Chapter 3800 【3800】Three Situations

Holding the surgical retractor, Zhang Shuping carefully helped Teacher Xie pull the surgical incision while holding his breath with the assisting emergency nurse.

I just remember what the textbook said, if you try to reach the pericardium immediately if you try to reach it at the wrong angle, you may encounter obstacles or the operation may be awkward. If external pericardial compression is unsuccessful, you will need to disconnect the third and fourth ribs for intrapericardial compression. of. At that time, it will be a dead horse and a living horse doctor.

Best, it's best to get it right the first time. Zhang Shuping felt that the hot breath he breathed was going to burn him to death.

The current situation is really a hot potato for him and Teacher Xie.

I don't want to save him, but the success rate of treating a dead horse as a living horse is really low.

This is the same reason why clinical routine advocates external chest cardiac compression while intrathoracic cardiac compression is extremely rare.

According to medical statistics, there is no advantage in the success rate of intrathoracic heart compressions compared to external chest heart compressions. Therefore, there are special prerequisites for doctors to perform intrathoracic heart compressions on patients. For example, in the current case, a patient who had undergone thoracotomy and the chest cavity was not closed after surgery was seen in Shouguang Hospital and was rescued unexpectedly.

Oh, surgeon Xie's gloved right hand reached into the surgical incision.

She has never done this kind of surgery independently, but she must have done intrathoracic heart compression, otherwise she would never have dared to do it if she thanked the surgeon. She once remembered the trick that her fairy brother made her do when she was a child, making her frantically perform heart compressions on the little baby with her bare hands.

After experiencing such a worse encounter, her mentality is undoubtedly stable now.

Thanks to Brother Shenxian, a group of "cruel and ruthless" mentors for leaving her with all kinds of painful experiences and lessons.

After touching the patient's heart wrapped by the pericardium, the first step is not to press, but to further clarify the diagnosis: is the patient's heart completely stopped, or is the patient's heart simply weak, that is, the heart beats weakly and with little strength, or is it ventricular fibrillation?

If the heartbeat is weak, 0.1% epinephrine or 10% calcium chloride should be injected into the cardiac chamber to stimulate the myocardium and then cardiac compressions should be performed. At the same time, doctors should order the nurse to inject dopamine and other drugs into the intravenous channel to assist in maintaining blood pressure.

If it is ventricular fibrillation, it is not necessary to perform defibrillation immediately. Instead, after performing heart compressions for a certain period of time, wait for the myocardial tension to improve before performing defibrillation. It can be seen that the most professional medical cardiac compression technique is not as simple as teaching laymen to perform pre-hospital on-site rescue, but must be coordinated with precise first aid measures such as rescue medication.

After carefully touching the patient's heart, Xie Wanying was sure: it was asystole.

Is it scary to have a complete arrest? It seems to be the worst of the three situations above. But no matter what the situation is, for doctors, it is not necessarily good unless the heart completely returns to normal beating. The patient's heart condition changes rapidly, and the three conditions may be interchangeable.

What doctors have to do is to carry out routine operating procedures step by step and follow the valuable clinical experience left to future generations by countless medical predecessors.

The gloved right hand immediately further prepares the compression position.

There are three methods of intrathoracic heart compression, the single-hand method and the sternum compression method.

The single-manipulation method is to touch the front of the patient's heart with the thumb and thenar eminence, and place the remaining four fingers behind the patient's heart. The purpose is to press the left and right ventricles evenly, forcefully and rhythmically.

The left and right ventricles are the heart's main pumps responsible for pumping blood. When the heart stops beating, the ventricles lose their ability to pump blood, causing the heart itself and other organs in the body to lose blood nutrients and die. This is exactly what cardiac compressions are designed to solve.