1 Prepare before entering the cabin.
1. 1 patient characteristics
L. 1. 1 The medical staff introduced the basic process of hyperbaric oxygen therapy and the feelings and precautions in the process of pressurization, decompression and stabilization, so as to eliminate the fears and doubts of patients and cooperate with the treatment correctly and actively.
1. 1.2 It is forbidden to bring inflammable and explosive articles into the cabin.
1. 1.3 The personnel entering the cabin should change into cotton clothes, and don't wear clothes that are easy to generate static electricity and sparks.
1. 1.4 Don't eat too much before entering the cabin. Do not eat gas-producing food and carbonated drinks, and empty urine.
1. 1.5 patients with drainage devices should empty the drainage liquid in the bottle before entering the cabin.
1. 1.6 patients should know the oxygen supply device and call method in the cabin, and be able to use the mask correctly and adjust the pressure. If you feel unwell, you should communicate with the medical staff immediately and deal with it in time.
1.2 medical staff escort cabin
1.2. 1 Do a good job in the preparation and inspection of rescue drugs and medical devices in the cabin.
Infusion device: try to use open infusion bottles or plastic bags (bottles) for infusion in the engine room to avoid and reduce the influence of pressure change. Ampoules with a capacity greater than 10ml should be taken out of the cabin or brought in, so as to avoid the imbalance between the cabin pressure and the pressure in the ampoule. When the ampoule is opened in the booster stage, glass fragments fall into the contaminated liquid in the ampoule, or when the cabin pressure is lower than that in the ampoule, glass fragments splash and injure people.
Respirator: If the patient suddenly stops breathing during hyperbaric oxygen therapy, he should immediately use a respirator to force breathing. Use pneumatic respirator or simple rubber ball respirator. Simple ventilator is a common equipment for surgical anesthesia. It is connected to the oxygen supply device and mask in the oxygen cabin, and artificial respiration can be carried out by squeezing the ball.
The use of negative pressure aspirator: there is a medical "cocker" and a negative pressure meter in the multi-person oxygen cabin, which is a device that uses the pressure difference outside the cabin to cause negative pressure suction. Manual negative pressure suction with pedal or 50 ml syringe. The related electric attractor can be used before boosting. If pressurization starts, it will be relocated outside the cabin for standby.
1.2.2 Precautions for cabin care
Most onboard medical staff can bear the pressure of 0. 1MPA (gauge pressure). If the pressure is greater than 0. 1MPA when treating decompression sickness or air embolism, cabin attendants should receive professional training. Medical staff must master the basic principles, indications, contraindications, adverse reactions and treatment principles of hyperbaric oxygen therapy. In order to ensure safety, it is forbidden to bring explosives into the engine room. Operate in strict accordance with the operating procedures and make nursing records. Do a good job in patients' health education and psychological care, and teach patients to open the eustachian tube, such as opening mouth, chewing, swallowing, pinching nose, closing mouth and inflating.
2 nursing
2. 1 Nursing in Pressurized Stage
2. 1.65438+
2. 1.2 Ask the cabin patients frequently. If there is any discomfort such as earache, inform the cabin operator to "stop pressurizing" or decompress appropriately. If the earache is severe, stop pressurizing immediately, and properly exhaust and decompress if necessary. If it doesn't work, terminate the treatment and decompress and leave the cabin.
2. 1.3 observation of the disease
2. 1.3. 1 critically ill patients, especially those with a history of hypertension, must measure their blood pressure at any time to prevent accidents caused by sudden increase in blood pressure, observe whether comatose patients are restless or groaning, help open the eustachian tube, relieve ear discomfort, and pay attention to changes in breathing, heart rate, blood pressure and pupils.
2. 1.3.2 Patients undergoing tracheotomy or intubation should inject appropriate amount of gas into the airbag to ensure the airbag inflates, prevent the cannula from falling off and keep the respiratory tract unobstructed. When the pressure in the cabin is above 0.03MPA (gauge pressure), you can use the suction device in the cabin to clean the respiratory tract and keep the respiratory tract unobstructed.
2. 1.3.3 infusion patients should pay attention to the infusion speed and the liquid level in Murphy's tube, and reduce the liquid level if necessary. The center of the infusion bottle must be directly connected to the liquid surface with a long needle to adjust the pressure inside and outside the bottle.
2. 1.3.4 Temporarily clamp all drainage tubes and fix them properly to prevent them from falling off and shifting.
2. 1.3.5 In the process of boosting pressure, if the patient needs to do medical operations (such as injecting drugs and replacing infusion bottles, etc.). ), he should stop boosting, and then continue boosting after the pressure stabilizes.
2.2 Nursing in the stage of voltage stabilization (oxygen inhalation)
2.2. 1 instruct the patient to wear a mask to inhale pure oxygen, and the mask should be close to the cheek to prevent air leakage, and pure oxygen cannot be inhaled, which will affect the curative effect. Old and frail children can provide oxygen to the deformable mask or use open self-flow oxygen supply. For newborns, oxygen can be inhaled through nasal catheter or oxygen mask, and tracheal intubation or incision can be connected with special connector.
2.2.2 Observe the flowmeter to understand the oxygen inhalation of patients.
For endotracheal intubation or nasal catheter, the oxygen flow should be adjusted to 10 ~ 15L/min. When rescuing patients, do special care and observe the condition, assist patients to wear masks and other oxygen inhalation devices, observe vital signs and make records. Adjust the liquid level of Murphy's tube during infusion to keep the respiratory tract unobstructed, and the pressure difference should not be too large when negative pressure suction is used.
2.2.3 Intermittent oxygen inhalation to prevent oxygen poisoning. If you find symptoms of oxygen poisoning such as facial muscle twitching, cold sweat, salivation and irritating cough, you should immediately pull out the oxygen inhalation device, stop using pure oxygen, and inhale the air in the cabin instead, strengthen ventilation, report to the doctor and take corresponding treatment measures.
2.2.4 After the pressure-stabilized oxygen inhalation is completed, open all kinds of closed air bags and drainage tubes before decompression, and open the sphygmomanometer valve to prevent the air bags from bursting due to excessive expansion during decompression. If normal saline is injected into the airbag, it will not be affected by pressure, because the liquid is incompressible.
2.3 Nursing in decompression stage
2.3. 1 ask patients to take off their masks, keep breathing naturally, and do not hold their breath and cough violently to prevent lung compression injury.
2.3.2 Strictly implement the decompression scheme, and do not arbitrarily shorten the time or change the decompression scheme.
2.3.3 During decompression, the air expands and absorbs heat, and the cabin temperature drops. Keep warm to prevent colds and frostbite.
2.3.4 During decompression, open all drainage tubes and closed air bags, suck out secretions in time, keep the drainage unobstructed, and release a proper amount of gas, so as to avoid air expansion pressing the tracheal wall, causing damage or air bag rupture; Due to the decrease of cabin pressure, the gas in the infusion bottle and Murphy's tube expands and the pressure in the bottle increases, which may lead to gas entering the blood vessels and causing gas embolism; When depressurizing, if conditions permit, the infusion can be suspended, or a long needle can be inserted into the liquid surface to ensure exhaust, and the vent pipe can be clamped to prevent the liquid from overflowing; Before decompression, the liquid level of Murphy's tube can be adjusted to a higher level to prevent air embolism, especially when subclavian vein is inserted. Open the infusion bottle, open the bottle cap and cover it with sterile gauze to prevent the medicine from overflowing.
2.3.5 If the resuscitated patient underwent intracardiac injection, tracheotomy or tracheal intubation, pay attention to the presence of pneumothorax and subcutaneous emphysema; The operator should bandage the surgical site with pressure to prevent bleeding.
2.3.6 Rebound symptoms may appear in patients with brain edema during decompression. Hormones and dehydrating agents can be used, and the pressure can be slowly reduced. Patients with harmful gas poisoning, drowning and pulmonary edema also have rebound symptoms during decompression, which can be treated with cardiotonic agents, diuretics and hormones.
2.3.7 Some patients have defecation or urgency during decompression, because intestinal gas expands and gastrointestinal peristalsis accelerates during decompression. Don't eat food and drinks that produce gas before treatment.
2.4 Nursing after leaving the cabin
Ask patients whether they have discomfort, joint pain, itchy skin, headache and abdominal pain, so as to take corresponding measures, adjust decompression scheme and prevent decompression.