In anesthesia, breathing and circulation are the two big chunks. It can be said that as long as breathing and circulation are maintained, there is generally no danger to life. However, a woman not long ago suffered heart and lung injuries at the same time. Breathing and circulation need to be taken into account at the same time, let’s see how medical staff treat it.
Due to the huge inertia of the car accident, Xiao Li, who was riding a battery car, hit the green belt on the side of the road. The green belt in winter is full of tree branches. Unbiased, her body fell heavily on a tree branch. The hard, water-deprived branches pierced straight into her chest. Immediately, she had difficulty breathing. Fortunately, passers-by found her in time and called 120.
After being sent to the hospital, Xiao Li appeared to be suffering from acute blood loss, pale and dripping with cold sweat. Conscious, but irritable. From the clinical manifestations, it can be diagnosed as hemorrhagic shock compensation, and the total blood loss is roughly estimated to be more than 2000ml. Physical examination: heart rate 145 beats/min, respiration 42 beats/min, blood pressure 70/40mmHg. Auscultation: shortness of breath, distant heart sounds. It can be said that her vital signs are already extremely dangerous and may be taken away at any time.
Anti-shock, pay attention to volume expansion, acid correction and improvement of microcirculation. However, her extremely distended jugular veins remind everyone that the condition is not so simple. Imaging confirmed that she not only had a hemopneumothorax but also a cardiac tamponade. The manifestations of cardiac tamponade are mainly hypotension and jugular vein distention.
Complicated disease, the Department of Anesthesiology did not back down and did not dare to back down. If you back down, it’s a life. In the face of the life that could die at any time, everyone quickly sent Xiao Li to the operating room.
During anesthesia, the anesthesiologist tries to choose drugs that are less depressing to the heart. At this time, the heart function can be said to be extremely weak. A small inhibition may become “the last straw that breaks the camel’s back”.
Due to the huge preload of the heart, routine blood transfusion and volume expansion cannot be performed, and the anesthesiologist can only choose active blood-activating drugs to move forward against the circulation.
Actually, everyone in the know knows: this kind of resistance, once the cardiac tamponade is relieved, may face a circulatory collapse. It can be said that this is a great test for the anesthesiology department.
At this point, the strength of the team is reflected. In the operating room, the arrangements for follow-up operations have been suspended, and almost all anesthesiologists who have not performed surgery rushed to this operating room to help: some help with tracheal intubation, some perform deep vein puncture, some perform invasive arterial puncture, some help Adjusting blood transfusion…
The thoracic doctor has done a closed thoracic drainage of both lungs for the patient in the crevice. Blood oxygen was significantly improved as the mask was pressurized to give oxygen, and as the bubbles “grumbled” out of the closed chest drainage.
After opening the chest cavity, I saw more than 1000 ml of blood.
At this point, the anesthesiologist shouted: Quickly deal with the blood in the pericardium. Of course, the chest doctor is also very experienced, going straight to the pericardium.
In order to resist the insufficiency of blood circulation after the recovery of cardiac function, several people have been waiting on the two upper limbs and deep venous access. As long as the heart is liberated, you can rest assured of blood transfusion.
At this point, some people may still ask: Why didn’t you make up sooner? Already in shock!
This is because rapid volume expansion can overload the heart, further aggravate cardiac tamponade, and even lead to cardiac arrest.
Then why are you so busy?
This is because, under the influence of anesthesia, the circulation is definitely inhibited. If the circulation is inhibited, it must be supported with vasoactive drugs.
Some people say, can’t you just keep going?
Vioactive drugs are not a long-term solution. In the state of circulatory hypoperfusion, with the accumulation of metabolites such as lactic acid in the body, vascular tension will gradually decrease, and vasoactive drugs will become more and more “ineffective”. The ever-increasing amount of vasoactive drugs, withdrawal is also a big problem. Only quick repairs and good treatment before cardiovascular damage can be done to maximize the success rate of rescue. Otherwise, if the person is rescued, some complications caused by ischemia will not be preserved.
With everyone working together, the cycle has finally stabilized.
Wipe the sweat from the foreheads, everyone looked at each other and felt a sense of accomplishment.
[Warm reminder] Please pay attention, here are a lot of professional medical science, to reveal the secrets of surgical anesthesia for you~