Detailed Treatment Process
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Female, 62 years old. She visited the hospital emergency department on September 7 and later died. In response, the hospital provided the following written reply to the family: Date of visit: September 7 Emergency diagnosis: Dilated cardiomyopathy; rapid atrial fibrillation; heart failure; bronchiectasis with pulmonary infection; renal insufficiency. II. Course of events: The patient presented to our hospital’s emergency department at approximately 17:00 on September 7 with “chest tightness and palpitations for 1 day.” She had a history of dilated cardiomyopathy, atrial fibrillation, bronchiectasis, and renal insufficiency. On arrival, she had obvious chest tightness, shortness of breath, and palpitations. Physical examination showed clear consciousness, temperature 37°C, blood pressure 119/90 mmHg, heart rate 148 beats/min with irregular rhythm, and finger oxygen saturation 73%. Electrocardiography revealed atrial fibrillation with rapid ventricular rate. She was advised to stay for observation. The family was informed that her condition was critical. Necessary tests were ordered, including routine blood work, venous blood gas analysis, D-dimer, troponin, and serum creatinine. She received 5% glucose 20 ml + amiodarone 150 mg by slow intravenous injection to control the ventricular rate of atrial fibrillation, with further treatment to be decided after the laboratory results were available. During the amiodarone injection, she suddenly developed worsening shortness of breath, loss of consciousness, and open-mouth breathing. Finger oxygen saturation dropped to 70% and blood pressure could not be measured. Immediate rescue medications were given, along with endotracheal intubation and mechanical ventilation. Her consciousness did not recover during subsequent treatment, and her vital signs remained unstable. On the morning of September 9, she was transferred to another hospital at the family’s request. III. Hospital opinion: Based on the patient’s medical history, symptoms, and laboratory results, the diagnoses of “dilated cardiomyopathy, rapid atrial fibrillation, heart failure, bronchiectasis with pulmonary infection, and renal insufficiency” were clear. The emergency administration of intravenous amiodarone complied with guidelines for antiarrhythmic therapy and there were no absolute contraindications. The patient’s sudden deterioration was primarily due to the critical nature of her underlying condition rather than a clear causal relationship with the amiodarone injection. In summary, the hospital’s diagnosis and treatment did not violate standard medical practice. We hope the family can understand the severity of the patient’s condition and the inherent risks of treatment. If the family disagrees, they may apply to the relevant authorities for medical damage assessment or file a lawsuit with the court to protect their legitimate rights and interests. October 24
Electrocardiogram report ECG diagnosis: 1. Atrial fibrillation (rapid ventricular rate) 2. ST-T changes QRS duration: 0.08 s P-R interval: 0.00 s; Q-T interval: 0.30 s QTc: 0.43 Electrical axis: -37° V₁ and V₂ showed QS pattern; please correlate clinically. Recording date: September 7 Recording time: 18:23:32 Report date: September 7
Shortly after transfer, the patient died. The family filed a medical malpractice lawsuit, and the court ruled that the hospital bore partial responsibility. Specific details are not available. In the emergency department handwritten records, the amiodarone dose of 150 mg showed signs of possible alteration, raising the possibility that the original entry may have been 450 mg rather than 150 mg. Regarding the method of administration, the hospital’s written review described “slow intravenous injection,” while the doctor’s handwritten note used the term “intravenous push.” These two approaches differ significantly.