I can see the status bar

Chapter 560 Rescue

Sudden cardiac arrest does not mean that a working heart suddenly stops beating.In fact, in most cases, patients with clinical "cardiac arrest" (except for "cardiac arrest"), the heart is still beating in some abnormal way.It's just that the way of beating determines that they may not be able to maintain a normal working condition.

Ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) are the only two types of abnormal cardiac arrest that can be reversed with a shock—that is, a shockable heart rate.Pulseless electrical activity (PEA) and asystole (ASY) are non-shockable heart rates.

These four abnormal heart rates are basically identical in clinical symptoms, but just like the classification difference, ventricular fibrillation and pulseless ventricular tachycardia can be reversed by defibrillation, but the other two need to be reversed by vasoactive drugs and atropine, etc., and continue chest compressions to reverse.

The key to rescuing cardiac arrest patients is to distinguish between these two types of cardiac arrest, which have completely different treatment options but completely consistent symptoms.The only thing that can distinguish them is the heart rate monitor.

Zhou Jun's supplementary doctor's order was very timely. If the waveform is not confirmed and the electrical defibrillation is performed directly, it is likely to make the already bad situation worse-the wrong use of electrical defibrillation may further damage the already damaged myocardium. And eventually lead to the patient's failure of recovery rate and death.Of course, Sun Lien knew about the patient's ventricular fibrillation.But Zhou Jun didn't have a status bar, and he was a little worried that there might be a problem with Sun Lien's judgment, so he hurried over to take over.

Under the ECG monitor, the waveform of ventricular fibrillation was very obvious - in Wang Baoguo's ECG, the QRS complex and T wave completely disappeared, replaced by irregular high-frequency fibrillation waves of different shapes and sizes.At the same time, the bruising on the face and the blood pressure indicator displayed as ?/? on the monitor further indicated that there was no blood pressure in the patient's body.

Other medical staff were in charge of the defibrillation rate. Sun Lien jumped off the stretcher bed, took the laryngoscope handed over by the nurse, turned around and stood on top of Wang Baoguo's head, raised his jaw backwards, Intubation then begins.Chest compressions and artificial respiration at a rate of 30:2 alone are not enough to completely reverse ventricular fibrillation.For patients in cardiac arrest, keeping the airway open and even intubating for mechanical ventilation is a very important treatment content.It's even as important as maintaining efficient chest compressions.

Intubation while the patient is receiving chest compressions is a very difficult job. How to find the glottis deep in the ups and downs of the mouth and insert the trachea accurately - the difficulty of this job is self-evident.Sun Li'en's intubation experience is not particularly rich, but today he seems to be possessed by Dr. Cao Yanhua.In just ten seconds, he successfully completed the intubation and quickly adjusted the parameters of the ventilator.At the same time, the defibrillator was pulled aside and started charging.

The doctor who took over the chest compressions was replaced by another doctor.According to the experience of the Fourth Hospital, as long as the manpower is sufficient, the chest compression doctor should be changed every 2 minutes.This thing is a heavy physical activity. Generally speaking, after more than 2 minutes, the strength and frequency of pressing will begin to decline.Chest compressions that are not up to standard will not be able to artificially maintain circulation.

"110 joules, get out of the way!" The emergency room of the Fourth Hospital underwent a complete equipment update two months ago.The defibrillator has been upgraded from the original single wave defibrillator to the two-way wave, and the price of the new defibrillator is more than five times more expensive.However, since the duration of myocardial potential can be prolonged during defibrillation, complex rates can be performed with energy much lower than that of a single wave defibrillator, and the success rate is very high.

It was Dr. Cao Yanhua who operated the defibrillator. He originally wanted to come over to help with intubation, but after seeing Sun Lien's success, he took the defibrillation paddle from the nurse without hesitation.Now is not the time to praise Sun Lien for his high level of intubation, and completing defibrillation as soon as possible is more important than anything else.

A defibrillation paddle coated with conductive gel was placed on the collarbone of Wang Baoguo's right forearm, and another defibrillation paddle was placed on the apex of Wang Baoguo's heart.After making sure that no one was in contact with the patient or the stretcher, Dr. Cao Yanhua pressed the button without hesitation.

"The waveform of ventricular fibrillation, continue!" Sun Lien glanced at the monitor, and it was still the waveform of ventricular fibrillation.He rushed to the bed and started another round of chest compressions.The reminder on Wang Baoguo's head was very clear, there were still five more defibrillations to successfully recover, and there were no intubation error prompts such as "foreign body in the esophagus" or "foreign body in the right bronchus".Chest compressions must be continued throughout multiple repetitions.Thinking of this, he felt a little lucky—thanks to having completed the intubation and mechanical ventilation, otherwise he would have scored to pinch the ball for Wang Baoguo alone.

The number of doctors in the emergency room of the Fourth Hospital is seriously insufficient, and almost all active doctors in the entire emergency room have put down their work and come here consciously to take over the chest compressions.Zhou Jun, on the other hand, was instructing the nurse to continue administering the medicine to Wang Baoguo, "One milligram of epinephrine, intravenous injection!"

Two minutes after the first defibrillation—that is, after Sun Lien insisted on another 2 compressions, the second defibrillation began.However, defibrillation was still ineffective, and Wang Baoguo still maintained a VF heart rate.

"Forty units of vasopressin, intravenous injection!" Zhou Jun's face remained unchanged, and he began to adjust the medication plan.Lidocaine can theoretically reduce the threshold of ventricular fibrillation, but the clinical effect is not satisfactory. Therefore, in this year's guidelines, the status of lidocaine has declined, and amiodarone has successfully entered the first-line drug regimen.If the second defibrillation still fails, then you have to consider whether to increase the dose of epinephrine, or to give amiodarone again-epinephrine can be used by another mg every three to five minutes.Of course, there are also side effects.The use of large doses of epinephrine can easily cause ventricular fibrillation or tachycardia to recur immediately after the patient is rehabilitated.

"Third defibrillation, 140 joules!" Cao Yanhua defibrillated again, and Wang Baoguo's heartbeat seemed to return to sinus rhythm for a short time, but it lasted only a few seconds, and the monitor indicated that the patient fell into ventricular fibrillation immediately middle.

"Lidocaine, 5 mg intravenously." After much consideration, Zhou Jun decided to use lidocaine first.The reason is also very simple-the dose of amiodarone is too large, and it needs to be injected through a central venous catheter in ventricular fibrillation.And Wang Baoguo has been in the emergency room for less than [-] minutes now, and the central venous catheter has not been buried yet.On the other hand, in the emergency room to rescue patients with ventricular fibrillation, lidocaine is used in most cases.Zhou Jun also tends to use the drugs he is familiar with at work first, rather than changing at any time according to the guidelines in medical conferences-unless there is clear evidence that the previous plan is wrong.

"The fourth defibrillation, 150 joules!" Cao Yanhua defibrillated for the fourth time, but the effect was still very poor.Sun Li'en was about to go up to take over and do another chest compression, but was stopped by Zhou Jun.

"Let the nurse go." Zhou Jun glanced at Sun Lien, twitched his brows and reminded, "You have blood on your arm."

Sun Li'en was stunned, Wang Baoguo had ventricular fibrillation and no trauma, how could he be stained with blood?But Sun Li'en could see Zhou Jun's expression clearly. He followed Zhou Jun's gaze and glanced at his left arm, and then he was surprised to find that his arm looked bloody, as if the injury was quite serious.

"It's okay, I probably just fell and broke my skin. I'll just deal with it later." Sun Lien quickly checked his arm. He didn't know if it was because of the adrenaline secretion in his body, but he didn't feel any pain at all. . "Should I call the anesthesia to bury the tube?"

"No need." Zhou Jun shook his head, and took a pack of buried tube equipment from the cabinet beside him, "I'll do it."

(End of this chapter)