Patient woman,69 years old, married, due to"左Low back pain, vomiting with oliguria, chills1天Admitted at 13:13 on April 21, 2022。

患者于2022-04-20上午，因"Double kidney stones, left hydronephrosis, slight dilation of the upper segment of the left ureter" were lithotripsy in the local health center治疗, postoperative low back pain is severe,并Radiation to the abdomen, nausea, vomiting several times, stomach contents。有血Urine, no frequent urination pain。The pain does not relieve after rest。傍晚时分，He went to the local health center again and received symptomatic treatment with lansoprazole and clindamycin.After getting homePoor effect。At night, patients begin to develop chills, accompanied by dizziness, chest tightness, irritability,The third timeGo to the health center to check blood pressure60/？mmHg, blood sugar 25.7mmol/L, ECG showed sinus tachycardia, abnormal Q wave, ST-T changes。立即120 to this hospital(No treatment records are found in medical records)。Since this onsetNo fever,Unconsciousness disorder, no limb convulsions, no cough and sputum, no severe chest pain, unprovoked sitting breathing and pink bubbling sputum, no diarrhea, no stool自解。

History of hypertension over 10 years, highest blood pressure180/110mmHg, normal oral "amlodipine besylate" antihypertensive;She has a history of diabetes for more than 10 years, and uses "insulin aspartate 30 injection 16u early and 12u late" for hypoglycemia, and her blood sugar control is poor。A history of rheumatoid arthritis44She was treated in a number of first-class hospitals, and intermittently took dexamethasone, alfacalcitol, and etocoxib orally10余年；8He had a history of acute brainstem infarction years ago, and had taken aspirin and atorvastatin orally for a long time without residual sequelae.He has a history of coronary heart disease for many years and has not been diagnosed and treated systematically.Deny the history of hepatitis, tuberculosis and other infections, deny other surgeries, deny the history of trauma, deny the history of drug and food allergies。

查体：T 37℃P 110 times/min R 25 times/min BP 80/60mmHg。Consciousness styleClear, articulate, to the point,但有Irritability, physical examination欠Cooperation, no yellow skin and mucous membranes,见有散在Peechiae, cold limbs, no swelling of superficial lymph nodes in the whole body, soft neck, no resistance, no filling of jugular vein, trachea centered, normal chest appearance, quiet sound of both lungs when percussion, symmetrical respiratory movement on both sides。Double lungs breathing loud, double down肺闻及A little dryMoist rales, heart rate110 times/min, law, no noise heard。The abdomen is flat, the xiphoid process is tender, no rebound pain, the liver and spleen are not reached under the ribs, and the percussion pain in the left kidney area is obvious。Depressed edema of both lower limbs, pathological signs were negative。

Electrocardiogram (outside hospital) : sinus tachycardia, abnormalQ wave, ST-T change。

急诊CT：1, bilateral basal ganglia, radiative crown area lacuna;Senile brain。 2, two pneumonia, bilateral pleural effusion, it is recommended to review after treatment。3, slightly larger heart shadow, aortic sclerosis, mitral valve calcification。4. Right breast space, bilateral axillary lymph nodes, further examination is recommended。5, low density lesions in the spleen, it is recommended to follow up or further examination。6. Saponification of perirenal fat sac。7Signs of left urinary tract hydrops, no positive stone shadow。8. L4 vertebral body wedge-shaped, lumbar spine sequence instability, L4 vertebral body mild anterior displacement。

Laboratory tests:D dimer 11.81mg/l。 Hypersensitive C-reactive protein 159.9mg/l。Troponin I: 0.94ng/ml, N-terminal - forebrain natriuretic peptide: 16838.00pg/ml。Immediate anti-shock treatment andBe admitted to hospital。

讨论：1.患者初步诊断及Diagnostic basis？

2.How to identify诊断？

3.Further improve which checksAnd first aid处理？

请于2023年5月22Send your answer today to:Fushou West Road, Rugao City2 Shenzhen Jingcheng Medical Group Rugao Hospital Wu Zhenhua Or email:maozirong526@sina.com 电话：13773832620 (wechat same number)