洗胃并发症.ppt

,洗胃术之并发症管理,医以济世，术贵乎精【清】吴尚先理渝外治方要略言,洗胃技术认识,胃管洗胃技术的应用前提,常见并发症的分析与管理,三个模块学,熟记胃管洗胃术的五个动作掌握胃管洗胃术的适用范围学会并发症的管理,目的：是彻底清除自服或误服的毒物,分类：催吐洗胃术和胃管洗胃术,洗胃：是将胃内容物冲洗抽吸出来的操作,定义及分类,插入胃管,运用原理,灌入溶液,混和毒物,反复抽洗,胃管洗胃术：是将胃管由口腔或鼻腔插入胃内，利用重力,虹吸或负压等原理，将一定量的溶液灌入胃腔，混和胃内容物后抽出，再反复冲洗的方法。,记住五大步,五个步骤，下文还用,哪些要洗胃,洗胃是抢救服毒者生命的关键一般服毒者：除吞服腐蚀剂(强酸、强碱等)者外一律6小时内迅速彻底洗胃6小时以上者：也要争取尽可能洗胃,然而，洗胃也会因患者自身疾病因素，合作情况，及操作者对适应证、禁忌证的掌握不当，操作不熟练或操作违规等引致并发症，甚至死亡,适应证（一）清除胃内毒物（二）胃瘢痕性幽门梗阻做术前准备（三）做胃十二指肠检查前的准备,禁忌证（一）吞服腐蚀性药物、毒物的病人（二）食管静脉曲张、上消化道出血、食管狭窄、胸主动脉瘤、冠心病、重度高血压、心力衰竭、深昏迷、休克等,适应/禁忌症,失之毫厘，谬以千里准确的判断是抢救病人的关键步骤错误的判断不仅会延误抢救进程，还可能给病人造成严重的后果,视评估内容决定,毒物类型,服用剂量,意识情况,配合程度,评估很重要,接触时间,病史情况,急性胃扩张,窒息或心跳停止,急性水中毒,上消化道出血,吸入性肺炎,虚脱及寒冷反应,常见并发症,胃穿孔,中毒加剧,列出其中几个与大家介绍，余下的大家回去自行分析,1插管创伤。2病人剧烈呕吐造成食道黏膜撕裂。3当胃内容物基本吸、排尽后，极易因洗胃机的抽吸造成胃黏膜破损和脱落而引起胃出血。4.烦躁、不合作的患者，强行插管引起食道、胃黏膜出血。,原因,洗出液呈淡红色或鲜红色，清醒病人主诉胃部不适、胃痛，严重者脉搏细弱、四肢冰凉、血压下降、呕血、黑便等。,症状,1插管动作要轻柔，快捷；插管深度要适宜。2做好心理疏导，尽可能消除病人过度紧张的情绪。3抽吸胃内液时负压适度，洗胃机控制在正压0.04MPa，负压0.03MPa。对昏迷、年长者应选用小胃管、小液量、低压力抽吸（0.010.02MPa）。4如发现吸出液混有血液应暂停洗胃，按医嘱予胃粘膜保护剂，止酸、止血等。5大量出血时应及时输血，以补充血容量。,预防及处理,上消化道出血,1洗胃管孔被食物残渣堵塞，造成活瓣作用，使洗胃液体只进不出，多灌少排，进液量明显大于出液量，导致急性胃扩张。2洗胃过程中未及时添加洗胃液，药液吸空或药管吸头一部分甚至全部浮出药液面使空气吸入胃内，造成急性胃扩张。,原因,腹部高度膨胀，呕吐反射消失，洗胃液吸出困难。,症状,1遇餐后中毒，洗胃前应先刺激咽喉部，加速催吐，以防食物阻塞胃管。2对昏迷病人，小剂量灌洗更为安全可靠。3.洗胃过程中，保持灌入液量与抽出液量平衡，并严格记录出入洗胃液量。4洗胃前备好足量药液，以防洗胃过程中因药液不足导致空气吸入胃内。5洗胃过程中应严密观察病情变化，如神志、瞳孔、呼吸、血压及上腹部是否膨隆等。6.对于已发生急性胃扩张的患者，协助患者取半卧位，将头偏向一侧，并查找原因对症处理。如因洗胃管孔被食物残渣堵塞引起，立即更管重新插入将胃内容物吸出；如为洗胃过程中空气吸入胃内引起，则应用负压吸引将空气吸出等处理。,预防及处理,急性胃扩张,1洗胃液选用不当，如敌百虫中毒者，应用碱性洗胃液，使敌百虫转化为毒性更强的敌敌畏。2洗胃液灌入过多，造成急性胃扩张，增加胃内压力，促进毒物吸收。3洗胃液过热，易烫伤食道、胃黏膜或使血管扩张，促进毒物吸收。,原因,清醒患者意识可逐渐变模糊，昏迷患者脉搏细速，血压下降等。,症状,1毒物的理化性质不明者，选用温清水洗胃。2.洗胃时先抽吸胃内浓缩的毒物后再灌注洗胃液，避免毒物被稀释后进入肠道内吸收。3保持灌入与抽出量平衡，严格记录出入洗胃液量。,预防及处理,中毒加剧,1多见于误食强酸强碱等腐蚀性毒物而洗胃者。2病人患有活动性消化道溃疡、近期有上消化道出血、肝硬化并发食道静脉曲张等洗胃禁忌证者。3.洗胃管堵塞出入量不平衡，短时间内急性胃扩张，继续灌入液体，导致胃壁过度膨胀，造成破裂。4医务人员操作不慎，大量气体被吸入胃内致胃破裂。,原因,腹部隆起，剧烈疼痛，腹肌紧张，肝浊音界消失，肠鸣音消失，脸色苍白，脉细速。腹部平片可发现膈下游离气体，腹部B超检查可见腹腔有积液。,症状,1误服腐蚀性化学品者，禁止洗胃。2.正确掌握洗胃操作技术，洗胃过程中，保持灌入与抽出量平衡，严格记录出入洗胃液量。3洗胃前详细询问病吏，有洗胃禁忌证者，一般不予洗胃。有消化道溃疡病史但不处于活动期者洗胃液应相对减少，一般300ml次左右，避免穿孔。4电动洗胃机洗胃时压力不宜过大，应保持在100mmHg左右。5洗胃过程中应严密观察病情变化，如神志、瞳孔、呼吸、血压及上腹部是否饱胀，有无烦躁不安、腹痛等。6胃穿孔者立即行手术治疗。,预防及处理,胃穿孔,通过症状找原因,通过原因找对策,通过对策解症状,因果关系齐总结,处理四部曲,胃管类问题,原理类问题,溶液类问题,清洗类问题,吸入性肺炎中,如:洗胃液选用不当，如敌百虫中毒者，应用碱性洗胃液，使敌百虫转化为毒性更强的敌敌畏,中毒加重时,如:洗胃机正负不均衡，造成溶液进出失衡而引起水中毒,急性水中毒中,如:洗胃过程中未及时添加洗胃液，药液吸空或药管吸头一部分甚至全部浮出药液面使空气吸入胃内，造成急性胃扩张,急性胃扩张中,五个背锅侠,灌入类问题,如:拔除胃管时没有捏紧胃管末端,如:灌入的洗胃液过凉,虚脱及寒冷反应,归类问题的出现频率,出现问题原因分析,对比后做出正确改进,问题联系实践操作,评价改进效果,五个和事佬,检验学会否,案例分析:吴某，女，33岁,昏迷45min。自服药物半瓶1h，1h前因吵架后服用半瓶不明药物，家属发现后立即送往医院抢救。急诊医生询问情况后立即予以胃管洗胃术。在洗胃结束后，护士于某遵医嘱胃管拔出。在拔胃管时，护士于某将鼻翼旁固定的敷贴撕开，缓慢将胃管拔出，拔出过程中患者出现呛咳，听诊，闻及肺部湿罗音和水泡音。1，病人洗胃出现了什么症状2，出现这个症状原因以及如何应对运用本节课所学方法加以分析总结,谢谢大家咯,THANKYOU,Entrepreneurialactivitiesdiffersubstantiallydependingonthetypeoforganizationandcreativityinvolved.Entrepreneurshiprangesinscalefromsolo,Sunny,Entrepreneurialactivitiesdiffersubstantiallydependingonthetypeoforganizationandcreativityinvolved.Entrepreneurshiprangesinscalefromsolo,Raining,Entrepreneurialactivitiesdiffersubstantiallydependingonthetypeoforganizationandcreativityinvolved.Entrepreneurshiprangesinscalefromsolo,Spring,Entrepreneurialactivitiesdiffersubstantiallydependingonthetypeoforganizationandcreativityinvolved.Entrepreneurshiprangesinscalefromsolo,Lightning,Entrepreneurialactivitiesdiffersubstantiallydependingonthetypeoforganizationandcreativityinvolved.Entrepreneurshiprangesinscalefromsolo,Cloudy,Entrepreneurialactivitiesdiffersubstantiallydependingonthetypeoforganizationandcreativityinvolved.Entrepreneurshiprangesinscalefromsolo,Winter,Entrepreneurialactivitiesdiffersubstantiallydependingonthetypeoforganizationandcreativityinvolved.Entrepreneurshiprangesinscalefromsolo,part-timeprojectstolarge-scaleundertakingsthatcreatemanyjobs.Manyh,WRITEHEREANEWTITLEWeatherConditionsandSeasons,CompetitorA,Entrepreneurialactivitiesdiffersubstantiallydependingonthetypeoforganizationandcreativityinvolved.,CompetitorB,Entrepreneurialactivitiesdiffersubstantiallydependingonthetypeoforganizationandcreativityinvolved.,CompetitorC,Entrepreneurialactivitiesdiffersubstantiallydependingonthetypeoforganizationandcreativityinvolved.,CompetitorD,Entrepreneurialactivitiesdiffersubstantiallydependingonthetypeoforganizationandcreativityinvolved.,Entrepreneurialactivitiesdiffersubstantiallydependingonthetypeoforganizationandcreativityinvolved.Entrepreneurshiprangesinscalefromsolo,part-timeprojectstolarge-scaleundertakingsthatcreatemanyjobs.Manyh,WRITEHEREANEWTITLEFourCompetitorsComparison,Loremipsumdolorsitamet,consecteturadipiscingelit.Donecmaurislorem,vestibulumacrutrumid,suscipitindui.Donecvitaedapibustellus.Vestibulumnuncsem,finibusquiselementumac,variusactellus.Namfaucibusfaucibusvenenatis.Donecnecarcuvelit.Fusceviverra,duivitaeeuismodmollis,tortormagnaegestasnunc,etsuscipitnuncexquisnunc.Pellentesquehabitantmorbitristiquesenectusetnetusetmalesuadafamesacturpisegestas.Integeregetauctornunc.Maecenastincidunteleifendconsequat.,WRITEHEREANEWTITLEOurCommonServices,Demographic,Directdatacomesfromvitalstatisticsregistriesthattrackallbirthsa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