Brief description of the condition:The patient is a 79-year-old male. At 20:23 on February 21, he went to the emergency department of Defendant A Hospital for "vomiting and diarrhea for 1 day", and complained of nausea and vomiting in the past 1 day, with watery stools several times, pain in the middle and upper abdomen, no headache and dizziness. Physical examination: clear, heart rate 80 beats, irregular rhythm, soft abdomen, tenderness in the middle and upper abdomen, no muscle guard and rebound tenderness. B ultrasound: fatty liver, blood routine: leukocytes 158x109 l, neutral ratio 913%。Consider acute gastroenteritis and give anti-infective and rehydration**. At 6:40 a.m. on the 22nd, the patient sought medical attention again due to "aggravation of abdominal pain symptoms accompanied by hemolysis of stool 2 times", and the physical examination: body temperature 361°C, pulse 65 minutes, blood pressure 209 108mmHg. Surgical consultation is requested: ECG (suggestive of atrial fibrillation), abdominal vascular CTA suggests poor middle and distal filling of the superior mesenteric artery, and atherosclerosis of the abdominal aorta. Physician consideration: Superior mesenteric artery embolism, please consult the vascular surgery department and recommend transfer to a higher-level hospital**. After 90 minutes, he was transferred to Hospital B, and the preliminary diagnosis was: superior mesenteric artery embolism, acute diffuse peritonitis, and atrial fibrillation. In the emergency department, he underwent "superior mesenteric artery incision and thrombectomy + necrotic small bowel resection", transferred to ICU ** for 14 days after surgery, and died at home after automatic discharge.
Court Hearing:According to the appraisal of the Provincial Medical Association, no autopsy was performed in this case, and the exact cause of death could not be determined, and the cause of death was inferred from the existing materials as "acute superior mesenteric artery embolism, avascular necrosis of the small intestine, atrial fibrillation, sepsis, septic shock, and multi-organ failure". Superior mesenteric artery embolism is a dangerous condition with a poor prognosis, and the mortality rate is extremely high, even in better hospitals**. Therefore, the death of patients is mainly related to the severity of their own disease. If the patient had an arrhythmia at the time of his first visit to Hospital A, but did not have an ECG, and the ECG confirmed atrial fibrillation the next morning, if atrial fibrillation could be diagnosed early, superior mesenteric artery embolization might be considered, and it could be performed as soon as possible**. When the patient was seen in Hospital A for the second time, he asked for surgical consultation and relevant examinations, and immediately transferred to a higher-level hospital** after considering the embolization of the superior mesenteric artery, and did not violate the diagnosis and treatment routine. Superior mesenteric artery embolism is rare in clinical practice, and hospital A has insufficient understanding of this disease, but the patient's symptoms at that time are indeed suspected of acute gastroenteritis, and it is indeed difficult to diagnose the disease early in the short term. Therefore, the comprehensive analysis of the appraisal team believes that Hospital A has a certain fault, and this fault has a causal relationship with the patient's death, and should bear slight responsibility.
The court ordered the defendant A hospital to compensate the plaintiff 10% of the reasonable losses, a total of 8More than 40,000 yuan.
Brief Analysis:The fault of the doctor is that the acute superior mesenteric artery embolism was not detected in time, resulting in a delay in treatment, and there is a certain causal relationship with the consequences of death. If the ECG shows atrial fibrillation, it is helpful to indicate a high probability of acute superior mesenteric artery embolism, which greatly improves the chance of early detection of the disease and the chance of successful treatment.
The elderly have many underlying diseases, so the medical history should be as thorough as possible, the diagnosis should be broader, and the existing signs should be vigilant enough and checked in time. If the patient presents for the first time with unexplained abdominal pain, inconsistent symptoms and signs, and arrhythmia, the patient should have an ECG examination in time, rather than delaying the ECG examination to find atrial fibrillation at the second visit. Clinicians should consider the complexity of the disease more comprehensively in the diagnosis and treatment of special populations. For example, elderly patients with sluggish pain sensation should be fully considered in diagnosis, once the symptoms are aggravated, enough attention and vigilance should be paid attention to, and at the same time, there should be enough ability to detect difficult, complex and rare diseases, and effective methods should be taken in time for treatment. Timely and clear diagnosis, even if there is no corresponding technology, do a good job of symptomatic**, timely conversation, transfer, and the process is flawless, the hospital is still not responsible.
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