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Nantong City First Aid grassroots 219 -- Case discussion (156)

2023-06-12 18:22:57
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概要:

  Zhu Baofeng, Emergency Department, Nantong First People's Hospital
  The patient, a 67-year-old male, married, was admitted to the hospital at 12:08 am on June 10, 2022 after being "found unconscious for 3 hours.。
  At around 9:00 on June 10, 2022, the patient was found unconscious by her family members, unable to respond to the breath, collapsed at home, accompanied by vomiting, the vomit was seen as stomach contents, no convulsions were seen, accompanied by urinary incontinence。120 cars were sent to the emergency room of our hospital。After the family complained, the patient had no dizziness, headache, cold and fever, no cough and sputum, no hemoptysis, no chest tightness and chest pain, no dyspnea, no abdominal pain, abdominal distension, no hematemesis black stool, unformed stool, food and sleep were OK。
  Previous: In May 2022, she had a history of craniocerebral trauma. Head CT revealed subdural hematoma, contusion and laceration of the brain, and subarachnoid hemorrhage. She was discharged from our hospital after conservative treatment and improved, with no special sequelae。Denial of hypertension, diabetes, coronary heart disease and other medical history;Denial of hepatitis, tuberculosis and other infectious disease history;Denied any drug or food allergies。
  Physical examination: T 37.At 2℃, HR 106 times/min, R 25 times/min, BP 132/78mmHg, SpO2 97%。Coma, GCS score 7, failure to respond to exhalation, tingling without opening eyes, bilateral pupil diameter 2mm, slow light reflex, bilateral nasolabial sulci symmetry, no gaze in both eyes, soft neck, no resistance。The skin of the whole body was dry without sweat, the mucous membranes were not yellow stain, no petechiae were found, the trachea was centered, the chest appearance was normal, and the respiratory movement was symmetrical on both sides。Double lungs breathing sound coarse, double unheard and obvious dry and wet rales, arrhythmia, unheard and pathological murmurs。Abdomen flat soft, no muscle guard。There was no edema in both lower limbs, and bilateral pathological signs were negative。
  Relevant auxiliary examination after admission: Laboratory examination: Blood routine: white blood cells 15.2*10^9/L, neutrophil 89.7%, hemoglobin 128g/L, platelets 227*10^9/L;Urine routine: white blood cell negative, ketone body negative;Blood gas analysis + Electrolyte: pH 7.358, oxygen at 70.4mmHg, PCO2 28.4mmHg, potassium 3.21mmol/L, 143 sodium ions.3mmol/L, chloride 106.8mmol/L;Blood Sugar 9.05mmol/L;DD dimer 716ug/L;Troponin < 0.01ng/ml。Ecg: Sinus tachycardia, prolonged PR interval, left ventricular hypervoltage。Head and chest CT: right frontal malacia, multiple solid nodules in two lungs, calcification in two lungs, fibrosis in two lungs, cystic lesion in right lobe of liver。
  讨论:1.Preliminary diagnosis and differential diagnosis?2 Which checks should be improved next? 3.Emergency handling points?
  Please send the answer to Dr. Zhou Hao, Emergency Department, Nantong First People's Hospital, 18862920735 or 1825956572@qq before June 19, 2023.The lottery will be held on June 25, 2023 at the Second People's Hospital of Qidong City。
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The hospital officer spoke faintly

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Published by Nantong First Hospital

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