"Where did you find the coma?" the doctor asked curiously. The doctor on the car shook his head and said, "In the XX bathing center, I don't know if it's too refreshing······." ”
The doctor suddenly realized, but then said righteously: "The bathing center also has a regular one, don't you laugh?" The doctor was already thinking about what the reason for this patient was unconscious.
The doctor immediately took out a small medical flashlight and irradiated the patient's pupils. His bilateral pupils are equal to large and circular, and he is sensitive to light reflexes. It doesn't seem to be particularly bad.
The doctor who brought him told the doctor that considering the patient's current condition, the probability of cerebrovascular accident was the highest, and according to the person who called 120, the patient was taking a nap in the bathing center and could not wake up after falling asleep.
The doctor was also a little surprised: "What about the patient's family?" The nurse said, "I just told you, it should be almost there." At this moment, there was a sound of running and shouting at the door of the emergency department, it was the patient's family who rushed to the hospital, and his wife cried: "Please save my husband, what is wrong with him"?
The doctor said, "Don't panic, just say if he was unwell before"?
The wife said that the patient had no symptoms before, never had fever, cough, headache, nausea, vomiting and other symptoms.
This is strange, is it an asymptomatic coma? Is it possible?
However, the patient's wife thought for a while and said, "My husband has high blood pressure."
The doctor knows this, after all, the highest blood pressure has been measured to 180/100mmHg.
But her next sentence frightened the doctors: "My husband never takes medicine."
Hypertension is never controlled by medication, then it is troublesome, and it may really be a cerebral hemorrhage, at this time the patient's limb muscle strength test is also over, muscle tone is low, and Babinski's sign is negative.
This made the doctor suspect that he had a cerebral hemorrhage or cerebral infarction, and the doctor said, "Let's inject mannitol first."
If doctors consider a patient to have a cerebrovascular accident, mannitol is necessary. The main purpose is to inhibit or eliminate cerebral edema, when patients have cerebral hemorrhage, cerebral edema after cerebral infarction is a common problem, if not controlled, cerebral edema can lead to cerebral herniation, and eventually lead to cardiac arrest, therefore, mannitol is a routine drug.
The nurse also connected the patient to the ECG monitor as quickly as possible, with a heart rate of 115 beats per minute, 32 breaths per minute, and oxygen saturation of 96%.
This vital sign is quite good.
However, the doctor observed that the patient's lips were a little purple, so he instructed the nurses to put on an oxygen mask for him to take oxygen.
Basically, after the process, the doctor asked the nurse, "Have you measured your blood sugar?"
The nurse replied: "I have already measured it, and now it is 5.8mmol/L, but fortunately there is no hypoglycemia." ”
The blood sugar of a comatose patient is very important because you can't tell if the patient's coma is due to hypoglycemia or other diseases, if it is really hypoglycemia, it can affect the function of the brain.
The doctor approached the patient's family and asked if the patient had any previous visceral diseases.
The doctor was unwilling: "What are the ones without hepatitis B?"
"No," she said with certainty, "I haven't heard him say anything like that." ”
"Then does he usually cough, chronic obstructive pulmonary disease, old chronic bronchia, such diseases?" The doctor noticed that the patient's breathing was relatively rapid, and he may have respiratory failure.
The patient's wife continued to shake her head.
The doctor nodded: "Let's do a CT scan of the head first." Actually, it could have been done a long time ago, but the patient's condition was relatively stable, so I wanted to do it later and figure out what was going on.
The CT scan of the head is very fast, the scan takes only a few minutes, and the results indicate that there is no intracerebral hemorrhage.
The doctor's brows furrowed, it was not a cerebral hemorrhage, could it be a cerebral infarction?
Although the cranial CT can immediately determine whether the patient has a cerebral hemorrhage, there is no way to see the cerebral infarction, because the blood flows out of the brain tissue after the cerebral hemorrhage, and the CT can be cleared, but in the case of cerebral infarction, the CT cannot be seen clearly due to cerebral ischemia.
It is best to supplement the MRI of the brain, which can quickly detect early cerebral infarction, which takes about 20 minutes.
In these 20 minutes, the doctor was also very anxious to wait, if it was not a cerebral infarction, then all diagnoses and speculations would have been overturned, and finally it was done, and the radiologist shook his head at the doctor and said, "There is no sign of cerebral infarction."
While this was a good thing, the doctor was once again caught in the vortex of diagnosis.
After returning to the emergency room, the blood routine examination came out, the patient's liver and kidney function were okay, the blood ammonia was normal, the electrolytes were normal, and there was mild carbon dioxide retention.
The doctor kept thinking about what the patient might have caused the syncope, and after thinking for a long time, the doctor felt that the patient seemed to be asleep, and suddenly a flash of inspiration flashed in his mind, could this guy have taken sleeping pills?
The doctor immediately called the patient's wife: "Did your husband take any medicine?"
Although the patient was found to be unconscious in the bathing center, and the probability of taking sleeping pills in the bathing center is very low, it cannot be ruled out whether the patient had taken a large amount of medicine the day before.
The patient's wife shook her head: "My husband never takes sleeping pills."
Once again, the doctor was disappointed.
"However, he takes other medicines," said the patient's wife.
The doctor was speechless, but he still patiently asked, "Do you remember what you ate?"
"Stability," she said without even thinking about it.
The doctor was ecstatic, and immediately arranged for the nurse to draw blood for another test, and at the same time, the doctor once again pulled the patient's eyes open and observed that the patient's pupils had become pinpoint-like, which is a typical manifestation of poisoning! And the detection was very fast, and it was indeed the presence of diazepam (diazepam) in the patient's body.
Immediate injection after naloxone detoxification!
After two or three days of emergency treatment, the patient finally woke up from a coma.
The family told the doctor that the patient had been being treated in a private clinic recently, and that the clinic doctor had prescribed diazepam for insomnia.
The doctor immediately decided that it was medical malpractice and immediately reported the matter to the medical regulator.
What is Valium?
Valium (diazepam) is a benzodiazepine.
It has sedative, anticonvulsant, and muscle relaxant effects and is a common drug used to treat anxiety and tension, reduce muscle spasms, and control seizures.
In addition, diazepam can also be used to treat sleep disorders such as insomnia and night terrors.
Usually diazepam needs to be prescribed by a doctor, and the dosage is determined according to the specific situation of the patient, and must be used under the guidance of a doctor. Because diazepam is a psychotropic drug, overdose or long-term abuse can lead to addiction and substance abuse problems.
After using too much, these symptoms can also occur:
(1) Respiratory depression. Excessive diazepam can lead to depression of the respiratory system, slowing down or even stopping breathing, which is life-threatening.
(2) Coma. Overdose of diazepam may result in a comatose state in which the patient is unable to wake up or communicate with the outside world.
(3) Low blood pressure. Excessive diazepam may cause a drop in blood pressure and symptoms such as dizziness, fatigue and palpitations.
(4) Muscle relaxation. Valium has a muscle-relaxing effect, and excessive use may lead to muscle weakness and difficulty moving.
(5) Memory and cognitive problems. Long-term abuse or overdose of diazepam may lead to impairment of memory and cognitive function, affecting thinking and learning Xi ability.
(6) Emotional and psychiatric problems. Diazepam overdose can lead to mental problems such as mood lability, depression, anxiety, and hallucinations.
All in all, diazepam is used to treat general insomnia, which is to kill chickens with a knife, which not only cannot play a role in continuous treatment but may also make patients seriously dependent.
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