e-FAST rapid diagnosis guides a successful case of severe shock rescue in anesthesia

The patient, female, 67 years old, 175 cm, 60kg, due to "left upper lung nodule, lung cancer may "propose" under the thoracic chamberectomyNo history of hypertension, no history of heart disease, diabetes, allergy, a history of cerebral atrophy, insufficient blood supply in the cerebrovascular vessels, preoperative blood routine, liver and kidney function, electrocardiogram, blood clotting function are normalIt is proposed to "pulmonary leaf excision under the chest mirror" in the static-sucking composite full hemp downstreamtested BP128/82mmHg, HR88 times/min, SpO2 99%Open the outer extremities vein pathway, drip compound sodium chloride, mask for oxygen, hemp down the left hand artery puncture continuous pressure measurementIntravenous in turn: Parisib sodium 40mg, Shufentani 25 mg, propofol 100mg, Roku bromine 50mg, induced smooth insertion of the left double cavity trachea catheter (35Fr, depth from the door teeth 28 cm), hand-controlled ventilation to listen to the sound of double lung breathing clear, single lung isolationRiffenteni 0.17 sg kg-1 min-1, right metorciin 2.78 sg-kg-1-min-1 intravenous pump injection, 1.5% heptafluoroetherination to maintain anesthesiaDouble lung mechanical ventilation, inhalation oxygen concentration FiO2 65%, airway peak pressure 16 cmH2O, PETCO234mmHg, SpO2 100%And in the B super-guide down the right side of the central vein puncture and juxtaposition tube, intravenous drip hydroxyethyl starch expansionAfter 20min drip plyrasilyn shubatan (preoperative skin test negative)take the right-hand position, the side lycing after ABP, HR sexual reduction, divided into 3 intravenous injection dopamine 2, 3 and 4 mg, invalid, and 3 times the injection of epinephrine 0.1, 0.2 and 0.2 mgBP continued to fall, after 5min of side rest BP plummeted to 20/10mmHg, HR80 times/min, SpO2 94%, PETCO2 10mmHg, respiratory airway pressure 20 cmH2O, observed that the skin has a small red spot, no obvious allergic rashThe patient is quickly diagnosed with differential diagnosis within 5min (extended-focused abdominal scan for, trauma-FAST)In the heart sword suddenly four cavity heart cut surface visible heart envelope cavity ring-free dark area, exclude heart bag filling, in the two-sided blue point can be seen "bat sign", there is pleural sliding sign, visible B line, exclude gas chest and tension gas chest; In the chest bone side length axis tip four cavity heart cut found the heart shape and movement normal, strong throbbing, but presented an "empty state", the rapid lock of severe anaphylactic shock is very likelythen quickly in accordance with anaphylactic shock treatment, immediate intravenous pump injection dopamine 10 to 15 sg kg-1-min-1, epinephrine 0.2 to 0.4 sg-kg-1 min-1, dopaphenol butamine 10 to 15 sg kg-1 min-1, norepinephrine 0.3 to 0.5 s.0-min-1,1,000 blood pressure, guaranteedImmediately remove the suspect allergen, deactivate the hydroxyethyl starch, deactivate the right metoramidin and rifentani, and replace all infusion linesIntravenous drip hormone methyl strong pine dragon 40mgPlace an ice cap on the head to protect the brainHeart B super under the guidance of a large number of rapid expansion, colloidal change to amber glythinThe lower extremities are raised by 15 degrees to increase the amount of blood in the body positionthe rapid examination of arterial hemogasise after pumping KCl4g, calcium gluconate 4g, intravenous drop 250ml of sodium bicarbonate, to correct the body acidosis and electrolyte balance disordersAfter treatment, MAP is 65mmHgStatic drop glycol 250 ml diuretic, patient MAP 75mmHgAfter the patient's condition is stable, the single cavity strengthens the trachea catheter catheter to send icU to continue to support treatment, ICU tested the patient's lactic acid level is high, 1.8mmol/LAfter 1d anesthesia patients awake, 2d after the tube back to the general ward, through the consciousness disorder assessment scale assessment, patients without post-anaesthetic consciousness disorders, recovery is good, 4d after the patient abandoned surgery requirements for dischargediscussion
unexplained shock refers to the cause, cause of vague cycle failure, and causes the body oxygen delivery reduction and/or oxygen consumption increase and/or oxygen utilization disorder caused by the lack of oxygen deficiency of cells and tissuesSevere shock patients are in a critical condition, vital signs are extremely unstable, examination means are limited, and organ perfusion is insufficient, tissue hypoxia, and mortality is highThe patient's timely determination of the cause and the treatment of the disease is the most critical part of the treatmentthe patient had no history of allergy in the past, in the conventional full hemp induction inserted left double cavity trachea catheter, line right side of the central venous tube, change the right side of the lysis appeared MAP sudden drop, the period of periesatic refractive shock, the whole body rash is not obvious, airway pressure is not high, then e-FAST rapid Diagnosis, excluding the possible by intubation and central venous puncture caused by the gas chest, blood chest, as well as heart congestion and other conditions, highly suspected of anaphylactic shock, timely take anti-anaphylactic shock measures effective, and through the bedside heart B super-directed infusion treatment is also another important factor in the success of rescuein recent years, bedside B super use in the period of periesthetic, e-FAST technology as a fast, accurate, non-invasive, repeatable auxiliary monitoring means, can assist anesthesiologists to quickly troubleshoot the cause of shock, for rapid and accurate rescue to win valuable timeThe advantages of e-FAST are: (1) no complex preparation, can be the first time assessment operation, (2) the abdominal organ bleeding, blood chest, chest and heart bag filling, such as high detection probability, (3) the examination process is not trauma-free, (4) can be dynamic and make real-time assessment of the target organ This patient saves valuable time with the rapid differential diagnosis of e-FAST Anaphylactic shock during the anaesthetic period had a mortality rate of about 3% to 6%, and allergic reactions accounted for 8% to 18% of the complications related to anesthesia the main drugs or substances that cause allergic reactions during the perithetic period of were myamin, latex, antibiotics, gelatins, lipids, blood products and fish essence proteins; The patient's allergy symptoms are mainly severe hypotension, rash is not obvious, airway pressure is not high, is not sensitive to epinephrine and other vascular active drugs, easy to interfere with the diagnosis of anaphylactic shock, through rapid and accurate diagnosis, and treatment of amyactivity shock is effective, is the success of this case patients can rescue It is a great regret that the patient was not screened for allergens after surgery