Male patient aged 28 years.
Died not long ago and he was a very good boyfriend for his girlfriend.
The girlfriend saw him in the rescue room, the electrocardiogram became straight, saw his eyes turn gray, the limbs of his body turned into a miserable white color, he opened his mouth, opened his eyes, and looked particularly unwilling.
He just had stomach pain and hit a hanging bottle in the hospital, how could he die suddenly?
(Let's not spray the hospital first, patiently watch it)
I just bought a house a week ago, I was just ready to renovate, I was just ready to get a license to get married, and then the person was gone.
This is too cruel for a girlfriend.
The girlfriend is a poor life, her father died 4 years ago, and her grandfather died 2 years ago, leaving only her to rely on her mother. He showed up 1 year ago and soon they established a male-female relationship and he was very nice, attentive and caring for his girlfriend.
He was like a swordsman in front of him, so that his girlfriend, the princess, could sit safely on the horse.
In early January 2021, when the epidemic broke out in their city, he was sent to the cabin duty, a city with a small population, a large number of infected people, and a hard job.
In April 2021, the girlfriend stomach bleeding hospitalized, at that time really bleeding too much, look at what is black (black, cerebral ischemia performance), almost planted on the ground, sweating, the doctor said that this is excessive bleeding caused by cerebral ischemia, cerebral ischemia after the limbs must be weak, so will be unstable, fall head broken blood flow is not uncommon, if the rescue is not timely, can not stop the bleeding in time, and even hemorrhagic shock, and even death.
Fate favored the girlfriend, sent to the hospital in time, the doctor said to do gastroscopy, the boyfriend was afraid of gastroscopy crime, directly went to pay for anesthesia (painless) gastroscope.
After the girlfriend came out after the gastroscope, the person was not awake, the tongue was still outside, he accompanied him the whole time, and took a cute and funny little video of his girlfriend, really funny, and later, he died suddenly in this hospital.
In May 2021, after their girlfriend's condition improved, they went to the Forbidden City together. Watched the fireworks. In order to accompany his girlfriend to take the jump machine, he was forced to queue for 8 hours, and the girlfriend was hungry during the queuing process (peptic ulcer patients are taboo to eat irregularly), and he went to buy squid rings.
They made a wish under the fireworks, hoping to be healthy and healthy, forever and ever, and get married as soon as possible.
He is a very strong person, has a good appetite, never leaves a grain of rice at dinner, and often helps his girlfriend to eat the leftovers and eat it. I was in particularly good health and never had any history of heart disease.
But I had pancreatitis once 2 years ago and was hospitalized for half a month.
Other than that, there was no other illness.
So everyone didn't expect that a stomach pain could make him die suddenly.
In fact, he has been sick for a long time, but everyone has not cared.
4 months ago, he suddenly had nausea and began to vomit (after eating two bowls of porridge and vomiting), diarrhea, hiccups, sweating, suspected that it was a cold, thought it was a gastrointestinal cold, because he had been in good health, thought it was okay, did not go to the hospital for examination, just bought medicine in the pharmacy. In fact, this time it got better very quickly, and after 2 days it was recovered and I was able to go to work.
2 months ago, after dinner, he began to have stomach pains, thinking that he was cold with the soles of his feet when he opened the window to play games, and he couldn't go to work, so he took a leave. Still did not go to the hospital, bought their own medicine to eat. After about a week, the stomach doesn't hurt anymore, okay.
2 days ago, the two of them went out shopping for dinner, to welcome the New Year's Day, after eating and shopping he began to feel uncomfortable, stomach pain uncomfortable, because it has been the esophagus and stomach discomfort, thought it was gastroesophageal reflux, ready to go to the pharmacy to buy drugs for the treatment of esophageal reflux, during which he has been sweating coldly, and then better, slowly drove home.
After returning home, it was alleviated, thinking it was indigestion. But it feels like people are still a bit vain, even a little confused. The stomach is no longer painful, but it burns panic (from the symptoms, it is consistent with the manifestations of peptic ulcer and gastroesophageal reflux). My mother bought chinese medicine for me, and my girlfriend let me eat rabeprazole.
Spit out, spit out everything you ate at noon, the food was not digested and absorbed, and you can still recognize what you ate.
I thought it would be all right, I thought it would be over.
The next day, she received a WeChat message saying that her boyfriend had gone to the hospital and was getting injections.
He said he originally wanted to do a gastroscope, but the doctor said that it was New Year's Day, there was no gastroscopy, and said that the doctor was resting.
The girlfriend was particularly panicked, called to ask if she wanted to go to the hospital to see him, it was his mother who answered the phone, said that she would finish the hanging needle in half an hour, and go home after the call, and there was no need to come to see.
I don't know what kind of needles I got.
Before the injection, the color ultrasound of the hepatobiliary pancreas and spleen was done, and there was no problem, and pancreatitis was ruled out at that time. Only the heart color ultrasound did not do.
He had been comforting her that it was all right, no need to come over and accompany him.
This is their last conversation.
Shortly after the phone was put down, he suddenly received a call from his mother asking her to hurry to the hospital. She also wanted to ask what was going on, and his mother said come on.
By the time she rushed to the hospital in a hurry, the doctor said she had been rescued for half an hour.
The sky had fallen, and she didn't know what to do. Her brain went blank, and she kept holding her boyfriend's hand tightly, reluctant to let go. Kneel on the ground, ask the doctor, please, the first time I have been kneeling like this to beg someone, please, we will be married soon, you press again (chest compression).
The doctor said yes, I will press you again.
The doctor finally gave up.
The girlfriend doesn't believe it's true, it's impossible, it's something. His eyes were gray, his pupils should have been dilated, his hands were still warm, and his stomach was still floating up and down because of the ventilator. The feet were already miserable.
Girlfriend ask the doctor for electric shock, when the father left there was no electric shock, regret until now, please do an electric shock. The doctor said that not all electric shocks are easy to make.
Please.
The doctor said yes, and everyone backed off.
At this time, she stared closely at the instrument of the electric shock, and pinned all her life's hopes on this machine, the doctor turned off the electrocardiogram machine, turned on it again, and the electric shock was twice, and the doctor gave up.
Everyone gave up.
Boyfriend Dad held his head and said over and over again, Son, let Daddy die for you, Son, let Daddy die for you.
To this day, my girlfriend can't believe that such an excellent and such good person, in order to marry her, even quit smoking, why suddenly disappeared.
The doctor told me to wear a birthday coat, otherwise I wouldn't be able to wear it when I was late. His mother broke down, didn't wear it, couldn't let her son go away in vain, and had to do an autopsy.
Parents are not willing, girlfriends are not willing, and patients themselves are not willing.
The doctor said that he had a hemangioma in his heart (the patient's family's original words), and the hemangioma was broken, so the person could not do it. Everyone does not believe that the heart color ultrasound has not been done, how do you know that there is a hemangioma.
After 3 days, the autopsy was completed. Some of the specimens were shipped to the field and took 45 working days to produce results.
The mother of the deceased said that at the beginning he had stomach pain, and then the hospital, without gastroscopy, determined that the stomach was bleeding, and gave amoxicillin injections, as well as famotidin injections, and at the end of the fight, the patient said, Mom I am confused, I am uncomfortable, and then the person is gone.
If it was really a medical malpractice, the family would not forgive the hospital.
Some people think that maybe the boyfriend does not have a physical examination and failed to find the problem in time, the key is that his unit welfare treatment is very good, and there are two physical examinations every year.
Now that the results have not yet come out, what is the cause of sudden death of the patient? Everyone is struggling to find this answer. There are also a lot of Aite me who want me to share my views. At the same time, there are no points of attention that can warn future generations.
The first is to ask the family to mourn the change.
I analyzed several possibilities for sudden death in patients:
First, severe drug allergies. The patient used amoxicillin, famotidine, amoxicillin belongs to the penicillin class of antibiotics, there are many people who will be allergic, so they will generally do a skin test before taking the drug. The patient will also be asked about the previous medication and whether there are any allergies.
But even if the patient has no allergies before, and even this time the skin test is negative, it cannot be completely ruled out that the patient will not be allergic to this medication, so it is still necessary to observe closely at the beginning after taking the drug, that is, to prevent serious allergic reactions. The incidence of nonfatal penicillin allergic reactions is about 0.7% to 10% (Concordia emergency medicine data), while the probability of fatal allergic reactions is very low, about 0.002% or one death per 7.5 million injections (Concorde emergency medicine data).
If it is really a drug allergy, generally after exposure to allergens for a few seconds or minutes will appear symptoms, in other words, if it is an allergy, the needle water just hung up will soon have a reaction, generally within 30 minutes, but there is also a delay to 1 hour before symptoms appear.
If it is really a drug allergy, there will generally be skin erythema and itching at the beginning, which the general emergency department doctor can recognize. Immediately after that, due to the occurrence of anaphylactic shock, dizziness and loss of consciousness may occur, and if the rescue is not timely, people can die in a few minutes.
The most critical thing in rescuing anaphylactic shock is to disconnect the allergen in time (remove the original needle water, replace it with a new saline or other needle water that can quickly replenish the liquid), and immediately use epinephrine injection subcutaneously or intramuscular injection. Epinephrine is the most powerful anti-allergic, anti-shock rescue drug, in addition to antihistamine drugs (such as diphenhydramine), glucocorticoids can also be considered.
Taken together, the likelihood that a patient is a fatal allergic reaction is relatively small. Because the emergency department will ask about allergy history, the probability of fatal allergies of amoxicillin and famotidine is also very small, even if there is an allergy, because there has been a family member (the patient's mother), it can also be quickly identified, and can be given timely drug rescue, generally not to death and can not be rescued.
Second, there is heavy bleeding in the digestive tract. Because the patient has stomach pain before death (not necessarily stomach pain, strictly speaking, it should be abdominal pain, may be the epigastric mainly, because it is difficult for patients to know exactly that it is stomach pain rather than pain caused by liver, pancreas, and gallbladder diseases), and vomiting, reflux, heartburn (burning panic), weakness, cold sweat, people confused, etc., the analysis is likely to have gastric ulcers or duodenal ulcer bleeding, the amount of bleeding is still quite large, after coming to the emergency department, because there is no gastroscopy, it can not be identified in time as gastric bleeding, and it can not stop bleeding in time Although famotidine (a drug that inhibits gastric acid secretion) is used, there is no way to stop bleeding well, and patients may have worsened gastrointestinal bleeding during needle water (intravenous infusion), and hemorrhagic shock occurs, so blood pressure drops rapidly, and people are uncomfortable, comatose, and even die.
But this possibility is not very likely. There are several reasons for the analysis, first of all, if it is really a stomach ulcer bleeding, the patient should vomit in front of the patient should probably vomit blood, but according to the reaction is simply vomiting out undigested food. Secondly, if severe gastrointestinal bleeding does occur in the emergency department, so severe that the blood pressure drops in shock, it must be a lot of bleeding, so much bleeding, it is likely to cause hematemesis, but there is none. Finally, even if severe bleeding causes shock, there is a reaction process, after a large number of rapid rehydration can stabilize blood pressure, can delay a little time, not to die quickly. From the description of the family, the disease progressed abnormally rapidly, unlike shock caused by heavy bleeding in the digestive tract.
Third, acute severe pancreatitis. Some people think that the patient had pancreatitis 2 years ago, treated for half a month, and this time there was abdominal pain (the patient believes that it was stomach pain), vomiting, and it is not excluded that pancreatitis may occur again. This consideration does exist. However, the patient's family said that during the emergency department, the liver, gallbladder, pancreas, and spleen ultrasound were done, no problems were found, the pancreas was no problem, and they ruled out pancreatitis.
Even pancreatitis, even the most severe pancreatitis, high mortality of pancreatitis, it also has a process, because the pancreas to complete necrosis, inflammation to spread to other organs (such as lungs, kidneys, etc.), it takes a time, maybe half a day, a few days, etc., there will be a very tricky circulatory respiratory failure, rather than the first few minutes, hours to develop to the point of irreversible.
Therefore, the possibility of death from severe pancreatitis is also very small.
Fourth, the aortic dissection ruptures. This is the highest probability. It's also a consideration I support. We analyze in detail.
28-year-old male, very tall and strong, has gastrointestinal symptoms in the months and days before the onset of the disease, including nausea, vomiting, abdominal pain, etc., but after a period of time on their own, this may be a manifestation of pancreatitis, may be a manifestation of gastric ulcers, may also be a manifestation of aortic dissection.
What is aortic dissection? I put a picture and you will understand.
The largest artery of the human body is from the heart, this large artery walks all the way, and gradually divides many branches to nourish the brain, lungs, limbs, liver, kidneys, pancreas, gastrointestinal tract and so on.
The artery is like a water pipe, it may rupture, but the rupture is not suddenly burst, because the artery has several layers, divided into the inner layer, the middle layer, the outer layer, at the beginning is only the inner layer, the middle layer is ruptured, the outer layer is still complete, then the blood will rush into the inner layer, the middle layer, just like the above picture, the arterial lining has a rupture, the blood rushes in, and then forms a false cavity, this false cavity is called aortic dissection, very understandable.
This aortic dissection has two fatal points after formation.
(1) After the existence of dissection, it will seriously affect the blood supply of each branch, so the organs that are affected along the way will appear ischemic, if the blood vessels in one side of the upper arm are affected, then the blood pressure of this side of the arm will drop, or even completely undetectable, because the blood cannot flow over. If the blood vessels of the kidneys are affected, there will be renal ischemia and kidney failure; if the intestinal blood vessels are affected, the intestinal ischemia will occur, abdominal pain, nausea and vomiting will occur. If the spinal artery is affected, it can lead to numbness or even paralysis of the limb. In short, there will be a variety of manifestations, depending on the extent to which the dissection is torn and which organs are affected.
(2) After the existence of the dissection, we can also see that the artery only relies on the envelope of the last layer, and if you are not careful, the laminated envelope will burst, this is the aortic dissection rupture, so that the blood pressure quickly gushes out, and all the blood pressure rushes out (chest or abdominal cavity), rather than staying inside the blood vessels, the patient's blood vessels will be rapidly ischemic, and then shock occurs, the brain has no blood supply, it will immediately faint, and then coma, the blood in the organs of the whole body is not enough, the tissues will be ischemic necrosis, The heart is not excreted, and then it will die, this time is quite short, the speed and amount of this bleeding is a hundred times more serious than the gastrointestinal bleeding a thousand times (exaggerated, the purpose is to tell everyone that dissection rupture bleeding is extremely high-risk).
Looking back at the deceased's previous manifestations, there was stomach pain (I think it is stomach pain, but it should actually be abdominal pain or back pain), which is a typical manifestation of aortic dissection, because the blood vessel is torn, there will be a very severe chest pain or back pain. Secondly, the patient has nausea and vomiting, which may be a dissection tear affecting the blood supply of the gastrointestinal tract, so there will be nausea and vomiting, not necessarily caused by gastric bleeding.
This aortic dissection can only be diagnosed by CT enhancement scan of the chest and abdomen, and cannot be detected by hepatobiliary pancreatic and spleen ultrasound, so doing this color ultrasound is basically not helpful for diagnosing dissection.
Patients may have aortic dissection lasting for several months, so repeated nausea, vomiting, and abdominal pain have not been taken seriously, not examined, and not known. The condition also progresses gradually, not at the beginning of the rupture, otherwise it would not work in the first place.
This stomach pain (abdominal pain), went to the hospital, intravenous infusion for a long time, people will not work, rapid shock, coma, and then should be heartbeat breathing gone, the doctor is anxious to put on the tracheal intubation ventilator auxiliary ventilation (family description), but for a patient with aortic dissection rupture bleeding, ventilator, defibrillator is also futile, because blood has been lost, light oxygen and heart is not enough, there is no blood there is no tool to transport oxygen, the body will still be hypoxic, and then waiting for only death, And it will be quick, a few minutes of things.
Some people think it is strange that such a large number of aortic dissection rupture and bleeding, why can't the appearance be seen? yes. Aortic dissection rupture bleeding, blood is flowing into the chest or abdominal cavity, can not be seen outside, will not vomit blood, will not blood in the stool, because the blood does not enter the gastrointestinal tract, but in the chest and abdominal cavity.
Therefore, I analyzed that the patient should be a tragedy caused by the rupture of the aortic dissection and bleeding, and it is also the patient's family that the doctor suspects that it is a cardiac aneurysm, this so-called cardiac aneurysm, it is estimated that it is a family error, it should be aortic dissection or aortic aneurysm, etc. The cardiac ultrasound can not find it, unless the dissection involves the aortic valve.
This is a very catastrophic emergency, a nightmare for emergency department doctors, because it happens very rarely in young people, the high incidence age is 50-70 years old, and if it is not pulled to do ct of the chest and abdomen, there is no way to identify the disease.
Mortality at aortic dissection is high, with sudden death not treated at about 3%, mortality rates of about 50% or more within two days, and 70% or even 90% of deaths within a week.
If the clinician misses the diagnosis of this disease, it is considered medical malpractice, I do not know. The most conservative way to avoid misdiagnosis and omission is to pull out every suspected patient for a CT of the chest and abdomen.
How to rescue the rupture of the aortic dissection? It is very tricky, first of all, absolute bed rest, strong sedation and analgesia, if the use of interventional or surgical treatment, the purpose is not to make the blood vessel tear worse, stabilize the blood vessel, do not let the burst.
Of course, the rupture of the aortic dissection is just a guess, there is no evidence at present, and everything has to wait for the results of the autopsy.
The deceased has died, I hope that this young man will go all the way, I hope that the family will mourn and change, and I hope that everyone can get some lessons from this case, when there is abdominal pain, vomiting, do not easily think that it is a stomach problem, it may also be cardiovascular disease, some diseases once misdiagnosed, may cause irreparable outcomes.
(End of this article)