When the emergency department was handing over shift in the evening, the doctors were still handing over the patient's condition. A man rushed into the doctor's office: "Doctor, I'm dying of low back pain, please relieve me!"
low back pain
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dress latched on the chair after entering the house. Dr. Song, who was on duty that night, quickly put down his medical records and came to the patient: "What's wrong? Where is it uncomfortable?"
After inquiring, he learned that the patient was 2 years old and started to suffer from low back pain 2 days ago. He also showed frequent urination of , urgency, and urination pain. I bought the medicine in the pharmacy and took it but it didn't work. About 5 days before this, I was treated with " acute tonsillitis " infusion in the local health center due to "cold, fever, sore throat". Two days later, the throat pain was relieved and the fever was no longer there, and the back pain began to appear. The pain was persistent and paroxysmal aggravated, accompanied by hematuria .
Doctor Song helped the patient to the examination bed, asked the patient to lie on the examination bed, and began to examine him. Generally, for patients with abdominal pain or low back pain in the outpatient clinic, a physical examination should be conducted immediately when inquiring about the medical history to clarify the range and extent of the pain and to find some important signs, which is of great help in judging the condition and diagnosing the disease.
examination found that the patient had a painful face, but he was aware of it. There were no bleeding spots in the skin and mucous membranes all over the body, the face of flushed, the pharynx and soft palate were obviously congested, and the bilateral tonsils were swollen. There is obvious tenderness in the left abdomen, no muscle tension and rebound pain and , and the percussion pain in both kidney areas is obvious, mainly on the left side. Both lower limbs are not swollen.
B ultrasound examination
After the examination, Dr. Song took off his gloves and said, "The initial consideration is urinary tract infection and ureteral stone . Do a test, that is, blood routine and urinary color ultrasound."
blood routine mainly depends on whether there are inflammation and blood system problems, while urinary color ultrasound mainly depends on whether there are urinary stones and hydronephrosis , etc. The results of
examination came out quickly and found that the blood sign was slightly high and the platelets were slightly lower. There was hydronephrosis on the left and upper ureteral dilated, but no positive stone shadows were found, which may be considered as gas interference.
Seeing these test results combined with the patient's symptoms and physical signs, Dr. Song initially diagnosed the patient as: "urinary tract infection, left ureteral stone."
patients also agreed with the patient's diagnosis. After all, they are so young and have severe low back pain, and the possibility of urinary tract stones is the greatest.
So Dr. Song gave a doctor's advice to treat symptomatic treatments for anti-infection, antispasmodic and pain relief. After the infusion, the patient's low back pain symptoms were greatly relieved. At this time, the patient wanted to go back, but Dr. Song said to the patient: "Your platelet is low. Considering that platelet may have wall attachment phenomenon and there is a risk of internal bleeding. It is recommended to check the following platelets. After all, there is a serious problem with platelets."
ureteral stones
But the patient's symptoms have been relieved at this time, so he did not follow Dr. Song's advice and left the hospital and went home.
But at 5:10 am, a rapid 120 ambulance sound woke Dr. Song. Dr. Song ran out of the duty room and saw that it was the young man last night. After learning, the young man returned home, the first half of the night was quite good, and the second half of the night was nausea, vomiting and black stool, so the emergency room came to the hospital 120.
At this time, the man took the initiative to ask for hospitalization, but during the process of hospitalization, he suddenly lost consciousness, breathed deeply and had difficulty measuring his blood pressure. After active rescue, he died ineffectively.
The patient died for about five minutes after rescue failed. Dr. Song punctured the patient's abdomen and did not coagulate.
renal damage
How can a patient die suddenly? The patient's vital signs are normal in the ambulance, including when admitted to the hospital. In order to find out the cause of the patient's death, the only way is to have an autopsy.
Then, the hospital contacted the patient's family and conducted an autopsy with the consent of the family. The final autopsy result surprised Dr. Song because he misdiagnosed.The reason why patients with
are disappointed is that they are particularly severe due to the endocardial bleeding of the new atrium, the medulla hemorrhage on both sides, and the left renal fat cyst bleeding. Due to a large amount of bleeding, a huge hematoma of 20×10×15cm was formed around the renal pelvis of the kidney.
More than 1000ml of blood were also found in the patient's abdominal cavity.
Pathological anatomy confirmed that the patient died of epidemic hemorrhagic fever.
The so-called epidemic hemorrhagic fever refers to an infectious disease caused by hantavirus infection after a rat bite. Most of the patients are in nomadic areas of rural grasslands, or are exposed to mice carrying hantavirus , lemon mites , etc. due to outdoor camping. Disease with epidemic hemorrhagic fever, mainly manifested as fever, bleeding and kidney damage. If not dealt with in time, it is likely to be life-threatening.
At this time, combined with the death of this 20-year-old man, the symptoms were almost completely consistent, but because the patient never revealed that he was bitten by a rat or had a history of outdoor play when explaining his medical history, the patient's urinary systoms and examinations made the doctor misdiagnose him as a urinary sysm and urinary calculi , so he was not able to detect it in time.
hantavirus
However, this case also exposed to a certain extent that the doctor is not very proficient in the characteristics of epidemic hemorrhagic fever. When the patient experiences kidney damage and platelet abnormalities, he failed to detect the abnormality immediately and did not associate it with the problem of epidemic hemorrhagic fever.
However, when the doctor found that the patient thrombocytopenia and was at risk of internal bleeding, he reminded him to be hospitalized, but the patient refused, which also led to delays in the condition.
