It doesn’t seem incongruent to use food, glucose and various hormones that raise blood sugar to combat hypoglycemia caused by large doses of insulin.

But this is an internal medicine department or an endocrinology department that is extremely sensitive to body fluids. It is not a surgery department that can cut it wherever it is not possible.

The surge insulin in the body and the sharp drop in blood sugar will bring about a series of chain reactions. Hypoglycemia is just a phenomenon of floating on the surface. Even passers-by who have never been to medical school know that excessive insulin can lead to hypoglycemia, and it is a bit embarrassing for front-line emergency doctors to stay at this level.

In the endocrinology department, the drug ratio is adjusted and balanced with various blood electrolyte values ​​is meticulous. For emergency doctors who usually only focus on rescue, it is understandable that they cannot do it.

It’s like letting a big man do rough work to embroider, that certainly won’t work, but at least you have to know that the embroidery tool is needlework.

"In the next 24 hours, this child will continuously produce a lot of insulin. Insulin will consume a lot of blood sugar when entering the blood. Then..." Qi Jing turned to the next page and used a laser pen to scan the screen, "It is continuous stubborn hypoglycemia."

"Can't the method we give fight against hypoglycemia?"

"You haven't thought that hypoglycemia would cause other problems?"

Qi Jing did not answer, but instead lost a question and went back. However, seeing that they didn't respond, they stopped forcing them. Since the focus was on hypoglycemia, let's get through the hypoglycemia first: "Forget it, let's talk about hypoglycemia first, let's go one by one."

The solutions given by those pre-hospital doctors are nothing more than two major solutions, which are to improve blood sugar and suppress insulin.

The hormones that suppress insulin are frequent visitors to pre-hospital emergency services. The usage and dosage are all in their minds, so there is no need to talk about it. However, this seemingly extremely simple operation hides many pitfalls.

"Is it okay to replenish hypertonic sugar?"

"It depends on how to supplement it. There are many clinical ways to supplement sugar." Qi Jing looked at the colleague who asked the question and asked again, "10%? 20%? or 50%?"

"50% is too exaggerated, 10% is not enough, I choose 20%.

"Indifference?"

"No, he has so much insulin in his body, so it is impossible for him to rely on intravenous injections to maintain it all the time. I choose intravenous drip."

"Intra-drip hypertonic sugar? You should know that this patient carries a lot of insulin, and the intra-drip time will be very long. Once the time is longer, it will cause many problems."

After saying that, ppt changed to the next page. As the pictures appeared, surprise and sighs came from the audience.

On the screen is the right hand of a middle-aged woman, with several seals on the back of her hand, while the needle for the infusion was hit on her finger. However, this finger is different from the other ones, and simply put it black.

Without this picture, those doctors might not have thought of this: "Is this a blood vessel leakage caused by hyperosmotic sugar?"

"Yes." Qi Jing looked at the photo on PPT and said, "This is a hypoglycemia patient admitted to a secondary hospital last fall. He also committed suicide, but he used Xiaoxie pills and swallowed 20 pills at a time."

In fact, this is a lawsuit that Lu Zishan received, and the pictures were also provided by her.

Xiaoxie Pills contain glibenflex, which is the easy to lower the sugar. It has a half-life of 8 hours. If you want to have antagonism, you need to maintain a long period of sugar replenishment.

This type of sugar supplement is often used for hypertonic sugar, but it is completely different from stuffing sugar into your mouth.

Because the doctor there was improper method of treating hypertonic sugar rehydration, he wiped out three or four blood vessels on the back of the patient's hand, and finally chose a vein on his finger for drip.

But the doctor there didn't know that leaking caused by hypertonic fluid in the peripheral vein will cause dehydration and necrosis of the endothelium, causing veins to shrink and harden. It will not only induce infection, but also cause limb ischemia and necrosis in severe cases.

The finger in the picture has reached the point of ischemia and necrosis. There is no possibility of recovery and can only be severed in the end.

After reading the materials, Qiao Li decided that the lawsuit would definitely be lost. In the end, the hospital had to settle the matter and paid a lot of money.

The picture left behind has become the best "souvenir" to educate doctors and medical students. It can not only tell them how to keep the patient's fingers while supplementing sugar, but also exempt them from compensation for the hospital where they are located.

"If it was a hand, it wouldn't be like this, right?"

"Even if there is blood clot in the arm phlebitis, it will not cause necrosis due to side collateral circulation."

"If the peripheral blood vessels don't work, use deep vein puncture."

“Yes, deep vein puncture doesn’t have this concern,”

"Yes, the deep veins are much more elastic and thicker. Facing hypertonic fluid will not cause such severe phlebitis. However..." Qi Jing glanced at them and asked casually, "I wonder how many of you here have successful experience in deep vein puncture in the ambulance car?"

Just now, a seemingly show-like case discussion became a special Q&A session.

Now, under the guidance of Qi Jing, ordinary questions and answers have further risen to the level of soul-searching.

In fact, let alone deep venous puncture in an ambulance, even ordinary venous puncture has a high failure rate. The bumpy carriage, without professional anesthesia doctors, the original training volume of pre-hospital doctors is insufficient.

Moreover, when patients need to puncture the deep vein for catheterization, they are often accompanied by very serious diseases and trauma. At this time, emergency doctors need to do a lot, and deep vein puncture is not the top priority. Even when it is time to puncture, they can wait in just a few minutes' drive.

After all, there are professional anesthesiologists in the hospital, and no matter what, the success rate is higher than that of the lone gangsters like them.

"I have too high requirements. As long as I have experience in puncture, I can raise my hand if I have done it."

The venue was still silent.

I don’t know who mentioned it first, but everyone packed the questions and threw them back to Qi Jing: “You are also a part of the pre-hospital emergency, have you done it?”

Qi Jing spread his hands, not shy about it: "Of course I haven't done it."

"Don't be too demanding of others if you haven't done it."

"Yes, we first extended the first aid journey to 20 minutes, and now we are asked to do deep vein puncture in the car. You must know that we are just one person and we don't have the help of nurses, so everything depends on ourselves, so we are not that omnipotent."

Qi Jing nodded and expressed his understanding of their complaints: "I know our working environment very well, so I don't do deep vein puncture, and I still choose peripheral veins."

"What if it's phlebitis?"

"You can't reduce the concentration?"

"The concentration is low, and the increase in blood sugar cannot keep up with the output of insulin."

"You can't take one more vein and drip on both sides?"

"this......"

"As long as the total amount of glucose is in place, high concentration is not the only option." Qi Jing pointed his head with his finger and said with a smile, "Sometimes you need to know how to adapt and don't be stubborn."

The truth is indeed this truth, but everyone seems to be unwilling to buy it.

But I really have to find a loophole but can't tell you, so I can only choose a shortcoming that is not a shortcoming: "Can the patient take so much fluid after so much fluid replenishment?"

"......this."

"If you really want to find a problem, you shouldn't say this."

"The child is only 15 years old, so I just need to replenish more fluids. What can happen if I go to the toilet a few more times?"

"Yes, what can I do...wait..."

The more everyone thought about it, the more something was wrong. Looking at Qi Jing standing quietly on the podium, he suddenly thought of a problem, a problem they had always ignored.

Seeing that they reacted well, Qi Jing finally laughed again: "I thought of it?"

"Is it hypokalemia?"

"The blood sugar in the blood circulation decreases, and the potassium ions required for synthesis of glycogen will decrease, and the potassium ions will transfer from the outside of the cell to the cell." A pre-hospital doctor recalled some electrolyte knowledge with difficulty, "Continuous hypoglycemia will cause the blood potassium to continue to decline, and finally..."

"Finally die!"

"Yes, I usually use glucose and insulin when treating hyperkalemia. Why do I forget it in reverse..."

"Congratulations on finally finding the key point of hypoglycemia, hypokalemia."

Qi Jing raised his hand and looked at the watch. It had been 13 minutes since the patient's case discussion. Although it wasted some time, it was still within the controllable range.

He pulled down his cuffs and comforted with a smile: "It seems that everyone's foundation is still there. He can consider electrolyte imbalance from a lot of urination, and then think of hypoglycemia and then hypokalemia, which is good."

Everyone breathed a sigh of relief after hearing this. Although they were a little embarrassed before, they still earned their face back. But they always felt that something was strange and they felt like they were led by someone.

The whole discussion process was like someone arranged it in advance.

It is certain that discomfort, but compared to Xiao Wansong's anger, it is just a minor disease of scabies, so I endured it. It is inappropriate to care too much about these details now, after all, the discussion has not ended.

"Since there is hypokalemia, you can try to supplement some potassium first."

"The blood potassium is too important. You must have specific values ​​before you can replenish it." A doctor on the other side asked, "I don't know how much blood potassium is in the patient?"

"After admission to the hospital, blood potassium 2.8," said Qi Jing.

"It is already moderately low potassium, and potassium must be supplemented as soon as possible. In order to resist the hypoglycemia storm caused by insulin, I think it can be supplemented to more than 5."

"Yes, that's right."

“Can be continuously monitored for blood potassium…”

There are many different opinions from pre-hospital doctors, but the final conclusion is very consistent, that is, to supplement potassium on the basis of sugar supplements.

Hypokalemia can cause problems with neuromuscular conduction, and it does need to be corrected as soon as possible, but the fact is not that simple. Stubborn hypoglycemia also affects blood potassium. Even after starting to supplement potassium, the blood potassium concentration in the girl's body remains below the normal value.

"Can't make up for it?"

"At least the amount you gave cannot be filled."

"I can't control that much, increase the potassium supplement."

"But will there be any problem with giving so much potassium at one time?" The doctor who just proposed to resolutely supplement potassium suddenly retreated, "I have never supplemented so much potassium."

"You just said you should prevent hypokalemia, why are you scared now?"

"What about the reason? You can give me a reason at least."

"I just think..." The man couldn't help but look at Qi Jing on the stage, "I think there will be a pitfall."

After he reminded me, everyone suddenly noticed something. Since the beginning of the case discussion, Qi Jing has been digging holes. Even if he is stupid, he should learn his lesson after stepping on the holes so many times.

Seeing that there was no sound in the audience, Qi Jing asked, "Hmm? Why don't you continue talking?"

"It's better to replenish potassium according to the original method and use potassium-conserving diuretics."
To be continued...