Diabetic ketoacidosis,

is a syndrome caused by insulin deficiency and inappropriate increase of glucagon, leading to dysfunction in the metabolism of sugar, protein, and fat.

It is considered a common acute complication among diabetic patients.

If treated in time, the mortality rate is not high.

However, it’s indeed a bit strange for it to occur in this girl without a history of diabetes.

When at Jiangcheng City First Hospital, Qin Feng had encountered a case of diabetic ketoacidosis, which involved a man with type 3 diabetes and almost died because of it.

So even though the fatality rate is not high, it still needs to be taken seriously.

"Nurse Chief Han, please call the lab to expedite the tests, I need to see the results as soon as possible."

Qin Feng turned his head and spoke to the short-haired middle-aged woman next to him.

"Okay, I’ll go now."

Han Yu, the senior nurse chief of the emergency department, started work along with Dong Hao in the emergency department.

years have passed, and now she has become one of the most important figures in the emergency department of Peking Union Medical College Hospital.

Known for her swift and efficient style, hardworking and diligent, not just ordinary doctors and nurses, even Dong Hao is courteous to her.

After all, nurses work even harder in the emergency department!

Meanwhile, Zhang Qingquan’s face grew increasingly uneasy, a trace of panic flashing in his eyes.

But at this moment, he already realized, fortunately, he didn’t perform surgery on Zhang Jiajia.

If it really were diabetic ketoacidosis, once she was on the operating table and something went wrong, the consequences would be significant!

This is why it’s necessary to conduct a comprehensive pre-surgical examination and ensure a second confirmation before the surgery.

"Director Qin, what’s going on? Is there something wrong with my daughter?"

Just as Qin Feng was about to speak with Zhang Qingquan, the girl’s father approached.

"Here’s the situation, we found that your daughter’s blood sugar level is several times higher than that of an ordinary person, which shouldn’t appear at her age.

Coupled with the lack of a previous history of diabetes, we initially suspect she might be experiencing diabetic ketoacidosis."

Qin Feng explained briefly.

"Diabetes... poisoning?

Could this be dangerous?"

Upon hearing this, the girl’s father frowned but remained calm.

"Don’t worry, if our diagnosis is correct, she should not need surgery."

Qin Feng smiled faintly and comforted him.

"No surgery needed? Does that mean it’s not serious?"

The girl’s father’s eyes lit up at these words, and he turned to look at Zhang Qingquan, asking in surprise,

"So that means the previous diagnosis was wrong?"

As soon as these words were spoken, Zhang Qingquan involuntarily trembled as he held the examination report.

Mistaken diagnosis!

This issue can be big or small!

If the family is understanding, it’s alright. But if it turns into a big deal, I’ll surely be in trouble.

At the least, I will have to apologize, and the department will have to intervene. If things worsen, it might reach the hospital level and possibly lead to disciplinary action.

After all, the situation was about to push the patient into the operating room!

If Qin Feng hadn’t intervened in time, the consequences...

Thinking of this, cold sweat broke out on his back.

I’ve been an attending physician in the emergency department for so many years, having received tens of thousands of patients!

This condition is rare, yet it is also simple.

The error was entirely due to my bias against Qin Feng, which forced me to confirm my viewpoint and neglect it lightly.

It nearly led to an outcome I would regret for the rest of my life.

"You can understand it this way, your daughter’s illness is indeed similar to the previously diagnosed intestinal obstruction because of past appendectomy, along with the current condition causing adhesions, the actual onset time should have been much earlier.

If surgery were performed, it could solve the obstruction problem, but it would still require returning for subsequent treatment.

This situation is quite rare.

Here’s the plan: I have a few more questions for the patient, and then I’ll take over from here.

Is that acceptable to you?"

After speaking, Qin Feng looked at the girl’s father with a mild smile.

The man remained silent, gazed at Zhang Qingquan briefly, then shifted his attention to the name tag on Qin Feng’s chest.

"Alright, Director Qin, I trust you."

"Okay, let’s head inside first."

Qin Feng nodded, turned his head to look at Zhang Qingquan,

"When the examination results come out, bring them to me immediately."

"Understood."

At that moment, Zhang Qingquan nodded in agreement.

About a few minutes later,

Zhang Qingquan pushed the door open and handed over the report.

"Director Qin... the report is ready."

Qin Feng took a look at it, indeed!

PH 7.8, metabolic acidosis~

The blood ketone test result also came out, significantly elevated, and the blood sugar is 4+.

Confirmed!

Qin Feng instantly confirmed in his heart.

Diabetic ketoacidosis, no doubt!

"Jiajia, let me ask, have you eaten exceptionally a lot before?"

Qin Feng asked, looking at the girl on the hospital bed.

"Um... yes, about a month ago. During that time, I was preparing for the mid-term exam, so I stayed up late every night, ate a lot, and lost several pounds."

Zhang Jiajia recalled and said.

"Yes, that’s right, this is one of the typical symptoms leading to diabetes."

Qin Feng nodded, everything aligned correctly.

Once the direction is correct, details that are forgotten by the patient but crucial for the doctor’s judgment naturally emerge.

Therefore, in any hospital, aside from observable symptoms,

the most crucial factor is whether a doctor can uncover the root of a disease through details, as the direction determines the diagnosis.

It also determines the treatment and the patient’s life safety.

"Doctor, what’s really happening to my daughter? Does she need surgery?"

At this moment, the mother was extremely anxious and urged.

"Don’t worry, it’s confirmed now, your daughter will be fine soon."

Qin Feng said with a smile.

...

Now that the condition is confirmed, the treatment plan needs to be changed as well.

The intestinal obstruction surgery is changed to correcting ketoacidosis, lowering blood sugar, and fluid replacement.

According to Qin Feng’s judgment, once the ketoacidosis is eliminated, and intestinal physiology restored, the obstruction will naturally resolve.

"Nurse Chief, take the patient to the examination room, and put her on the monitoring device."

In the examination room, the monitor was attached to Zhang Jiajia, and all the basic physiological indicators appeared on the screen.

Respiration 19 times/min

Heart rate 110/min

Blood pressure 110/78

Blood oxygen 100%...

All the data looked good, which eased Qin Feng quite a bit.

The infusion previously arranged by Zhang Qingquan seemed to have worked, as all indicators fell back into the normal range.

Next is to lower the blood sugar, continue infusions to maintain electrolytes, and also prevent infection and intestinal obstruction necrosis.

Intubate to expel gas from the stomach and intestines, relieving intestinal pressure.

Beep beep beep beep~

Right at this moment,

Less than 15 minutes into the blood sugar reduction, the monitor alarmed.

Zhang Jiajia suddenly experienced rapid breathing, showing some pain, and heart rate began to soar.

"Director Qin."

"Shock! Open another IV line for sodium replenishment, quick drip."

Seeing this, Qin Feng’s expression suddenly turned serious, and he said solemnly.

The heart rate on the monitor shot up from 110, 120, 130, 140...

In just over ten seconds, it had broken through 170/min, rushing towards 180.

The nurse chief’s actions were swift, quickly setting up the IV line, and starting the fast drip.

As the infusion entered the body, in less than two minutes, the heart rate began to drop rapidly.

Heart rate 135/min, basically normal.

"Alright, return to normal speed, continue lowering blood sugar."

Qin Feng breathed a sigh of relief and instructed.

The pain on Zhang Jiajia’s face also slowly disappeared, returning to normal.

An hour later,

The second examination was conducted again, the blood sugar had decreased significantly, and the abdominal distension also began to disappear.

Everything was developing in a normal direction...

"Alright, send to the ward, continue monitoring, with blood tests every 4 hours."

Qin Feng instructed.

Nurse Chief Han Yu nodded and arranged for the nurses to increase monitoring.

...

In the director’s office, 𝘧𝑟𝑒𝑒𝘸𝘦𝘣𝑛𝑜𝘷𝑒𝓁.𝘤𝘰𝓂

"Qingquan, what did I tell you yesterday?"

Dong Hao asked seriously, in a solemn tone.

"Director, I..."

Zhang Qingquan looked somewhat troubled, opening his mouth with a complex expression but not knowing what to say.

"Enough, don’t talk."

Dong Hao interrupted him irritably, "If you have any opinion about Qin Feng being the associate director, you can appeal to the hospital, or even report it.

But what I must tell you is, don’t take your dissatisfaction out on every patient that comes in!"

Bam!

Saying this, Dong Hao slammed the table.

"If it weren’t for Qin Feng today, think about the consequences yourself!"

"Maybe you think it’s luck that he spotted the problem, and if Qin Feng had come a little later, you might have found the anomaly before the surgery.

But what I have to say, Zhang Qingquan, is that this is foolishness!

If you really think this is luck, then you’re out of your mind!

Qin Feng is the designated associate director by the hospital, not to mention that his surgical skills are well-known throughout the hospital, I believe you know a bit about his record.

A bachelor’s graduate from a second-rate medical school, who became a dual department director in three years at a top-tier hospital in a third-tier city, and he established it himself, have you checked the level of Jiangcheng City First Hospital now?

The level 4 surgeries Qin Feng has performed over the last three years outnumber the ones you’ve done in over ten years!

What do you have to be dissatisfied about?"

The more Dong Hao spoke, the more heated he became, as if these words were pent up for a long time, and he had to let them out,

"And let’s talk about this disaster relief, the landslide blocked the roads, and Qin Feng ventured deep into the disaster area alone with the PLA, sorting out the chaotic township hospital and numerous patients in just half a day.

Moreover, in conditions of extreme medical scarcity, he treated over a hundred patients by himself, seamlessly integrating once the rescue teams arrived, successfully joining the work.

Can you do it?!"

At this point, Zhang Qingquan literally wanted to dig a hole with his toe and hide in it.

Towards Qin Feng, previously it was indeed envy clouding his judgment to some extent.

He originally thought this associate director position should’ve been his, why should it go to him?

Plus, Qin Feng seemingly never initiated provocation, which made him feel even more justifiably enraged.

And this happened on the first day!

If it weren’t for Qin Feng today, I really might have been disciplined.

"Director, I realize my mistake."

Zhang Qingquan said quietly, his head down.

"Mistakes must be corrected!"

Dong Hao exhaled and advised earnestly,

"Qingquan, I know these years haven’t been easy for you, emergency care is a thankless job, tough yet dealing with different patients’ families, can’t hit back or respond to insults.

You’ve been through the grind, you’re the leader among our young attending physicians in the emergency department.

So, you must have the right attitude, don’t let other matters affect yourself.

This time, learn from this experience, understood?"

"I understand, it won’t happen again."

Zhang Qingquan promised.

"And about Qin Feng?"

Dong Hao lifted his head and asked him.

"I’ll... follow the director and hospital’s arrangement."

Zhang Qingquan was still somewhat hesitant, but this time didn’t oppose.

After all, the recent events were still fresh in his memory!

"Hmm, you were brought up under my wing, so let me tell you frankly."

Dong Hao nodded, sighing,

"Actually, even if it weren’t Qin Feng, this associate director wouldn’t have been your turn."

"Director, why?"

Upon hearing this, Zhang Qingquan furrowed his brow, perplexed.

"Your qualifications don’t yet meet the hospital’s requirements for the emergency department office director, of course, neither does Qin Feng."

Dong Hao explained,

"But Qin Feng was a decision continuously discussed by the hospital affairs committee, and he bears a major responsibility, this is not only for the emergency department, it’s an attempt by Peking Union Medical College Hospital.

In the whole hospital, he is the only one most suited!"