07/12/2019

Is the strong man really strong?

On August 26, 105, I remember that I had just arrived in the intensive care unit for half a year. It was a big night shift. When I got to work, I received an emergency call from the hospital. The patient of Brain Stem Hemorrhage was transferred to the big hospital because of family requirements. Other hospitals come. People who have studied biology know that the brain stem is the life center of the human body. Responsible for life phenomena (such as: breathing, coughing, sneezing, heartbeat, reflex, etc.) and learning basic medicine knows that brain stem bleeding is impossible. Because the function of the brain stem is important and complicated. As long as a victim is injured, it will die. Although the condition is heavy, it can only be closely observed and conservative treatment. It was sent to the intensive care unit about 1 am that night. I remember very clearly the patient. It is a 35-year-old male. The occupation is a factory operator. The last morning when he stooped at the factory and smashed things, he couldn’t afford it. The mouth was foaming. He was sent to the hospital for emergency treatment. But because of brain stem bleeding, the doctor was unwilling to open the knife. So the family decided Transferred to the big hospital in the north. But I asked a few of them that there was no hospital to care. Finally, transferred to our hospital.

Coming in the coma index is three points (three points to the lowest coma index. The most serious coma. Mainly used to assess the patient’s state of consciousness. In the neurosurgical intensive care unit. Every hour needs to assess whether the patient’s consciousness has changed). And muscle power limbs are 0 points (mainly used to assess the strength of the limbs of the patient. It is also possible to know if any side is weaker. It is also assessed every hour).

Helpless

After I have finished the patient, I ask the family to come in and visit (usually the patient will first arrange the meeting, set up the machine, and draw blood after entering the house. Then he will introduce and sign some consent form with the family environment. Then the family will be asked. Let’s take a look at the patient.) I remember very clearly. The patient’s wife followed three children. The biggest look is that the kindergarten. There is also a patient’s older sister. I think about two women in the early morning, with three children. Every face is sad. It is conceivable that this patient must be the pillar of the family. The family is anxious to ask about the condition. However, no matter how the result is the same as the result of the foreign hospital. This kind of desperation in the dead of night.The fear of facing the unknown is shaking this family…

Hard night

After one night, the attending physician visited. I know that the patient has no cough reflex (meaning that when there is irritant into the throat, the cilia will swing and cough to discharge the foreign body).

And the pupils of both eyes have no reflection at 5.5mm (normal pupil size) About 2.5-5.5mm. and it will shrink when exposed to strong light.) It means that the brain stem bleeding is irreversible. The only thing that can be done now is to talk about organ donation with family members (usually, patients with neurosurgery have a chance to successfully negotiate a donation. Because other organs function well, but because of traditional concept factors, the chances of successful donation are not high.) Sure enough, the family does not agree to donate. And insist on salvation. Of course, you can understand why the family will persist in the rescue. 35 years old The head of the family. The child is waiting to be fed. How can I go this way. Just like this day. Two days have passed. In the morning, the guests are shouting at the family. But the voice is exhausted. The patient is moving. The heaven is always here. It’s vivid. Since I was the first person to have a brainstem hemorrhage, I didn’t have any experience with this type of patient. On the third and fourth days, the blood pressure began to fall. Generally, the Artery line will be played in the intensive care unit (A-line). This catheter can be used to monitor the patient’s blood pressure

and blood draw. The measured blood pressure is more accurate than the normal measured blood pressure. At this time, the patient has dropped to 80-70mmHg (normal arterial blood pressure should be 20mmHg higher than the general blood pressure. If the average person’s blood pressure is For example, 120/80mmHg, the arterial blood pressure should be 140/90mmHg. Of course, it will be boosted. (In the intensive care unit, a large part of the medicine is used for soaking. For example, some drugs are added to a bottle, then Fixed by machine.)

Death is here!

This situation has actually indicated that the patient’s brain stem hemorrhage affects cardiovascular regulation. The drop in blood pressure actually means that it is alive soon. Because the blood carries oxygen and nutrients to other organs. The lack of blood pressure means that other organs will be more difficult to support the body. But the family still insisted on saving to the end. Perhaps the family knew that they could not wake up. Even lived soon. But how can they be willing to let go. Day and night visits. Continue to bring photos of many patients and family. Memories. The Walkman at the bed keeps playing the shouts and encouragement of the family. That’s it. Until the 30th, I went to the night shift until 10 o’clock in the evening. I used to twitch the patient as usual. But the blood oxygen could not be maintained very well (usually the respiratory oxygen should be maintained at 100%). About 88- 92%. Because of the pressure to the brain stem. Seriously affect the breathing regulation. At this time suddenly the life monitor loudly. I turned around and saw the heartbeat only 20 times!? (Normal people 60-100 down / min) Actually, there is a blank in the brain. Everyone rushed to the first aid. And I can only listen to the instructions of the school. I pressed the patient’s chest again and again. But how can the 110 kg body be so good? The panic can hardly massage the heart with tension. Life is losing a little bit. At this time, the doctor judges that the heart rhythm determines the electric shock. In the past, only the pictures that were seen on the TV. At most, it was used several times in the first-aid test. Now it is necessary to emergency the real person. It is really shock.

But still have to continue to rescue. I heard the charge 200J. Then squeezed a little bit of lubricant on the chest. The doctor quickly put on the electric shock board and shouted clear, then the patient was thrown ashore like a fish. The whole bounced. And I continued to massage the heart. Finally The family arrived. I saw the family after the first aid. Finally, patient’s wife signed up to give up the first aid consent form. Finally, the patient died at 3 am on the 31st. That day is the Chinese folk custom ghost gate close!

Speaking of ghost gate close. There is another story…to be continued.

Alexa

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