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The 220th Emergency Treatment in Nantong City -- Case Discussion (157)

2023-07-13 09:34:45
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概要:

Patient, male,78岁,因“气急1.5 Hours "was admitted at 00:50 on May 18, 2023。

   History of present disease:Patient contract1.Sudden shortness of breath 5 hours ago, lack of energyObvious sweating, no nausea and vomiting, no chest tightness and chest painNo abdominal pain, diarrhea。Family members were admitted to our hospital by themselves。Patient on arrival气喘Obviously, sweating all overPurple complexionDuring the course of the disease, there was no vomiting, no fever, no abnormal urine and bowel movements。

Previous history:He has a history of hypertension10For years, the highest blood pressure was unknown, and no medication was taken;He has a history of chronic bronchitisFor more than 10 years, in recent years, there have been shortness of breath after activities, edema of both lower limbs, irregular examination and treatment。

查体:体温36.5℃      脉搏115/分     呼吸30 beats/min BP 151/95mmHg 

Conscious, lethargic, passive position, flat car thrust, physical examination cooperation。Conjunctival no congestion, sclera no yellow stain, bilateral pupil is as large as round, diameter2.5mm, sensitive to light reflection。Auricle cyanosis, lip cyanosis, small tonsils。No neck resistance, no jugular irritation, no abnormal carotid pulsation, trachea centered,Barrel chest,Thoracic symmetry, respiratory movement symmetry between lungs, intercostal space增宽The respiratory activity was consistent, the lower lung percussion dullness, the breathing sound was coarse, and the lungs could be heard with obvious wheezing sound and a little wet rale。No precordial bulge. Heart rate125 beats/min, absolutely irregular rhythm, unequal first heart sound,Abdominal examination showed no abnormalities,Both lower limbs足踝Muscle strength and tension of limbs were normalPhysiological reflex was present, pathological reflex was not induced。查体 

Auxiliary inspection:Blood gas analysis:pH 7.09, PCO2 65mmHg,PO2 55mmHg, HCO3- 19.7mmol/L, BE-10.1 mole per liter, LAC 5.9mmol/lBlood routine: white blood cells 14.89×10^9/L, hemoglobin 151 g/L, platelet 270×10^9, neutrophil percentage 27.4%, lymphocyte percentage 62.5 % Whole blood hypersensitivityC-reactive protein (bCRP)(blood) : 1.82 mg/LDetermination of brain natriuretic peptide precursors(Venous blood) : 1246.0 pg/ml Myocardial injury markers and myocardial enzyme profiles were normalelectrolyte(Venous blood) : Potassium ion 3.23 mmol/L, sodium ion 136.9 mmol/L Glucose determination (enzymatic method)(Finger blood) : 12.80 mmol/L

Electrocardiogram: Atrial fibrillation with fast ventricular rate and ventricular differential conduction,The ST-T changes。

胸部CT:It suggests slow bronchitis emphysema。A small amount of pleural effusion on both sides, partial lung tissue atelectasis in the lower lobe of both lungs, and local interstitial pulmonary edema in the lower lobe of both lungs may be possible。arteriosclerosis。

讨论:1. Preliminary diagnosis and differential diagnosis?

2. Next Step还需Which tests to improve?

3Case characteristicsEmergency management

 

This case is from the emergency Department of Qidong Hospital of Traditional Chinese Medicine Provided by Director Wu Stereotyping。将于July 23, 2023 Qidong City of Traditional Chinese MedicineThe academy lottery,

请于 2023717A few days ago will answer the paper (including unit, name, mobile phone), mailQidong Hospital of Traditional Chinese MedicineEmergency departmentDr. Chen Hua

电话18206283685或发Email:597183877@qq.comWelcome to attend。

 

 

答案:    Nantong city first aid to the grassroots220Phase - Case discussion (157

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The hospital officer spoke faintly

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Published by Nantong First Hospital

Published by Nantong First Hospital