On the fifth day of the Chinese New Year, a digestive perforation operation broke the tranquility of the operating room.
The patient reported that he began to hurt in the middle of the night, thinking that he had eaten the wrong thing. Moreover, the parents and children are at home, and they are afraid that everyone will worry, so they have been putting up with it.
At six o'clock, she could not get out of bed until she realized the seriousness of the problem. Therefore, the family rushed her to the hospital.
As a doctor, I want to tell you a basic common sense: abdominal pain must be taken seriously. If you suspect stomach pain, you may wish to drink some hot water, take some medicine at home, most of which can alleviate some.
Situations like this getting heavier are probably not a good thing. In case it is a heart or large blood vessel problem, it is likely to miss the best time.
After arriving at the hospital, the preliminary diagnosis was "gastrointestinal perforation" and laparoscopic exploration was planned.
After receiving the notification of the operation, the anesthesia department immediately began to prepare for anesthesia.
When they were ready, the nurse pushed the patient into the operating room.
Xiao Li, who is in charge of anesthesia, feels that something is not normal at the first sight of the patient. However, due to the urgency of the operation, he could only work on anesthesia and analyze at the same time.
At this time, the patient's reddened face is like a blush. Touching it, it is obviously incompatible with the temperature of 25 degrees in the operating room.
Turning over the case and seeing the rising white blood cells, Xiao Li thought in his heart: there may have been signs of infection, and fever is normal. So, he began steps such as anesthesia intubation.
What puzzled him after the intubation was that the patient's blood pressure and heart rate had remained high. Normally, some patients even need a little vasopressor to combat the circulation inhibition of a large number of anesthetics.
Some people say: Will it be a laparoscopic pneumoperitoneal problem?
No. Carbon dioxide absorption by laparoscopic gas ventrals is a process. Even if the breathing parameters are not adjusted in place, the blood pressure and heart rate caused by carbon dioxide accumulation will not increase so quickly.
With a safe intubation to control breathing, Xiao Li began to adjust various parameters while thinking about the reasons. By the way, he connected the temperature probe as well.
What he thought in his mind was that the patient had an infection, the body temperature might be higher, and the intraoperative monitoring was a little better.
However, when the temperature value just came out, he couldn't help but fight a cold war. What he saw was that the screen showed a body temperature of 38 degrees.
This tension stems from the bones. For every anesthesiologist, the complication of malignant hyperthermia is well known. Although this complication rarely occurs, the success rate of treatment is extremely low. The main feature of this complication is the persistent high temperature of the patient during surgery.
Thinking of this, he quickly looked at the carbon dioxide value at the end of the exhalation. The numerical value shows that the carbon dioxide at the end of the exhalation is 33. Uneasy, he quickly touched the calcium lime pot on the anesthesia machine with his hand. If carbon dioxide is produced in large quantities, the jar is bound to be very hot.
When it was confirmed that the jar was not so hot, he was slightly relieved. But where the 38-degree body temperature comes from, it must be figured out.
Check the surgical preoperative doctor's orders, this time there is a discovery. In the preoperative medication, it is written "atropine".
Xiao Li is very clear that some old doctors still have the habit of using atropine before surgery. However, you can't blindly fight! Patients like this who already have a fever, do you dare to fight?
At this time, some people will ask: Is there a relationship between fever and atropine?
Of course it does! Atropine is an anticholine drug that inhibits glandular secretion. The sweat glands are the main organs of the human body that excrete heat, which is not difficult to understand the problem of elevated body temperature.
If it's an ordinary patient, you hit it. But, to put it bluntly: what if the patient has contraindications? You regularly play atropine, what should you do if something goes wrong?
Some people will ask: What is wrong with hitting an atropine?
What if the patient has a fast heart rate because of a heart problem? What if the patient has Sjögren's syndrome?
If the heart is problematic, atropine speeds up the heart rate at the same time, but also greatly increases the oxygen consumption of the heart muscle, which means that the heart muscle will be more hypoxic. If so, it should be easy to understand what the consequences are?
In patients with Sjogren's syndrome, the various mucous membranes are dry, especially the eyes and perineum. If there is a problem with the cornea because of the use of atropine, who can be responsible?
Here, we sincerely warn everyone: be in awe of life, and not blindly adhere to your so-called habits or save trouble.
【Warm tips】Point to pay attention, here is a lot of professional medical science, for you to decipher those things about surgical anesthesia ~