is generally not used too much - its packaging is generally 10ml or 20ml ampoule.

He used 375 ml in one breath... Sun Lien adjusted his sitting position and felt a little sympathetic to the nurse responsible for dispensing medicine at the time.

"After we took the person up, we checked the blood sugar again, 22.8 mmol/l, replenished 3500ml of fluid again, and continued to use insulin. At the same time, we also used meropenem to fight the infection. At 5:20 am today, the patient had cyanosis. The spo2 was reduced to 80%, and we intubated him."

Professor Zhang's face was as deep as water. After a while of silence, he nodded gently and said, "I'll take this patient."

Sun Lien was silent thoughtfully, and it was easy to say otherwise, but from Director Wu's introduction, he still felt a little awkward. This awkward mainly comes from the physical reaction of this patient whose "blood may taste sweet".

The blood sugar content is 79.98mmol/l, which sounds terrible. But Sun Lien thinks that what's even more terrible is still there.

Insulin is a very powerful hypoglycemic substance. A unit of insulin can neutralize about 3 grams of glucose. The molecular weight of glucose is 180, while a normal person's blood volume is about 4.2~4.8 liters. In other words, a unit of insulin can reduce blood sugar by about 3.47~3.96 mmol/l.

And this patient...the emergency department alone used 160 units of insulin. If calculated according to this ratio, under such a huge dosage, as long as the patient's blood sugar content is not higher than 555mmol/l, fatal hypoglycemia may occur.

But not only did he not have hypoglycemia, but even after supplementing 8,000 ml of liquid, his blood sugar was still as high as 22.8 mmol... The insulin resistance was too serious.
Chapter completed!