patients gender: male
the patient age: 47,
the chief complaint: sudden abdominal pain for 10 hours, 1 hour with disturbance of consciousness.The brief history of
: 10 hours earlier sudden abdominal pain, can endure, no back radiation pain, nausea and vomiting, anti-inflammatory, spasmolysis to local clinic infusion of symptoms after treatment is not obvious, go home and rest.1 hour ago appear disturbance of consciousness, kubla khah dripping wet, clammy skin, 120 emergency.
no special previous medical history.Professional farmers.
physical examination: HR 102 times/min, 20 times R/min, BP 60/40 mmHg.His indifference, clammy skin, under the double lung wet sex then sound, rhythm of the heart.Abdominal muscle tension, tenderness and bounce painful (+).No positioning signs of the nervous system.
line immediately abdominal puncture see dark red hemorrhagic fluid, urethral catheterization less urine output.
auxiliary examination, routine blood: the WBC 18 x 10 ^ 9 / L, 87% neutral.ECG: T wave change.
bedside ultrasound: bedside chest ultrasound (-), abdominal B to exceed, only a small amount of abdominal cavity effusion GanDanYi spleen kidney (-).
the preliminary diagnosis: acute gastrointestinal perforation?Septic shock.
immediately to the liquid recovery + dopamine, blood pressure recovery is not obvious.
discussion: clinical diagnosis?
the first take a look at each station friends opinion:
station friend @ xiao pang said: 407
consider for severe acute pancreatitis: in the patients with epigastric pain onset, condition change fast, short time shock, positive peritoneal irritation syndrome, abdominal puncture with dark red liquid, prompt hemorrhage or hemorrhagic effusion, high white blood cells, blood neutrophils elevated prompt infection, cases gave no amylase, bilirubin and as a result, also no abdominal lie or CT slice results.The disease also can consider to acute suppurative cholangitis, however inadequate support point.
station friend @ xiao said: 0306
a, the diagnosis problem:
shock to check for:
1. Low blood volume shock: the basis of patients without overt bleeding, B ultrasonic of abdomen is just only a small amount of abdominal cavity effusion, temporarily can be ruled out, but need more evidence to support, for example, patients with history, the presence of the digestive tract ulcer is the current status to move bowels?Stomach area expansion?Hear the vibration stomach area water sound?
2. Distribution of shock: common septic shock, abdominal viscera can cause infection, and elevated white blood cell, but no fever, heaviest is acute obstructive suppurative cholangitis in patients with no obvious yellow dye, and B ultrasonic not suggests biliary calculi and liver disease, remains to be further confirmed.
3. Cardiac shock: electrocardiogram (ecg) in patients with T wave change, but the middle-aged patients, and is a manual labor people, temporary not consider.
4. Obstructive shock: I think most likely.Why do you say so?Because there is no obvious cause of shock, the illness heavy ruptured aortic dissection should be considered, cardiac tamponade, such as acute pulmonary infarction, remains to be further examination to rule out.
1. Open the vein channel, as soon as possible to maintain mean arterial pressure, 65 mmHg, pay attention to the perfusion, perfect the relevant inspection as soon as possible.
2. Didn't see blood gas analysis, if a lack of oxygen, invasive ventilation needs in a timely manner.
3. Antibiotic levels increase, mainly against gram-negative bacilli.
what is the case diagnosis?
standing friends speak what good?
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