He always felt that the matter was not that simple. What was the cause of the metabolic and respiratory acidosis? Was it the direct cause of the patient's coma?
In his heart, Chen Xia kept repeating the "coma mantra", AEIOU, low sugar and liver heat.
A=cerebrovascular disease; E=epilepsy; I=infectious disease; O=poisoning; U=uremia; hypo=hypoglycemia; hypo=hypotension; sugar=diabetes; liver=hepatic encephalopathy; heat=heatstroke.
Which one is it?
Since one person can't figure it out, let's all work together.
Chen Xia looked at the young doctors in front of him and said:
"What do you all think about this patient? We can discuss it. How about expressing your suspicions?"
Wu Shaochen was the first to speak: "The patient has impaired consciousness, no convulsions, no incontinence, and no pathological signs. The possibility of a cerebrovascular accident is low."
Bai Hua said: "The patient is in shock, but the hemoglobin level is 14.8, so hemorrhagic shock is not a concern. So ectopic pregnancy or dissection rupture is unlikely, but anaphylactic shock should be considered."
Tao Lili added: "The patient's lactate level was 21, but his blood sugar level was 13.1, his blood sodium level was 147, and his ketone levels were unknown. I don't know if he had diabetes in the past, and the patient was clearly dehydrated. I don't think he's in a diabetic ketoacidosis coma."
Wang Jinfa made the final statement: "Based on the onset of the disease, the presence of trauma also needs to be considered. The breath sounds are symmetrical bilaterally, pneumothorax can be ruled out, the hemoglobin is stable, and shock from abdominal organ hemorrhage is basically ruled out, but the possibility of cervical spine injury needs to be considered."
Chen Xia touched his chin. "The patient's jugular vein is engorged, so pulmonary embolism or pulmonary hypertension cannot be ruled out. Next, we need to pay attention to the blood vessels in the lower limbs and D-dimer levels to see if there are any high-risk factors for pulmonary embolism."
After saying this, he always felt that there was something he hadn't expected...
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