What you need to know as an emergency doctor.

1, for young patients with fever and cervical lymphadenopathy, if antibiotic treatment fails, the possibility of necrotizing and proliferative lymphadenopathy should be considered.

2. Cardiogenic (coronary artery or malignant arrhythmia) should be given priority to middle-aged and elderly patients with syncope, regardless of whether they have similar attack history in the past.

3. Young and middle-aged patients who complain of digestive tract symptoms should think of the possibility of acute severe myocarditis.

4. If you are poor when you are old, is it difficult to swallow? Let him laugh, is it a mask face!

5, shortness of breath, dizziness, especially teenagers, young and middle-aged women who look immature, see if the lips are dark red (not lipstick, brighter than lipstick), which may be alkalosis (alkali substitution for hysteria and acute gastroenteritis).

6, dizziness, vomiting, to prevent cerebellar hemorrhage, infarction!

7. Young male hypertensive patients with sudden abdominal pain, high fever and hypotension shock. We should think of hemorrhagic necrosis of pheochromocytoma and proliferative occlusive endarteritis of gastrointestinal tract caused by pheochromocytoma.

8, abdominal pain at night, often gallstone colic, kidney calculi renal colic prone period, adults have a history of attack; Attach importance to the diagnosis of the first acute appendicitis.

9, intravenous infusion of cephalosporins, symptoms after drinking, pay attention to the disulfiram-like reaction.

10, hand injury 2 The possibility of finger nerve injury should be considered when the flexor tendon breaks.

1 1, chest trauma, thoracotomy requires surgery, intercostal vascular injury should be considered to cause hemorrhagic shock-death!

12, ECG should be done for all pain below maxillofacial region and above umbilicus.

13, suddenly tossing and turning With the change of heart rate and blood pressure (increase or decrease), the first consideration for back discomfort is aortic dissection.

14, let your diagnosis explain all the symptoms, signs and auxiliary examination results of the patient, otherwise you should doubt the correctness of the diagnosis.

15, skin hyperalgesia, the possibility of early herpes zoster should be considered.

16. There must be something wrong with the brain of trauma patients who deny their injuries and ask the same questions repeatedly.

17, patients with cardiac arrest and respiratory arrest with tattoos should consider the possibility of drug poisoning.

18, if the lips are still rosy after the heartbeat and breathing stop, the possibility of cyanide poisoning should be considered.

19, paroxysmal dyspnea at night, normal heart color ultrasound, the possibility of reflux esophagitis should be considered.

Don't let others control your emotions, work hard and treat every patient sincerely, which can prevent disputes between doctors and patients.

2 1, pay attention to whether there is a cervical fracture when you fall, because other injuries on the body can reduce the tenderness of the vertebral body.

22, middle-aged and elderly patients with acute abdomen, the symptoms and signs are "not relying on all sides", abdominal distension is obvious, and vascular factors must be thought of.

23, chest pain, back pain As long as there is hip pain, you must think of mezzanine!

24. Female abdominal pain, as long as it is over 16 years old, it is necessary to check HCG.

25, patients over the age of 50 have difficulty breathing for the first time-consider cardiogenic first!

26, intractable cough must ask whether the patient is taking antihypertensive drugs such as angiotensin converting enzyme inhibitors, captopril, etc.

27, nail removal surgery for paronychia, the edge nail bed must be scraped and destroyed, otherwise it will recur.

28, without certain conditions (C-arm machine, or several colleagues), don't take foreign objects easily, it's not as simple as you think.

29. When a foreign body is stabbed, be sure to shoot, and there may be foreign body residues in the body!

30, inexplicable vomiting should think of pregnancy, uremia.

3 1, sudden unexplained low back pain with fever and jaundice, highly supporting hemolytic crisis.

32. No matter how old the patient is, whether he is a hospitalized patient or a first-time emergency patient, it is not wrong to take a blood sugar test immediately if his consciousness suddenly changes.

33. For any patient whose situation you judge may be unstable, it is always correct to establish a venous access immediately.

34. After acute cardiogenic cerebral ischemia syndrome, huge inverted T wave or huge biphasic T wave with significantly prolonged QT interval may appear on ECG. The unknown reason may be related to the extreme excitement of sympathetic nerve during cerebral ischemia attack. If the ECG fails to record the ECG at the time of ventricular fibrillation, but only has a huge inverted T wave, combined with the attack of syncope or convulsion, it can also be inferred that malignant arrhythmia has caused cerebral ischemia syndrome.

35, trauma patients with a history of heart disease must do electrocardiogram, because trauma may induce myocardial infarction.

36, persistent abdominal pain, no fixed tenderness point, routine auxiliary examination and no positive results, may be mesenteric vascular disease.

37. Patients with aortic dissection may not have obvious chest and back pain, which is manifested as abdominal pain and organ ischemia.

38. Patients with negative X-ray examination after trauma must be told to re-examine, especially rib fractures and some parts of ankles and wrists that may not be visible at that time, so as to avoid patients saying that you have not been diagnosed afterwards.

39. Don't forget the opening position of cervical X-ray.

40. Any trauma patient who may cause abdominal injury, no matter how normal the ultrasound was at that time and how good the patient was, must be handed over for observation and reexamination. It is very likely that the results of the second interview will surprise you or break out in a cold sweat.

4 1. Don't rely on radiologists' reports. They sometimes make mistakes, so no matter how busy you are, you must watch this movie carefully by yourself.

42. Apply a classic line of Dr. House: "Everyone can lie!" Sometimes the patient's medical history is concealed or misleading, so you should believe what you see and find.

43. The age and diseases mentioned in textbooks are only statistical data. In fact, you will encounter many strange and inconsistent cases in clinic, so you should keep an open mind and everything is possible.

44. Acute chest pain Considering patients with acute inferior myocardial infarction, it is necessary to increase the right chest lead, because V3r-V5r has high sensitivity and specificity in diagnosing right ventricular infarction, but its duration is short, and in most cases it can only appear in emergency room electrocardiogram.

45. After tracheal intubation, the doctor must ensure that the tracheal intubation is in place accurately and the patient can leave or take over after effective ventilation.

46. Don't casually lower blood pressure for cerebral infarction, and ignore him if the systolic blood pressure does not exceed 200.

47. When patients get out of bed after PCI, they suddenly have chest tightness, shortness of breath, sweating and blood pressure drop. Don't forget to consider pulmonary infarction.

48, acute onset limb weakness check blood potassium electrocardiogram.

49, consider the spinal cord lesions must check whether there is tenderness in the spine.

50, the elderly abdominal pain should be alert to biliary pancreatitis.

5 1, penicillin allergy should pay attention to its incubation period.

52. Traumatic patients complained of uncomfortable eyes or decreased vision. While performing routine brain CT and optic canal CT, don't ignore eye consultation. There are too many possible things, such as retinal detachment, retrobulbar hemorrhage and glaucoma.

53. Traumatic patients had no abnormal abdomen for the first time and complained of abdominal pain at night. While considering common injuries such as liver, gallbladder, spleen and kidney, we must be alert to traumatic aneurysms.

54, children's trauma, the first CT is normal, or only skull fracture, don't be afraid to wake up children at night, don't be disturbed by their families, be sure to wake up children regularly, beware of intracranial delayed hematoma, because the mortality rate of children's craniotomy is extremely high.

55, teenagers if suddenly abdominal pain, vomiting, fatigue, to test blood sugar, alert to diabetic ketoacidosis.

56, diabetic patients suddenly lost appetite, but also be alert to ketoacidosis.

57. Young patients with respiratory arrest and dilated pupils should not draw conclusions prematurely, and timely and effective respiratory support may be reversed.

58. Patients with organophosphorus pesticide poisoning should carefully clean their hair and skin to prevent toxins from being slowly absorbed again.

59. Ten possible causes of coma in patients-brain detoxification urine, cardiopulmonary dripping.

Brain encephalopathy; Intermittent epilepsy; Solution-electrolyte disorder; Poisoning; Urine-uremia; Drip hypoglycemia; Drip hypotension; Heart-heart disease; Liver-liver coma; Pulmonary encephalopathy.

60. Patients taking digoxin must check the blood concentration of digoxin when they have yellow-green vision and arrhythmia, and be alert to digoxin poisoning.

6 1, chest radiograph should be taken to check the position of the tube head after deep vein catheterization, except pneumothorax.

62, for the physical examination of trauma patients, try to be fully exposed.

63. For patients with mental disorders who may be traumatized after drunkenness, don't think with "he is just drunk". Because the medical history is unclear, many clinical manifestations of alcohol overdose, such as hypotension, unconsciousness and pupillary reaction, may be manifestations of craniocerebral injury and organ bleeding at the same time, so we should be cautious.

64, for patients with abdominal pain, after the initial diagnosis, still want to repeatedly observe the abdominal situation. Because according to statistics, only 30% of abdominal pain was diagnosed when it was first diagnosed.

65. When the systolic blood pressure of patients with cerebral hemorrhage or brain trauma is not higher than 180mmHg, don't easily lower blood pressure!

66. For patients with symptomatic epilepsy, especially patients with status epilepticus, when the effect of active application of AEDs is not good, whether the patient has hyperglycemia or hypoglycemia should be considered. Timely examination and correction can often relieve symptoms quickly.

67. For the elderly with atypical dizziness, headache, mental symptoms, weakness of one limb and hypomnesis, we should think of the possibility of chronic subdural hematoma, pay attention to asking if there is a history of trauma for about half a month or longer, and make routine head CT examination.

68. Rule out sudden hypotension caused by other reasons, don't believe in seemingly "normal" ECG monitoring, and do bedside ECG, which may lead to unexpected findings-ventricular tachycardia.

69, mild dizziness, mental impotence, men should pay more attention to cerebellar stroke, on the contrary, dizziness is heavier, the spirit is acceptable, women, peripheral dizziness is more likely.

70. If CK is high, don't forget to check the thyroid function.

7 1, patients with high fever in summer, don't forget the possibility of Japanese encephalitis, dysentery and heatstroke.

72. When debridement and suture, you must touch and explore the situation in the wound by hand to avoid transparent foreign body residue.

73. Patients with chronic dry cough should consider the possibility of cough variant asthma.

74. In the face of emergency patients brought by ambulances or whose families are very nervous, what you must do is:

1. Oxygen inhalation (except paraquat);

2. Establish venous access with normal saline;

3. ECG monitoring and service;

4. Assess vital signs, especially respiration and circulation;

5. If the vital signs are stable, you can appease the family members and patients, ask about the medical history, improve the relevant examinations and make a preliminary diagnosis and treatment;

6. If the vital signs are unstable, give first aid immediately and inform the nurse to prepare for the rescue. Consult immediately, and check the items that can be checked at the bedside as soon as possible. At the same time, briefly explain the situation to the family members, and the rescue of critically ill people will be life-threatening;

7. It is forbidden to go out blindly without evaluating vital signs;

8. In case of special circumstances (no escort, no money, car accident, signs of dispute, suspected murder, poisoning, etc.). ), be sure to report to the superior doctor or the medical department or the total value monitor;

9. In case of sudden chaos or out of control, avoid being beaten as soon as possible and report to the relevant departments of the hospital through mobile phones.

75, the elderly sudden heart failure shock malignant arrhythmia, to rule out acute myocardial infarction.

76. Patients who have a small wound on their thighs but are still awake should put on gloves and go in with their fingers to see if it is possible to hurt the femoral artery.

77. Patients with small abdominal wound, low blood pressure, depressed pulse and fast heart rate should consider whether there is pericardial hematocele.

78, hospitalized patients suddenly appear dyspnea, chest pain or respiratory cardiac arrest after getting up, need to be highly suspected of pulmonary thromboembolism.

79, mechanical ventilation patients suddenly appear oxygenation decline, breathing difficulties, especially after choking cough, sputum aspiration need to be highly suspected of pneumothorax, because of the emergency, it is feasible to try aspiration.

80. Intestinal perforation and acute peritonitis in the elderly may not have abdominal pain, abdominal muscle tension, abdominal tenderness and elevated hemogram. Diagnostic abdominal puncture can usually find the cause of shock in such patients.

8 1, middle-aged and elderly patients, with a history of hypertension, suddenly dizzy, normal muscle strength and tension of limbs, not necessarily just hypertension, but also lacunar cerebral infarction, don't let patients use some antihypertensive drugs!

82. Abdominal pain with unclear positioning, even if there is no abdomen, if the bowel sounds disappear, gastrointestinal perforation should be highly considered.

People who are over 83.35 years old and have pain and discomfort above the upper abdomen should have an electrocardiogram (postmenopausal women), which has been taught by blood.

84. Women of childbearing age must ask if they are pregnant before filming! And it should be recorded in the medical record to avoid unnecessary trouble.

85, drug sensitivity history, menstrual history must be clearly written in the medical record; Record the changes of illness at any time, think twice before taking the medicine, ask for instructions more, and see the patient several times more; Professors often teach: check what you can do and you must do it; Don't deal with it if you can.

86, trauma patients according to the order of "crash plan" physical examination, it is not easy to miss items, after physical examination can be written physical examination, especially cardiopulmonary auscultation, don't guess; Three basics must be solid!

87. Master more intensive care scores and know the severity of the illness, but you can't trust the guidelines absolutely blindly.

88. Be sure to check the patient in person. Others may not be reliable and often have unexpected gains.

89. The relationship between colleagues and patients should be improved. The strongest shield may be broken from the inside, and it is three points true and seven points heart disease, so caring for patients needs consideration; Protect peers, protect yourself, and protect patients.

90. You have a notebook, a digital camera and a USB flash drive, so you can keep important information with you and organize them frequently, which is quite beneficial.

9 1, summarize more after seeing a doctor, read more books, check more materials, set up special topics, form teams, and break through one by one.

92. Be kind to interns, doctors and nurses. Maybe a word from others is your lifeline. Think about how you got here.

93, the therapeutic effect of hyperthyroidism must pay attention to exclude Hashimoto's thyroiditis.

94. Preschool children with paroxysmal periumbilical pain and fever should pay attention to intestinal parasitic diseases complicated with infection.

95. Teenagers or school-age children should pay attention to allergic purpura (abdominal type) and pay attention to physical examination.

96. If the symptoms of abdominal pain in the elderly are more serious than the signs, we should pay attention to the possibility of mesenteric embolism and intestinal necrosis when there is no abnormality in B-ultrasound electrocardiogram, especially in the case of atrial fibrillation.

97, young female, unconscious but stable vital signs, all tests are normal, pupils are large, and occasionally get angry. Attention should be paid to psychedelic drug (ketamine) poisoning.

98. For patients with general fatigue, besides checking blood potassium and blood sugar, T3, T4 and TSH should also be checked. Sometimes hyperthyroidism may have low potassium content.

99, young patients suddenly pale, low blood pressure, to consider acute gastrointestinal bleeding.

100, asthma cannot be ruled out for patients with dyspnea, dyspnea, no rales in the lungs, prolonged expiratory phase and unconsciousness. Be sure to ask their families if they have a history of asthma, which may be severe asthma.

10 1, the patient has abdominal pain and renal button pain. If the patient finds stones by B-ultrasound, it cannot be taken for granted that it is renal colic, and sometimes it is probably appendicitis, pancreatitis or other diseases. Therefore, attention should be paid to observing and excluding other diseases, and it is best to do more examinations.

102, infants and young children are short of breath. First of all, let's see whether there are many boogers or not.

103, pneumonia in elderly patients, not necessarily shortness of breath and cough, sometimes only manifested as poor appetite, attention should be paid to lung auscultation.

104, epigastric pain always appears in supine position, and gets better after standing up. Pay attention to sliding esophageal hiatus hernia!

105, dizziness, dizziness and syncope should be clearly distinguished.

Dizziness: the sense of loss or balance in the spatial relationship of the body. It is characterized by the sudden rotation, fluctuation, drift or rolling of itself or foreign objects in a certain direction.

Dizziness: mainly a feeling of groggy and unconsciousness.

Dizziness: intermittent or persistent feeling of being top-heavy and shaky.

Syncope: sudden attack, loss of consciousness for a period of time, inability to maintain normal posture or fall to the ground, and recovery in a short time.

106, patients with acute abdomen, if they first have fever or vomiting, and then abdominal pain, generally do not meet acute appendicitis. The symptoms of appendicitis often appear in the following order: periumbilical or upper-middle abdominal pain, nausea and vomiting, abdominal pain transferred or concentrated in the right lower abdomen, which is obviously tender-body temperature rising-leukocytosis, and nuclear shift to the left.

107, female patients, if they have acute abdominal pain, should ask about leucorrhea besides HCG examination mentioned by many comrades earlier. If they have fever, increased leucorrhea, type change and peculiar smell, the possibility of acute pelvic inflammatory disease should be considered.

108, abdominal aortic dissection should be considered when 5P syndrome occurs.

109. Pay attention to routine fecal occult blood test, which will reduce missed diagnosis and misdiagnosis.

1 10, for patients with limb weakness, when they have polyuria and hypertension, they should think of primary aldosteronism.

1 1 1. Patients with coronary heart disease suddenly have chest tightness and shortness of breath. They should not only consider left heart failure, but also pay attention to the changes of pneumothorax and breathing sounds in both lungs and learn lessons.

1 12. If the head CT is normal, patients with severe headache cannot rule out subarachnoid hemorrhage. It may be that the quantity is small and undeveloped.

1 13, patients with seizures and no previous history of epilepsy should consider tetramine poisoning.

1 14, hypokalemia should consider whether there is barium poisoning.

1 15. Patients with abdominal pain should undergo routine urine analysis to consider the possibility of abdominal pain caused by diabetic ketosis.

1 16, people who meet the symptoms of intestinal obstruction should think about whether it is caused by incarcerated hernia, and the physical examination should fully expose the inguinal region.

1 17, epigastric pain may also be the only symptom of pneumothorax.

1 18. Patients with hypertension will have repeated rashes, especially those with swollen tongues. Attention should be paid to angioneurotic edema of ACEI.

1 19, abdominal pain is urgent, and those who cover their abdomen with their hands should consider surgical abdominal pain; Abdominal pain is urgent, and those who press the abdomen with their hands should consider internal abdominal pain.

120, with a history of diabetes and coma for unknown reasons, urban patients first ruled out hypoglycemia, rural patients first ruled out hyperosmotic coma or ketoacidosis (the former has better economic conditions and takes drugs for a long time; The latter is poor and often does not take drugs).

12 1, the elderly patients did not respond for unknown reasons, and cerebrovascular accident was ruled out first, followed by pulmonary infection.

122. When young women have difficulty breathing after emotional changes, hyperventilation syndrome should be ruled out first.

123, when checking the electrocardiogram, look at the heart rate first, not the heart rate.

124. In the differential diagnosis of chest pain, the top diseases are: aortic dissection (rupture)-acute massive myocardial infarction-pulmonary vascular embolism-tension pneumothorax-acute pericardial tamponade-diaphragmatic hernia-chest tumor. In addition, pay attention to the lesions of abdominal subphrenic lesions leading to chest pain.

125. The first diseases to be ruled out when trauma patients quickly judge the condition are: "spinal cord injury, craniocerebral injury, closed injury of chest and abdomen (heart, lung, liver, spleen, kidney), pelvic crush injury (hemorrhagic shock caused by urethral injury or iliac vascular injury)".

126, patients with periumbilical pain and diarrhea must check whether there is a rash, be alert to allergic purpura and pay attention to the differentiation from acute appendicitis.

127, a common clinical woman of childbearing age, suddenly suffered from lower abdominal pain after urinating, showing severe pain. B-ultrasound showed that ovarian cysts were twisted, and of course stones should be excluded.

128, coma cause: AEIOU low sugar liver heat.

Cerebral artery; E- mental nerve; One. Infectious diseases; Type o poisoning; U type uremia; Hypoglycemia; Low-hypotensive potassium; Sugar-diabetes; Liver-liver disease; Summer heat-heatstroke.

129, hemoptysis, hematemesis, don't forget to check the mouth, do not rule out oral bleeding.

130, emergency hypertension, no previous medical history, please observe for a period of time, don't rush to decompress, it may be just an illusion.

13 1, severe pain in the upper abdomen, please check the B-ultrasound of the liver, gallbladder and spleen: stooping low back pain and abdominal pain, please check the B-ultrasound of urine; Pain comes and goes to the right lower abdomen, and appendix B can't run away.

132, miss seems to have abdominal pain, check HCG and gynecological B-ultrasound; When the young lady came to see a doctor in a coma, she first considered whether she was drunk or took an overdose of LSD, but don't forget to check her head CT.

133, "Once you get osteomyelitis, you will get osteomyelitis forever": Discuss the prognosis of the disease; In view of the types and characteristics of osteomyelitis infection, it may recur at any time. But the exact recurrence rate of osteomyelitis is not 100%.

134, "three noes of myeloma: no fever, no splenomegaly and no elevation of alkaline phosphatase": discuss the problem of disease diagnosis. Usually, fever and splenomegaly are common symptoms of hematological tumors, but they are not common in myeloma without complications.

Tumors that destroy bones can lead to an increase in alkaline phosphatase, but the alkaline phosphatase in myeloma is not high. If the patient has a fever, there will be infection; If you have splenomegaly, you need to consider amyloidosis or POEMS syndrome: elevated alkaline phosphatase. Consider a fracture.

135. If patients with COPD have clubbed fingers, CT should be checked. There are few clubbed fingers in chronic obstructive pulmonary disease without tumor.

Parkinson's patients under 136 and under 40 years old should have their liver function checked and consider the possibility of Wilson's disease.

137, chronic symmetrical polyarthritis may be gout if it does not involve the buttocks and shoulders.

138. For adult patients with iron deficiency, unless they can be confirmed as other diseases, the patients have already bled.

139, only 10% pulmonary embolism originated from upper limbs; Because there are more tissue plasminogen activators in the veins of upper limbs.

140. If patients with chest pain have "shock-like manifestations" accompanied by elevated blood pressure, then the diagnosis should be aortic dissection.

14 1. If there is no toothache patient with lung abscess, it is lung cancer unless it can be proved that it is another disease.

142. Patients with tuberculous pleural effusion developed delayed paralysis of both lower limbs during treatment. Besides hypokalemia and peripheral neuritis caused by isoniazid, Guillain-Barre syndrome and thoracic/lumbar tuberculosis should also be considered. Although spinal tuberculosis is rare, the lesson is profound.

143, low coma: hypotension, hypoglycemia, hyponatremia, hypokalemia, hypoxemia and low pH.

144, watery eyes, respiratory failure, carbon dioxide retention.