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8次电除颤,我终于从死神手里抢回了他!

2017-12-27 桐梓县人民医院急诊科张超红 "医学界"微信号

9月1号,从医以来最惊心动魄的一个夜班。

9月1号,从医以来最惊心动魄的一个夜班。

凌晨00:13分,一名42岁男性患者因为左下腹痛来急诊科,就诊时腹痛已自行缓解,进行体格检查未发现阳性体征,患者拒绝行辅助检查和留院观察。自诉有胃溃疡病史4年,要求开护胃药回家,患者不听劝阻带着胃药回家了。

怎么也想不到,从这里开始,一个惊心动魄的夜班就来了。

01:30分患者再次返回医院,这一次是家属背进来的,痛得不能说话,表情痛苦,忍着剧痛说他上腹痛,想刀割一样,扯到到胸背痛部、头颅枕部、双上肢疼痛,呕吐了1次。

他这一讲我的心都提到嗓子眼了,我知道死神的魔掌已经伸向他了,他很有可能是心肌梗死或主动脉夹层。

我立即给他吸氧、心电监护、建立静脉通道。同时做了一个床旁心电图。很不幸,心电图提示下壁心肌梗死

立即请了心内科医师会诊,给予药物处理。紧急和家属交代病情,这种疾病随时会死亡,死亡率很高,可以说他已经在死神手里拽着了,需要立即转到上级医院行冠脉造影,将心脏上堵死的血管疏通让心脏恢复血液供应。

这个时候对患者来说,时间就是命,早点转到遵义早点手术,生存的希望越大。

家属还在考虑,死神已经越拽越紧了。

02:15分,患者发生室颤,呼之不应,出现呼吸、心跳停止,小便失禁,口吐泡沫,牙关紧闭。

从患者进入科室来,我们医护人员就一直守护在他身边,此时立即给他进行心肺复苏术,持续胸外按压,打开气道,球囊辅助呼吸,第1次除颤,所有动作一气呵成,经过10多分钟抢救,他恢复了心跳和呼吸,意识也清醒了,这是我们和死神的第一次较量,很高兴我们胜利了。

但是死神不会这么轻易认输。

我们也没有低估死神,请来了ICU医师协助我们。

02:36分,死神再一次出手。

这一次出手更重,患者再次出现室颤,昏死过去了,我们又立即进行第2次电除颤,心肺复苏,胸外按压,开放气道,球囊呼吸,2分钟患者再次清醒,没到1分钟又再次室颤,眼睛开始“翻白眼”就要昏过去了,立即第3次除颤胸外按压,患者立即清醒并清楚感觉到被电击的感觉,说了一句“谁打我脑壳”。

死神一套组合拳,我们从容应对,但是大家的神经是崩得越紧了,能除颤3次胸外按压挺过来的已经很少有了,我们暗暗为患者捏一把汗,紧接着死神又一套组合拳,没过2分钟,患者再次发生室颤昏过去了,立即第4次除颤胸外按压,还是室颤。

患者没有苏醒的迹象,我们感到希望在逝去……

负责除颤的医师沮丧地问了一句继续除颤吗,因为我们都知道每多一次除颤对心脏造成的伤害就越大,苏醒的可能越小,但是我们没有退却,只要患者还有一丝希望,我们就要和死神硬磕到底。

第5次除颤,胸外按压一直没有间断,患者没有苏醒,被死神越拉越远,抢救室里空气死一般的沉寂,继续第6次除颤,持续胸外按压。

02:40分,患者终于再次苏醒了。

但是我们知道死神没有善罢甘休。

02:51分,患者再发室颤昏迷,我们进行第7次除颤胸外按压,没有苏醒,第8次除颤持续胸外按压。

02:57分,胜利终于向我们招手了,患者苏醒了,并且没有再发室颤昏迷,死神放弃了,我们赢了,赢了。

03:22,转入ICU继续稳定生命体征,随后经我院120安全护送到遵义医学院附属医院。第二天上级医院传回来兴奋的消息,患者成功做了手术,原来患者心脏的整个血管,左右冠状动脉都堵死了,经手术治疗后打通了。

这一刻我们才真正高兴起来,哪怕平时急诊的工作就像在嘈杂的菜市场让我们心力憔悴,但是我们依旧热爱这个科室,为我们的工作而自豪。

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    2017-12-28 zhouqu_8
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    2017-12-27 Y—xianghai

    学习了新知识

    0

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    2017-12-27 龙胆草

    学习谢谢分享

    0

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    2017-12-27 榄枷檬

    谢谢分享

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1439144, encodeId=c2ee143914409, content=<a href='/topic/show?id=8e3a98396f2' target=_blank style='color:#2F92EE;'>#除颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98396, encryptionId=8e3a98396f2, topicName=除颤)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Dec 28 16:03:00 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=272891, encodeId=a9cc2e2891c0, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Dec 27 09:55:42 CST 2017, time=2017-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=272871, encodeId=c5b02e2871fa, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed Dec 27 09:00:21 CST 2017, time=2017-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=272847, encodeId=ec7b2e2847bd, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Wed Dec 27 07:19:49 CST 2017, time=2017-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=272812, encodeId=2aed2e28123e, content=好好好好好好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Dec 27 05:20:58 CST 2017, time=2017-12-27, status=1, ipAttribution=)]
    2017-12-27 yjs木玉

    好好好好好好好好

    0

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