(Disclaimer: This article is for scientific use only, and relevant information in the following content has been processed to protect patient privacy.) Abstract: A 45-year-old female depressed patient who took poison and slit her wrist after getting angry was admitted to the hospital. Due to excessive blood loss, the patient went into shock and was immediately given anti-shock and corrective anemia treatment, while ligating blood vessels, suturing damaged tendons, and local fixation were performed on the cut site for disposal. The best time for gastric lavage was missed because the patient was heavily poisoned by taking poison at the same time, and blood purification treatment was also performed when the patient was given atropine and other antidotes. The patient was discharged clinically cured after 18 days of hospitalization. 【Basic information】 Female, 45 years old 【Disease type】 Hemorrhagic shock, cutting injury, deep vein injury, tendon rupture, lego toxicity, depression 【Visiting hospital】 The Second Hospital of Harbin Medical University 【Visiting time】 March 2022 【Treatment plan】 Pharmacological treatment (saline, hydroxyethyl starch, red blood cells, plasma, chlorophosphamide, atropine, glutathione, high sugar, amino acid The patient took 50ml of the pesticide Legol after getting angry 6 hours before admission, and at the same time cut his left wrist several times with a blade, during which he experienced nausea and vomiting. Six hours later, the patient’s family found a large amount of blood on his clothes and the surrounding ground, and the patient was pale and extremely weak. When we received the patient, we found that he was in very poor general condition, drowsy, cold sweat, foaming at the mouth, pale face and eyelids, vomit and large blood stains scattered around his body, deep left wrist cut, poor activity, blood pressure 70/45 mmHg, heart rate 108 beats/min. Medical history was taken and previous depression was observed. Initial diagnosis considered shock due to excessive blood loss, as well as left wrist cut wound, lego toxicity, and depression. Considering that the patient was in shock, he was immediately pushed into the resuscitation room and urgently requested the consultation of trauma surgery. Meanwhile, hemostasis, fluid replacement and pressure elevation were given, and laboratory tests such as routine blood, blood type, liver and kidney function, coagulation function were perfected and blood was prepared. The routine blood report: red blood cell 1.76×10^12/L, hemoglobin 55g/L, blood cholinesterase 230U/L. Because the patient missed the best time for gastric lavage, he was not given gastric lavage disposal. II. Treatment Considering that the cause of the patient’s shock was related to excessive blood loss after wrist cutting, emergency hemostasis was the key. The surgeon gave emergency debridement, clarified deep vein injury and tendon rupture, and gave treatment such as ligation of blood vessels, suture of damaged tendon and local fixation. Postoperatively, cefuroxime and tetanus were routinely used to prevent infection. Since the body was in a low blood volume state, we immediately gave the opening of intravenous access for rapid infusion of saline, hydroxyethyl starch for volume expansion and rehydration, infusion of red blood cells and plasma to rapidly correct the anemia state, lego is an organophosphorus pesticide, rapid administration of antidote chlorophosphamide and atropine, intravenous glutathione to prevent multi-organ damage, intravenous supplementation of high sugar (i.e. 50% concentration of glucose), amino acids, fatty milk, Potassium chloride, vitamin C, vitamin B6 and other drugs were used for nutrition and stabilization of the internal environment. Considering that the patient’s blood cholinesterase was low and the poisoning was heavy, he was prone to respiratory muscle paralysis and respiratory arrest, he communicated with the family to perform blood purification therapy as soon as possible to promote the excretion of toxic substances in the body, but since blood purification therapy required heparinized blood, the patient had trauma to the hand, which would further aggravate the bleeding, and considering that the traumatic vessels had been ligated, it would be more beneficial to perform this therapy. The family agreed to the hemodialysis treatment after deliberation. III. Treatment effect After rapid volume expansion, rehydration and blood transfusion treatment, the patient’s blood pressure rose to about 100/60 mmHg, urine volume was normal, consciousness was restored, and he reported dry mouth, thirst and blurred vision, and was told that this was caused by the use of detoxification drug atropine and there was no need to be nervous. Cholinesterase was rechecked: 2184 U/L. The rapid recovery of this index was closely related to the transfusion of red blood cells in addition to the antidote. After the hemodialysis treatment, the wound of the left hand showed bleeding, the amount was not large and there was no hematoma, which was considered to be related to the use of heparin anticoagulation. With the metabolic decomposition of heparin, the bleeding gradually stopped and the wound bleeding gradually stopped. The movement of the left finger was still possible, but the wrist was relatively poor, which was considered to be related to tendon injury, and it took some time to repair the injury. When the patient was hospitalized for 18 days, the blood routine was rechecked: erythrocytes 3×10^12/L, hemoglobin 87g/L, blood cholinesterase 7750U/L, which was back to normal, renal function and liver function were normal, coagulation function was normal, the wound was well repaired, and there was no sign of infection, so the patient was discharged. IV. Precautions We are glad that the patient was discharged successfully. Before discharge, we informed the patient that there was a rupture of the tendon of the hand, and although sutures were given, the wrist activity would be affected, and the repair time of the injury is usually long, usually in 5-6 weeks, and most patients have a good prognosis and should have some patience and confidence after discharge. Although patients have reached clinical healing from organophosphorus poisoning, some patients will have delayed peripheral nerve injury, which is manifested as inability to move limbs and abnormal sensation, and some patients may have sudden onset of dyspnea, wheezing, muscle tremors, sweating and other symptoms, which are signs of recurrent disease, and once these abnormalities appear, they need to seek timely medical attention. In addition, the patient has a past history of depression, and judging from the current behavior of the patient, the condition may be in an unstable state. It is recommended that the family accompany the patient to a psychiatric specialist as soon as possible to give formal treatment to avoid the recurrence of this situation. V. Personal insight As a clinician, in the face of patients with unstable vital signs, we should immediately start emergency treatment to preserve life first in order to have the opportunity to further investigate the cause of the disease and improve the quality of life, and to distinguish priorities when resuscitating patients with trauma and bleeding. In the face of treatment contradictions, such as this patient will aggravate traumatic bleeding when performing blood purification, it is necessary to weigh the pros and cons, fully communicate with the family, and if the pros outweigh the cons, actively advise the family to accept. Currently, the suicide rate of patients with depression and anxiety is extremely high, which requires our clinicians to pay attention and raise awareness. Resuscitation is only the cure, and effective treatment of psychosomatic diseases is the cure, and these diseases should be detected and treated as early as possible.