溺水的抢救办法

So this was a case report that laid out the treatment from following a case of a 3 year old girl.

下面是案例报告，描述了对一个三岁女孩儿的救治。

She’d been in a small town in Austria and there her parents – it had been a winter day – her parents had gone out on a walk with her. And it was one of those terrible things: the parents lost sight of their little girl just for a moment and the next thing, they looked and she was out on the surface of this icy fishpond and then she fell through the ice under the water and was gone.

她一直住在奥地利的一个小镇上。在一个冬日里，父母陪着她散步。然后可怕的事情发生了：父母只是一小会儿没看到她，再看到的时候她已经在鱼塘的冰面上了，紧接着她掉下冰面不见了。

They ran, jumped in after her, and they could not find her. It was more than 30 minutes before they finally felt a limb at the bottom of this pond, pulled her up to the surface, got her to the shore, and she was of course not breathing. 

人们跑过去，跟着跳下冰面，但是找不到她。最后在池塘底部抓到肢体，捞上水面，带到岸边的时候，已经过去了超过30分钟，她当然已经没有呼吸了。

The parents called the local emergency services from their mobile phone and the operator on the phone gave instructions to tell them how to begin doing cardiopulmonary resuscitation, CPR. So they began doing chest compressions and a team was dispatched. The rescue team arrived 8 minutes later and they took the first vital signs at the scene. The girl’s temperature was just 66 degrees Fahrenheit, more than 30 degrees below normal. She had no pulse, she had no respirations. And most ominously, when they shined a light in her eyes, her pupils were what they describe as “fixed and dilated” meaning they did not react to light. The pupils were just stuck wide open. And what that means is the brain is gone. 

她的父母用手机拨了当地的急救服务，接线员通过电话教他们如何进行心肺复苏。于是他们开始进行胸部按压。急救队8分钟之后赶到，在现场检查了她的关键生命体征。女孩儿的体温只有66华氏度（18.89摄氏度），低于正常体温超过30华氏度。没有脉搏，没有呼吸，最不妙的是，当急救员用亮光照她的眼睛时，她的瞳孔据描述是“散开不动”的，就是说对光线没有反应。瞳孔一直张开着。这意味着大脑已经不行了。

But nobody wants to give up on a little child and so they continued to do the chest compressions, the CPR. She was loaded into a helicopter. They took her to the nearest hospital. There they bypassed the emergency room and went straight to the operating room and what they wanted to do was begin warming her. The most effective way to do that with someone who has no heartbeat, no respirations was to put her onto a heart lung bypass machine. That’s no small matter. In order to do that, you have to cut down over the groin and expose the femoral vessels. You have to plug in in-flow and out-flow lines to the cardiopulmonary bypass machine. They have to prime the pump, start the flow going, and then gradually you had a machine now taking over for her breathing and her circulation.

但是谁都不愿意放弃这个小女孩儿，所以他们继续按压胸部，进行心肺复苏。她被抬上直升机，转入最近的医院。人们绕过急诊室直奔手术室，准备开始升高她的体温。对于失去心跳和呼吸的病人，升高体温最有效的办法就是把她接到一个心肺旁路机上。这可不简单。为此，必须首先切开腹股沟，把血管暴露出来，然后把动脉和静脉分别接到机器上。然后必须在泵注满之后启动血流，然后机器可以逐步接管她的呼吸和循环。

By this point, it had been more than an hour and a half since the last time she had taken a breath. They gradually warmed her blood and her body. You can’t warm too fast or you’re going to end up rupturing the red cells, and so it was two hours before they could raise the temperature just 10 degrees. But at that point, her heart began to beat in a normal rhythm, and what they realised was they had one organ back.  

至此，距离她失去呼吸已经过去了一个半小时。人们逐步升高她的血液和身体温度。升温不能太快，否则会导致红细胞破裂，所以两个小时过去，温度才提高了10华氏度。此时，她的心脏开始以正常节律跳动，医务工作者知道，他们救回了一个器官。

Over the next 6 hours, they raised her temperature in her body, warming her gradually, gradually, until it came up to the normal 98.6 degrees. And then at that point they thought they would try to see if they could put her on a ventilator that would breathe for her; that would push oxygen down through her … through her windpipe. And they found that that did not work. The oxygen wasn’t getting through because her lungs were too full of pond water and debris, they found, for the oxygen to penetrate to her bloodstream.

在接下来的6个小时里，他们逐步升高体温，慢慢地，慢慢地，直到温度达到正常的98.6华氏度（37摄氏度）。当时，救治人员觉得可以尝试看看能不能用呼吸机辅助她呼吸，这样她可以提供通过气管吸入氧气。但是他们发现这样不行。氧气不能进入，工作人员发现因为肺部充满了池水和碎屑，氧气无法进入血流。

The cardiopulmonary bypass machine was made for heart operations. It wasn’t meant to be something, it wasn’t made to be something that people could stay on for long periods of time, so they had to bring in a different machine. It’s an artificial lung called an extracorporeal membrane oxygenator (or ECMO). Now this machine had to be plugged in in an entirely different way. For this, they had to open her chest with a saw. They had to plug the in-flow and out-flow lines directly into her aorta and the right atrium of her heart. They had to remove the other pump from her groin and repair those vessels. But now, with this machine turned on, they now had an artificial lung for her that could bring oxygenated blood into her bloodstream and her heart would keep on pumping.

心肺旁路机是用于心脏手术的，无法用于长期支持。所以他们不得不用上另外的仪器。这是一台体外氧膜合机，也就是人工肺。这种机器的插入方式完全不同。为了使用它，人们必须用锯子打开她的胸膛，把流入和流出分别直接接到她的心脏主动脉和右心房。还必须把腹股沟上接的泵去掉，把血管修复。但是现在，机器打开之后，她就有一个人工肺可以将含氧的血液注入血流，而她的心脏可以继续跳动。

Now with this machine, they had to pull a big sterile drape over her open chest and wheel her on her table with this machine out of the operating room and into an intensive care unit where she could be managed. For the next day, every hour they took a bronchoscope and suctioned out the fluid that was in her lungs. They tried to wash all that debris out. And 24 hours later, when they tried to put her onto a mechanical ventilator, they found the oxygen got through. Two organs back.

用着这台人工肺，工作人员不得不把一个巨大的无菌隔帘垂在她打开的胸口，机器放在台子上，把她和机器一起推出手术室，推进ICU进行监护。次日，他们用支气管镜辅助，每隔一个小时从肺部吸出一次液体。他们尝试将碎屑冲出。24小时之后，当他们尝试给她使用呼吸机的时候，发现氧气能够通过气管了。两个器官回来了。

And this was the way it went. They worked on every part of her body – how to bring her kidneys back, her liver back, her gut back. And after two days, they found that all the organs were back except one: her brain. 

就这样，医务工作者一个器官一个器官地修复——肾脏恢复了，肝脏恢复了，肠道恢复了。两天之后，所有的器官都就回来了，除了一样：她的大脑。

But she was stabilised enough that at this point they transported her out of the ICU, downstairs to the radiology suite where they could do a CT scan of her brain and look to see whether there was any damage there. And what they found that was … was that her brain had swelled to the limits of her skull, but there were no dead zones that they could see and so they decided to keep going. They called the neurosurgery team. Because of the pressure they saw on the brain, the neurosurgery team drilled a hole in her skill, put a pressure probe all the way down into her brain. And then with that pressure probe, they had the readings on the pressure there and they could dial the medicines and the fluids up and down until they could gradually lower the pressure inside her brain. 

但当时她的情况已经稳定，可以被移出ICU，到楼下放射科以便对大脑进行CT扫描，看看大脑有没有损伤。人们发现，她的大脑已经肿胀到了颅骨的容限，但是并没有发现坏死的区域。因此决定继续救治。他们请来了神经外科小组。因为看到颅压很高，神经外科小组在她的头骨上钻了一个孔，将压力探头放入她的大脑。然后，有了这个探头，他们可以根据压力读数调节药物和液体直到能够逐步降低颅压。

She remained comatose for a week, totally unresponsive. But then her pupils began to react to light and then she began to breathe on her own. And then one day, she simply awoke. Her eyes opened and she was there. 

她昏迷了一个星期，完全没有反应。然后瞳孔开始对光线有反应，接着开始自主呼吸。然后有一天，她就醒过来了。睁开眼睛，清醒过来了。

Two weeks later, she ended up going home.

两周后，她回家了。

Now it still wasn’t over. Her right arm and leg were paralysed, her speech was severely slurred. She had to get intensive physical therapy, educational therapy just to learn what she could learn, how much speech she could bring back. And two years later, they brought her back to the hospital for a round of neuropsychological testing and physical testing. They found that physically her strength was completely back – she was equal on both sides of her body – and what’s more is that they found her psychological capabilities were exactly where they were supposed to be for someone of her now 5 year old age. She was, in other words, after all of that, just like any other little 5 year old girl that you and I know.

事情还没完。当时她的右臂和右腿瘫痪了，讲话含混不清。她必须接受高强度的物理治疗，教育治疗，才能尽可能恢复技能。两年之后，人们把她带回医院进行一次神经心理学和生理测试。结果发现她在生理上完全恢复了——两边肢体没有差别，不仅如此，她的心理能力也完全符合她现在的年龄（5岁）。换句话说，在经过所有这些之后，她的发展跟我们看到的其它5岁女孩儿没有区别。

And so what they did was they made a checklist and they gave it to the person who had the least power in the system: the telephone operator. And the telephone operator got the call and could activate the checklist. They could call up the anaesthesiologist and the cardiac surgeon and tell them “You need to come in from home now.” The engineer would get the machine ready. And this was the way they had their first survivor – that little girl – and since then, when I called him he said they’d had “Many” and he told me about the most recent.

所以，他们制作了一个检查表，交给其中最没有权力的人：接线员。而接线员接到电话就启动这个检查表。接线员会打给麻醉师心脏手术师，告诉他们，“你们需要立即来医院”。工程师们会把机器准备好。他们就是这样救活了第一个溺水者——那个小女孩，之后——我最近跟他们通电话，他说——他们已经救活了很多人了。最近的案例（应该是演讲时间，2014年的案例）是这样的：

He said that there was a mother and a daughter who’d been in a car and they were driving on an … on an icy mountain road and the car skidded on the ice as it lost control, hit a guardrail, instantly killing the mother. The car went through the guardrail, over the cliff and into a mountain river and then went under the water. The emergency crew got there just in time to see the car going under the water. They had to use the jaws of life to get the door open under the water. I don’t even know how they did that and then they got the girl to the surface again with more than half an hour with no breathing under the water.

母女两人开车行驶在结冰的山路上，车在路面上打滑之后失去了控制，撞上了护栏，母亲当场死亡。车辆越过护栏，掉进山崖西面的河流然后钻入水底。急救人员到现场刚好看到车辆滑入水底。他们必须使用在水下把车门锯开。我都不知道他们怎么做的，但是他们把女孩救出水面，当时她已经在水下失去呼吸超过半个小时了。

But from that point on, the system went like clockwork. The hospital was notified, they arrived within minutes, they by-passed the emergency room, went straight to the OR, they crashed onto the bypass machine. They got the heart back. They worked on getting her lungs back, moving the fluids and the drugs. They were able to get this process going even faster. 

但从这一刻起，整个系统就像时钟一样工作起来。医院得到通知，他们在几分钟之内到达，跳过急诊环节，直接进入手术室，接入旁路机器。救回了心脏。继续救回肺，调整颅内液体和药物。整个流程越来越顺利，越来越快。

And here was the result: the next day all her lines and tubes were removed, and the day after that she was already sitting up in bed ready to go home.

最终结果是，第二天女孩就去掉了身上连接的各种管子，再过一天她就坐了起来，可以回家了。