临床急诊医学病例精析

本书引进自剑桥大学出版社，由美国斯坦福大学医学院急诊医学（外科）的 Joel T. Levis 博士和Gus M. Garmel博士联合编写。本书着眼于急诊医学培训中的不同临床情境，结合了真实的患者诊疗方案，可帮助急诊科医师掌握相关急诊情况的有效处理方法，从而做出及时、理智的决策，挽救更多患者的生命。书中精选了 111 个急诊病例的临床情境与诊疗措施，辅有高质量的临床照片和影像图片。本书病例真实，阐释简洁，图文并茂，适合广大急诊科医师、护士及医学生在临床实践中借鉴参考，也可作为住院医师规范化培训的指导资料。

Joel T.Levis，教授是斯坦福大学医学学院急诊医学(外科)临床讲师，美国加州圣克拉拉凯撒医疗集团急诊部主任，美国加州洛斯阿尔托斯山 Foothill 学院护理学部主任。 Gus M.Garmel，是斯坦福大学医学院急诊医学（外科）临床副教授，美国加州圣克拉拉凯撒医疗集团内科医生和高级急诊医生。 吴利东，主任医师，南昌大学第二附属医院急诊科（急危重症医学救治中心）主任，中国医师协会急诊医学分会委员，中国医师协会急诊医学分会心肺复苏专业委员会副主任委员，中国医学救援协会标准化工作委员会委员，中国脑死亡判定专家，中国卫计委脑卒中防治工程中青年常委，中华医学会急诊医学分会委员。

第一篇　头颈部（头、眼、耳、鼻、咽喉） .......................................................................................001 病例 1　咽喉痛 ................................................................................................................................001 病例 2　左眼疼痛伴流液 ................................................................................................................003 病例 3　右眼突发失明 ....................................................................................................................006 病例 4　突发晕厥伴右眼失明 ........................................................................................................008 病例 5　左眼疼痛伴视物模糊 ........................................................................................................011 第二篇　心血管系统 ...............................................................................................................................013 病例 6　胸闷、心悸 ........................................................................................................................013 病例 7　胸痛 ....................................................................................................................................016 病例 8　心悸 ....................................................................................................................................019 病例 9　胸部压迫感 ........................................................................................................................022 病例 10　腰痛伴左下肢无力 ..........................................................................................................025 病例 11　突发胸痛 ..........................................................................................................................029 病例 12　突发心悸 ..........................................................................................................................033 病例 13　胸痛、晕厥 ......................................................................................................................037 病例 14　低血压晕厥 ......................................................................................................................040 病例 15　心悸伴气短 ......................................................................................................................043 病例 16　胸痛伴精神紧张 ..............................................................................................................046 病例 17　身体虚弱、心率偏慢 ......................................................................................................049 病例 18　头痛、颈痛、胸痛 ..........................................................................................................051 病例 19　几乎晕厥、心动过速、胸痛 ..........................................................................................054 病例 20　胸痛 ..................................................................................................................................058 病例 21　咳嗽、气短 ......................................................................................................................061 病例 22　虚弱、乏力、气短 ..........................................................................................................065 病例 23　突发背痛 ..........................................................................................................................068 第三篇　呼吸系统 ...................................................................................................................................071 病例 24　胸膜炎性胸痛 ..................................................................................................................071 病例 25　突发急性呼吸困难 ..........................................................................................................073 病例 26　复发性肺炎 ......................................................................................................................080 病例 27　咯血 ..................................................................................................................................083 病例 28　咳嗽、发热、气短 ..........................................................................................................086 第四篇　消化系统 ...................................................................................................................................091 病例 29　腹痛，排尿困难 ..............................................................................................................091 病例 30　左上腹疼痛 ......................................................................................................................095 病例 31　腹痛呕吐 ..........................................................................................................................098 病例 32　右下腹疼痛伴发热 ..........................................................................................................101 病例 33　腹痛腹泻 ..........................................................................................................................105 病例 34　直肠和腹部疼痛 ..............................................................................................................108 病例 35　腹痛 ..................................................................................................................................110 病例 36　腹痛厌食 ........................................................................................................................113 病例 37　突发背部疼痛 ..................................................................................................................116 病例 38　阵发性腹痛 ......................................................................................................................119 第五篇　泌尿生殖系统和妇科 ..............................................................................................................121 病例 39　右下腰部疼痛 ..................................................................................................................121 病例 40　右下腹疼痛 ......................................................................................................................124 病例 41　右腹痛伴阴道出血 ..........................................................................................................127 病例 42　阴茎胀痛 ..........................................................................................................................131 病例 43　流产后反复阴道出血 ......................................................................................................133 病例 44　阴囊红肿疼痛 ..................................................................................................................136 第六篇　神经系统 ...................................................................................................................................139 病例 45　左侧肢体乏力 ..................................................................................................................139 病例 46　剧烈头痛 ..........................................................................................................................143 病例 47　双下肢无力 ......................................................................................................................147 病例 48　头痛、头晕、颈部疼痛 ..................................................................................................150 病例 49　腰背部疼痛、乏力 ..........................................................................................................154 病例 50　左侧头痛伴左上肢麻木无力 ..........................................................................................157 病例 51　头痛、癫痫发作 ..............................................................................................................161 病例 52　突发意识改变 ..................................................................................................................165 第七篇　创伤 ...........................................................................................................................................169 病例 53　撞车后左上腹疼痛 ..........................................................................................................169 病例 54　刀刺伤 ..............................................................................................................................173 病例 55　左大腿疼痛 ......................................................................................................................177 病例 56　后颈部疼痛 ......................................................................................................................179 病例 57　心搏骤停 ..........................................................................................................................181 病例 58　右下腹疼痛 ......................................................................................................................184 病例 59　头部钝挫伤 ......................................................................................................................186 病例 60　颈部疼痛 ..........................................................................................................................189 病例 61　后颈部疼痛 ......................................................................................................................192 第八篇　骨科 ...........................................................................................................................................195 病例 62　肘关节外伤 ......................................................................................................................195 病例 63　右足外伤 ..........................................................................................................................198 病例 64　左前臂疼痛、肿胀 ..........................................................................................................201 病例 65　足部疼痛 ..........................................................................................................................203 病例 66　肘部外伤 ..........................................................................................................................205 病例 67　前臂外伤 ..........................................................................................................................207 病例 68　左膝疼痛 ..........................................................................................................................209 病例 69　左髋部疼痛 ......................................................................................................................212 病例 70　大腿外伤 ..........................................................................................................................215 第九篇　手 ...............................................................................................................................................217 病例 71　右手拇指红肿、胀痛 ......................................................................................................217 病例 72　手喷枪伤后疼痛 ..............................................................................................................219 病例 73　手指胀痛 ..........................................................................................................................222 病例 74　右手示指撕裂伤 ..............................................................................................................224 病例 75　右手示指猫咬伤 ..............................................................................................................226 第十篇　儿科急症 ...................................................................................................................................229 病例 76　心动过速 ..........................................................................................................................229 病例 77　发热伴咳嗽、气促、厌食 ..............................................................................................233 病例 78　头部外伤 ..........................................................................................................................236 病例 79　经皮内镜胃造口术后出现并发症 ..................................................................................238 病例 80　发热伴咳嗽 ......................................................................................................................240 病例 81　呕吐 ..................................................................................................................................244 病例 82　窒息梗阻 ..........................................................................................................................247 病例 83　腹痛伴呕吐 ......................................................................................................................250 病例 84　呕吐、腹泻、抽搐 ..........................................................................................................253 病例 85　左侧肢体肌力减退 ..........................................................................................................256 病例 86　胸痛 ..................................................................................................................................259 病例 87　头痛、呕吐 ......................................................................................................................264 第十一篇　感染性疾病 ..........................................................................................................................267 病例 88　腰背痛、发热 ..................................................................................................................267 病例 89　间歇性发热、寒战、头痛 ..............................................................................................270 病例 90　发热、皮疹 ......................................................................................................................274 病例 91　发热、腹痛、腹泻 ..........................................................................................................278 病例 92　右侧腹股沟区肿胀、疼痛 ..............................................................................................281 病例 93　间歇性发热、盗汗、疲劳、体重减轻 ..........................................................................284 第十二篇　中毒 .......................................................................................................................................287 病例 94　突发躁动不安、意识模糊 ..............................................................................................287 病例 95　嗜睡、心动过缓 ..............................................................................................................290 病例 96　服用过量对乙酰氨基酚 ..................................................................................................292 病例 97　突发头痛伴皮疹 ..............................................................................................................296 病例 98　双足疼痛伴肿胀 ..............................................................................................................298 病例 99　蛇咬伤 ..............................................................................................................................301 病例 100　颜面部肿胀 ...................................................................................................................305 病例 101　故意摄入强碱 ...............................................................................................................307 病例 102　症状性心动过缓 ...........................................................................................................310 第十三篇　其他 .......................................................................................................................................313 病例 103　双下肢水肿 ...................................................................................................................313 病例 104　头痛伴四肢皮肤瘀斑 ...................................................................................................315 病例 105　全身皮疹 .......................................................................................................................318 病例 106　牙龈出血伴全身疲乏 ...................................................................................................321 病例 107　呕吐伴眩晕 ...................................................................................................................324 病例 108　右腿肿胀 .......................................................................................................................328 病例 109　发热伴皮疹 ...................................................................................................................332 病例 110　脱水、乏力 ...................................................................................................................334 病例 111　左上肢肿胀 ...................................................................................................................337