Detailed Treatment Process
Baby girl, age: 1 year 10 months The baby girl has remained in a vegetative state after receiving hernia surgery. The following are two routine blood test reports from the day of the surgery. The first routine blood test report is as follows Department: General Surgery Sample type: Blood Report date: November 3 00:48 White blood cell count: 7.42×10⁹/L Red blood cell count: 5.60×10¹²/L ↑ Hemoglobin concentration: 119.00 g/L Platelet count: 355.00×10⁹/L ↑ Neutrophil absolute value: 4.02×10⁹/L Lymphocyte absolute value: 2.60×10⁹/L Monocyte absolute value: 0.76×10⁹/L ↑ Eosinophil absolute value: 0.00×10⁹/L ↓ Basophil absolute value: 0.04×10⁹/L Neutrophil percentage 54.30% Lymphocyte percentage 35.00% Monocyte percentage 10.20%↑ Eosinophil percentage 0.00%↓ Basophil percentage 0.50% C-reactive protein 5.00mg/L High-sensitivity C-reactive protein 4.50mg/↑ The second routine blood test report is as follows Patient type: Inpatient (emergency) Department: ICU Age: 1 year 10 months Specimen type: Blood Application time: November 3 07:51 Receipt time: November 3 08:40 Report time: November 3 09:02 White blood cell count: 6.57×10⁹/L Red blood cell count: 5.06×10¹²/L Hemoglobin concentration: 107.00 g/L ↓ Platelet count: 119.40×10⁹/L ↓ Neutrophil absolute value: 4.91×10⁹/L Lymphocyte absolute value: 1.18×10⁹/L Monocyte absolute value: 0.34×10⁹/L Eosinophil absolute value: 0.14×10⁹/L Basophil absolute value: 0.00×10⁹/L
Neutrophil percentage 74.74% Lymphocyte percentage 18.04%↓ Monocyte percentage 5.24% Eosinophil percentage 2.14% Basophil percentage 0.00% C-reactive protein 5.00mg/L High-sensitivity C-reactive protein 4.00 mg/L↑ The following is the first surgical record Department: General Surgery Gender: Female Age: 1 year 10 months Surgery date: November 3 Preoperative diagnosis: Left inguinal mass, left inguinal hernia Intraoperative diagnosis: Left inguinal mass, left inguinal hernia Operation name: Left inguinal exploration Surgical incision type: I Anesthesia method: General anesthesia Surgical procedure The patient was placed supine on the operating table. After preoperative safety verification was completed without error, tracheal intubation general anesthesia was performed. After anesthesia took effect, routine disinfection and draping were carried out. After the second surgical safety verification was completed without error, a surgical incision approximately 2 cm long was made above the left inguinal mass. Upon incising the skin, airway pressure increased and blood oxygen saturation decreased. This was considered to be caused by sputum plug obstruction of the trachea leading to tracheal spasm. The operation was immediately terminated and resuscitation was implemented. Record date: November 03, 2017 08:00 The above is the first surgical record. The following is the second surgical record Basic information Department: General Surgery Gender: Female Age: 1 year 10 months Surgery date: November 05 Preoperative diagnosis: Left inguinal mass, left inguinal hernia Intraoperative diagnosis: Left indirect inguinal hernia Operation name: Left inguinal incarcerated hernia reduction + high ligation of hernia sac Surgical incision type: II Anesthesia method: Inhalation general anesthesia + local anesthesia Surgical procedure The patient was placed supine on the operating table. After surgical safety verification was completed without error, inhalation anesthesia was performed. After anesthesia took effect, routine disinfection and draping were carried out. After the second surgical safety verification was completed without error, and after 0.1% lidocaine local infiltration anesthesia produced satisfactory effect, the subcutaneous tissue was incised along the original skin incision in the right lower abdomen (as written in the original, it should correctly be left lower abdomen). The external oblique aponeurosis was incised layer by layer along the surface of the mass, and an indirect hernia was considered. The subcutaneous tissue was freed on the superficial surface of the external oblique aponeurosis down to below the inguinal ligament, revealing the hernia sac. After releasing the external ring, the hernia sac was opened, revealing approximately 15 milliliters of pale yellow exudate. After suctioning the exudate completely, the hernia contents were found to be part of the ovarian tissue and omentum, with mild congestion and edema. After releasing the hernia ring, they returned spontaneously with no signs of necrosis. The hernia sac was sutured and ligated at the hernia ring, and the excess hernia sac was excised. There was no active bleeding during the operation. After counting the surgical items correctly, the incision was closed layer by layer, and the wound was dressed with sterile gauze. The operation was completed. The surgical process was smooth, anesthesia was satisfactory, there was no obvious bleeding during the operation. After the second surgical safety verification was completed without error, the patient was safely returned to the ICU ward. Record date: November 05 21:00 The above is the second surgical record. The following is the first discharge record Department: ICU Gender: Female Age: 1 year 10 months Admission date: November 2 Discharge date: November 10 Hospital stay: 8 days Diagnostic information Admission diagnosis: Left inguinal mass Discharge diagnosis: 1. Left inguinal mass + left inguinal hernia, 2. Upper respiratory tract infection, 3. Pulmonary infection, 4. Hypoxic-ischemic encephalopathy, 5. Secondary epilepsy, 6. Hypokalemia, 7. Status epilepticus Treatment outcome: 1 and 6 improved; 2, 3, 4, 5, and 7 not cured Hospital course Admission status: The patient was admitted due to "discovery of left inguinal mass for more than 4 days." Physical examination: T 37.3°C, weight 10.6 kg. A mass approximately 2×2 cm was visible in the left inguinal region, medium texture, with tenderness, and could not be pushed back into the abdominal cavity by hand. Surgery and complications: After admission, auxiliary examinations were completed, and left inguinal exploration surgery was performed under general anesthesia. During anesthesia, the patient developed airway spasm. After resuscitation and relief, the surgery was terminated and the patient was transferred to the ICU for intensive monitoring. Subsequent treatment: Sedation, antiepileptic treatment, dehydration to reduce intracranial pressure, anti-infection treatment, neurotrophic support, and symptomatic supportive treatment were given. A second surgery was performed on November 05, which went smoothly. Complications: The patient developed frequent secondary epileptic seizures after surgery, with apnea during episodes, and was given tracheal intubation and ventilator-assisted breathing. Discharge status The patient is currently in a diazepam-sedated state, with reduced pain response reflexes, intubated, on ventilator-assisted breathing, with spontaneous breathing present. Both pupils are equal and round, approximately 3 mm, with absent light reflexes. The neck is soft. Breath sounds in both lungs are coarse, with scattered dry and wet rales audible. Bilateral Babinski signs are positive. Doctor's assessment: The patient's condition is complex with a poor prognosis. Expert consultation outside the hospital suggested transfer to a higher-level hospital for continued treatment. After discussion, the family agreed to the transfer and signed the consent form. Discharge instructions were to continue treatment at a higher-level hospital. The above is the first discharge record. The following is the second discharge certificate Department: Critical Care Medicine (ICU) Gender: Female Age: 1 year 11 months Admission date: November 10 Discharge date: December 06 Discharge diagnosis 1. Hypoxic brain injury: Convulsive status epilepticus Respiratory failure Intracranial hypertension syndrome Brain herniation Cognitive dysfunction Limb motor dysfunction 2. Severe bronchopneumonia 3. Status post left inguinal hernia repair Treatment course Admission status: Relevant examinations were completed, critical illness was reported, and ventilator-assisted ventilation was provided. Main medications: * Anti-infection: Piperacillin-tazobactam, azithromycin (etiology indicated Mycoplasma positive). Intracranial pressure reduction: Furosemide, mannitol, glycerol fructose. Neurotrophic: Monosialotetrahexosylganglioside, mouse nerve growth factor. Anticonvulsant: Levetiracetam. Hemostasis: Etamsylate, hemocoagulase (CT indicated intracranial hemorrhage). Rehabilitation progress: Tracheal intubation was removed after 15 days of treatment; oxygen could be tolerated without support after 16 days; body temperature was normal after 20 days of hospitalization, with no convulsive episodes observed. Current status: Vital signs are basically stable, with minimal airway secretions and no need for further life support. Further home-based rehabilitation is required. Treatment outcome and recommendations Treatment outcome: 1. Improved; 2 and 3. Clinically cured. Discharge recommendations: 1. Continue treatment at the local hospital. 2. Avoid vomiting and choking during nasogastric feeding. 3. Strengthen airway management and nursing care to avoid catching cold and infection. 4. Perform rehabilitation training when general condition permits. The above is the second discharge certificate. The child has remained in a vegetative state after undergoing hernia surgery. The judicial appraisal concluded that the hospital bears 25% responsibility.
This case has one point worth noting. That is, the first general anesthesia method was tracheal intubation anesthesia, while the second was inhalation anesthesia. Compared with inhalation, tracheal intubation anesthesia may incur significantly higher costs.