Weight. In the eyes of doctors, the probability of obese people getting sick is real.
One case of abdominal pain encountered in an emergency.
The patient was a 29-year-old, of course, fat.
The patient’s girlfriend came to see her. She looks close.
He said he had a barbecue with his girlfriend at night and had a little drink, and it started abdominal pain very soon.
At first it wasn’t so bad. I took some medicine at home, thought it would hold.
I didn’t know that abdominal pain was getting worse and diarrhea was diarrhea, five times back and forth, every time it was yellow.
He threw up two times, ate everything, and smelled like acid.
There’s no way.
He asked me if it was food poisoning.
I explained to him that it was impossible because his girlfriend ate the same thing but nothing.
That must be acute gastroenteritis. He diagnosed himself directly.
They asked me if I could give him some antibiotics, and said that intestinal inflammation used to be good for antibiotics.
A friend who read my article should know that an emergency doctor is the one who fears abdominal pain.
You think the abdominal pain may be intestinal, but the abdominal pain in the doctor’s eyes is tens of millions, and I can’t conclude that he is acute gastrointestinal.
But according to his description, he ate the barbecue and drank alcohol, and then had abdominal pain, diarrhoea and vomiting, which was really like acute gastrointestinal inflammation.
However, before the diagnosis of acute gastrointestinal inflammation, I have to routinely remove diseases such as acute pancreas, acute appendicitis, acute cholesterol and stomach perforation.
These diseases, too, are so uncomfortable.
I routinely checked his abdomen, not too bad.
It’s not too bad to listen to heart and lungs, but it’s normal for people with stomach pain.
And for the sake of safety, Dr. Fupé pulled his EKG.
The EKG doesn’t see a graphic like a heart infarction, it’s a ecstasy.
Then I measured him blood pressure, blood pressure 180/100 mm mg.
I thought it was Dr. Frieder’s wrong blood pressure.
His blood pressure is high.
The patient told me that two years ago she found her blood pressure high and she didn’t take her medication.
The doctor told him that he was going to take high blood pressure for the rest of his life and that he could not accept it, so he did not insist.
It wasn’t that high before, it was probably this time when people were nervous, so blood pressure was higher.
I told him that your body, your blood pressure, was high, and if you were not careful to control it, there would be more risk in your head than others, and that you would not be able to take it lightly.
He just stuffed me in, hoping I could get him some antibiotics.
When I opened the prescription, his stomach was in pain again, and his stomach turned and said he needed to go to the toilet.
By the time he got back, his abdominal pain was a little reduced.
He told me he just pulled some blood and took a picture.
I looked at it, a little blood, but not much, covered in shit, like hemorrhage from hemorrhoids.
He does not believe in hemorrhoids and says that shit is usually smooth and sometimes a little blood.
I’m not arguing with him that hemorrhaging is not my concern, and I’m concerned about the haemorrhage caused by this acute gastrointestinal inflammation, which suggests that intestinal inflammation may be serious and inoperable.
In addition, rectal cancer is likely to cause this.
He heard it could be rectum cancer, but he was more nervous, saying that last year his uncle died of rectum cancer.
Then he has family history.
He’s so young, it doesn’t look like rectum cancer. I’m just saying.
But he asked me something that I still remember:
Doctor, can you do a rectal examination for me? I heard that this check will determine if it’s rectal cancer.
Now? Here? I’m sweaty.
I don’t have the time to give you a rectum check.
He was supposed to be rejected and sent to the digestive internal or anal surgery clinic tomorrow morning, where the outpatient doctor would do it.
He was not reassured, however, that he wanted to do it now, and that if it was not convenient to do a rectal examination, he could be provided with an intestine examination.
All right, let’s do a rectal check. Where are you going with the colon? I had to compromise.
He was examined for the first time by a doctor and for the first time in an emergency.
My finger turned around his anus and touched something. It’s probably a crotch, not rectum cancer.
He’s so relieved.
I’d rather recommend that he go to the clinic and do an intestines.
The first thing to do is get the stomach CT done and see what’s inside.
Liver pancreas, kidneys and urine tubes were seen together, and if no problems were found, acute gastrointestinal inflammation was likely.
I’ll take care of it. It’s my plan.
Can you do B? The patient’s girlfriend asked me to worry about C.T. radiation.
Do B super would do, but that was the time when I was in the B-room and nobody was working night shifts.
If you really have to be B super, you have to call people back from home, it’s trouble.
Only if we can’t be a CT, like a pregnant woman, we’ll call the B superdoc.
Besides, B’s supersighted without CT knowing that the patient is a big fat guy, and I’m guessing B’s supersight is white, so step-by-step, just let him do the abdominal CT.
“This radiation is not enough, it’s not as dangerous as your body. Gotta lose weight. I don’t forget to flirt with him.
He did what I had to do.
Before doing CT, his abdominal pain seemed to have increased, asking if I could get a shot.
I explained to him that the use of analgesics by persons with an undiscovered abdominal pain disorder was in violation of the principle, as it could cover up a change in the condition and result in a misdiagnosis.
But look at his pain and his blood pressure is high, and I’m afraid he’ll continue his pain and his blood pressure will be so high that he may have a brain bleed.
So after a quick trade-off, I decided to give him a shot of phenol, a drug for gastrointestinal pain.
When the nurse pushed him back from the CT room, the abdominal pain was reduced.
CT came to me very quickly.
Patients have heavy fat liver!
That’s what I’m talking about. Big fat guy.
Then there was the gallbladder, but the rock looked quiet, and the gallbone was not big, unlike acute cholebitis, and the abdominal pain of the patient did not look like a choleb.
Fatty liver is a problem, but pure fat liver does not cause abdominal pain and vomiting.
There are other reasons for the illness.
However, CT saw no problems with pancreas, spleen, kidneys, urine tubes, appendix etc.
It really looks like abdominal pain, diarrhoea and vomiting caused by acute gastrointestinalitis.
Looks like my phenol needle was right. The abdominal pain of the patient was caused by a gastrointestinal convulsion, which was the cure, so it worked.
The patient also asked me to give him intravenous antibiotics and called him for a left oxidoxen, saying that the drug worked well, that it was used last time for acute gastrointestinal inflammation, and that it was alive the next day.
Of course I wouldn’t listen to him. Everything has to wait until the blood is drawn back.
Acute gastrointestinal inflammation is not caused by bacteria, but by viruses, parasites, etc.
In addition, food such as cold food and overheating can cause gastrointestinal inflammation, which is not suitable for antibiotics.
Within a short period of time, the blood results returned, with a significant increase in the blood cell count of 21x10E9/L (normal 3-10x10E9/L).
This means it could be bacterial infections, and it’s appropriate to use antibiotics.
Now that he’s used the left oxen salsa and it’s working well, use the drug, at least it’s not allergic.
But when another report appeared before me, we were all stupid.
The liver function of the patient showed a significant increase in aminoases, up to over 2000 (normal 0-40U/L).
The kidney function is also poor, with haemocelline increasing to 150 μmol/L (normal 30-110, different hospitals).
Condensation indicators are also available, and some results are unusual. Cardiac lesions are normal.
What’s going on? Dr. Pepe can’t read. I’m confused.
Patients with acute gastrointestinal inflammation are unlikely to have such poor liver and kidney functions.
In general, gastrointestinal inflammation is relatively minor, the disease is confined to the gastrointestinal tract, is unlikely to reach the liver and kidneys, and may not lead to abnormalities in condensation indicators.
Could it have been the fatty liver?
After all, CT saw that the patient’s fatty liver was very visible and that the patient’s drinking on a day-to-day basis.
Alcohol can cause liver damage, but not kidney and coagulation.
Isn’t there a history of hypertension?
I can’t understand.
The patient ‘ s girlfriend quickly pulled out the annual medical report form from the phone and the patient ‘ s liver function, kidney function and coagulation function were normal last year.
At that time, the abdominal pain of the patient was exacerbated, sweating on the forehead, and pain was evident mainly in the umbilical week.
He said he wanted to go to the bathroom again, but only a little water had been pulled this time, and when he came back, it felt like the whole body had gone off.
One night, so many times, then a few times vomiting, all the food ate at night, and the stomach ache, and it was normal for people to fall off.
And when the potassium was low, I put two more bottles of rehydration on him, one to replenish the energy, and the other to make up for the water that was lost, without dehydration.
“Doctor, give me a left oxen salsa. That drug works for me. He was almost begging me.
I had to rush the pharmacy. I had to send him some medicine.
But the instinct tells me that his condition may not be that simple.
I’ve been in E.R. for so long that I’ve been dealing with too much acute gastrointestinal inflammation, and very few abdominal pains as bad as his, and he’s sweating.
His girlfriend blames him, tells you not to eat so much at night, and you can’t control your mouth.
Whether he agrees or not, I have another EKG drawn by Dr. Phoebe, and there is still not much to be found, i.e. a ecstasy.
So he’s getting bored that it’s necessary to do EKGs back and forth.
I explained to him that your body, your high blood pressure, your abdominal pain, must rule out myocardial infarction.
Most of the infarction is chest pain, but a few will be abdominal pain, so beware.
Dr. Frepe wonders that myocardial lesions are normal.
Not really.
Cardiac lesions are not elevated in the early stages of heart infarction.
It’s usually only a few hours after the heart infarction, and there’s a certain degree of heart cell damage, so we can see these signs in the blood cycle, and there’s a window of time.
I told Dr. Frepe that no pain below the teeth or above the shamebone can forget myocardial infarction, especially for patients with high blood pressure.
Because of the crossover of neurodulgence, sometimes it is a heart problem, but it manifests itself in a stomach pain, which can happen if you do not pay attention.
But both EKGs were similar, and no further signs were found, and my concern was superfluous.
But at least I’m relieved it’s the heart.
But the patient’s significantly abnormal liver function makes me nervous.
Why is it so high? And the blood acetic anhydride has risen, and condensation indicators are abnormal.
Dr. Pope reminded me, “Isn’t it really poison, teacher? I’m sorry.
That’s what I’m worried about.
Significant hepato-renal abnormalities and abnormal levels of condensation are observed, and it is important to be alert to diseases such as severe infections or poisoning.
In the case of severe infections, fever usually occurs, but the temperature of the patient is normal.
And CT didn’t see the obvious infection stove, the only thing suspected of being infected was the intestinal tract.
When I thought about it, I told the patient to leave a toilet and take it to the lab.
Is it really poison?
He eats so much stuff tonight, lots of barbecues are not very clean and may have a lot of fungus.
Or he ate toxic food directly, before which a patient ate an ear immersed overnight, followed by liver and kidney failure and life was on the line.
Could this patient be in a similar situation?
My brain is spinning at a high rate, and I’m analyzing every possibility.
But the patient had barbecues with his girlfriend, and there was no reason for the patient to be poisoned, and the girlfriend was safe.
But the next thing our patient’s girlfriend says, it scares us even more.
The girlfriend said that most of the barbeque at night was eaten by the patient himself, and that there were lots of mussels, beaks, meatballs, etc., most of them were killed by the patient himself, who ate only a fraction of them and did not always get them.
If that were the case, it would have been possible for the patient to eat the toxic food himself, and the girlfriend was able to avoid it.
But it’s too low a chance to eat together.
But the patient’s aminoase is so high, 2,000, it’s not the normal height of hepatitis, it’s definitely because of the severe damage to liver cells.
Anyway, let’s call down the indigestion and ICU doctors. Let’s see which room we should take.
I said to Dr. Pieper that it would not always be appropriate for our emergency doctors to analyse the patient’s condition in the short term, and that it would be appropriate to have a timely consultation with the relevant sections, both to protect the patient and to protect ourselves.
I had to give him another shot of phenol to relieve the abdominal pain.
He added that, apart from abdominal pain, he felt a little numb to the lower left leg and was completely inoperable.
Following the arrival of the digestive internal physician, the risk of intestinal infection is considered high, after abdominal pain, dilution, vomiting and a significant increase in blood-cell count.
C.T. doesn’t see any obvious dirty tool stoves, that’s just the intestinal problem, that’s the intestinal mucous membrane problem, that’s not obvious, that’s just an intestinal lens, and obviously it can’t do it now.
It is also necessary to consider acute hepatitis and to recommend that hepatitis B, hepatitis C and other virological examinations be improved after hospitalization to see if there are any such possibilities as acute hepatitis B. Watch out for liver failure. Once liver failure, there’s less.
When you hear a few words about liver failure, the patient and his girlfriend are scared.
It’s just a gastrointestinal disease. The patient felt that the digestive physician was intimidating him.
Dr. ICTU is here, and after assessing the situation, agrees with me, not except for poisoning.
The question is, how can a patient be poisoned?
Although the reasons are unknown, there are indications.
Dr. ICTU suggested an artery to see the internal environment.
An arterial blood and gas analysis is the direct extraction of the patient ‘ s arterial blood, which is sent for testing in minutes and shows the environment within the patient.
As a result, pH is only 7.2 (normal 7.35-7.45), with significant acid poisoning.
This indicates that the various organs of the patient have anaerobic tissues, and cells are exposed to anaerobic fermentation, leading to acidic poisoning as a result of the accumulation of acid metabolites.
That’s more likely to support poisoning!
But we kept asking about the patients, and we didn’t find out what suspicious food they had at night.
The result, however, is that the liver and kidney function of the patient is impaired, condensation indicators are abnormal, and acid intoxication, if not poisoning, may be serious, and the next step may be liver and kidney failure, even multi-organ failure.
I suggest ICU go to close custody and consider blood purification.
There is a blood flow, a sort of blood dialysis, a needle at the root of the patient ‘ s thigh, a catheter to enter and a vein to extract the vein.
If there is a toxin in the blood, this machine in vitro is capable of adsorbing most of the toxin and reproducing the rest of the clean blood back to the patient.
It’s called a blood flow. It’s a blood purification.
The patient was told to live in ICU, and he was told that he was going to have some blood flow, which was even more contradictory, saying that one intestinal inflammation was not so serious as to urge me to use the painkillers and the left oxidoxen.
Dr. ICTU told the patient he didn’t want to live in ICU, and then he left after two sentences.
And I talked him into it, but the patient didn’t want to live with the ICU, so I had to go to the infirmary, not the ICU.
It’s better to stay in the emergency room.
Soon after the drugstore came back, I asked the nurse to give it to him and prepare for inpatient ingestion.
When preparing for bed, the patient suddenly told me that the lower left leg was number and could not even move.
Is that what happened? I don’t believe it.
At first I thought he had been lying in a position for too long, and it was the vascular nerve that made his feet numb.
But I looked at his lower left limb, which was, indeed, a decrease in his muscle, which was almost normal compared to the lower right limb.
My back’s cold!
The patient’s own abdominal abdominal pain was not alleviated, and it was found that the lower left leg could not be moved, and he screamed.
His girlfriend was tougher, so I had to drag my collar.
I don’t know what to say.
It’s impossible. The phenyltriphenol injections are our usual antipsychotics for gastrointestinal convulsions, kidneys, etc., which are more effective than ever before, and have never been reported to cause physical incapacitation or even paralysis.
Also, this left-oxen salsa is also new, and it is impossible to have such a significant adverse reaction so soon, unless the drug is allergic.
Even if the drug is allergy, it should be skin itching, red spots or cycling instability.
In the meantime, I had no idea.
What the hell is going on?
Patients have come to say that they are weak, weak, etc., but not to the point where they cannot move to their lower limbs.
But now it’s true that he can barely move his lower left limbs, and he has a level 1 (normally a level 5).
The nurse recalculated his blood pressure, which remained high.
Dr. Pepe reminds me that there’s no stroke?
As I said before, a patient’s blood pressure is so high that if it’s bad enough, it’s really in his head.
But it doesn’t look like a stroke because there’s no other positioning signs.
And the two major diseases of intoxication and strokes that patients suffer at the same time in one night, which is how many lifetimes have to go down.
I kept a close eye on the blood pressure of the patient, repeatedly touched the pulse of the patient ‘ s lower left limb, was weak, and the body skin was cold and suddenly thought of a disease.
When I think of this disease, I’m upset. I’m confused. I should have thought of it at the beginning.
The more you want to get upset!
But now is not the time to be upset, and we need to solve it right away, because if it is the disease, the patient could die in the next second, it’s a real tragedy, and I can’t wash it out even if I jump into the Yellow River.
Dr. Pope asked me, what’s wrong?
The aorta trap!
As soon as that came out, Dr. Phoe looked up.
He asked me if the typical appearance of the aorta is a tearing back pain.
If the chest aorta is torn, of course it’s pain in the back.
But what if it’s a diarrhea? That should be a stomach ache.
Normal human veins have several layers, with inner layers (magic membranes), mesbranes (muscular muscles), and outer layers (mulcanes), as if they were pipes.
Some, however, are more vulnerable, or have excessive long-term blood pressure, which strikes the inside of the vein and may scratch out a mouth for a long period of time, which may tear apart several layers of the inside of the vein and create a false cavity.
At this point, patients experience severe pain in their backs and chests, and if the exterior of the veins is also broken, the blood flows, and the patient loses a large amount of blood in an instant and then dies of haemorrhagic shock.
As long as the veins are broken, there’s no time to save them.
There’s no doubt about it.
Dr. Frépé is still wondering that if it were an aortic trap, the blood pressure that should be measured on both sides of the arm was not equal in the book, but I’ve just measured it on both sides, and the results are similar, they’re equal.
I couldn’t wait to explain it to him. I had to ask the patient to go back to the CT room and do it again.
And this time, make a C.T. Angiography, see if there’s an aorta trap!
Hurry! If it’s really the aorta, it’ll have to be found before it breaks.
I took the shortest time to tell the patient that all of his symptoms tonight, including abdominal pain, nausea, vomiting, diarrhoea, impotence in left lower limbs, reduced skin temperature in left lower limbs, severe loss of liver function, impaired kidney function, and even abnormal blood condensation… were caused by a disease, not poisoning, not hepatitis, much less intestinalitis, but an aorexia!
Patients and girlfriends face each other. I don’t understand what I’m saying.
It doesn’t matter if you don’t understand, but listen to me. If the disease is misdiagnosed, it can die.
The patient frowned and said that in such a short time tonight, all three of you doctors said I was heavy and I didn’t know if I was really heavy.
I’ll get Dr. Phoe to contact the CT room while I keep explaining to the patient.
I told him that as a result of your history of hypertension and your failure to take good medication, blood pressure had been high, which was likely to damage the blood vessels, cause an aorta trap, tear down the abdominal aorexus and affect the veins along the way.
Some of these veins give blood to the liver, some to the intestinal, some to the kidney, some to the spinal cord and some to the lower limb, and now they’re torn, so the blood of the organs is broken, so there’s a functional impairment, which explains all the symptoms of tonight!
If you hesitate any longer, your veins will explode.
Maybe I really scared him. He agreed to do CTA.
I asked the nurse to bring another analgesic, to give him a shot, to try to relieve the pain and to lower the blood pressure, in order to stabilize the veins and not to burst, if it really is an aortic trap.
And then all the way to the CT room.
Everyone doesn’t know that my heart refers to the voice.
I’m even ready to do something about how people on the road can be saved if their heart breaks out, and what can be saved by the tube intubation?
The only thing that’s expected is not to explode on the road.
I told the CT-room doctor that head CT would do it too. Make sure it’s not brain bleeding.
No problem with the skull.
And then they scoured the abdominal veins.
As soon as the agent enters the patient’s vein, the image on the screen comes out.
Jesus!
“You’re right, it’s a trap! I’m sorry.
The CT doctor was so surprised, and on the screen he said to me, “You see, it’s been tearing down from the abdominal aorta, and it’s a very classic DeBakey III. I’m sorry.
When I saw this image, I felt my throat blocked, and I couldn’t speak for seconds.
I’m really nervous! Fortunately, the patient didn’t push the ICU directly into the blood flow, which was used to inject anticondensatives, which are forbidden to use in the aortics.
If you try, if the layer breaks and we use anticondensants, it’s worse, and the patient has no chance of surviving.
The aorta is a fighter in critical condition, even worse than myocardial infarction.
The point is that we’re very alert to the intimacy, but sometimes we’re less alert to the aortics.
Because the diagnosis is simple, it’s like making an EKG.
But it’s a lot harder to diagnose the aorta, and it’s gonna have to be a CTA.
If this disease is not dealt with in a timely manner, about 3% will suddenly die. The death rate in two days is as high as 70 percent, and if you don’t handle it in a week, 90 percent will die.
I took a breath of cool air and called down the vascular surgeons and the cardiovascular internal surgeons.
They’re the only ones who can handle it.
The patient learned that he was an aortic layer, first for a second and then for a second for fear.
I kept consoling him, and then I asked the nurse to give him a shot of morphine, which was a strong painkiller, and for him, the benefits were far too bad.
Pressure-relief pills have also been used, and blood pressure must be stabilized to avoid vascular rupture.
The attending doctors soon arrived and saw such a classic and severe aorta layer, and their eyes were so big that it was a hot potato, and if not, the patient died.
If it is later, the organs are bound to suffer worse.
Finally, the patient was placed in the Cardiovascular Internal Care Unit, where he was given absolute bed rest, sedated, depressive treatment, etc., during the night, which stabilized the general situation and eventually did not cause angioplasty.
Later discussions took place in several sections to prepare for intervention surgery, called the internal repair of the cavity of the aneurysms.
The operation is not complicated by the fact that, by micro-initiatives, a diaphragm strangulation is put into the veins, re-opening the veins, crushing the false cavity, and returning the veins to their original state, both to protect the veins from rupture and to restore the body blood supply.
We are all prepared to see the operation, and unfortunately, since the hospital next to us is the strongest cardiovascular disease centre in the province, the patients have been transferred and further treated there, subject to medical approval.
The operation was also said to have taken place.
The dead survive.
Think about us, we’re all dead.
Cope-class: acute abdominal diarrhoea, what should be considered?
Emergency abdominal pain.
There are too many patients who are most afraid of abdominal pain, fever and chest pain, as the underlying causes are too many and some diseases are still very serious, and life risk may arise if they are not identified in a timely manner, such as the aorexic layer of the patient.
We have considered several causes of the disease, but at first we did not take into account the aortic cortex, which was not typical at first. The typical aortic artery layer is the heart and chest pain that is torn apart, and most of the elderly suffer from the disease. The patient is young, but he has a high-risk factor: obesity and hypertension.
Of course, most abdominal pains are not fatal and there is no need to be too afraid. It is only that when dealing with abdominal abdominal pain, emergency doctors sometimes have to perform some tests in order to be better identified.
How can we prevent the horde of the artery?
The aortic pyrophoric layer is a pathological change in the aneurystic cavity resulting from a pathological change in the aortic cavity, which occurs when the blood in the aortic cavity is torn from the anortic inner membrane to the aortic membrane and extends in the direction of the aortic long axis. Clinical characteristics are acute outbreaks of severe pain, shock and haematoma, which are associated with an arterial ischaemic manifestations.
The age of 50-70 is very high, and if it is not treated in a timely manner, the death rate within 48 hours can be as high as 50-70 per cent.
The causes of the disease are unknown and may be genetic. High blood pressure, sclerosis of the artery are medical factors, and most patients have high blood pressure. So if prevention is necessary, it can only start with the prevention of hypertension. If high blood pressure already exists, it must be actively controlled in order to minimize the occurrence of the aortic cortex. Case number: YX11Xb8vjzz
I don’t know.
Keep your eyes on the road.
