For the patient’s family,It is a thrilling dead escape.,If it is a rabies,Then you have finished playing.。And myastosome is weak, although I can’t cure,But some drugs can be controlled,And you can return to life completely,That’s lucky。As for a diagnostic error,Old horse,They are now happy now.,It is estimated that you will not find trouble.445
Piece68Elderly male,I was found in a coma at home,Hurry and send hospital emergency。
Patients with coma come to emergency,That is very tricky。There are too many reasons for coma.,From the head to the foot, dozens of diseases,And each cause may have several dozens of changes,Classifying a little change。
The emergency doctor initially suspected that it would be a brain,Such as cerebral hemorrhage or cerebral infarction,After all, this is the most common cause of coma in middle-aged and elderly.,Especially the family said that patients have high blood pressure for more than ten years.,Not taking medicine,Take medicine is also intermittent,This makes the emergency doctor suspect,How many good guys are in the high blood pressure puzzle,Hypertension is not easy to really, it is very easy to bleak blood bleeding or cerebral infarction.。
The emergency doctor carefully saw the patient’s mouth corner,No mouth skew performance,There is also no limb hemiplegia performance,This is not big as cerebral hemorrhage or cerebral infarction。So I quickly made a craniholect,This is the gold standard.,If there is a cerebral hemorrhage,ctI can see it at a glance.。ctIt is possible to see the organization of different density of brain tissue.,Bleeding words will be high density,Show a white。
So the patient is not a cerebral hemorrhage。Is there any cerebral infarction??possible,ctCan you rule out a cerebral infarction??no。Cerebral infarction is a cerebral blood vessel.,Blood flowing,Brain tissue ischemic hypoxia,Not a cerebral hemorrhage,So short-term(24Within an hour)ctCan’t see。Must be onset24Review the brain after hoursctCan you see that it is a cerebral infarction?。
Neurologists also read,Assess,I feel that cerebral infarction is not like。
In addition to cerebral hemorrhage、Cerebral infarction can lead to coma,There are still many reasons.。Patients may be poisoned,Such as pesticide poisoning、Sleeping pill poisoning?The family denies,Impossible,There is no such chaos in the family.。
Will it be hypoglycemia?Does the patient have diabetes??Diabetes hypoglycemia is also coma。Emergency doctor is fast than the big brain,The problem has not yet been asked,Just give the nurse to take a blood sugar。A few seconds were saved.,blood sugar69ol/l,This is normal blood sugar,No hypoglycemia。
This is not,That is not,What is the reason for coma??The family is also anxious,Doctors。
The emergency doctor carefully looked at the patient.,I feel that the patient’s breathing is slightly promoted,Not too obvious,Just a little bit,I am afraid that it is not a respiratory problem.。To know,Severe pneumonia can lead to hypoxia in patients,It is also coma。But generally severe pneumonia will have a breathing、Lips(Hypoxia)Performance,But he is not very obvious。
Sweepingctwhen,LungctAlso sweep together,Didn’t see obvious pneumonia lesions。
So serious pneumonia caused a coma like a coma is not like。
Will it be myocardial infarction??Elderly,Hypertension,It is also possible to make a bad myocardial infarction.。The family said that the patient has no history of coronary heart disease.,And there is no performance of chest pain talking on TV.,It should not be。Emergency doctor interrupted him,Saying that disease is not typical,Do you have evidence?。I will know if I have a heart map.,ECGettical more than a dozen dollars,Master out。The family is not good to say anything.,Agree to make an electrocardiogram。
Is such that,Typical myocardial infarction will have chest pain、Chest tightness,But some serious maybe it is coma.,No time to show chest pain,This is completely possible。Therefore, the emergency doctor is routinely to do an electrocardiogram for the patient.。
There was a result.,Not myocardial infarction,Didn’t see itst-tSegment change。The emergency doctor used a stethoscope to listen to the heart and the lungs.,Looking at the camera results,Talk to the perspective,The first ECG did not see an abnormality,Can’t block the heart muscle infarction,You can continue to make an electrocardiogram after an hour.,Do a few times,Have normal,Can be assured。
Speech,The blood of the arteries also came out。Other blood draws have also come out。These blood draws are all in the blood test.,Basically, there will be results for an hour.。
Original emergency doctor is still suspected that it is not a respiratory problem,Is it a problem of hypoxia?,However, ECG monitoring is not low in blood oxygen saturation.,Now there is no hypoxia,Basically, it can be excluded is the problem of respiratory tract.。
But there is a significant error,That is the alkalinity,There is only the acid and alkalinity of the patient in the blood gas.70(normal735-745),This is really a patient’s old life.!The emergency doctor finally found the problem.。
Why is the acid alkalin so low??Why is the patient in the body so acid??
After contrasting other blood loss results,See the patient’s blood creatinine710μol/l。
Finally found the problem。
Blood creatinine710μol/lwhat,Normal people’s blood muscle anhydride top110about,Many people are100Inside。Creatinine is human muscle、Small substances produced by metabolism such as protein,Can be considered a garbage in the blood,These garbage are kept from the kidneys.,Follow the urine。
In the case, it will cause blood creatinine so high.?The answer is self-evident。That is the time when kidneys have problems。For example, there is renal failure.,The excretion of the kidney has a problem.,Creatinine can’t go out,There is more accumulated in the blood.。The kidney is like the body’s garbage excretion workstation,Rubfish recycling station,Good things are filtered over again, they will re-absorb them back.,The bad thing will be flushed away.。The kidney is a good worker who is not afraid of suffering.,model。
But there is no day and night work,Stress from work,Or other problem,Such as hypertensive nephropathy、Diabetic nephropathy、Kidney stones、Nephritis, etc. will cause renal dysfunction,It will cause the function of the kidney to decline the function of the station,In the end, the garbage of a series of hard creatinine can’t go out.,Stacked in the body,Problem。
Patient,Very might be kidney failure,Garbage accumulation,For example, creatinine、Urea, etc.,There are still many other acid metabolites accumulated,It may lead to serious acidosis in patients.,And may lead to a coma,This is also very common in clinical。A lot of coma patients,A kidney function,Utinish,Hardsthydride is high。
Emergency doctor told the patient’s family,It is said that the patient is uremia.,The reason for coma is caused by uremia.,Must wash the kidney(Hemodialysis)Can save him。
Thinking of patients are uremia,The emergency doctor quickly asked the family.,How the patient in these days,Normal urine is normal。
Family is a bit,I don’t know.,Not living with him,He lives in the old house there。If you don’t know the urination。
Emergency Department
Kidney filtration,Garbage will be filtered with the blood,Enter the urinary tract,Water will also enter the urinary tract,Forming urine rushing out。Once the prostate is large to a certain extent,Completely blocking urethra,Water and garbage will not come,Will accumulate in ureteral、Bladder,Time long,The kidney will also give water,The kidney is very large,Eventually because of the pressure of water,Hold the blood filtration,At the same time, forced the kidney ball,Then the function of the kidney will naturally shrink。Chaosteen dirty east stacked inside the kidney,Also very easy to form infection,Patients ultimately infectious shock,It will be quickly lethal。