醉酒饱胃手外伤患者

小根子

刚才急诊来了一个24岁手外伤患者，打算行清创肌腱吻合中指骨折内固定，患者四小时前饮白酒半斤，饱胃，来院后意识还算清醒，但情绪激动，醉酒状，嗜睡，手术医生希望在臂丛下手术，考虑到饱胃醉酒，我拒绝了，如果手术可以等，希望酒醒后手术麻醉。以防术中出现呕吐误吸，且病人不太配合，考虑麻醉过程中患者反抗。不知道大家遇到这种情况会怎么办。希望大家可以给点建议。

工作二十年

饱胃下给全麻快速诱导插管手术

scv168

等酒醒后再做臂丛麻醉好了，没有必要冒风险，毕竟不是什么紧急手术

anescn

brachial plexus block needs cooperation.  it is not the best choice here. reason 1, pt seems have alcohol toxicity with full stomach. reason 2, acholol pt may have coagulation issues which may cause hematoma in this case, well seemly unlike here. but needs to be considered for
before live function test confirm it. reason 3, with a full stomach and uncooperative patient, if there is a intravascular injection during the brachial plexus block, then aspiration is likely. reason 4, for a uncooperative pt, there are technical difficulties.  in this case no Sedation should be  given for procedure, so block might not work  fully. so is angesia needs to supply during the case, it will add to the problem of vomiting and depressing airway. reason 5, acute injury of hand and fingers may involve nerve damage.  for the reason of liability, if there is nerve dysfunction afternoon procedure, then brachial block will be questioned for contribution to the never injury at higher level.  so for all those reasons, in this case, GA is reasonable and practical.

anescn

this case is not elective case and seems need to be done case author mentioned I and D . Not a close injury. infection is a issue here. it is unreasonable to wait 8 hours to clean dirty wound.
this is another case that anesthesia like is stressful.

无所畏惧

等，清醒了在做

dr.zhang

等，如果不等就必须快速诱导插管，有助手帮你压住患者的环状软骨，以防大量气体入胃，防止呕吐。最重要是拔管，必须清醒以后才能拔管。实习时候遇见一例，还好当时还未拔管，正准备拔管时，患者突然呕吐，几乎把胃内容物全部吐出来了，当时带我的那个老师脸色都变了。急忙把患者翻过来。要是早拔一分钟，后果就很严重了

ljsong_2013

anescn 发表于 2015-3-8 09:34
this case is not elective case and seems need to be done case author mentioned I and D . Not a close ...

太棒了，佩服，向你学习！

anescn

ljsong_2013 发表于 2015-3-8 20:16

                               
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太棒了，佩服，向你学习！

thank you. I am glad you like my post.

福麻

经常遇到这样的状况，只能说我们和手术医生的立场出发点不同，他们当然希望在规定时间内尽快完成手术，不顾及麻醉的禁忌。所以，只能说多数时候只能靠沟通和协商。没招。

农丕渡

催醒再行臂丛麻醉，要不然就等了

xuwenxue

催醒后再臂丛阻滞，推迟3-4小时不会死，为什么要冒生命风险去做呢？和外科医生沟通很重要！

丹江口

催醒恐怕也不是很合适吧，病人可能会烦躁更难控制。

zhangxiaomei012

我们这经常遇到，全是急诊做手术，病人骂骂咧咧，真相就让他不打麻醉下手术，事实全是臂丛麻醉，病人或骂骂咧咧或呼呼大睡

鸿运当头888

给纳洛酮，灭吐灵