On Monday morning, after learning about the latest situation of the patient, everyone felt that the situation was too bad! This is because the patient's gastrointestinal decompression effect is very poor. Only a small amount of feces-like things are attracted in the gastric tube. This means that patients may experience severe reflux and aspiration at any time.
Whatever you are afraid of, and before the anesthesia begins, the patient develops spray-like vomiting.
When everyone lifts the patient from the transport bed to the operating table, the feces may be sprayed out from the patient's mouth and nose due to changes in position.
At that time, the patient was less conscious due to pain, respiratory dysfunction and electrolyte disorder . Although it has been sprayed like that, I just pushed the feces out with my tongue.
Seeing the patient vomiting like this, the anesthesiologist certainly knew the severity of the situation. So, he immediately rushed up and tilted the patient's head to one side. At the same time, pick up the suction tube and insert it directly into the mouth to attract it.
almost blocked the large amount of reflux in the suction tube, making everyone feel desperate.
before giving anesthesia, the anesthesiologist picked up laryngoscope and inserted it into his mouth. What he thought was to insert the tracheal catheter into the airway as soon as possible.
However, the oropharyngeal cavity is black and the patient is constantly struggling, so I don’t know where to insert the tube.
Although the patient struggled very hard and even had some muscle trembling, the anesthesiologist still held the laryngoscope's hand holding the laryngoscopy and did not dare to relax at all. At that moment, he made up his mind: even if he threw away the patient's teeth, his hands would not be relaxed. Once you miss it, you may never be able to save it again.
Fortunately, as the patient struggled and inhaled, the anesthesiologist saw a small hole in the dark reflux. The alert anesthesiologist immediately realized that this was the glottis.
At that time, the anesthesiologist inserted the tracheal catheter into it at once.
Pinching the hand of the tracheal catheter, I immediately felt the "knock, slap" that passed through the tracheal cartilage on the wall of the tracheal catheter. This "kick" feeling made the anesthesiologist very excited. Because he knew that this tube was likely to enter the trachea.
Pressure and pinch the ball, the airway pressure is very high. However, the stethoscope that is attached to the stomach did not hear the sound of air or other sounds. This again confirms that the tracheal catheter is not in the stomach.
Although blood oxygen has not risen to its ideal state, it is ideal not to fall.
At this time, the patient is still struggling and even biting the tube from time to time. In order to ensure airway safety, the anesthesiologist used medicine to "swallow the patient".
After several large amounts of saline rinses, the liquid in the patient's tracheal catheter finally cooled down.
Emergency Blood gas analysis , the result is not that bad. So the operation was carried out as usual. Without surgery, he wouldn't be able to survive. A glimmer of hope is to take surgery to relieve obstructions.
opened the abdominal cavity, and the thick intestines filled with feces "surged" like a flood broke a dam. In such cases as
, the operation will definitely not be able to be carried out. So, the nurse in the operating room took a sterile basin and temporarily put the flowing intestines. At the same time, punch holes in the intestines and reduce pressure.
Although the pressure decompression tube is very thick (sterilized washing machine drain pipe), it was drained for a full ten minutes before the intestines returned to normal.
The extremely smelly air filled the entire operating room. The head nurse who came to check the situation was almost vomited by the sudden stench. I waited for a long time before I dared to come in. It’s not her spoiledness, it’s a normal reaction for people. The people in the surgery room gradually became more and more odor because they gradually adapted to it, and the situation was urgent, so they did not feel the stench at all. The lesion, sigmoid colon tumor, was quickly found on
. So, I started to remove it. Under the
, the anesthesiologist monitors the internal environment, breathing and circulation, and has been working hard to pull the patient's abnormal indicators back.
At the end of the operation, all the indicators of the patient improved.
In view of the complexity of the patient's condition, everyone agreed to send the patient to intensive care unit for further treatment.
is sent to the intensive care unit, which also makes the anesthesiologist feel at ease. After all, the intensive care unit has complete monitoring equipment and can detect changes in the condition. At least, the respiratory function he has always worried about can be well monitored.
However, what I didn’t want to see most happened: 3 hours after the operation, the intensive care unit once again convened experts from all hospitals for consultation.
went to the intensive care unit and learned that the patient had Mendelson syndrome.
Mendelson syndrome occurs shortly after aspiration occurs or 2-4 hours.
patients showed cyanosis, tachycardia, bronchospasm and dyspnea . In the affected lung leaves can be heard wheezing or ralmus.
The degree of damage to lung tissue is directly related to the pH value of the gastric contents. The damage caused by gastric juice with a pH greater than 2.5 is much lighter than that of those with a pH less than 2.5. In addition to being related to chemical properties, the damage of
Mendelson syndrome is also related to the activity of digestive enzyme .
The chest X-ray is characterized by irregular and blurred edges of the affected lung field.
Subsequently, the intensive care unit increased respiratory support, fluid resuscitation, atomization inhalation, and hormones.
Two days later, good news came: the patient had extubated. At this point, a worrying case of Mendelson syndrome has finally been successfully treated.
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