Emergency treatment and nursing of reflux misabsorption during 1 case of whole hemp induction

The case male, aged 40, 78kg, 165 cm, was admitted to hospital on 26 October 2017 after a preliminarydiagnosisfor two-sided chronic purulent mediaAfter a preoperative examination, it is proposed to "left drum sinus and upper drum room opening" on October 27, 2017 in full mahjongPreoperative chest tablets, electrocardiograms, blood routines, biochemical and other routine examinations did not see specialPatients have a history of snoring and occasional lysabys during nighttime sleepEnter the operating room to check: clear, body temperature 36.2 degrees C, pulse 80 times / min, breath19 / min, blood pressure 160/100mmHg, pulse oxygen saturation 97% without oxygen absorptionPatients are generally in better condition and have been fasting and drinking 8hto be ready, give the patient a mask oxygen absorption, oxygen flow of 8L/min; Ku ammonium 16mg, Hydrochlorite Aislow 30mg, Deprimal 15mg, waiting for the patient's eyelid shhel and autobreath disappear, hands holding up the patient's jaw mask pressure to oxygen denitrogen, hand-controlled ventilation sense airway is not smooth, airway pressure is high, adjust the position of the mask still feel resistanceAfter 1min, a small amount of colorless transparent liquid was found in the patient's mouthquickly adjust the patient to the head low foot high side lying, full negative pressure attraction, the ordinary laryngoscope into the sound door exposure is fully exposed, successfully inserted 7.5 ordinary trachea catheter, confirm the position and depth of the catheter, fixed at 23 cm away from the door teethAfter re-negative pressure attraction, the hearing double lung smell and the upper right lung lobe a little wet toneImmediately suction 0.9% physiological saline 10 ml injection into the trachea catheter, and then using the sputum tube from the catheter to extract the injected physiological saline re-suctionrepeated the above steps 3 times, again to listen to the patient's double lung breathing sound, right lung wet tone decreased, while intravenous injection of methyl strong pine dragon 40 mgThe anesthesia was carried out smoothly and the patient's vital signs were stable during the operationAfter 5min after the operation, the patient's self-respiratory recovery, hearing double lung breathing sound clear, to reach the tube after the sign smooth extraction After the tube extraction, the patient breathed smoothly, no irritating cough cough inglegum, the vital signs were stable, and the anesthesia resuscitation room was returned The next day, the review of the chest tablets showed clear texture of the double lung, no obvious signs of lung infection discussion
anaesthetic inthertic process is the most dangerous and critical stage, vomiting or reflux misabsorption can cause patients to develop hypoxia, hair, throat spasms, bronchospasm, pulmonary edema, lung infection , cardiac arrest and other serious complications, is a common cause of death during anesthesia The main causes of reflux misabsorption during anesthesia induction include: the effect of the induced drug on the function of esophageal sphincter, the airway obstruction when induced, the apparent decrease of intrathal pressure when inhaling the gas, plus the gravity effect of the low head, after the use of muscle relief medicine, the mask is pressurized to oxygen, gas Entering the of stomach, anesthesia and surgery can also make the stomach intestinal peristaltic weakened, the stomach memory accumulated a large amount of air and stomach fluid, the stomach intestinal tension decreased, the patient coughed or struggled hard, preoperative patients with gastric tubes are also prone to reflux and misabsorption inhaling vomiting or reflux of stomach content can cause bronchospasm, hypoxia, pulmonary indifference, shortness of breath, tachycardia and low blood pressure, the patient's clinical the seriousness of symptoms depends on the nature, quantity and pH of reflux content A large number of reflux can block the airways, affecting the smooth flow of the respiratory tract, serious will cause the patient to suffocate to death Therefore, after the reflux of the patient during the induction, measures should be taken to deal with it in a timely manner Effective measures include: after reflux, the patient takes the head low foot high to reduce the passive flow of stomach contents into the trachea; Before positive pressure ventilation, the tube in the trachea should be attracted to avoid pressing the contents of the stomach into the far end airway the body fat, short neck thick, airway resistance, induced mask pressure to oxygen when the respiratory tract is not smooth, excessive pressure so that the amount of gas into the stomach increased, resulting in a sudden increase in intra-gastric pressure; After this case of reflux mis-suction, the anesthesiologist the first time skillfully adjusted the operating bed, the patient was placed at a low head foot high, and carried out a full negative pressure attraction, immediately assist the anesthesiologist to carry out trachea intubation, open large intravenous infusion channels, facilitate the injection of drugs, for the anesthesiologist to do a good job of central venous puncture tube preparation, according to the doctor's instructions to give the patient hormones, anti-inflammatory and bronchosic antisvulsive use the period of anesthesia closely monitor the patient's electrocardiogram, blood pressure, oxygen saturation changes, found abnormaltimely inform the anesthesiologist and participate in the preparation of rescue, but also for the anesthesiologist to carry out rescue conditions, won time, achieved good rescue results, to avoid the occurrence of large complications Although this case was handled by anesthesiologists in a timely manner to avoid the occurrence of large complications, but from the beginning, or can avoid the patient's reflux mis-absorption occurred preoperative visit son of patients, that is, found that the patient's neck is short and coarse, snoring history, sleep occasionally have wake-up symptoms, should consider whether the patient has ventilation difficulties A matching pharynx or nasopharyngeal vents should be prepared for the patient before induction After finding ventilation difficulties, the oral or nasopharyngeal ventilation channel should be used in a timely manner, rather than forced pressure to oxygen, resulting in a sudden increase in the pressure in the patient's stomach, resulting in the occurrence of reflux and misabsorption This case suggests that the risk of reflux misabsorption is still present in the whole line of elective surgery, emphasizing the importance of prevention of , and that once the patient has reflux misabsorption, the skilled operation of the anaesthetic nurse and perfect pre-induction preparation can win time for the anesthesiologist to save the patient, create conditions, so as to improve the rescue effect and avoid the occurrence of larger complications