As the days passed, the emergency department was always busy.

Emergency department→ rental → emergency department.

Li Xiyang's life is like an alarm clock on the clockwork,

Walk 24 hours on time and on time every day.

Today it was his turn to be on the night shift, and as soon as he came out of the changing room, Chen Xu hurriedly ran over.

"What's wrong?"

Chen Xu handed over the patient's case and a stack of examination reports, "The patient is delirious, and surgical exploration is recommended." ”

Li Xiyang looked at the report carefully,

The patient, female, was admitted to the emergency department at 5:20 this morning.

nausea and vomiting of gastric contents 3 times, non-projectile vomiting, no coffee-colored liquid, and 3 times of yellow, watery stools,

chest tightness, palpitation, dizziness, fatigue, visual impotence, no fever, and twitching of the limbs.

Physical examination:

T37℃，

P32 times/min,

R21 times/min,

BP160／110mmHg。

The breath sounds in both lungs are slightly thicker, not as good as the dry and wet rales,

The heart rhythm is absolutely irregular, fast and slow, the heart sound is low and dull, and the first heart sound is different in strength......

Judging from the examination report, it is indeed difficult to determine the cause.

"Have you taken a medical history?"

Chen Xu shook his head, "Not yet." ”

"If the medical history is not clear, you dare to perform surgical exploration?"

Li Xiyang was speechless.

Isn't it a joke to cut a knife in the patient's stomach when nothing is clear?

Chen Xu's face was scornful, "The main thing is that this patient is too strange!" ”

"Strange?"

"Let's go, take me to see it!"

Chen Xu led the way, and the two soon came to the hospital bed.

The patient is an aunt and doesn't look any different.

"Hello, I'm emergency doctor Li Xiyang, can you tell me where you are uncomfortable?"

The patient's face turned sickly, covering his head and snorting, "Headache, it hurts badly!" ”

"When did you start getting headaches?"

"This morning, like!"

As soon as these words came out, Chen Xu was stunned, "No, Auntie, you obviously told me that you had a headache last night." ”

"Really?"

The patient patted his head with his hand, as if he had forgotten to say this.

Li Xiyang stared at the patient's movements, groaned slightly and continued to ask.

"Do you remember how many times you vomited?"

"Vomit?"

"No, I have a headache!"

"Hey, you obviously vomited three times, and the medical records all say it, Auntie, you can't talk nonsense!"

Chen Xu hurriedly showed the case to the patient.

The patient waved his hand, "You say three times, three times!" ”

"Hey, you patient, what do you mean I said three times..."

Li Xiyang raised his hand to interrupt Chen Xu and continued to ask the patient, "Auntie, what did you eat last night?" ”

The patient thought about it for a moment, then shook his head, "My head hurts too much, I can't remember!" ”

"And where do you live?"

"My family lives..."

The patient was visibly stunned again, "Home... Live... Oops, my head hurts so much that I can't remember, doctor, hurry up and give me some painkillers! ”

Chen Xu poked Li Xiyang, "Look, I'll just say it's very strange, I can't even tell where I live." ”

Li Xiyang ignored it and continued to ask.

"Auntie, we'll give you painkillers in a while, don't you have to tell me how old you are first, our painkillers are given according to your age."

"Year... Age? ”

The patient thought about it seriously, "30! ”

"What's that?"

Chen Xu's eyes widened, this patient must be at least 60 years old.

"Dr. Li, do you think she's Alzheimer's?"

Li Xiyang picked up the patient's brain CT plain film and looked at it.

Alzheimer's disease, also known as Alzheimer's disease, is a neurodegenerative disease, and the manifestations on imaging are mainly some atrophy.

These atrophys occur mainly in the lobes of the brain, such as the frontal or temporal lobes of the brain.

There are also some brain regions related to cognitive function that also atrophy, such as the hippocampus, which is often referred to as the hippocampus.

The hippocampus is a very important part of cognitive function, and in the event of Alzheimer's disease, the hippocampus of these patients will have very severe atrophy.

In addition, due to cerebral atrophy, the patient will have enlargement of the ventricles and deepening of the sulcus.

However, the brain CT scan of the patient in front of him did not show brain atrophy or enlargement of the ventricles.

Apparently not Alzheimer's.

So Li Xiyang did another physical examination on the patient's body.

But no matter where he pressed, the patient said it hurt.

It is no wonder that Chen Xu suggested surgical exploration, this patient is indeed very strange.

At that moment, the virtual light screen flickered.

[Heart: weak, unable to beat]

[Brain: Lack of oxygen, sluggishness and confusion]

[Eyes: melancholy, tired and tired]

[Gastrointestinal: nausea, lack of motivation]

【……】

Seeing the dialogue of the patient's organs, Li Xiyang confirmed that this was definitely not just a headache.

All organs seem to be in a state of malaise, as if...

Poisoning!

！

Li Xiyang had a flash of inspiration, thought of a possibility, and immediately picked up a banana from the fruit basket at the bedside.

"Auntie, what color do you see this?"

Chen Xu on the side looked confused, thinking about what was wrong with this special mother.

As a result, the patient opened his mouth and said, "Green! ”

"What's that?"

Chen Xu opened his mouth widely, "This person is still color blind?" ”

Li Xiyang shook his head, "It's not color blindness, it's digitalis poisoning!" ”

Digitalis is a common cardiac drug, usually used for the treatment of cardiac insufficiency and heart failure, but it is easy to overdose and poisoning;

The main manifestations of digitalis poisoning are headache, dizziness, nausea and vomiting, as well as yellow vision and green vision.

Chen Xu was still puzzled, "Although these symptoms are consistent, there is one of the most significant features of digitalis poisoning, that is, the cardiac manifestations of digitalis poisoning can include almost any type of arrhythmia.

For example, tachycardia with atrioventricular dissociation, or premature ventricular contractions, or sudden changes in heart rhythm..."

However, before Chen Xu finished speaking, a rapid alarm suddenly sounded on the ECG monitor.

"Damn, I'm really here!"

The patient was fine just now, and the heart rate abrupt turn was only 28 beats per minute.

There is also supraventricular tachycardia with atrioventricular block.

Chen Xu's cheeks twitched, thinking to himself what he and this guy are called!

"Fast, phenytoin sodium is injected intravenously 50~100 mg, lidocaine is given intravenously for the first dose of 50~100 mg, and maintained by intravenous infusion at a rate of 1~4 micrograms/minute."

Li Xiyang quickly gave a doctor's order, and Chen Xu hurriedly went to get the medicine.

In general, the antiarrhythmic effect of phenytoin is very average, but it is miraculous when used in patients with digitalis poisoning.

Sure enough, after five minutes, the patient's heart rate slowly returned to 70 beats per minute.

However, the patient fell into a coma because of the accident just now.

Chen Xu wiped a cold sweat, "Doctor Li, how to treat it next?" ”

"The patient most likely has a history of coronary heart disease, but just in case, you should push her for a cardiovascular imaging later."

"Good!"

"Follow-up treatment." Li Xiyang thought for a while and said, "First stop the cardiotonic medicine that the patient is taking, and at the same time use strong tea or 1:2000 potassium permanganate solution to lavage the stomach, and use magnesium sulfate to guide catharsis."

Oral administration of general antidote or tannic acid protein 3~5g,

At the same time, potassium and magnesium supplementation are supplemented to correct myocardial ischemia,

Atropine is used in conduction block, and epinephrine and isoproterenol are contraindicated.

Install a temporary pacemaker if necessary. ”

"Good!"

After giving the doctor's order, the rest will be handed over to Chen Xu to deal with.

Leaving the ward, Li Xiyang prepared to go to the lounge first to make up for yesterday's case.

At this time, I happened to hear a conversation in the next hospital room.

"Big brother, isn't that one in your family diabetic?"

"yes!"

"Then you shouldn't be lowering blood sugar, why are you still transfusing glucose?"

"Huh?!

”

"Hey, it's really glucose, this doctor has repeatedly explained before, you must lower blood sugar and blood sugar, this... What's going on? ”

"Damn, why did your insulin hit me?"

"It's over, it's over, the little nurse must have made a mistake just now."

"Stop, stop, stop!"

At this time, the door of the ward was pushed open, and Li Xiyang walked in.

As soon as he saw the white coat, the aunt and uncle in the ward directly fried the pot.

"Doctor, what are you doing, how do you work!

”

"This medicine is all wrong, you are not afraid of death!

”

"Fortunately, we noticed, you see that this bottle is almost half dry, hurry up and give our wife a full body check, if something happens, I won't finish with you."

“……”

Everyone was gossiping, and Li Xiyang was really a big one.

Walking to the side of the bed, Li Xiyang glanced at the patient's information.

"He Cuiyun?"

"That's right, it's my wife!"

"Huang Zheng?"

"Yes, that's me!"

Li Xiyang looked at the two of them, then looked at the infusion sheet, then shook his head and smiled, "Don't worry, your medicine is not wrong!" ”

"What's wrong, do you see clearly, we are diabetic, and you still give us glucose, do you think our sugar is not high enough?"

"And I'm here, I don't have diabetes, what insulin do you give me, I'm not afraid of anemia?"

"Don't worry, listen to me!"

Li Xiyang patiently explained, "To give everyone rehydration, normal saline is usually used in hospitals, but in some cases, normal saline is not suitable, and glucose solution is necessary."

For example, in patients with cardiac insufficiency, excessive saline infusion will increase the burden on the heart and induce heart failure;

For example, patients with high blood pressure need to limit sodium intake and should not infuse too much saline;

There are also patients with renal insufficiency, large infusions of normal saline, which can cause hyperchloremic metabolic acidosis,

Especially when used in a state of shock, it can aggravate metabolic acidosis, increase the burden on the kidneys, and even have the possibility of pulmonary edema;

In addition, some patients who have limited food intake for some reason may also need to be given a glucose infusion to replace the calories. ”

He Cuiyun's family clapped their hands, "Yes, my wife has high blood pressure and has a little heart problem!" ”

Li Xiyang smiled and said, "So it's not that diabetics can't use glucose at all, but they can't overdose."

Under the premise of not changing the conventional treatment of diabetic patients, insulin can be used to neutralize the glucose in the infusion, and the ratio of glucose to insulin is generally about 5:1.

The usual usage is to mix 5 U of insulin into a 500mL bottle of 5% glucose injection, which is the normal amount. ”

He Cuiyun's family laughed and stopped.

Then Li Xiyang turned to another patient, "You were admitted to the hospital with a myocardial infarction, right?" ”

The patient nodded, "That's right!" ”

Li Xiyang explained, "The liquid we infused you with is not a simple insulin solution, but a conventional polarizing solution. ”

"Polarizing fluid?"

"Well, the conventional polarization solution is to add 10 ml of regular insulin and 10 ml of 10% potassium chloride to 500 ml of 10% glucose solution, and inject it intravenously."

"Your myocardial fibers are ischemic and the energy is insufficient, and the polarizing fluid provides sugar and potassium chloride at the same time as insulin, which can transfer extracellular potassium back into the myocardial cells and improve the metabolism of the ischemic myocardium;

At the same time, it promotes the entry of glucose into myocardial cells, which has a certain effect on protecting ischemic myocardium, improving sinus and atrioventricular conduction, and preventing arrhythmia. ”

In addition, magnesium sulfate is added, and the main function is to restore the polarized state of myocardial cells damaged by ischemia, thereby reducing the occurrence of arrhythmias, and can provide energy, thereby strengthening myocardial contractility.

So it's not diabetes that requires insulin. ”

Huang Zheng didn't seem to understand it, but he just felt that it made sense.

For a while, the patients on both sides were a little embarrassed.

"Hehe, so that's it, it scared me to death."

"Little doctor, you are really professional, old man, I have always heard that the First People's Hospital is the best hospital in Lan Province, it seems that it is really right!"

"No, my daughter wants me to come to the first courtyard."

Li Xiyang smiled, "Thank you uncle and aunt for your trust in our first hospital, we will definitely work harder in the future." ”

"But if you don't understand anything in the future, ask our nurses to ask our doctors, don't stop taking the medicine by yourself."

"Good, good, certain doctor!"

After reopening the two infusion pipes, Li Xiyang walked out of the ward.

But he hadn't gone two steps before there was a commotion in the other room.