Key Points of Traditional Chinese Medicine Emergency Medicine (18 Excellence Self-Compiled)
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Concept of Acute Hemorrhage
@Fan Hongyou March 15, 2022, 20:00 - March 30, 2022, 18:30
Estimation of bleeding volume?
@Fan Hongyou March 15, 2022, 20:00 - March 30, 2022, 18:30
Hemoptysis vs Hematemesis?
[[Hemoptysis]]
[[Hematemesis]]
History
Tuberculosis, bronchiectasis, lung cancer, heart disease, etc.
Peptic ulcer, cirrhosis, etc.
Symptoms before bleeding
Itchy throat, chest tightness, cough, etc.
Upper abdominal discomfort, nausea, vomiting, etc.
Mode
Expectoration
Vomiting, may be projectile
Color
Bright red
Brown-black or dark red, sometimes bright red
Mixture
Foam and/or sputum
Food residues, gastric juice
Melena
None (may occur if blood is swallowed)
Present; may persist for several days after hematemesis stops
Acid-base reaction
Alkaline
Acidic
March 30, 2022, 18:30 @Fan Hongyou March 15, 2022, 20:00
Upper GI bleeding vs Lower GI bleeding?
@Fan Hongyou March 15, 2022, 20:00 - March 30, 2022, 18:30
Sudden Cardiac Pain
Concepts of transient cardiac pain, true cardiac pain, and fainting cardiac pain
Transient cardiac pain: Due to deficiency of vital qi, with invasion by phlegm, stasis, cold, and other pathogenic factors; sudden onset, characterized by paroxysmal oppression or dull pain behind the sternum or in the left anterior chest, radiating to the left shoulder back or medial left forearm tb
True cardiac pain: Severe pain, often accompanied by sweating, anxiety, and a near-death sensation, lasting longer; severe cases are called true cardiac pain
Fainting cardiac pain: Mild pain, short duration, can be relieved within 3–5 minutes, called fainting cardiac pain
@Wang Yuquan
Pathogenesis of transient cardiac pain
@Fan Hongyou March 15, 2022, 20:00 - March 30, 2022, 18:30
Key points of diagnosis and treatment ideas for fainting cardiac pain and true cardiac pain
Fainting cardiac pain
True cardiac pain
More common in middle-aged and elderly people, often induced by physical labor or emotional agitation (anger, anxiety, overexcitement), also by heavy meals, cold, and smoking
More common in middle-aged and elderly people; most patients have prodromal symptoms, such as fatigue, chest discomfort several days before onset without prior chest pain, palpitations, shortness of breath, irritability, chest pain during activity; or patients with a previous history of chest bi or angina have frequent chest pain episodes recently, worsening in severity and duration; no obvious inducement, often occurring at rest
Pain location: mostly behind the sternum, left anterior chest area, about fist-sized; can involve the entire anterior chest; may radiate to the medial left arm down to the ring and little fingers
Pain nature: mostly dull pain, oppression, fullness, constriction, burning discomfort; severe pain often accompanied by sweating, anxiety, occasionally near-death fear
Pain is the earliest symptom, pain site and nature the same as in fainting cardiac pain; some patients have pain in the upper abdomen or radiate to the lower jaw, neck, or upper back, easily misdiagnosed, attention needed for differentiation; accompanied by restlessness, sweating, fear, or near-death feeling; nausea, vomiting, upper abdominal distension during pain; severe cases may have palpitations, dizziness, syncope, restlessness, pale complexion, cold moist skin, weak rapid pulse, or shortness of breath, cough, cyanosis of the face, some patients have no pain, initially presenting with profuse sweating and restlessness.
Pain gradually worsens and disappears within 3–5 minutes, usually not exceeding 15 minutes; relieved after stopping activity and taking fast-acting rescue heart pills.
Pain more severe and lasting longer, up to several hours or days; rest and medication often ineffective.
Tongue: pale or purple-blue, white coating; pulse: wiry and forceful, intermittent, or weak and forceless, intermittent
Tongue: pale or purple-blue, white coating; pulse: thin and rapid, intermittent, or weak and barely perceptible
@Dai Jinlin
Western medicine differentiation of fainting cardiac pain and true cardiac pain?
Fainting cardiac pain (angina pectoris)
True cardiac pain (acute myocardial infarction)
TCM understanding
Heart vessel spasm
Heart vessel occlusion
Location
Middle to lower segment behind sternum
Similar, but can be in upper abdomen and radiate to lower jaw, neck, upper back
Nature
Crushing, suffocative
Similar but more intense
Triggers
Labor, emotional agitation, cold, heavy meals
Often no obvious trigger
Duration
Short, less than 15 minutes
Long, several hours to one or two days
Frequency
Frequent
Low frequency
Nitroglycerin efficacy
Significant
Poor
Dyspnea or pulmonary edema
Rare
Possible
Blood pressure
Increased or unchanged
Decreased, even shock
Pericardial friction rub
None
Possible
Necrotic material absorption manifestations
Fever, elevated white blood cells, accelerated ESR, increased serum myocardial necrosis markers
None
Frequent
ECG
None or transient ST or T wave changes
Characteristic dynamic changes (see next question)
Characteristic ECG changes in acute ST-segment elevation myocardial infarction?
① ST segment elevation in a convex upward shape, appearing in leads facing the necrotic area myocardial injury zone
② Wide and deep Q wave (pathologic Q wave), appearing in leads facing the transmural myocardial necrosis zone
③ T wave inversion, appearing in leads facing the ischemic area surrounding the injury zone
@Dai Jinlin
Briefly describe the indications and contraindications of thrombolytic therapy for acute myocardial infarction
Thrombolytic indications
- ST segment elevation in two or more contiguous leads (chest leads ≥ 0.2 mV, limb leads ≥ 0.1 mV)
- Or history suggesting AMI with left bundle branch block
- Onset <12 hours, age <75 years
- Thrombolysis within 3 hours of onset can achieve effects comparable to PCI (if PCI cannot be completed within 120 minutes)
Absolute contraindications to thrombolysis
- Any history of hemorrhagic stroke, ischemic stroke or cerebrovascular events within 6 months
- Intracranial tumor
- Recent (2–4 weeks) active bleeding
- Suspected aortic dissection
- Large vessel puncture site that cannot be compressed within 24 hours (lumbar puncture, liver biopsy, etc.)
@Dai Jinlin @Wang Yuquan
Heart Failure (Xin Shui)
Q: Briefly describe NYHA heart function classification
Based on daily activity capacity grading, applicable to chronic heart failure
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@Wang Yuquan
Q: Briefly describe Killip classification of post-infarction heart function (based on pulmonary rales)
Based on pulmonary rales grading, applicable to heart failure during acute myocardial infarction
Unable to replicate loading content
@Wang Yuquan
Urinary Retention
Main causes of acute renal failure (prerenal, renal, postrenal)?
- Prerenal: insufficient blood volume, decreased cardiac output, peripheral vasodilation, increased renal vascular resistance
- Renal: acute nephritis, [[acute tubular necrosis]] (mainly)
- Postrenal: urinary tract obstruction (stones, malformations)
@Tong Yao March 15, 2022, 21:00 - March 30, 2022, 18:30
Auxiliary tests for acute renal failure (especially biochemistry, blood gas)? - Blood creatinine absolute value rises daily, daily increase ≥44.2–88.4 μmol/L, or relative increase 25–100% within 24–72 hours. Blood urea nitrogen markedly elevated.
- Blood routine: in late acute renal failure, reduced red blood count and hemoglobin. Elevated white blood count if infection present.
- Urinalysis: low specific gravity urine. May have erythrocytes, proteinuria, urinary casts; casts in sediment indicate acute tubular necrosis. Urine cytology helps understand some causes of acute renal failure.
- Ion examination: mainly shows ==hyperkalemia==, hyponatremia, hyperphosphatemia, hypocalcemia.
- Dynamic blood gas analysis: pH decreased, blood HCO3- decreased, showing ==metabolic acidosis==
- Imaging: kidney and urinary tract ultrasound to assess obstruction; renal Doppler ultrasound to assess renal blood flow; CT scan if necessary.
March 30, 2022, 18:30 @Tong Yao March 15, 2022, 21:00
Difference between acute renal failure and chronic renal failure?
Acute renal failure: rapid onset, generally with three phases of oliguria, polyuria, and recovery. Usually occurs on the basis of prerenal, renal, or postrenal damage with sharp elevation in blood creatinine and urea nitrogen.
Chronic renal failure: history of chronic disease or related toxic drug damage, without the three phases, insidious progression, mainly presenting with multi-system damage at discovery.
@Wang Yuquan
Treatment of hyperkalemia?
- Control potassium intake: all potassium-containing foods (dark-colored fruits such as strawberries, watermelon), medications
- Promote K+ shift into cells or excretion:
- Infusion of sodium bicarbonate solution (volume expansion and dilution, increase renal excretion, shift into cells)
- Infusion of glucose solution and insulin (shift into cells)
- Cation exchange resin (oral, increases potassium excretion via colon)
- Diuretics (renal potassium excretion)
- Dialysis (the fundamental method)
- Counteract myocardial toxicity: calcium antagonizes potassium; intravenous injection of 10% calcium gluconate (does not reduce blood potassium concentration, only counteracts myocardial toxicity)
@Dai Jinlin @Wang Yuquan
Acute urinary retention formulas (deficiency and excess)?
Unable to replicate loading content
Wind-Warm Lung-Heat Disease
Wind-Warm Lung-Heat Disease syndrome differentiation and treatment formulas (three syndrome types)?
Unable to replicate loading content
@Wang Yuquan
Sudden Asthma
Three syndrome types and formulas for sudden asthma
Evil Qi blocking the lung
Ma Xing Gan Shi Tang
Phlegm-Heat fullness in the bowels
Xuan Bai Cheng Qi Tang
True deficiency and asthma collapse
@Wang Yuquan
Differentiation between Heart Failure and Acute Respiratory Distress Syndrome
Heart failure
Acute respiratory distress syndrome
History
Often with cardiac disease
Severe infection, acute trauma, exhaustion, acute splenic heart pain, etc.
Onset
Sudden, with orthopnea
Relatively rapid, can lie flat
Sputum
Large amounts of pink frothy sputum
Little sputum early; sputum if combined with infection
Signs
Abundant moist rales in both lungs
Less moist rales
Chest X-ray
Cardiomegaly, upper lung vessels dilated, butterfly shadow spreading from hilum outward, few signs of bronchial aeration
Heart and hilum not enlarged; bilateral lung infiltrates with bronchial aeration signs common
@Wang Yuquan
Poisoning
Manifestations of mild, moderate, and severe carbon monoxide poisoning
Mild poisoning
Moderate poisoning
Severe poisoning
Blood COHb concentration 10–20%
30–40%
30–50%
Dizziness, headache, nausea, vomiting, general weakness
Skin and mucous membranes may present “cherry red” color; above symptoms worsen with excitement, decreased judgment, ataxia, hallucinations, vision loss, clouded consciousness or mild coma
Seizures, deep coma, hypotension, arrhythmia, and respiratory failure; some develop aspiration pneumonia due to inhalation; pressure area skin prone to blisters or compression rhabdomyolysis causing release of myoglobin leading to acute renal failure.
@Dai Jinlin March 25, 2022, 16:00 - March 30, 2022, 18:30
Manifestations of mild, moderate, and severe alcohol intoxication
Excitement phase
Ataxia phase
Coma phase
Blood ethanol concentration
500 mg/L
1500 mg/L
2500 mg/L
Dizziness, fatigue, loss of self-control, euphoric feeling, increased speech, mood swings, rudeness or aggression, or silence, withdrawal, or sleep
Incoordination, staggering gait, clumsy movements, slurred speech, nystagmus, blurred vision, diplopia, nausea, vomiting, somnolence
Somnolence, pale face, decreased body temperature, cold moist skin, cyanotic lips, slowed breathing, rapid heartbeat, low blood pressure, incontinence; severe cases may develop respiratory and circulatory failure, life-threatening. Also may die from aspiration pneumonia or suffocation due to weakened pharyngeal reflex after a full meal vomiting
@Dai Jinlin March 25, 2022, 16:00 - March 30, 2022, 18:30