#郴州头条 ##郴州市第一人民医院#
Recently, the medical team of Neonatal District 1 of Chenzhou First People's Hospital (Children's Hospital) successfully treated a newborn with severe tension pneumothorax with ARDS (neonatal respiratory distress syndrome), septic shock, pulmonary hypertension and pericardial effusion, giving him a new life.
▲Group photo of medical staff and family members
Starry Night referral
At more than 2 o'clock in the morning on March 31, 2024, a rapid phone ringing broke the silence of the night, and Zhu Wenjun, director of the first neonatal district, received a call from the primary hospital and immediately urgently transferred a newborn who was in critical condition, with a large number of pneumothorax, dyspnea, and cyanosis all over the body.
Race against time and race against death
After being admitted to the hospital, Xuan Xuan (pseudonym) was delirious and in shock, his whole body was cyanosis, his blood oxygen saturation was only 40~50%, and his life was in danger at any time, and his condition was very critical and urgent.
The doctor in charge, Xiong Xin, immediately gave endotracheal intubation and high-frequency ventilator-assisted ventilation and improved relevant examinations, and clearly diagnosed severe tension pneumothorax on one side of the lung, massive emphysema under the skin, mediastinal displacement, consolidation atelectasis on the other side, ARDS, meconium aspiration syndrome, pulmonary hypertension, sepsis, septic shock, and moderate and large pericardial effusion.
▲Chest X-ray results at admission
In the face of such a dangerous condition of the child, facing the threat of death at any time, the medical team worked together, the nurse team worked closely with the doctors, and quickly established a venous life channel with superb technology, and the second-line doctor Li Kaihua quickly carried out continuous thoracentesis negative pressure closed drainage to effectively reduce the compression of the pneumothorax on the lungs, and at the same time used nitric oxide inhalation therapy to reduce the pressure of the pulmonary artery, punched out strong anti-infection and anti-shock, vasoactive drugs to maintain blood pressure and a series of first-aid diagnosis and treatment measures.
Breaking through several "ghost gates" in a row
However, after the above series of emergency diagnosis and treatment measures, the child's blood oxygen saturation is still unstable. Director Zhu Wenjun led the medical team to immediately conduct continuous monitoring and condition analysis of bedside B-ultrasound, and bedside ultrasound showed severe tension pneumothorax on the right side and ARDS (neonatal respiratory distress syndrome) on the left side of the lungs.
However, the requirements for pneumothorax and ARDS treatment are completely different, the requirements for pneumothorax treatment are as low as possible ventilator pressure support, while the treatment requirements for ARDS are high pressure support, which has produced contradictions in treatment and brought unprecedented difficulties.
Director Zhu Wenjun organized a team to urgently analyze the child's condition, immediately adjust the treatment plan, and continuously adjust the ventilator parameters under the continuous monitoring of bedside ultrasound, and the peak pressure of the ventilator was gradually raised to 42cmH2O during the treatment, and such a high peak pressure value could easily blow up the alveoli and aggravate the pneumothorax.
However, due to the combination of ARDS, there is no high pressure to open the alveoli, and blood oxygen cannot be maintained, and the peak pressure value of 42 cmH2O for the ventilator parameter is also used for the first time in recent years.
In order to prevent the child from being traumatized again at such a high peak pressure value, the director personally stayed at the child's bedside, used bedside B ultrasound to continuously monitor and evaluate the alveoli, and adjusted the ventilator parameters. Septic shock was also guided by bedside ultrasound to more accurately target fluid volume and vasoactive drug use, and the child's vital signs gradually stabilized.
After precise rescue, Xuan Xuan's (pseudonym) vital signs were temporarily stable, but the medical team did not dare to slack off. A large amount of pericardial effusion can be fatal, and pericardiocentesis has the potential to damage the heart and aggravate the condition.
Director Zhu Wenjun once again organized the team to discuss and analyze and bedside ultrasound for real-time monitoring and evaluation, and Xuan Xuan (pseudonym) was able to maintain basic circulatory stability in cardiac function, and temporarily adopted conservative treatment in internal medicine. With real-time monitoring and evaluation by bedside ultrasound, the pericardial effusion was gradually controlled, and the amount of pericardial effusion slowly decreased until it was finally slowly absorbed.
▲Ultrasound monitoring
With the continuation of thoracostomy drainage for a long time, the adjustment and treatment of patency problems during the period, the stubborn large number of pneumothorax slowly improved, the pneumothorax was obviously absorbed after more than 10 days, and the compressed lung tissue on the right side gradually re-expanded. After 24 days of meticulous treatment and careful care, the child was cured and discharged from the hospital, which is the reward for the perseverance of the entire medical team day and night.
In recent years, the neonatal critical care treatment technology of the First People's Hospital of Chenzhou has been continuously improved, and it has also won the trust of the grassroots hospitals in the surrounding areas.
The team successfully treated this critically ill neonate with rich experience and exquisite technology, and behind this success is the perseverance and meticulous care of medical staff day and night, the efficient cooperation of emergency referral from primary hospitals, and the unconditional trust and full cooperation of family members.
Hunan Medical Chat Special Author: Jiang Meilan, First People's Hospital of Chenzhou City
Follow @Hunan Medical Chat to get more health science information!
(Editor YH)