Recently, Shenzhen Qianhai Shekou Free Trade Zone Hospital received a critically ill patient with diarrhea, and after 9 days of rescue treatment in the ICU, the crisis turned to safety.
Ma Mou (pseudonym) female 66 years old, according to family reactions the patient began to have diarrhea after eating raw pickled lemons in the refrigerator, and after 12 hours, he became unconscious and comatose. At 5:00 a.m. on January 3, he was transported by 120 ambulance to the emergency department of Shekou Free Trade Zone Hospital for treatment. At the time of presentation, the patient had a high fever, a body temperature of 40 degrees, a heart rate of 146 beats per minute, and a blood pressure of 72/50 mmHg, and his condition deteriorated and he was transferred to the intensive care unit (ICU) for rescue treatment.
After entering the ICU, according to the laboratory and examination report, the patient is considered to have infectious diarrhea, septic shock and multi-organ function impairment. At 13:17 on January 3, the patient developed respiratory failure, the oxygen saturation continued to decrease, and the patient was given a ventilator with endotracheal intubation to assist breathing. Since the patient is still in a state of shock, the patient's blood pressure drops significantly, and cannot be monitored, under the guidance of the director of the Jingxin Department of the ICU and the head nurse Han Yongtang, 14:27 divided into patients using arteriocenter catheterization and PICCO hemodynamic monitoring, monitoring the patient's CVP (central venous pressure) and invasive arterial blood pressure, followed by a large amount of continuous rehydration nearly Marriott fluid, a large number of vasopressor drugs and blood transfusion products after the patient's shock is still difficult to correct, Paramural severe ultrasound evaluation and Picco monitoring still indicate effective volume depletion, severe metabolic acidosis, refractory shock, difficulty maintaining blood pressure, secondary neurological, respiratory, cardiac, coagulation, endocrine system and other organ dysfunction, requiring a bedside continuous renal replacement treatment CRRT (ST100) + perfusion (HA380) continuous blood purification, removal of inflammatory mediators, replacement of kidney replacement to reduce cardiopulmonary load therapy to solve the problem, to correct water, Electrolyte and acid-base balance disorders.
It is reported that this blood purification tandem technology is a new technology and new business carried out by the ICU, which can provide new treatment programs for sepsis patients and achieve good treatment effects. After more than 11 hours of continuous rescue measures from 5:45 to 19:00, the patient's shock improved compared with before, and his blood pressure gradually rose to 91/53mmHg, and the rescue was successful.
According to the attending physician of the hospital, patients with septic shock have a high mortality rate, such as with organ dysfunction, their prognosis is worse, and early intervention and standardized treatment have a great impact on their prognosis, especially in the 24-hour treatment of the disease. ICU doctors, according to the characteristics of the patient's disease, to develop a medical diagnosis and treatment plan in line with the patient, combined with bedside arterial blood pressure, Picco and bedside ultrasound real-time hemodynamic monitoring, purposeful treatment, with a number of multi-departmental collaborative cooperation meetings, invited cardiology, urology, pharmacy and other related departments to jointly diagnose, the patient's condition was timely controlled, considering that the patient belongs to the ICU acquired weakness high-risk group, during treatment to pay attention to the occurrence of patient ICU acquired debilitation, Early intervention and management of the pathogenesis of acquired debilitating in the ICU, and coordination with the Rehabilitation Department to develop a rehabilitation training plan for patients, who recover physically after 2 weeks of treatment.
During the patient's hospital stay in the ICU, not only medical behavioral interventions are adopted, but also individualized care plans are developed in the nursing area that is consistent with the patient. Provide humanized care for patients and their families, such as timely communication and feedback on the progress of patient rescue with family members during rescue, and provide corresponding psychological comfort for family members.
After the patient wakes up, the medical staff also attaches great importance to the patient's humanistic care and psychological care. Explain the condition and rescue process to the patient, use ADIET communication skills to increase communication with the patient and increase the patient's confidence in cooperating with the treatment. Make a targeted psychological care plan for the patient's anxiety, listen to favorite music, video chat with the family, and carry out personalized psychological counseling to alleviate the patient's anxiety. Through the cooperation of all the medical staff of the ICU and the relevant departments of the hospital, the patient was successfully treated and has now been transferred to the general department to continue rehabilitation.
[Reporter] Ding Kan
[Correspondent] Han Yongtang Li Jianda
【Author】 Ding Kan
【Source】 Southern Press Media Group South + client