How to understand ‘ignorance is fearless’?

I once treated a fat young man who came to the hospital with vomiting and diarrhea. He was suspected of being poisoned.

As a result, he showed signs of a stroke again. I looked at him and remembered a more fatal disease, but he was still instructing me to prescribe medicine…

I was on night shift in the emergency department that night, and near the dawn a 29-year-old young man came in.

My first impression of him was that he was a fat man.

The patient was accompanied by his girlfriend to see the doctor, and they looked very close.

He said he had a barbecue with his girlfriend in the evening and drank some wine, and not long after that he started to have abdominal pain.

It wasn’t serious at first, so I took some medicine at home, thinking I could control it.

Unexpectedly, the abdominal pain became more and more severe, and I also had diarrhea. I had diarrhea 5 times in total, and each time it was yellow watery stool.

I also vomited twice, and all the food I ate came out, and it had a sour and smelly smell.

There was no choice but to go to the emergency room.

He asked me if it was food poisoning.

I explained to him that it was unlikely because his girlfriend had eaten the same thing and was fine.

It must be acute gastroenteritis, he diagnosed himself directly.

He also asked me if I could prescribe some antibiotics for him, saying that he had always cured his gastroenteritis by taking antibiotics in the past.

Friends who read my article should know that emergency doctors are most afraid of patients with abdominal pain.

You may think that the abdominal pain is caused by gastroenteritis, but in the eyes of doctors, there are thousands of causes of abdominal pain. Without definite evidence, I cannot conclude that he has acute gastroenteritis.

But from his description, he ate barbecue and drank alcohol, and then had abdominal pain, diarrhea, and vomiting, which really looks like acute gastroenteritis.

But before diagnosing acute gastroenteritis, I have to routinely rule out diseases such as acute pancreatitis, acute appendicitis, acute cholecystitis, and gastric perforation.

These diseases will also cause the above-mentioned discomfort.

I did a routine check of his abdomen and there was nothing major wrong.

Auscultation of the heart and lungs showed no major problems, except that the heart rate was a little fast. It is normal for people with stomach pain to have a fast heart rate.

To be on the safe side, the resident doctor also did an electrocardiogram for him.

The electrocardiogram did not show any signs of myocardial infarction, but the heart rate was a little fast.

Then I took his blood pressure, which was 180/100 mmHg.

The blood pressure was so high that I thought the resident doctor had measured it wrong, so I measured it again and it was still about the same.

His blood pressure is indeed high.

The patient told me that he had discovered that his blood pressure was high two years ago but had not taken any medication.

The doctor told him that he would have to take medication for high blood pressure for the rest of his life, but he couldn’t accept that, so he didn’t stick with it.

It wasn’t this high before. Maybe it’s because the abdominal pain was severe this time and I was more nervous, so my blood pressure was even higher.

I told him that with his body shape and high blood pressure, if he doesn’t pay attention to controlling it, his risk of heart attack and stroke in the future will be much higher than other people, so he should not take it lightly.

He made some excuses, hoping that I would give him antibiotics as soon as possible.

While waiting for me to write the prescription, his stomach started to hurt again, and his stomach was rolling, and he said he needed to go to the toilet.

When he came back, the abdominal pain was slightly relieved.

He told me that he had just pulled some blood and took a picture to show me.

I looked carefully and saw some blood, but not too much, covering the stool, like bleeding caused by hemorrhoids.

He didn’t believe that he had hemorrhoids and said that his bowel movements were usually smooth, except that there was a little blood occasionally.

I didn’t argue with him. I was not worried about hemorrhoid bleeding. What I was worried about was the bleeding caused by acute gastroenteritis. That meant that the intestinal inflammation might be quite serious and should not be taken lightly.

In addition, rectal cancer may also cause blood in the stool.

When he heard that it might be rectal cancer, he became even more nervous and said that his uncle died of rectal cancer last year.

Then he has a family history.

He is so young, and this kind of blood in the stool really doesn’t seem like rectal cancer. I just said it’s something to consider.

But he persisted and asked a question that I still remember to this day:

Doctor, can you do a digital rectal examination for me? I heard that this examination can determine whether I have rectal cancer.

Now? Here? I was sweating.

There are so many patients now, I don’t have time to do a digital rectal examination on you.

I wanted to refuse him and ask him to go to the gastroenterology or anorectal surgery clinic tomorrow morning and let the outpatient doctor operate on him.

But he was worried and said he wanted to do it now. If it was not convenient to do a rectal digital examination, he could also be arranged for a colonoscopy.

OK, let’s do a rectal examination. Where can I arrange a colonoscopy at this time? I had to compromise.

It was the first time for him to have a digital rectal examination performed by a doctor, and it was also the first time for me to perform a digital rectal examination on a patient in the emergency room.

I circled my fingers in his anus for a few times and felt something. I guess it was hemorrhoids, not rectal cancer.

Only then did he feel relieved.

To be on the safe side, I still recommend that he find time to go to the outpatient clinic for a colonoscopy to see more clearly.

The most urgent thing is to do an abdominal CT scan to see clearly the condition inside the stomach.

If no problems are found in the liver, gallbladder, pancreas, spleen, kidneys, and ureters, then there is a high possibility of acute gastroenteritis.

Then I will treat the symptoms accordingly. This is my arrangement.

Is it okay to do B-ultrasound? The patient’s girlfriend asked me, saying that she was worried about the radiation from CT.

It would be fine to do an ultrasound, but there was no one on night duty in the ultrasound room of our hospital during that period.

If you really want to do an ultrasound, you have to call the person back from home, which is very troublesome.

We will only call back the doctor from the ultrasound room for people who are unable to undergo CT scans (such as pregnant women).

In addition, B-ultrasound is not as clear as CT. The patient is a fat man, so I thought it would be useless to do B-ultrasound. So I just went straight to the point and asked him to do an abdominal CT scan.

“This amount of radiation is not worth mentioning. It’s not even as dangerous as your body shape. You need to lose weight.” I didn’t forget to tease him.

Although he was somewhat reluctant, he still went for the CT scan as I arranged.

Before going for the CT scan, his abdominal pain seemed to worsen, and he asked me if I could give him an injection for pain relief.

I explained to him that it is against principle to use painkillers for people with abdominal pain of unknown cause, because it may mask changes in the condition and lead to misdiagnosis or missed diagnosis.

But seeing that he was in so much pain and his blood pressure was high, I was really afraid that if he continued to feel pain, his blood pressure would soar and he might even have a cerebral hemorrhage.

So after a quick weighing of the pros and cons, I decided to give him an injection of phloroglucinol, a drug for treating gastrointestinal spasm and pain.

I don’t know if it was the effect of the medicine or a psychological effect, but when the nurse pushed him back from the CT room, his abdominal pain had eased a little.

The CT results were also sent to me quickly.

The patient has severe fatty liver!

This is expected. It would be strange for such a fat man not to have fatty liver.

Then there is gallstones, but these stones look very quiet and the gallbladder is not big, so it does not look like acute cholecystitis, and the patient’s abdominal pain does not seem to be caused by the gallbladder.

Fatty liver is a problem, but simple fatty liver will not cause abdominal pain or vomiting.

There are other causes for the illness.

However, CT scan showed no problems with the pancreas, spleen, kidneys, ureters, appendix, etc.

It looks like the abdominal pain, diarrhea and vomiting are really caused by acute gastroenteritis.

It seems that I used the phloroglucinol injection correctly. The patient’s abdominal pain was caused by gastrointestinal spasm. This medicine can relieve spasm, so the effect is good.

The patient also asked me to give him intravenous antibiotics, and specifically asked for levofloxacin, saying that this medicine is effective. He used this medicine last time for acute gastroenteritis and he was full of energy the next day.

Of course I won’t listen to him. I’ll have to wait until the blood test results come back before I decide.

Acute gastroenteritis is not always caused by bacteria, it may also be caused by viruses, parasites, etc.

In addition, eating raw, cold, or overheated food may also cause gastroenteritis, which are not suitable for antibiotics.

没多久，抽血结果回报了，血白细胞计数 21x10E9/L（正常 3-10x10E9/L），显著升高了。

This means that there may be a bacterial infection and antibiotics are appropriate.

Since he has used levofloxacin and it worked well, let him use this medicine. At least it won’t cause allergies.

However, when another report appeared in front of me, we were all dumbfounded.

病人肝功能显示转氨酶显著升高，ALT 高达 2000 多（正常 0-40U/L）。

The kidney function was also not good, with blood creatinine rising to 150μmol/L (normal 30-110, varying in different hospitals).

The coagulation indexes were also released, and some of the results were abnormal. The myocardial injury markers were all normal.

What was going on? The resident doctor was confused. I was also confused.

It is impossible for patients with acute gastroenteritis to have such poor liver and kidney functions.

Generally speaking, gastroenteritis is relatively mild, with lesions limited to the gastrointestinal tract. It is unlikely to affect the liver and kidneys, let alone cause abnormal coagulation indicators.

Could it be caused by the patient’s fatty liver?

After all, the CT scan showed that the patient had obvious fatty liver, and the patient was a heavy drinker on a daily basis. Could it be alcoholic hepatitis?

Alcohol can cause liver damage, but it will not cause damage to the kidneys or blood coagulation function.

Doesn’t the patient have a history of hypertension? Could it be that long-term untreated hypertension has led to hypertensive nephropathy?

I just can’t figure it out.

The patient’s girlfriend quickly took out the report form of her physical examination last year from her mobile phone. The patient’s liver function, kidney function, and coagulation function were all normal last year.

At this time, the patient’s abdominal pain worsened, sweat appeared on his forehead, and the pain was mainly around the navel.

He also said he wanted to go to the toilet again, but this time he only defecated a little, and when he came back he felt a little exhausted.

I had diarrhea so many times in one night and vomited several times. I vomited everything I ate in the evening. My stomach also hurt. I was very exhausted and it was normal for me to faint.

And seeing that his blood potassium was also low, I gave him two more bottles of fluid replacement, one to replenish his energy, and the other to make up for the lost water to avoid dehydration.

“Doctor, please give me levofloxacin. That medicine is particularly effective for me.” He almost begged me.

I had no choice but to urge the pharmacy to send the medicine to him quickly.

But my intuition told me that his condition might not be that simple.

I have been in the emergency department for a long time and have dealt with many cases of acute gastroenteritis. Very rarely has abdominal pain been as severe as his, causing him to break out in a sweat.

At this time his girlfriend blamed him, telling him not to eat so much at night, but you couldn’t control your mouth and put oysters, beef skewers, and lamb skewers into your mouth, and drank beer and white wine together. It was a mess. If you don’t have a stomachache, who will have a stomachache?

Regardless of whether he agreed or not, I asked the resident doctor to do an electrocardiogram for him, but there was still no significant finding, except that his heart rate was a little fast.

He was a little annoyed. Was it necessary to do electrocardiograms over and over again?

I explained to him that with his body shape, high blood pressure and abdominal pain, the possibility of myocardial infarction must be ruled out.

Most heart attacks present with chest pain, but a few present with abdominal pain, so be careful.

The resident doctors were also confused. Since the myocardial injury markers were all normal, could myocardial infarction not be ruled out?

It really doesn’t work.

In the early stages of myocardial infarction, myocardial injury markers will not increase.

Generally, we have to wait a few hours after a myocardial infarction and the myocardial cells have been damaged to a certain extent before we can see these markers in the blood circulation. There is a time window.

I reminded the resident doctors that any pain below the teeth and above the pubic bone should not be considered as myocardial infarction, especially in patients with hypertension.

Because of the crossed nerves, sometimes a heart problem manifests itself as stomach pain. If you are not careful, problems can easily arise.

But the two electrocardiograms were similar and no further signs were found, so my worries were unnecessary.

But at least I feel relieved and no longer consider it a heart problem.

但病人显著异常的肝功能，又让我提心吊胆。

Why is the transaminase so high? The blood creatinine is also elevated, and the coagulation index is also abnormal.

The resident doctor reminded me, “Is it really poisoned, teacher?”

That’s exactly what I’m worried about.

显著的肝肾功能异常、凝血指标异常，一定要警惕严重感染或者中毒等疾病。

If it is a serious infection, there will usually be a fever, but the patient’s temperature is normal.

Moreover, the CT scan did not reveal any obvious foci of infection, and the only suspected infection was in the intestine.

When I thought of this, I told the patient to leave some stool for testing if he went to the toilet again.

Could it be that he was really poisoned?

He ate so much and so many different kinds of food tonight, and many of the kebabs were not very clean and might have a lot of pathogens attached to them.

Or they may have directly eaten poisonous food. Before this, a patient ate black fungus that had been soaked overnight and later developed liver and kidney failure, and his life was hanging by a thread.

Could the patient in front of me be in a similar situation?

My brain was racing, analyzing every possibility.

But the patient had barbecue with his girlfriend, so there was no reason why only the patient would be poisoned while his girlfriend would be safe and sound.

But what the patient’s girlfriend said next made us even more frightened.

My girlfriend said that most of the barbecue skewers in the evening were eaten by the patient himself. There were also a lot of black fungus, oysters, meatballs, etc., most of which were finished by the patient himself. She only ate a small part of them, and not every one of them.

If this is true, it is entirely possible that the patient himself ate the poisonous food and his girlfriend luckily avoided it.

But this possibility is still too low. It is unlikely that only one of them was poisoned when two people were eating together.

But the patient’s transaminase level is so high, over 2000. This is not a high level that can be reached by ordinary hepatitis. It must be due to severe damage to the liver cells.

In any case, let’s call the gastroenterologists and ICU doctors down first, and let’s discuss which department will be better for treatment.

I told the resident doctors that we emergency doctors are not always able to analyze the patient’s condition in a short period of time, and it is appropriate to consult with relevant departments in a timely manner, which can protect both the patients and ourselves.

During the consultation, the patient’s abdominal pain worsened and he became restless, so I had to give him another injection of phloroglucinol to relieve the abdominal pain.

He also said that in addition to the abdominal pain, he felt a little numbness in his left lower limb and had no strength in his whole body.

消化内科医生来了，了解完患者情况后，觉得肠道感染的可能性很高，毕竟患者有腹痛、拉稀、呕吐情况，查血白细胞计数又显著升高。

If the CT scan shows no obvious lesions in the internal organs, then it must be a problem with the intestines. Problems with the intestinal mucosa cannot be detected by CT scan, and the only way to find out is by doing a colonoscopy, which obviously cannot be done now.

Another thing to consider is acute hepatitis. It is recommended to complete virological tests such as hepatitis B and hepatitis C after hospitalization to see if there is any possibility of acute hepatitis B. Be alert to liver failure. Once liver failure occurs, it is very dangerous.

When the patient and his girlfriend heard the word liver failure, they became frightened.

It was just a case of gastroenteritis, why did it become related to liver failure? The patient felt that the gastroenterologist was trying to intimidate him.

The ICU doctor also came and after evaluating the condition, he agreed with my consideration and believed that poisoning could not be ruled out.

The question is, how did the patient become poisoned?

Although the cause is unclear, there are many signs.

The ICU doctor suggested doing an arterial blood gas test to check the internal environment.

Arterial blood gas analysis is to directly draw the patient’s arterial blood and send it for testing. The results will be available in a few minutes and can show the patient’s internal environment conditions.

结果一看，pH 只有 7.2（正常 7.35-7.45），显著酸中毒。

This indicates that the patient’s organs and tissues are all hypoxic, the cells undergo anaerobic glycolysis, and the accumulation of acidic metabolic products leads to acidosis.

This further supports the possibility of poisoning!

However, we repeatedly asked the patients about their conditions and found nothing suspicious about what they had eaten at night.

But the result is that the patient’s liver and kidney function is damaged, coagulation indicators are abnormal, and there is acidosis. Even if it is not poisoning, it may be a serious infection. The next step may be liver and kidney failure, or even multiple organ failure.

It is recommended to go to the ICU for close monitoring and consider blood purification treatment.

This involves blood perfusion, which is somewhat similar to hemodialysis. First, an injection is given to the patient’s thigh vein, a catheter is placed into it, and then the venous blood is drawn out.

If there are toxins in the blood, this machine outside the body can absorb most of the toxins and then return the remaining clean blood to the patient.

This is called hemoperfusion, a type of blood purification.

When the patient heard that he had to be admitted to the ICU and undergo blood perfusion, he became even more resistant. He said it was just gastroenteritis and it was not that serious, and urged me to use painkillers and levofloxacin immediately.

When the ICU doctor saw that the patient was unwilling to stay in the ICU, he persuaded him for a few words and then left, but did not forget to remind me to ask him to sign.

I also advised him a few words, but the patient refused to stay in the ICU. If he really had to be hospitalized, he would stay in the gastroenterology department instead of the ICU.

At least I can be hospitalized, which is better than staying in the emergency department.

Soon the medicine from the pharmacy returned, and I asked the nurse to give it to him immediately, and then prepared to admit him to the Department of Gastroenterology for inpatient treatment.

Just as he was preparing to move over the bed, the patient suddenly told me that his left lower limb was getting more numb and he couldn’t even move it.

Is there such a thing?? I don’t believe it.

At first I thought that he had been lying in one position for too long, compressing his blood vessels and nerves, causing the numbness in his feet.

But I checked his left lower limb and found that the muscle strength was indeed reduced. Compared with the right lower limb, the left lower limb was almost paralyzed.

I broke out in a cold sweat on my back!

The patient’s abdominal pain had not yet subsided, and he discovered that his left lower limb could not move, and he cried out in panic.

His girlfriend was also quite aggressive. She almost grabbed me by the collar and asked me why this happened, and whether I had used the wrong medicine and damaged my nerves!

I have no way of defending myself.

This is impossible. Phloroglucinol injection is a commonly used antispasmodic drug. It is very effective in relieving gastrointestinal spasms, renal colic, etc. I have never heard of any reports of it causing limb weakness or even paralysis.

还有，这个左氧氟沙星也是刚刚用上，不可能这么快就有这么显著的不良反应，除非是药物过敏。

Even if it is a drug allergy, the initial symptoms should be skin itching, erythema or unstable circulation, etc. How could it cause one side of the lower limb to be unable to move!

For a moment, I was at a loss.

What is going on? ?

When the patient first came, he complained of fatigue and weakness, but it was not serious to the point where he could not move one of his lower limbs.

But now checking his left lower limb, it is indeed almost impossible to move it, and the muscle strength is at most level 1 (normal is level 5).

The nurse took his blood pressure again and it was still high.

The resident doctor reminded me that I might have had a stroke.

I have said before that if the patient has such high blood pressure, he or she may really have a stroke if he or she is unlucky enough.

But it didn’t look like a stroke because there were no other localizing signs.

Moreover, the patient suffered from poisoning and stroke at the same time in one night. He must have been unlucky for many lifetimes to have this happen.

I kept a close eye on the patient’s blood pressure and repeatedly palpated the pulse of the patient’s left lower limb. It was very weak and the skin temperature of the limb was cool. Suddenly, I thought of a disease.

Whenever I think of this disease, I feel so upset. I am so stupid. I should have thought of it at the beginning. Why did I think of it only now?

The more I think about it, the more upset I get!

But now is not the time to regret. The problem must be solved immediately, because if it is really this disease, the patient may fall to the ground and die in the next second. That would be a real tragedy, and I cannot wash myself clean even if I jump into the Yellow River.

The resident doctor asked me, what disease is it?

Aortic dissection!

As soon as these words were spoken, the resident doctor’s eyes widened.

He asked me, shouldn’t the typical symptom of aortic dissection be tearing chest and back pain? The patient in front of me has abdominal pain, so why would you suspect aortic dissection?

If the thoracic aorta is torn, then of course there will be pain in the chest and back.

But what if it is a tear in the abdominal aorta? Wouldn’t that cause abdominal pain?

The blood vessels of a normal person have several layers of structure, including the inner layer (mucosa), the middle layer (muscle), and the outer layer (serosa), just like water pipes.

However, some people’s blood vessels are more fragile, or their blood pressure is too high for a long time. The blood pressure impacts the vascular endothelium and may scrape a cut. Over time, it may tear apart several layers of the vascular endothelium and form a false lumen.

At this time, the patient will feel severe pain in the waist, back, chest and abdomen. If the outer layer of the blood vessels is also ruptured, blood will gush out, and the patient will lose a large amount of blood in an instant, and then die from hemorrhagic shock.

Once a blood vessel ruptures, there will be no time to rescue it.

Death is certain.

The resident doctor was still wondering, and said that if it was aortic dissection, the book said that the blood pressure measured on the left and right arms should be unequal, but I just measured both sides on purpose, and the results were almost the same, they were equal.

I was so impatient at that time that I didn’t have the energy to explain to him. I had to ask the patient to go to the CT room and do another CT scan.

And this time we are going to create contrast agent to do CT angiography (CTA) to see clearly whether there is aortic dissection!

As soon as possible! If it is really an aortic dissection, it must be discovered before the dissection ruptures, only then will there be a glimmer of hope!

I told the patient in the shortest time possible that all his symptoms tonight, including abdominal pain, nausea, vomiting, diarrhea, immobility of the left lower limb, weakened pulse and cool skin temperature of the left lower limb, severe liver damage, kidney damage, and even abnormal coagulation indicators… were all caused by one disease, not poisoning, not hepatitis, and certainly not gastroenteritis, but aortic dissection!

The patient and his girlfriend looked at each other, not understanding what I said.

It doesn’t matter if you don’t understand, but listen to me and do a CTA first! If this disease is misdiagnosed, people may die at any time.

The patient frowned and said, “In such a short time tonight, you three doctors all said that my condition is very serious, but I don’t know whether it is really serious or not.”

While I asked the resident doctor to contact the CT room, I continued to explain things to the patient.

I told him that since he had a history of hypertension and had not been taking his medicine properly, his blood pressure had always been high, which may have damaged his blood vessels and caused aortic dissection. The abdominal aorta was torn all the way down, affecting the blood vessels along the way.

Some of these blood vessels supply blood to the liver, some supply blood to the intestines, some supply blood to the kidneys, and some supply blood to the spinal cord and lower limbs. Now they are all torn, and the blood supply to the above organs is cut off, so functional disorders will occur. This can explain all the symptoms tonight!

If I hesitate any longer, my blood vessels will burst and there will be nothing I can do!

Maybe I really scared him, so he agreed to do the CTA.

I asked the nurse to get another kind of analgesic and gave him an injection directly to relieve the pain and lower his blood pressure as much as possible. The purpose was to stabilize the blood vessels and prevent them from bursting if it was really aortic dissection.

Then run all the way to the CT room.

No one knew that my heart was in my throat.

我甚至做好了准备，如果路上患者突发心跳骤停应该如何抢救，气管插管又能挽回什么呢，似乎什么也于事无补。

The only thing I hope for is that I don’t get a blood vessel burst on the road.

I told the doctor in the CT room that I should also do a head CT scan to make sure it wasn’t a cerebral hemorrhage.

There’s no problem sweeping the head off.

Then the abdominal blood vessels were scanned.

As soon as the contrast agent enters the patient’s blood vessels, the image appears on the screen.

Oh my god!

“You’re right, it’s really a mezzanine!”

The doctor in the CT room was extremely surprised. He pointed at the screen and said to me, “Look, the tear has gone all the way from the abdominal aorta to the iliac artery… This is a very classic DeBakey III type.”

When I saw this image, I suddenly felt my throat was blocked and I was unable to speak for a few seconds.

I was really nervous! Fortunately! Fortunately, the patient was not pushed directly to the ICU for hemoperfusion. Hemoperfusion requires the injection of anticoagulants, and this anticoagulant happens to be contraindicated for aortic dissection.

You try it. If the dissection ruptures and we use anticoagulants, it will make the situation worse and the patient will have no chance of survival.

Aortic dissection is a fierce fighter among critical illnesses, even more ferocious than myocardial infarction.

The key is that we are very vigilant about myocardial infarction, but sometimes we are not so vigilant about aortic dissection.

Because diagnosing myocardial infarction is very simple, just doing an electrocardiogram is enough.

But diagnosing aortic dissection is much more difficult, and it requires a major effort to do CTA.

If this disease is not treated in time, about 3% of patients will die suddenly. The mortality rate is as high as 70% within two days, and if it is not treated within a week, 90% of patients will die.

I took a deep breath and quickly called the vascular surgeon and the cardiovascular physician down.

Only they can cure this disease.

When the patient learned that he had aortic dissection, he was stunned at first, and then became terrified.

I kept comforting him and then asked the nurse to give him an injection of morphine, a powerful painkiller. For him, the benefits far outweighed the disadvantages.

I also took antihypertensive drugs. My blood pressure had to be stabilized to prevent blood vessels from rupturing.

The consulting doctors arrived soon, and their eyes widened when they saw such a classic and serious aortic dissection. This was indeed a hot potato, and if not handled properly, the patient would die.

If it is any later, the ischemic organs will inevitably be more seriously damaged.

Finally, the patient was sent to the cardiovascular intensive care unit, and was given conservative treatments such as absolute bed rest, sedation, analgesia, and blood pressure reduction that night. His general condition was stabilized, and ultimately no vascular rupture occurred.

Later, several departments discussed and prepared to perform an interventional surgery called endovascular aortic stent graft repair.

The principle of this operation is not complicated. It is to use a minimally invasive method to send a covered stent into the blood vessel, reopen the blood vessel, squeeze the false lumen, and restore the blood vessel to its original state. This not only protects the blood vessel from rupture, but also restores blood supply to the organs.

We were all preparing to watch the operation, but unfortunately, since the hospital next door was the best cardiovascular disease center in the province, the patient was transferred to another hospital for further treatment if his condition permitted.

It is said that this operation was also performed.

Escape from death.

Think about the few of us who escaped death.

Popular Science Class: What should we consider in case of acute abdominal pain and diarrhea?

What are the situations of emergency abdominal pain?

There are too many. The emergency department is most afraid of encountering patients with abdominal pain, fever, and chest pain because there are too many causes behind them. Some diseases are very serious and may be life-threatening if not identified in time, such as this patient’s aortic dissection.

We considered several causes, but we didn’t consider aortic dissection at first, because it was not typical at first. Typical aortic dissection is mainly characterized by tearing chest and back pain, and most cases occur in middle-aged and elderly people. This patient is young, but he has high-risk factors, one is obesity and the other is hypertension.

Of course, most abdominal pain is not fatal, so there is no need to be too afraid. However, when emergency doctors treat patients with abdominal pain, they sometimes need to do some tests to better identify them.

Aortic dissection is so scary, how to prevent it?

Aortic dissection refers to a pathological change in which blood in the aorta enters the aortic media from the tear in the aortic intima and expands along the long axis of the aorta, causing the separation of the true lumen and false lumen of the aorta. The clinical characteristics are acute onset, sudden severe pain, shock, and ischemic manifestations of hematoma compressing the corresponding aortic branches.

The high-risk age group is 50-70 years old. If not diagnosed and treated in time, the mortality rate within 48 hours can be as high as 50%-70%.

The cause is unknown, but it may be related to genetics. Hypertension and atherosclerosis are medical factors, and most patients have hypertension. So if we must talk about prevention, we can only say that it starts with preventing hypertension. If you already have hypertension, you must actively control your blood pressure to avoid the occurrence of aortic dissection to the greatest extent.