Cases
The patient, a 45-year-old male, presented with a 5-hour onset of low back pain and was presented urgently.
Anamnesis: Have "hypertension" for 5 years, the highest blood pressure is 150 105mmHg, intermittent oral antihypertensive drugs, and blood pressure is not regularly monitored; denial of a history of "diabetes"; Denial of history of acute and chronic infectious diseases such as hepatitis and tuberculosis.
History of present illness:The patient had sudden low back pain when resting 5 hours ago, no chest tightness, chest pain, shortness of breath, no nausea, vomiting, no amaurosis, syncope and limb mobility disorders and other accompanying symptoms, and was admitted to a county-level hospital, the blood pressure of the left upper limb was 135 88mmHg, the blood pressure of the right upper limb was 137 55mmHg, and the vascular CT imaging (aorta and lower abdomen): 1Aortic dissection, StanfordB, DebakeyIIIB 2Aortic sclerosis 3Right kidney cyst.
Admission Diagnosis:Aortic dissection.
What is aortic dissection?
Aortic dissection is the most dangerous dissection in the human body, it carries the passage of arterial blood flow, and the formation of aortic dissection is mainly related to the abnormal media of the aorta and hemodynamic interaction, if the patient has congenital vascular malformation or Marfan syndrome, it is more likely to occur aortic dissection, if hemodynamic changes are easy to cause arterial wall damage.
What are the common ones?
A common hypertensive disease in daily life is a concomitant disease of aortic dissection, and most patients with aortic dissection have severe hypertension, in addition, pregnancy is also one of the risk factors for aortic dissection.
How it works:Risk assessment
Difference in blood pressure and interarm blood pressure
Difference in blood pressure between arms is an abnormal sign of AD1. It is the upper limit of normal systolic blood pressure, and it is generally recognized as an abnormal diagnostic criterion 2-3 in clinical application in China.
Risk Scoring Tool
The improved early warning score was applied to clinical practice earlier, which is of great significance for reducing the missed diagnosis and misdiagnosis of patients. With the continuous improvement of the diagnosis and treatment level of the medical industry, it has been widely used in clinical practice in recent years, and clinical data have confirmed that it can improve the accuracy of non-traumatic emergency triage.
How it works:UrgentRescue and care
The most effective first aid measures that need to be given to the patient in the shortest possible time are as follows:
Triage:If the patient has sudden chest, abdomen and back pain, tearing pain, and irritability, sweating and other symptoms, accompanied by a sense of impending death, the nursing staff needs to give the patient a first aid against time, closely observe whether there is aortic dissection, if there is any adverse phenomenon, you need to notify the relevant doctors in time, and send the patient to the emergency room to prepare for rescue.
Absolutely bedridden :Nursing staff should carry out emergency treatment for patients with aortic dissection, assist patients to stay in bed immediately, and calm the patient's emotions, and guide patients to take deep breaths slowly, so as not to induce sympathetic nerve excitation due to panicked emotions, thereby increasing heart rate, increasing blood pressure, and forming internal hematoma. Limit the number and frequency of visits to ensure that patients can have a good recuperation effect in a comfortable environment, advise patients to avoid excessive activities as much as possible during bed rest, and choose to defecate and defecate in bed if possible.
Oxygen:Nursing staff should give oxygen to patients who are in bed for rescue**, and closely monitor the patient's blood pressure, heart rate, respiration and other vital signs, and collect blood samples from patients for blood testing if necessary.
Control your blood pressureKeeping blood pressure levels within the normal range can help inhibit further intima-stripping and ensure blood from all organs of the patient's body, such as the heart, brain, kidneys, etc. At the same time, the nursing staff needs to advise the patient to maintain absolute sedation in daily life, and if necessary, the patient can be provided with sedation medication according to the doctor's instructions. Next, the patient's vital signs need to be observed, and the nursing staff should closely monitor the changes in the patient's blood pressure level, make targeted care in a timely manner, and record the basic parameters such as the patient's heart rate, blood pressure, and oxygen saturation.
The world of naloxone care, like 45Managed nursing:The patient needs to have a urinary catheter placed during the ** period, for which the nursing staff needs to take care of the urinary catheter and record the patient's urine output every hour. If it is found that the patient's right upper limb is less affected by aortic dissection during this period, the medication regimen can be appropriately adjusted according to the clinical monitoring results under the guidance of the doctor
Pain Care:Because the patient's pain level is directly related to the condition, it should be scientifically evaluated according to the patient's pain performance, closely observe the patient's clinical symptoms, and listen to the patient's description of his or her own condition, so as to grasp the patient's pain degree and relieve it in an appropriate way.
Medication careAfter the patient takes the drug, the nursing staff should pay close attention to the patient's clinical response, record the patient's blood pressure monitoring results five minutes before and five minutes after the drug, and appropriately extend the blood pressure monitoring time after the patient's condition is stable, but in this process the patient's blood pressure should be avoided from being too high or too low, and the patient's consciousness, pain, heart rate and urine output should also be observed at the same time, so as to prevent the patient from affecting the blood supply of important organs due to low blood pressure. In addition, in the use of some special drugs, it is necessary for nursing staff to use them on the spot, and patients use professional equipment to inject into the patient's body, control the speed during the infusion, and try to avoid adverse reactions to patients.
Psychological careAfter the patient seeks medical treatment, the nursing staff should take the initiative to popularize the basic knowledge related to aortic dissection to the patient, so as to avoid the patient's panic and other bad psychology due to lack of cognition, and at the same time, the nursing staff is also required to calm the patient's emotions, avoid the occurrence of high-risk behaviors, and guide the patient to adjust his own mentality, control the bad emotions, and face the ** with a comfortable mood.
9.Preparation for transshipment:In terms of patient transport, it should also be noted that preparations should be made in advance before transport, and only when the doctor's assessment determines that the patient's condition has been stabilized and can be transported, and rescue drugs should be prepared before transport, and preparations for endotracheal intubation should be prepared in case of emergency. During the transport process, the patient should avoid large movements and provide protective care to the patient.