吃月饼引发大抢救!这起死亡病例为所有人敲响警钟!

2018-09-24 最后一支多巴胺 三甲传真

“检查不用做,就是吃了月饼,拉肚子。”

作为医生,当我决定把这个悲惨经历写下时,内心是沉重的!一条鲜活的生命就这样没了,希望这起死亡病例能给所有人敲响警钟,能让更多的人尊重医学,理解医生。

这是一位65岁的男性患者,因为腹泻在家属的陪同下来到急诊。

在看见他的那一刻,我感觉到了病重的气息,意识到了那些潜伏的致命威胁。但是,我却从没有想到我会在五个小时后内心沮丧到身心俱乏。

“我肚子痛,拉肚子,可能吃了一小块过期的月饼。”患者的主诉很明确,七个小时前开始出现上腹痛和反复稀水样腹泻。

随着季节变化,最近急诊和腹泻病门诊出现了越来越多以腹泻为主要症状的患者。

“能输点消炎药吗?”患者的妻子打断我的问诊,急切地想知道答案。

“我要首先明确病情,才能对症给药。”我很肯定地告诉她。

因为患者有些苍白的面色引起了我的重视:“您的血压现在只有80/46mmHg,已经休克了,要做份心电图检查,再抽血化验一下。”

“检查不用做,就是吃了月饼,拉肚子。”患者妻子否定了我的诊疗建议。

“不检查,就不知道指标高低?不知道指标高低,就无法对症治疗?”我嘴上这么说,其实心里最担心的是:患者腹泻乏力,感染程度如何,电解质情况如何?患者休克,是否只是单纯的低血容量性休克,有没有合并其它情况?患者腹痛,真的只是肠道痉挛性疼痛?

“我们没有什么病,就是吃坏了东西!”患者妻子斩钉截铁。

家属还在喋喋不休,不肯配合,时间一点一点流逝。

我有些着急:“高血压糖尿病还不是病吗?我不管你以前如何,我只知道你现在需要做这些检查。”我站起身,示意患者跟随我前往抢救室。

或许是看见我态度比较坚决,家属再也没有说话。

第一份心电图并没有明显的异常。

“打开静脉通路,留取血标本,然后用0.9%氯化钠快速补液,监测血压/心率/尿量。”我叮嘱完护士后便准备开医嘱。

然而,就在距离我做完第一份心电图不到4分钟,患者的病情发生了天翻地覆的变化!

“快过来,室颤了!”护士尖锐的声音让我内心出现了一丝慌张。

一个箭步冲到患者窗前:胸外按压、电除颤、肾上腺素........

幸运的是,在患者病情巨变之前,护士已经打开了静脉通路。不幸的是,顽固而强大的心电风暴让人难以招架。

按压,除颤,呼吸机,深静脉,多巴胺,去甲肾,肾上腺素,利多卡因,艾斯洛尔,氯化钾,硫酸镁......

谈话,下病危,签字,汇报,会诊......

最终我们还是没有敌过死神,在距离患者第一次腹泻仅12个小时之后,便眼睁睁地看着他被死神所吞噬。

也许有人会问:为什么患者的病情会突然的恶化,又怎么会突然出现如此严重要命的心室电风暴?”

其实,这个世界上从来没有人会无缘无故地患病,更加不会莫名其妙地突然出现病情变化。现实中,有很多人都没有注意到那些发生在身体内的细微变化和求救信号。

很少有人知道,特别对于那些患有慢性病中老年人来说,发热、腹泻、呕吐、纳差、大量出汗后的电解质紊乱,往往可以诱发严重的恶性血管事件。也很少有人知道,有些不典型症状的急性心肌梗死患者就是以腹痛为首发的临床表现。

这位年逾六旬的男性患者,常年患有高血压糖尿病,大多数情况下心脏便存在或轻或重的问题。在出现腹痛腹泻后,患者和家属都没有在意,只不过认为这只是普通的拉肚子而已。腹痛不缓解、乏力明显后,才抱着到医院输液的目的出现在医生的面前。到了医院后,由于家属的偏执和对医学知识的匮乏,又干扰医生诊疗。这些都是导致悲剧发生的直接原因。

对于这位患者来说,最大的可能便是多次腹泻后电解质紊乱,加之低血容量性休克的存在,最终诱发了心脏异常。至于心室电风暴的发生则主要和交感神经过度激活、希普系统传导异常、B受体反应性增高等等因素有关。

患者被殡仪馆工作人员带走了,一条鲜活的生命骤然凋零了。空荡荡的抢救病床上不仅留下了患者的生命,也留下了我和同事的汗水。严重低钾血症和休克,或许便是真正的杀手。

只是腹泻,却为此付出了生命的代价。

我之所以写下这个诊疗经历,就是想告诉所有人:如何避免高危人群发生腹泻,发生后如何能够意识到问题的严重性?

第一:不要食用过期食品;不要食用生冷的食物;冰箱隔夜食物尽量不食;冰镇冷饮尽量不要食用;烧烤、田螺、小龙虾等可能不干净的东西不要食用。

第二:要知道有时候心肌梗死可以没有胸痛,只是腹痛;也要知道严重的呕吐、腹泻、发热、出汗也可以诱发心脏病。

第三:患病时要多测血压血糖,一旦有风吹草动要第一时间来医院就诊。

我知道,要想改变国人传统观念,帮助更多树立正确的健康意识,还有很长一段路要走。希望这篇文章能被更多人的看到。

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    2018-09-26 lfyang
  4. [GetPortalCommentsPageByObjectIdResponse(id=1772117, encodeId=668f1e7211759, content=<a href='/topic/show?id=122b63381b3' target=_blank style='color:#2F92EE;'>#死亡病例#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63381, encryptionId=122b63381b3, topicName=死亡病例)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=59d938370790, createdName=xuqianhua, createdTime=Tue Dec 25 04:46:00 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706336, encodeId=15311e063364f, content=<a href='/topic/show?id=20cc605e25d' target=_blank style='color:#2F92EE;'>#月饼#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60572, encryptionId=20cc605e25d, topicName=月饼)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ac6f31217857, createdName=12498474m40暂无昵称, createdTime=Tue Jun 18 06:46:00 CST 2019, time=2019-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1471342, encodeId=26d614e134297, content=<a href='/topic/show?id=ac13558e9cb' target=_blank style='color:#2F92EE;'>#抢救#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55879, encryptionId=ac13558e9cb, topicName=抢救)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=be1a7117101, createdName=lfyang, createdTime=Wed Sep 26 07:46:00 CST 2018, time=2018-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346632, encodeId=46b8346632c8, content=看到你写的抢救过程真的是惊心动魄,患者和家属的不理解却更是让人无奈, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLS3nbTc0lzBwDxSVnm5KA9vNmsZrjTSvKlld6teMf4RG4ZmZWRvC80GB7zl4TSib3BAoZgcCYpzxQ/132, createdBy=02681961038, createdName=若轩, createdTime=Tue Sep 25 22:48:18 CST 2018, time=2018-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346597, encodeId=820b34659edf, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Sep 25 20:30:51 CST 2018, time=2018-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346472, encodeId=1d5f3464e226, content=过期食品常常不被重视,但是缺引发疾病。, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eec82448528, createdName=123ed584m65暂无昵称, createdTime=Mon Sep 24 19:37:47 CST 2018, time=2018-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346458, encodeId=7d4934645868, content=什么乱七八糟的, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJXCR8W80NNgQuicJU3aIm3JtiaNAFLYSMlBuVfGkSlw5Z5VpmZK4PyiaDURLAorhvwhWVnaM1gQdJXA/132, createdBy=a01444383, createdName=lixh1719, createdTime=Mon Sep 24 17:35:45 CST 2018, time=2018-09-24, status=1, ipAttribution=)]
    2018-09-25 若轩

    看到你写的抢救过程真的是惊心动魄,患者和家属的不理解却更是让人无奈

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1772117, encodeId=668f1e7211759, content=<a href='/topic/show?id=122b63381b3' target=_blank style='color:#2F92EE;'>#死亡病例#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63381, encryptionId=122b63381b3, topicName=死亡病例)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=59d938370790, createdName=xuqianhua, createdTime=Tue Dec 25 04:46:00 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706336, encodeId=15311e063364f, content=<a href='/topic/show?id=20cc605e25d' target=_blank style='color:#2F92EE;'>#月饼#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60572, encryptionId=20cc605e25d, topicName=月饼)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ac6f31217857, createdName=12498474m40暂无昵称, createdTime=Tue Jun 18 06:46:00 CST 2019, time=2019-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1471342, encodeId=26d614e134297, content=<a href='/topic/show?id=ac13558e9cb' target=_blank style='color:#2F92EE;'>#抢救#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55879, encryptionId=ac13558e9cb, topicName=抢救)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=be1a7117101, createdName=lfyang, createdTime=Wed Sep 26 07:46:00 CST 2018, time=2018-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346632, encodeId=46b8346632c8, content=看到你写的抢救过程真的是惊心动魄,患者和家属的不理解却更是让人无奈, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLS3nbTc0lzBwDxSVnm5KA9vNmsZrjTSvKlld6teMf4RG4ZmZWRvC80GB7zl4TSib3BAoZgcCYpzxQ/132, createdBy=02681961038, createdName=若轩, createdTime=Tue Sep 25 22:48:18 CST 2018, time=2018-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346597, encodeId=820b34659edf, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Sep 25 20:30:51 CST 2018, time=2018-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346472, encodeId=1d5f3464e226, content=过期食品常常不被重视,但是缺引发疾病。, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eec82448528, createdName=123ed584m65暂无昵称, createdTime=Mon Sep 24 19:37:47 CST 2018, time=2018-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346458, encodeId=7d4934645868, content=什么乱七八糟的, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJXCR8W80NNgQuicJU3aIm3JtiaNAFLYSMlBuVfGkSlw5Z5VpmZK4PyiaDURLAorhvwhWVnaM1gQdJXA/132, createdBy=a01444383, createdName=lixh1719, createdTime=Mon Sep 24 17:35:45 CST 2018, time=2018-09-24, status=1, ipAttribution=)]
    2018-09-25 惠映实验室

    学习了,谢谢分享。

    0

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    2018-09-24 123ed584m65暂无昵称

    过期食品常常不被重视,但是缺引发疾病。

    0

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    2018-09-24 lixh1719

    什么乱七八糟的

    0

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俗话说,“八月十五月儿圆,中秋月饼香又甜”。月饼最初是用来祭奉月神的祭品,沿传下来,变有了中秋吃月饼的习俗。圆圆的月饼,成为了人们实现团圆,幸福夙愿的象征。月饼为“三高”食品,即高油、高糖、高脂肪的食物,一般而言,一个广式月饼的热量高达850大卡,相当于3碗白饭的热量;60克左右的蛋黄酥,热量是200大卡,相当于1碗白饭的热量;绿豆糕一般的小月饼,热量也将近50—100大卡,相当于1片半吐司面包的

温暖!医生自制月饼,坚持3年陪病人过中秋(附图)

中秋将至,大多数上班族即将踏上回家的旅途,与家人团圆。但对于朱晓凤来说,中秋节除了与家人团圆外,还有20多位老人需要她来照看,三年来,每个中秋节她都坚守在岗位上,陪伴这些老人,并为他们送上自制的月饼。朱晓凤今年32岁,在成都慢性病医院神经内科从事医师工作已有三年多时间,这里的病人几乎全是上了年纪的老人,大多患有老年性痴呆、帕金森病或脑血管疾病。“这些老人需要的不仅是治疗,精神上的安慰也相当重要。由

奇葩月饼太辣眼,如何健康吃月饼?

导语:中秋节是传统节日,除了要吃芋艿,鸭子,毛豆,当然少不了月饼这个主角了,那月饼是不是健康当然是大家非常关心的话题。

糖尿病患者“无糖月饼可以随便吃”是误区

中秋佳节将至,月饼陆续上架。第三军医大学新桥医院营养科主任王建提醒,食用月饼务必适量,中老年人和患有糖尿病、心脑血管疾病的人更应慎食月饼。他特别指出,对糖尿病患者,“无糖月饼可以随便吃”的说法是一个误区,因为无糖月饼其实只是不含有蔗糖,脂肪和能量等含量仍然很高。   王建介绍,月饼有高糖、高脂、高能量的特点,过量进食会增加血液黏稠度,特别是现在市场上常见的蛋黄月饼,还含有很高的胆固醇,不建议心脑血

健康小知识:月饼:浅尝即可,不宜多吃

1月饼有营养?小时候常听老人们说“月饼有营养”。这句话在当时也许是正确的,因为在不同的时期与社会背景下,“营养”的含义不尽相同。在物质匮乏的年代,人们体力活动量较大,而饮食供应不足,那个时候“营养”就意味着“热量”,高热量的食物被视为是有营养价值的。月饼的主要成分是油、糖与面粉等,这些都是高热量食材,所以当时认为月饼有营养是有一定道理的。然而在当今条件下,我国居民在膳食方面的最大问题是热量过剩,并