What is Electroconvulsive Therapy?

Electroconvulsive therapy (ECT), also known as electroconvulsive therapy, also known as electrical shock therapy, is a method in which a certain amount of current passes through the brain, causing loss of consciousness and seizures, thereby achieving the purpose of treatment method. At present abroad, developed countries have improved the traditional electroconvulsive therapy, that is, adding intravenous anesthetics and muscle relaxants before electroconvulsive treatment, so that patients with convulsions significantly reduced and no fear. Because of its wide indications, high safety, and few complications, it has been used as a standard treatment, and it is generally referred to as improved electroconvulsive therapy in China. ^[1]

Electroconvulsive therapy

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Electroconvulsive therapy (ECT), also known as electroconvulsive therapy, also known as electrical shock therapy, is a method in which a certain amount of current passes through the brain, causing loss of consciousness and seizures, thereby achieving the purpose of treatment method. At present abroad, developed countries have improved the traditional electroconvulsive therapy, that is, adding intravenous anesthetics and muscle relaxants before electroconvulsive treatment, so that patients with convulsions significantly reduced and no fear. Because of its wide indications, high safety, and few complications, it has been used as a standard treatment, and it is generally referred to as improved electroconvulsive therapy in China. ^[1]

Electric twitch

Electric shock therapy

Electroconvulsive therapy and insulin coma treatment

Electric twitch machine, covered with several layers of gauze, tongue depressor, gel,

1. Before each treatment, the treating physician should prescribe a treatment order. Urge patients to urinate and urinate and make preparations before treatment; it is important to eliminate concerns and seek cooperation.

2. Treatment must be performed on an empty stomach or 4 hours after a meal.

3 Remove movable dentures, glasses, watches and metal hair clips.

4 Blood pressure was measured and recorded in the electroconvulsive therapy record sheet. Watch for fever, vomiting, and diarrhea.

1. The patient lies supine on the treatment table, and the limbs are naturally straightened. Sandbags are placed between the scapular equivalent of the 4th to 8th thoracic vertebrae to prevent spinal compression fractures during treatment.

2. The assistants separated the two sides of the patient and pressed the joints of the shoulders, elbows, hips and knees appropriately to prevent dislocation, fracture and soft tissue damage.

3 The physician stood on the right side of the patient's head, placed a double laminated tongue covered with several layers of gauze between the upper and lower molars on one side of the patient, and instructed him to bite. Hold the tongue depressor with the right thumb and two fingers, and fix the lower jaw of the patient with the remaining three fingers and palm. Press the back pillow with your left hand and apply force against your right hand holding the lower jaw to fix the head. If the patient is uncooperative and unwilling to open his mouth, set the tongue depressor aside and protect his lower jaw with the right hand as described above. When the convulsions occur, open the mouthpiece quickly, but care should be taken to prevent biting the tongue tip and lips.

4 The two electrodes coated with conductive gel or saline were placed on the two temporal condyles of the patient. Once all of the above are ready, the surgeon can apply power to the treatment. The alternating current twitch machine generally uses a voltage of 90 to 120V and the power-on time is 0.3 to 0.6s; the pulse electric twitch machine generally uses 40 to 60mA power and the power-on time is 1 to 2s. If an AC convulsive machine is used, when a single electrification fails to cause a seizure, after the patient's breathing is restored, the electrification time can be extended, and then the electrification treatment is performed. If it is still unsuccessful, you can increase the power and extend the power-on time for the third power-on treatment. To cause systemic seizures as an effective treatment. Generally, it should not be more than 3 times for each treatment.

5. Before the convulsions stop and the breathing has not recovered, the patient's head is turned sideways to facilitate saliva outflow; at the same time, artificial breathing is performed to help the recovery of automatic breathing.

6. For those who have slow breathing recovery and cyanosis, the airway is mostly blocked due to the retraction of the tongue base, which can be opened with an opener and extended into the pharyngeal cavity with a tongue depressor. The retracted tongue base is pushed forward, and the respiratory obstruction may be immediately relieved. In the case of central respiratory depression, oxygen inhalation, artificial respiration, and injections of nicosamidine or osmanthine should be given.

7. If dislocation of mandibular joint occurs during the treatment (the lower dentition is forward, and the tongue plate cannot be bitten tightly), at this time, the thumbs of the hands wrapped with several layers of gauze should be immediately extended into the patient's mouth and placed under the sides of the patient. At the back of the dentition, press the lower jaw down evenly, and then push it back slightly upward to reset it. Quickly withdraw your thumb after resetting to prevent being bitten. Oral rejuvenation can also be used: first touch on the ears on both sides. When the condyle of the dislocated mandible is touched, place the thumb over the condyle with the thumbs of both hands, press down first, and then push slightly. Upper back reset. You can hear a click when resetting, and see the lower dentition reset.

8. After treatment and before consciousness is restored, intensive care should be taken to prevent falls. If dizziness is reported after treatment, it can be gradually reduced without treatment. If the headache is severe and lasts a long time, the nervous system should be carefully examined and symptomatic treatment should be given. When complaining of back pain, check the spinous process of the spine for tenderness or throbbing pain, and take a spinal film if necessary.

9. Electroconvulsive treatment is usually 2 to 3 times a week, and 8 to 10 times is a course of treatment. After each treatment, fill the treatment progress into the electroconvulsive treatment list. After the treatment is completed, a summary of the treatment is made.

The incidence of complications of electroconvulsive therapy is not high, but once it occurs, the consequences are more serious, so it should be taken seriously.

1. Fractures and dislocations are commonly caused by spinal compression fractures, followed by limb fractures. If fractures occur, electrotherapy must be stopped for orthopedic treatment; if the mandible is dislocated, it should be immediately reduced by manual manipulation, and it will not affect the treatment after reduction.

2. Respiratory cessation generally resumes automatically after the twitch stops for about 10s. If breathing does not recover after 30s, artificial respiration must be performed immediately, the airway must be kept open, and rescue should be conducted in a timely manner. In order to prevent poor breathing recovery or apnea, you can inject 1 lobelin before treatment.

3. After treatment of circulation collapse, if the patient is found to have pale skin, decreased blood pressure, and a rapid pulse, he should promptly inject central stimulants and cardiotonics, such as epinephrine, nicosamie, and caffeine. And should carefully find and find the factors leading to collapse, and give timely treatment, if necessary, should stop electroshock treatment.