Although he wanted to help, Sun Lien was just an emergency physician after all. On the other side of the ocean, there is very little content he can influence and grasp - even Xu Yourong, who has lived in the United States for several years.

Although Sun Lien himself has the idea of helping, self-knowledge is obviously more important than this thought. Xu Yourong has just arrived in the United States, and his lover is being locked up in a mental hospital and tortured, and now he is afraid that his mind will be full of lawsuits. In such a situation, it is obviously not a smart move to keep calling to inquire about the situation.

Sun Lien didn't know how much he sighed today. But he still restrained his emotions. Places like hospitals are places where science and technology are the main guiding factors, but the emotions of doctors are just as important. A confident doctor and a frustrated doctor can sometimes have a slightly different effect on a patient, even if the plan is exactly the same—especially when the patient is keenly aware of the lack of confidence in the doctor.

Since it's a job, you have to be worthy of your duties. Sun Lien rubbed his face, stood up and prepared to complete the final round. 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 somewhat, at least not as often as he used to be.

"Dr. 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 skimmed, patted Sun Lien's arm happily and said, "I just answered a phone call, and Dean Liu said that I should go to the ICU to see if there are any patients who need to be diagnosed." ”

The intensive care department of the four hospitals is basically the busiest department in the entire hospital except for the pediatric and emergency departments. Thanks to the CCU, intensive care units such as the PICU are directly managed by cardiology and pediatrics, otherwise doctors in the intensive care department would have died on the spot in protest.

Scoop up a few more departments and departments to generate income in your hands? If it doesn't exist, no matter how fragrant the banknotes are, you have to have a life to spend them.

From the perspective of intensive care physicians, 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 to find the cause of the patient's illness in time and stabilize their condition. Except for a small number of patients who were able to go directly to the comprehensive diagnostic center for inpatient treatment or transfer to other specialized inpatient units, the rest of the brain was stuffed into the ICU.

In the past year, the workload of the ICU has increased by at least 12% compared to last year, which is due to Sun Lien.

Although they hated a lot of work in their hearts, the doctors in the ICU also had to admit that Sun Lien and the patients sent by the diagnostic center were all diagnosed. They don't even need to do additional tests, just follow the advice of the diagnostic center.

Therefore, the attitude of the entire intensive care department towards the comprehensive diagnosis center is very inconsistent. Most of the inpatients and attending patients find the diagnostic center a nuisance, while the general manager and above have a good opinion of the diagnostic center - diagnosis in the field of critical care medicine is also a very important part. In many cases, the cause is identified, and doctors in the intensive care department are able to start targeted treatment even before the disease progresses further. This "one step ahead" treatment model greatly increases the survival probability of the patients who are referred.

But not all patients who remain in the ICU are able to enjoy this "one step ahead" treatment. Although the emergency department of the fourth hospital is strong, it is only an emergency after all. Not many patients are able to obtain a complete and accurate diagnosis in the emergency department. Especially when the patient's life is obviously in danger, the requirements for diagnosis in the emergency department will naturally be relaxed a little more - unless it is a monster like Sun Lien who can make a diagnosis while rescuing, other emergency doctors will first stabilize the condition of the critically ill patient, and then make a preliminary diagnosis and judgment based on the current information, and finally send the person to the ICU to settle the matter.

After other tests have been completed in the ICU, patients whose vital signs are stable and whose diagnosis is largely clear will be sent to the appropriate specialist for further hospitalization.

This also leads to the fact that there are many patients in the ICU who need to be diagnosed every day, and the general illness is not mild. In the past, it was almost impossible to completely cover these patients who needed to be diagnosed with only one Sun Lien team. But now with Professor Zhang's team, the Department of Critical Care Medicine is suddenly in spirit. Without even waiting for Professor Zhang Zhifu to take the initiative to contact them, the Department of Intensive Care Medicine found Liu Tangchun, "Director Liu, can you please ask Professor Zhang to come to us for a diagnosis?"

There are a few troublesome patients in the ICU. This is especially true for a diabetic patient who has been in the ICU for three days.

"Is diabetes mellitus a ketosis coma?" Sun Lien and Professor Zhang Zhifu sat together in the small office of the intensive care medicine department and looked at the materials. Sun Lien originally planned to remain silent the whole time, just come over and show up. But when he heard that the most difficult patient in the intensive care department was actually diabetes, Sun Lien couldn't help it.

Most people with diabetes can be classified into two categories – type 1 diabetes or type 2 diabetes. People with type 1 diabetes can't produce enough insulin from their pancreas, so they experience symptoms of high blood sugar. Whereas, most people with type 2 diabetes have symptoms of insulin resistance, and their bodies do not respond well to insulin. As a result, enough insulin is produced, but the blood sugar level in the body still does not go down.

And when the blood sugar level is always at an extremely high level, the human body will have serious metabolic disorders. This metabolic disorder causes the body to be unable to properly use glucose in the blood for energy, and thus burns fat instead.

Fat first needs to be converted into ketones before the body can switch to using it. However, when ketones are produced too much and beyond what can be used by tissues, patients will develop ketosis and ketonuria. The most direct consequence of ketone accumulation is diabetic ketoacidosis.

Ketoacidosis is a common medical emergency, but ...... From Sun Lien's point of view, it is far from the point where it needs to be diagnosed. There are very clear indications for ketosis, with random blood glucose levels greater than 16.7 mmol/L, blood ketones greater than 4 mmol/L, and patients with clear symptoms such as unconsciousness and decreased plasma carbon dioxide binding.

Although ketoacidosis is an emergency and can even be called severe, its diagnosis is not difficult. Sun Lien couldn't understand why the ICU would treat this patient as a case that "needed a diagnostic center".

"It's not acidosis. Sun Lien's doubts were quickly answered to a certain extent, "This is a hyperosmolar comatose patient. ”

The full name of hyperosmolar coma is "hyperosmolar non-ketotic diabetic coma", as the name suggests, this is a non-ketotic coma caused by diabetes. Patients are mainly due to hypertonic hypertonic dehydration of extracellular fluid, which is caused by increased glucose metabolism. And this dehydration manifests itself in the patient, which becomes a "coma".

The patient is 29 years old, and his family members said that the patient had obvious polyphonic polyuria in the past two years and drank more than 2,000ml of water per day. Wu Faxian, director of the Department of Critical Care Medicine, said to Sun Lien and Professor Zhang, "And this is a heavy lover of Coke, drinking at least three bottles of Coke a day." Because he has been losing weight for two years, his family didn't think there would be anything wrong with his body. ”

Drinking cola generally makes people gain weight, which is the main reason why many people love and hate carbonated drinks. But what is more terrible than gaining weight is the situation of "drinking a lot of Coke every day, but losing weight". In general, this means that the patient is at high risk of developing diabetes – polydipsia, polyuria, and weight loss due to polyphagia are the main early signs of diabetes.

"Good fellow...... 1000 ml a day. Professor Zhang was also shocked by this data, but he quickly focused on other content, "The onset of 29 years old is a bit early. ”

"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 drowsy by his family at 7 a.m. on the day he was admitted to the hospital, but he could answer questions simply. At half past twelve o'clock in the afternoon, the phenomenon of inappertion, restlessness and shortness of breath began to appear. The patient's family paid 120 and urgently checked the blood sugar in the emergency department, the blood glucose content was 79.42mmol/L, PH6.98, and the urine ketone body was 2+. ”

Boy...... Sun Lien was taken aback by this data. With such high blood sugar, this patient's blood may taste sweet.

"The emergency department examined him with a CT scan, which suggested the possibility of multiple infections in both lungs, pulmonary edema and cerebral edema. Director Wu continued, "The emergency department replenished 8,000ml of crystalloid and 3,000ml of urine output. After taking 160 units of insulin, the blood sugar dropped to 22 mmol/L. At the same time, it also gave cephalosporin convergence anti-infection, and 5% sodium bicarbonate was used in a total of 375ml. ”

Sun Lien vaguely saw the appearance of the emergency department in chaos at that time from this string of numbers. Sodium bicarbonate 5% is a first-line clinical drug used in the treatment of metabolic acidosis. But this injection is generally not used in large quantities - it is usually packaged in 10ml or 20ml ampoules.

I used 375 ml in one go...... Sun Lien adjusted his sitting posture and sympathized with the nurse who was in charge of dispensing medicine at that time.

"After we took the person in, we rechecked the blood sugar at 22.8mmol/L, rehydrated 3500ml, and continued to use insulin. Meropenem is also used to fight infection. At 5:20 a.m. today, the patient developed a cyanotic complexion. SPO2 was reduced to 80% and we intubated him. ”

Professor Zhang's face sank like water, and after being silent for a while, he nodded lightly and said, "I took this patient." ”

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

The blood sugar level is 79.98mmol/L, which sounds terrible. But Sun Lien felt that more terrifying was yet to come.

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

And this patient ...... He was given 160 units of insulin in the emergency department alone, and if calculated according to this ratio, as long as the patient's blood sugar level is not higher than 555mmol/L, there is a risk of fatal hypoglycemia under such a huge dose.

But not only did he not have low blood sugar, but even after supplementing 8000ml of fluids, his blood sugar was still as high as 22.8mmol...... This insulin resistance is also too severe.