Clinical Diagnostic and Therapeutic Perspectives in Primary Care Practice：a Case Study of Unconsciousness

doi:10.12114/j.issn.1007-9572.2020.00.518

Abstract

Abstract: We reported a case of unconsciousness received by a general practitioner.The diagnostic procedure was performed with RICE（Reason-Idea-Concern-Expectation）skills，in-depth interviews，and John Murtagh's safe diagnostic strategy-a clinical 5-question thinking method was used：（1）What are the most common diseases causing unconsciousness？（2）What serious disorders must not be missed？（3）What conditions are easily missed？（4）Could the patient have a masquerading illness?（5）Is the patient's family member trying to say something? The diagnosis of hypoglycemia was performed by the evidence from a combination of medical history，physical examination and laboratory tests.The takeaway from this case is that it is important for general practitioners to obtain valid information when encountering unconscious patients.In this case，a history of taking hypoglycemic drugs was noted in the consultation，so hypoglycemia was considered first，and then the diagnosis was confirmed after a rapid examination of plasma glucose.The consultation in a general medical practice focuses not only on the disease，but also on the “person”，and the diagnosis is made based on exploring the causes thoroughly，which demonstrate a holistic diagnostic and therapeutic perspective.

Key words: Unconsciousness, Hypoglycemia, Diabetes mellitus, General practitioners, Clinical 5-question thinking method, RICE inquiring

摘要： 本文介绍全科医生接诊意识不清的患者时，采用约翰?莫塔教授的临床安全策略——临床5问思维法，并结合RICE问诊，进行深入访谈：（1）导致意识不清的常见疾病有哪些？（2）哪些重要疾病不能忽视？（3）有什么容易被遗漏的病因吗？（4）是否患有潜在的常被掩盖的疾病？（5）是不是有什么话还没说？结合病史、查体和实验室检查，确诊低血糖症。本案例的启示：全科医生接诊意识不清患者时，获取有效的信息非常重要。本例患者在抢救阶段问诊得知有服用降糖药物史，因此首先考虑低血糖问题，速查血糖，证实诊断。全科医生的问诊不仅关注疾病，还关注发生问题的“人”，找到病因，明确诊断，展现全科医学整体性的临床诊疗思维。

关键词: 意识丧失, 低血糖症, 糖尿病, 全科医生, 临床5问思维法, RICE问诊

WANG Li,WANG Jing. Clinical Diagnostic and Therapeutic Perspectives in Primary Care Practice：a Case Study of Unconsciousness　[J]. Chinese General Practice, 2020, 23(32): 4146-4150. DOI: 10.12114/j.issn.1007-9572.2020.00.518.
王力,王静. 全科医学临床诊疗思维研究——意识不清[J]. 中国全科医学, 2020, 23(32): 4146-4150. DOI: 10.12114/j.issn.1007-9572.2020.00.518.

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