The two only exchanged a few words in a low voice and did not continue.
It was a mess all around, and who knew if there were any family members of the patients. And just by listening to what the 120 emergency doctor said, there was no way to judge the specific situation at that time.
It's all just guesswork, there's no way to tell. But if you are self-righteous and preach to the patient's family, the doctors below may be in trouble.
Don't cause trouble for people, that's the most basic thing.
Fortunately, the patient has woken up and there is nothing to worry about.
Zhou Litao called the patient's family to ask about the situation and asked them carefully. Zheng Ren listened for 2 minutes, then leaned over and asked, "What medicine did the patient take last night?"
"Uh..." The patient's family members were stunned and tried to think.
"Boss Zheng, what do you suspect?"
When Zheng Ren saw his family members looking for a medicine box in their luggage, he whispered: "Patients with hyperthyroidism generally have a fast heart rate. Oral propranolol is recommended to lower the heart rate. It is recommended in major guidelines and can inhibit the conversion of T4 to T3, making it the first choice drug."
However, large doses of β-blockers can weaken the effect of catecholamines, inhibit hepatic glycogen decomposition, reduce hepatic glucose output and gluconeogenesis, inhibit fatty acids, reduce blood glucagon levels, and reduce blood sugar production. "
In other words, taking too much of this drug will cause blood sugar to drop.
"I understand." Zhou Litao said immediately.
In fact, as soon as Zheng Ren started, Zhou Litao thought of this.
After all, he is not an endocrinologist, so Zhou Litao is not very familiar with the fact that beta blockers can cause hypoglycemia.
But if Zheng Ren wasn't here, he probably wouldn't miss it. Zheng Ren was there, reminding me of the direction and speeding up the process of asking for medical history.
Sure enough, family members came over with propranolol pill boxes.
Because the patient's condition is not serious and his activities are normal, he does not have any family members to accompany him. I heard from a clinical person this morning that the patient's heart rate was fast last night and there was no obvious relief within 30 minutes after taking the medicine orally, so the dosage was increased again.
After this incident, Zhou Litao saw that the patient was fine, so he asked the emergency medicine doctor to write a bill and keep him in the hospital for observation.
Let’s observe it for a while first.
It's just hyperthyroidism, but there is no way to be admitted to the hospital.
After finishing his work, Zhou Litao called Zheng Ren to his duty room.
"Boss Zheng, your eyes are so bright. Have you ever done endocrinology?" Zhou Litao took out a box of Ziyun, which Su Yun despised.
"No, I met a similar patient in Xiangjiang a while ago, but it was not hyperthyroidism." Zheng Ren said casually.
Su Yun glanced at Zheng Ren. This answer was too careless.
Hypoglycemia refers to a decrease in glucose concentration in the blood, eventually leading to symptoms and signs including impaired brain function.
Clinical manifestations range from behavioral changes, fatigue, and confusion to seizures and loss of consciousness, that is, functional brain failure.
Therefore, many patients with hypoglycemia are often misdiagnosed as epilepsy or even depression or mania.
Qin Lu's illness, mania, etc., was related to hypoglycemia, but he seemed to see it at a glance at the time.
This guy is so sneaky and really unpleasant to look at.
It's a pity that no matter what I do, I can't catch up with him. I really want to find a chance to confront him once, Su Yun thought to himself while smoking a cigarette.
"By the way, Mr. Zhou, how do you judge that your blood sugar is low?" Zheng Ren asked.
"When the patient came, I felt something was wrong." Zhou Litao said with a smile: "If you want to sleep with the nurse on duty, and flirt with a girl without being so direct in the ward in front of others, there must be something wrong."
"Well, yes." Su Yun said: "I once met a patient who suffered from a car accident, multiple rib fractures on both sides, bilateral hemopneumothorax, ruptured lung, traumatic wet lung, and head trauma. In the ICU after the operation, I was put in a tube and ventilated for 3 days. Then I was extubated. What do you think the first sentence was?"
Zheng Ren smiled but said nothing.
Zhou Litao asked suspiciously: "Isn't it related to the nurse?"
"He held the ICU head nurse's hand and said they would go drink wine together in the evening." Su Yun laughed.
"What happened next?" Zhou Litao also had a lot of gossip on his mind.
Being the general resident in the emergency department and listening to some gossip is considered as joy in suffering.
"Later, his condition stabilized a little, and he was kicked out of the ICU." Su Yun said with a smile.
The conditions are different, but the symptoms are similar.
"Boss Zheng, what are the patients in Xiangjiang you are talking about?"
"There is plaque in one of the feeding arteries of the pancreas, and the intermittent flow rate changes lead to abnormal insulin secretion. He is a little more advanced than these two patients. He is not talking nonsense, but what he has experienced virtually." Zheng Ren briefly told Qin Lu disease.
"Tsk, tsk." Zhou Litao secretly wrote down the case Zheng Ren mentioned.
Although you may not encounter similar patients in your life, if you do, you can have a shadow or an impression in your mind, which will at least reduce the chance of misdiagnosis or missed diagnosis.
"Mr. Zhou, if the patient is not hypoglycemic, what are you going to check?" Zheng Ren continued to ask.
"Psychiatric symptoms in patients with hyperthyroidism may generally be due to electrolyte imbalance, pre-hyperthyroid crisis, hypoglycemia, or autoimmune encephalitis. It is most convenient to check blood sugar, and the symptoms may appear when the patient is asleep. If not, check one by one."
Zhou Litao had a solid foundation. Zheng Ren had just finished asking, and he said casually.
Zheng Ren thought to himself that 912 has a profound foundation. A chief resident of the emergency department is so powerful.
It is difficult for doctors in departments other than glandular surgery and endocrinology to know the details about hyperthyroidism.
This is the role of specialists, but every good thing has its disadvantages. The more you delve into a certain direction, the less you will know about diseases in other departments.
"Boss Zheng, you are really all-powerful." Zhou Litao said with a smile, "Do I have anything to pay attention to about this patient?"
"It's nothing, you can take care of it." Zheng Ren said with a smile, "After two days of observation, he will be sent to a specialist clinic. You can handle the hypoglycemia in the emergency department. By the way, tell the patient not to take medicine casually. "
"Yeah, it's really life-threatening to eat as much as you want." Zhou Litao said, "Boss Zheng, for patients with Gaucher's disease, when are you going to do a live broadcast of the surgery?"
"I don't know. If there are no problems, the sooner the better." Zheng Ren said.
"I've watched your live surgery, and it was really good." Zhou Litao was a little envious.
No one wants to be in the emergency department if they can go to surgery and be a surgeon.
But when I made a mistake, I regretted it for eternity. I was young, ignorant and deceived into coming to the emergency department.
Today's children are more sophisticated than the last, and not many of them are engaged in the medical field after graduation, let alone emergency medicine.
The more Zhou Litao thought about it, the more he felt that his future was bleak.
How great it would be to be like Boss Zheng.
These are still bearable. The key is that Boss Zheng is very skilled and has a girlfriend!
It doesn’t matter if he has a girlfriend. I can give it to him when he still has surgery.
Sigh... Zhou Litao sighed.
Zheng Ren and Su Yung were about to leave when they suddenly heard a series of hurried footsteps coming from the corridor.