"Jingle Bells!" In the Department of Critical Care Medicine of the Twelfth People's Hospital of Guangzhou, a rapid bell sounded.
This is a distress call from Zhongshan City, where the 16-year-old daughter of the helper drank 100 ml of the "Enemy Grass Fast" pesticide five days ago, and his condition has recently worsened, and he hopes to transfer the child from the local hospital to Guangzhou for treatment. A cross-city transfer and rescue for life began.
On October 27, the reporter learned from the Twelfth People's Hospital of Guangzhou that after all-out rescue, the poison in the patient's blood was completely removed, and he was recently discharged home, and the follow-up needed to be rehabilitated locally.
Fast transfer! Do everything possible for life
Among the poisons of acute poisoning, "dichox fast" and "paraquat", which belong to the herbicide of the bipyridine class, can make patients, families and doctors despair.
There is no specific antidote to such pesticides, and patients have multiple organ damage and are in great pain in waking. Family members seek medical treatment everywhere, and most of them get such results - the amount of poison taken exceeds several times the lethal amount, and the patient has multiple organ dysfunctions such as heart, liver, kidney, lung, brain, pancreas, etc., and the mortality rate is as high as 90%, and the hope of rescue is slim.
The person who asked for help at the beginning of the article was such a desperate patient's family. After learning that the Twelfth People's Hospital of Guangzhou was the Guangzhou Poisoning Chemical Rescue Center, he held on to the last glimmer of hope and called.
Let's go! Although it was a weekend, Dr. Chen Yunchao of the Department of Critical Care Medicine of the Twelfth People's Hospital of Guangzhou and Cao Shaoyan, the leader of the nursing team, gave up rest and immediately returned to the hospital. Within an hour of receiving the call, they boarded an ambulance bound for Zhongshan.
At the local hospital, Chen Yunchao carefully examined the patient's condition and believed that the patient's sudden aggravation was caused by the toxic encephalopathy of "enemy grass fast". At this time, the patient is in a state of deep coma and requires the use of vasopressors and ventilators to maintain life. Although the condition is extremely critical, but there is no brain hernia, if the poisoning rescue experienced Guangzhou Twelfth People's Hospital intensive care medical team cooperation treatment, there is still a glimmer of hope.
But at this time, a realistic dilemma is in front of Chen Yunchao - from Zhongshan back to Guangzhou, the transfer process is expected to take 3 hours, and patients who are already very vulnerable may have various conditions in the bumpy transfer process, and even need to face the danger of death. In the face of the unconditional trust of the patient's family, Chen Yunchao's team still decided to refer the patient back to the hospital for rescue.
Not a glimmer of hope! At that time, the patient had renal failure, anurea, and completely relied on blood purification to remove poisons, how to shorten the time for interrupting blood purification due to hospital transfer? The intensive care team decided to start the emergency rescue process.
When Chen Yunchao took the patient to zhongshan for transfer, the Intensive Care Medicine Department (ICU) in Guangzhou prepared the bedside blood purification equipment to ensure that the blood purification treatment was carried out as soon as the patient arrived. On the ambulance, Chen Yunchao stayed by the patient's bedside throughout the whole process, always paying attention to the parameters of the patient's ventilator and ECG monitoring. Upon arrival at the hospital, within 10 minutes of the patient's admission to the ICU, continuous blood purification treatment has begun.
The condition is full of twists and turns, and the medical staff is "guarded 24 hours a day" for 7 days
In the ICU, the rescue is racing against the clock, all the time.
Inside the ICU, healthcare workers are performing blood purification for patients
After the first 12 hours of blood purification treatment, the poison test indicated that the toxic content in the patient's body gradually decreased. Medical staff used the time to change the blood purification line to quickly complete the CT assessment of the head and chest for the patient.
The results of cranial CT suggest that the patient's toxic encephalopathy is very serious, involving multiple parts such as brainstem, bilateral basal ganglia, thalamus, cerebellar dentate nucleus, and a small amount of bleeding in the brainstem. If the brain condition is slightly worse, a cerebral hernia can occur! Once the brain hernia appears, it means that the life of the 16-year-old girl will come to an end.
Bad news ensued, and chest CT also suggested damage to the lungs, and even if the brain was saved, patients may need to receive lung transplants or even face death in case of pulmonary fibrosis at a later stage.
Blood purification became the only way to remove poison from a patient's body, and the only hope. The Intensive Care Medicine team decided to perform a 24-hour continuous blood purification for the patient. In order to avoid interrupting treatment due to the replacement of pipelines, the department decided to alternate between two bedside blood purification units. The head nurse Xu Cui temporarily adjusted the nursing staff schedule for this reason, and the colleagues who had planned to take leave also voluntarily gave up their vacation.
After 7 days of non-stop blood purification and drug treatment, the toxic content in the patient's body was significantly reduced, and the review ct suggested that the scope of toxic encephalopathy in the patient was not expanded and the brainstem was not seen, the amount of bleeding did not increase, and the lung exudation also improved.
At this time, the patient's condition is temporarily under control, but still in a deep coma, quadriplegic, and the damage caused by toxic encephalopathy needs to be continued. She is still anauria and her kidney failure has not yet recovered.
Rehabilitation of neurological function and replacement therapy of kidney function became the focus of treatment at this time. ICU adjusted the treatment plan to shorten the time of blood purification treatment to 12 hours per day, while carrying out intensive rehabilitation treatment such as neuromuscular stimulation and passive limb movement.
After precise treatment and meticulous care, on the 10th day of transfer to the hospital for treatment, a heartening good news was finally ushered in - the poison in the patient's blood was completely removed, the state of consciousness changed from a deep coma to a shallow coma, spontaneous breathing was stabilized, the ventilator was stopped, and the daily urine output was restored to 1000 ml.
"When I woke up, I felt like I had really grown up"
On the 12th day of admission, the patient's condition improved, the endotracheal tube was removed, and the blood purification was changed to alternate-day treatment. Her sanity also improves every day, she can open her eyes on her own, she can complete some of the commands, but she can't pronounce it, and her limb strength is only level 3. At this time, the patient's condition is stable and can enter the rehabilitation stage of sequelae.
On the 17th day of admission, the patient can leave the ICU and transfer to the Poison Department for rehabilitation of the sequelae of toxic encephalopathy. After multidisciplinary diagnosis and treatment in the department of toxicology, neurology, rehabilitation medicine, entolaryngology and other disciplines, the patient's condition gradually recovered, the ability to speak, read, write and think was restored as usual, and the physical activity has returned to be able to take care of herself, and she was discharged from the hospital and returned to her hometown to continue further rehabilitation treatment.
Before discharge, the patients and their families presented a pennant to the intensive care medical team of the 12th Guangzhou People's Hospital to express their gratitude. After learning about her life and death in the intensive care department, the 16-year-old girl was moved to tears: "When I woke up, I felt that I had really grown up and knew that I was wrong!" Thank you to my parents, and thank you to the medical staff at Twelve Hospitals for giving me a new lease of life! ”
Before discharge, patients and their families send pennants to medical staff
The reporter learned from the 12th People's Hospital of Guangzhou that since August 2019, the intensive care department of the hospital has received a total of 22 cases of severe acute "enemy grass fast" poisoning combined with toxic encephalopathy and multi-organ dysfunction referred from Guangdong Province, and successfully rescued 7 people, with a rescue success rate of about 31.82%. Medical staff remind that everyone must cherish life, if you find a family member or friend acute poisoning, you should send it to the hospital in time.
[Reporter] Zhu Xiaofeng
[Correspondent] Liao Wenbo
【Author】 Zhu Xiaofeng
Guangdong health headlines
Source: South+ - Create more value