Cardiac arrest does not mean that a normally working heart suddenly stops beating. In fact, in the vast majority of cases, the heart of a patient with clinical "cardiac arrest" (except for "cardiac arrest") is still beating in some abnormal way. It's just that the way they beat out means that they may not be able to maintain their normal working order.

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

These four abnormal heart rates are basically the same in terms of clinical symptoms, but as with the classification difference, ventricular fibrillation and pulseless ventricular tachycardia can be reversed by electrical defibrillation, but the other two need to be reversed by vasoactive drugs and atropine, and chest compressions are continued.

Distinguishing between these two types of cardiac arrest with completely different treatment regimens but identical symptoms is the key to resuscitating cardiac arrest patients. And the only thing that can distinguish them is the ECG monitor.

Zhou's supplemental instructions were very timely, and if the waveform was not confirmed and defibrillation was direct, it was likely to make an already bad situation worse – the wrong use of defibrillation could further damage the already damaged heart muscle and eventually lead to the patient's failure to recover 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 Sun Lien's judgment might have problems, so he hurried over to take over.

Under the ECG monitor, the ventricular fibrillation waveform is very obvious - in Wang Baoguo's ECG, the QRS complex and T wave are completely gone, replaced by high-frequency fibrillation waves that vary in shape and size, and are irregular. At the same time, facial bruising and a blood pressure indication on the monitor that showed a ?/?, further indication that blood pressure was not present in the patient's body.

Sun Lien jumped off the stretcher, then took the laryngoscope handed by the nurse, turned around and stood on top of Wang Baoguo's head, raised his jaw back, and then began to intubate. Chest compressions and rescue breaths at a rate of 30:2 alone are not enough to completely reverse ventricular fibrillation. For patients with cardiac arrest, keeping the airway open and even intubating for mechanical ventilation is very important. It is even as important as maintaining a high level of chest compressions.

Intubating a patient while receiving chest compressions can be a challenging task, and finding the glottis deep inside the mouth that rises and falls, and inserting the trachea accurately, is a difficult task. Sun Lien's experience in intubation is not particularly rich, but today he seems to be possessed by Dr. Cao Yanhua. In just 10 seconds, he successfully completed the intubation and quickly adjusted the parameters of the ventilator. At the same time, the defibrillator was pulled aside and began to recharge.

The doctor who took over the chest compressions was replaced. According to the experience of the four hospitals, as long as there are enough people, the doctor who performs chest compressions should be replaced every two minutes. This thing is heavy physical work, and generally speaking, after two minutes, the force and frequency of compressions will start to decrease. Chest compressions that do not meet the standards do not play a role in maintaining the circulation manually.

"110 joules, dodge!" 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 a two-way wave, and the price of the new defibrillator is more than five times more expensive. However, due to the ability to prolong the duration of myocardial potential during defibrillation, the repetition rate can be carried out at a much lower energy than that of a single-wave defibrillator, and the success rate is very high.

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

A defibrillator board coated with conductive gel was placed on the collarbone of Wang Baoguo's right forearm, and another defibrillator board was placed on the tip of Wang Baoguo's heart. After making sure that everyone had no contact with the patient and the stretcher bed, Dr. Cao Yanhua pressed the button without hesitation.

"Ventricular fibrillation waveform, continue!" Sun Lien glanced at the monitor, and sure enough, it was still a ventricular fibrillation waveform. He scurried to the bed and began a new round of chest compressions. The prompt on Wang Baoguo's head is very clear, there are still five defibrillations to successfully recover, and there are no intubation errors such as "esophageal foreign body" or "right bronchial foreign body". In the process of multiple repetitions, chest compressions must be continued. As soon as he thought of this, he felt a little fortunate - thanks to the completion of intubation and mechanical ventilation, otherwise he would have scored one person to pinch the ball for Wang Baoguo.

The number of doctors in the emergency room of the fourth hospital is now seriously insufficient, and almost all the doctors who are able to move in the entire emergency room have put down their work and come over consciously to take over chest compressions. And Zhou Jun is directing the nurse to give Wang Baoguo the continuous use of medicine, "one milligram of epinephrine, intravenous bolus!"

Two minutes after the first defibrillation – that is, after Sun Lien insisted on another 240 compressions, the second defibrillation began. However, defibrillation was still ineffective, and Wang Baoguo still maintained a VF heart rate.

"Forty units of vasopressin, intravenous bolus!" 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, so 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, it's important to consider whether to increase the amount of epinephrine or to reapply amiodarone, which can be used every three to five minutes. Of course, there are side effects. High doses of epinephrine can easily lead to recurrence of ventricular fibrillation or tachycardia immediately after recovery.

"Third defibrillation, 140 joules!" Cao Yanhua defibrillated again, Wang Baoguo's heartbeat seemed to briefly recover sinus rhythm, but the maintenance time was only a few seconds, and the monitor prompted the patient to immediately fall into ventricular fibrillation.

"Lidocaine, fifty mg intravenous bolus. After thinking about it again, Zhou Jun still decided to use lidocaine as an aid first. The reason is also simple - amiodarone is too large to be used in ventricular fibrillation and needs to be injected through a central venous catheter. Wang Baoguo has been in the emergency room for less than five minutes, and the central venous catheter has not yet been buried. On the other hand, lidocaine is used in the vast majority of cases in emergency rooms to rescue patients with ventricular fibrillation. Zhou Jun also prefers to use a drug he is familiar with first in his work, rather than changing it at any time according to guidelines in a medical conference – unless there is clear evidence that the previous protocol was wrong.

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

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

Sun Lien was stunned, Wang Baoguo had ventricular fibrillation and not a traumatic injury, how could he have blood on his body? But Zhou Jun's expression Sun Lien really saw it, 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 should have just broken my skin. I'll just have to deal with it later. Sun Lien quickly checked his arm, and he didn't know if it was because of the adrenaline secretion in his body, but he didn't feel any pain at all. "Shall I call anesthesia to bury the tube?"

"No, I don't have to. Zhou Jun shook his head, and took a package of buried pipe appliances from the cabinet on the side, "I'll just come." ”