In mid-November, 61-year-old Liu Dabo (pseudonym) dined with friends. Between pushing the cup and changing the cup, Uncle Liu was suddenly choked by food and fell to the ground, and his heart and breathing stopped.
Uncle Liu's friend quickly tried to pick out the food in his mouth and called the 120 emergency number. About half an hour later, the ambulance sent Liu Dabo to the Binjiang Branch of the Second Hospital of Zhejiang University.
Food suffocation, causing cardiac arrest
"When he was taken to the emergency room, Uncle Da's heart was no longer breathing and heartbeating, and his pupils were dilated to the side, and the situation was very dangerous." Lu Xiao, deputy chief physician of the Emergency Medicine Department of the Second Hospital of Zhejiang University, recalled.
The emergency department doctors immediately rescued the uncle. Within 1 minute, the patient's bone marrow cavity access was opened and endotracheal intubation was performed. At the time of intubation, it was found that There was a large amount of food residue in the throat of Uncle Liu - the cause of suffocation was found. The doctor immediately cleared the foreign body for him. During this period, emergency medical care continued to perform high-quality CPR for him. After 7 minutes, Uncle Liu resumed his spontaneous heartbeat. However, at this time, Liu Dabo's pupils were still dilated to the side, there was no spontaneous breathing, and his blood pressure and heart rate were extremely unstable.
Encounter rare "cold acid condensation"
Hypothermia, coagulation dysfunction and acidosis are a triad of traumatic blood loss and death in critically ill patients. If not corrected in a short period of time, the mortality rate is extremely high. After entering the emergency ICU, Liu Dabo appeared this dangerous and rare "cold acid condensation" death triad symptoms:
Cold: Spontaneous very low body temperature is only 31 ° C
Acid: Blood PH-grade acid to the machine can not detect the result, blood lactate up to 33mmol /l (normal value is 1-2mmol/l)
Coagulation: abnormal coagulation function, activated partial thromboplastin time (APTT) >180s, fibrinogen 1.69 g/L.
Since blood lactate is related to the state of microcirculation in the body, it directly reflects the degree of ischemia and hypoxia of tissues and organs. Therefore, Liu Dabo seemed to have a deep impression on Lu Xiao at that time as if the lactic acid value of "acid" to the bone was deeply impressed.
Emergency medicine departments carry out emergency treatment
In view of the patient's situation, the emergency care unit of the Second Hospital of Zhejiang University quickly carried out treatment. Deputy Chief Physician Lu Xiao and Attending Physician Jiang Libing immediately divided the work to carry out arteriocentesis, deep vein puncture, and hemodialysis tube insertion, and it took only 8 minutes to let the bedside CRRT (continuous hemodialysis treatment) begin treatment, and combined with the inflatable rewarming blanket for rewarming, PICCO, NIRS (brain oxygen monitoring), ultrasound monitoring three sharp tools at the same time dynamic monitoring of the patient's circulation and brain conditions, the use of fibrobrososcope in the patient's airway sucked out a large number of food residues, and began to start the extracorporeal membrane pulmonary oxygenation (ECMO) process (standby).
The attending physician of the emergency ICU Ying Lan is 9 months pregnant, and she still insists on working overtime to rescue patients with a big belly. On the night of treatment, under the guidance of Director Zhou Wen and Xu Shanxiang, the rescue work continued to be carried out. Uncle Liu's vital signs gradually stabilized, the body temperature rose to 35 ° C, the lactic acid dropped to 10mmol /l, and the coagulation function was basically restored. What is even more gratifying is that the patient's pupil has shrunk from 7 mm to 4 mm, and the light reflex has also been restored.
Until the early hours of the morning, several doctors were still discussing the patient's condition in the WeChat group
After a day of treatment, Uncle Liu appeared to breathe spontaneously, and with pain stimulation, lactic acid dropped to normal levels. Two days later, Uncle Liu opened his eyes and made a decision to do as he was told. Due to the fact that Liu Dabo had heart disease and other underlying diseases, liver and kidney function were seriously damaged, and the emergency department carried out enteral nutrition, tracheostomy and strict volume management and stabilization of the internal environment in the early stage.
One week after the treatment, Liu Dabo got rid of the ventilator, the kidney function basically returned to normal, the consciousness was completely cleared, and he was smoothly transferred to the rehabilitation department for treatment. Two weeks later, Uncle Liu was fully recovered and could go home.
▲ Before returning home, Liu Dabo and his family specially went to the emergency care unit and sent a pennant to the emergency department of Zhejiang University Second Hospital to express their gratitude.
It is very rare for patients with cardiac arrest to have such a severe "death triple", difficult to treat, and extremely poor prognosis. The successful treatment of patients is inseparable from the "rapid and accurate" rescue concept of the Emergency Medicine Department of the Second Hospital of Zhejiang University in this category of critically ill patients, using the most advanced technology to carry out medical services for critically ill patients.
Prevent cardiac arrest in winter
The temperature in winter is cold, and the probability of cardiovascular and cerebrovascular diseases is greatly improved. Some elderly people are prone to food suffocation when eating food with a very sticky texture such as rice dumplings, rice cakes, and tangyuan. Both of these conditions can easily trigger cardiac arrest in patients.
Lu Xiao introduced that before the arrival of the 120 ambulance, patients who had undergone cardiopulmonary resuscitation rescue had an overall rescue success rate and the patient's neurological function recovery effect significantly better than that of patients who had not undergone on-site cardiopulmonary resuscitation. Therefore, in life, it is recommended that you learn Heimlich first aid, cardiopulmonary resuscitation, etc., in order to prevent it.
Source | Zhejiang City Radio and Television News Gao Shan
Audit | Chen Guozhong Lu Xiao
Editor-in-charge | Chen Dan