1. "Mental Illness!?"

After staying in the emergency department for 10 years, I have both the joy of successful rescue and the sadness of being unable to turn things around. I have gained a lot of experience and some bloody lessons. Here is a case that I feel very sorry for.

I just arrived at the emergency department for three years and felt that I had mastered a lot of things and was invisibly a little proud and complacent, so many things are prone to neglect.

One afternoon, on day shift, at about five o'clock in the afternoon, a patient came from a nearby county and district. He was in his 40s and was dressed in a farmer. He looked like a strong laborer at home. This man was "kidnapped" by two or three brothers. At the same time, he was muttering something, not knowing what he said, and his behavior was very uncooperative, and several people couldn't hold him back. When I asked about the situation, I had been walking around for two days, talking nonsense, not having a fever, nor vomiting.

"Go to the psychiatric hospital now!" I didn't ask in detail, nor did I check my body carefully, and told my family without thinking.

The family took the patients to the psychiatric hospital (about half an hour's drive from our hospital), and I didn't think much about it.

It happened that day that I had something to do at night, so I greeted Dr. Wang in advance and asked him to come one hour early to take over at 6 pm (usually, he took over at 7 pm).

At six o'clock, Dr. Wang took over the shift on time on time, and I changed into casual clothes and prepared to go home. At this time, I saw several middle-aged people break into the emergency room. As soon as I entered the door, I asked Dr. Wang, "Where is the doctor just now?"

Dr. Wang asked, "What the hell? Are you looking for the doctor on duty on our day shift?" One of the middle-aged men said, "The doctor just asked us to go to the psychiatric hospital. When we went there for CT, it was a cerebral hemorrhage. The patient was unable to do it after CT. He was not rescued. The doctor just now was irresponsible and delayed the patient..." Dr. Wang asked in detail again. The patient fell two days ago and injured his head.

I was nearby. Because I changed into casual clothes, my family did not recognize me. A "Yin and Yang Man 1" who had been active in the hospital for a long time stabbed me and signaled me to leave. I fled from the emergency department with regret and fear.

It is said that the family members were going to cause trouble later. Several "yin and yang people" moved them with emotion and reason. Finally, they persuaded the family members, rented their black ambulance, and returned home smoothly!

Alas, whenever I think of this, I feel extremely guilty. Because of my negligence, a living life disappeared instantly. If I asked more carefully at that time, if I checked a CT scan at that time, if...

This incident has unforgettable to me. From now on, I always remind myself: We do work that is at stake in life, be careful and be cautious!

[Note](1 Yin and Yang people: Some people who appear in hospitals all year round, serve the deceased, and also work part-time in medical care, resell patients, and transport patients.)

[Summary] Non-psychiatric diseases that cause mental symptoms:

1. Organic brain lesions, such as craniocerebral trauma, intracranial infection, tumors, cerebrovascular diseases, and degenerative brain lesions.

2. Physical diseases outside the brain: infectious diseases, endocrine diseases (such as hypoparathyroidism), nutritional metabolic diseases (such as hypoglycemia, diabetes hyperglycemia hypertonic state), etc.

This happened last year, so I still remember it fresh.

One morning, we were busy one after another, and we were very busy. I asked the students to see some milder patients and check them by themselves, while the serious patients were treated by me personally.

At around 10 o'clock, the outpatient nurse sent a patient, who was in his forties, a man, and was slightly listless. He said that he was dizzy in the outpatient department of neurology for treatment. He suddenly fainted while waiting in line. The outpatient doctor asked him to send him to the emergency department. The patient was pushed over in a wheelchair, and there was no liquid!

I moved the patient from the wheelchair to the bed. I don’t know why. Maybe it was because the nurse was kind and comfortable for the patient. The head of the bed was shaken up and it was shaken quite high. A blood pressure of 130/70mmHg and a pulse of more than 90 times. It was quite strong. The patient was clear and in good spirits. When asked about the medical history, he had black stool twice in the morning. So the nurse was asked to slap liquid. He did not emphasize 500ml of saline or balance liquid, nor did he emphasize the number of drops. He turned around and went to the workbench to make a doctor's order. So, a bag of 250ml of saline was hung up and dripped slowly. To be honest, on the one hand, there were many patients, and in addition, I was really a little careless!

At most 10 minutes later, when I was still dealing with other patients, the nurse exclaimed, "Doctor Qi, come here quickly! The patient fainted." He hurried over and saw that the patient was sweating profusely, his limbs were wet and cold, his pulse was unclear, and he lost consciousness. He immediately pressed and pinched the person. The patient slowly woke up and quickly opened the liquid to the maximum. He asked the nurse to take a bottle of 500ml of compound sodium chloride and hung it on it. At the same time, he quickly shook the patient's head to a level, let the patient lie flat, and measure his blood pressure of 80/40mmHg.

With the rapid infusion of liquid, the patient's condition improved significantly and his blood pressure rose. Then he was added with another step of intravenous infusion of pantoprazole. The test showed that hemoglobin was 106g/L, and the urea nitrogen increased a lot, and the blood creatinine was normal. He was diagnosed with gastrointestinal bleeding. He was soon received from the gastrointestinal department.

【Summarize】

1. For cases with blood loss and fluid loss, you must pay attention to early shock. At this time, the patient's blood pressure can be normal or even increased. At this time, you must pay attention to the resuscitation of the fluid. At the same time, the patient's position should be in a flat position to avoid sitting up or semi-lying position. The cause treatment will be carried out simultaneously. Early intervention will make your treatment twice the result with half the effort and avoid many troubles in the later stages.

2. Principles of shock rehydration:

1Crylate first and then glue.

2Salt first and then sugar.

3Fast first and then slow.

4Further thicker then light

5 See potassium supplementation in urine.

6See calcium supplementation.

3. About fainting:

1 definition:

Syncose refers to a brief state of loss of consciousness caused by transient cerebral blood supply. During an attack, the patient fell to the ground due to the loss of muscle tone and was unable to maintain a normal posture. It is usually a sudden attack and recovers quickly, with few sequelae.

2 Causes:

1 Vascular dysfunction: it is seen in vasovagal syncope, orthostatic hypotension, carotid sinus syndrome, urinary syncope, cough syncope and painful syncope.

2 Cardiac syncope: seen in severe arrhythmia, obstruction of cardiac blood discharge, myocardial ischemia and heart failure, etc. Such as paroxysmal tachycardia, rapid atrial fibrillation, long Q-T interval syndrome, pathological sinus node syndrome, high atrioventricular block, hypertrophic cardiomyopathy, angina and acute myocardial infarction

etc., the most serious one is A-S syndrome.

3 Brain-derived syncope: seen in cerebral atherosclerosis, TIA, migraine, pulseless disease, chronic lead toxic encephalopathy.

4 abnormal blood components: hypoglycemia, hyperventilation syndrome, severe anemia, crying fainting and plateau syncope.

(The above content is excerpted from the first article of the eighth edition of Diagnostics: Common symptoms: fainting)
Chapter completed!