Doctor's Life Simulator

Chapter 46 Isn't This Nonsense!Wu Youtu's worries

Soon Qin Lang entered the operating room.

The cervical segment of the trachea is located between the lower edge of the cricoid cartilage and the suprasternal notch. The front of the tracheal neck section is from shallow to deep, followed by the skin, superficial fascia, deep cervical fascia, suprasternal space, and jugular arch.

It also involves the inferior thyroid vein, the thyroid azygos plexus, and the recurrent laryngeal nerve in the paratracheoesophageal groove of the most inferior thyroid artery. The requirements of the readers are very high.

The surgeon is required to have a clear understanding of the anatomical structure of the entire neck, and the patient is severely burned, so the entire operation is very difficult, and even ordinary residents dare not do it rashly.

Therefore, in the operating room, the anesthesiologists, itinerant nurses, and equipment nurses also have a little worry in their hearts.

"Local anesthesia, because the patient has difficulty breathing, so first take a half-lying position under the shoulders, and after I separate to the trachea, I will cooperate with me to tilt his head back."

However, what responded to them was Qin Lang's very calm and precise instructions.

"Okay, Doctor Xiao Qin."

In the operating room, all the medical staff began to follow the instructions of the chief surgeon at the same time.

Generally speaking, the tracheotomy site is often located in the 3rd-5th tracheal ring, so the Qin corridor is directly in the middle of the lower edge of the cricoid cartilage to 4cm above the suprasternal notch. The incision site is almost an inverted triangle, with the cricoid cartilage as the bottom and the top For the suprasternal notch, on both sides are the anterior border of the sternocleidomastoid muscle.

Qin Lang's hand holding the knife was very neat, simply making horizontal incisions.

Under the perfect level of incision, the skin and subcutaneous tissue are quickly separated longitudinally.

".1: 50 Licadoine Injections of Epinephrine, Retractor"

Under the fast rhythm, the equipment nurse cooperated quickly, and it was really Doctor Xiao Qin, with vigorous movement frequency!
The two sides of the retractor are retracted evenly, and the white line connecting the anterior jugular muscles on both sides at the midline is clearly exposed, which is the anterior jugular vein.

".Sutures, Needle Holder."

Qin Lang cut it off very quickly and ligated it. Since a small amount of lidocaine was injected in advance, there was very little bleeding.

Immediately afterwards, Qin Lang continued to separate up and down along the linea alba, separated and stretched the anterior cervical band muscles to both sides, and then saw the thyroid isthmus, which covered the 2nd-3rd tracheal ring.

After careful observation, Qin Lang used blunt dissection to separate the posterior capsule from the anterior fascia of the trachea and pull it upward.

The equipment nurse on the side was well-informed, but she was still a little surprised. Doctor Xiao Qin was really good. The trachea was fully exposed, laying a solid foundation for the next steps.

".Thin needle, No. 11 sharp knife"

After Qin Lang completed the separation, the anterior fascia of the trachea was incised, and then the larynx was spaced between the thumb and middle finger of the left hand.

After some inspection, it is determined that the trachea is centered, and a local anesthetic is injected into the trachea with a fine needle.

The anesthesiologist at the side sighed slightly: "Doctor Xiao Qin, this operation is really meticulous. Generally, only some old doctors who have been immersed in it for more than ten years will add this step of micro-operation, which can reduce the stimulation of the trachea."

Sure enough, geniuses are different.

In the operating room, Qin Lang quickly used the No. 11 sharp knife to penetrate under the cartilage ring to be incised, penetrate the trachea, and open the 3-4 cartilage ring upwards.

The whole movement is done in one go, flowing.

".tracheal spreader, tracheal tube"

Qin Lang gave orders loudly, and the little nurses on the side responded to the voice, coordinating with Qin Lang's high-speed movements, racing against time and cooperating seamlessly.

I saw Qin Lang stretching the trachea spreader into the tube, stretching the incision of the tracheal ring, sucking out the secretions, inserting the tracheal cuff together with the tube core into the trachea, then taking out the tube core, and carefully inspecting the wound again to confirm that there is no active bleeding point .

Seeing Doctor Xiao Qin, moving like a tiger out of the mountains, whizzing through the mountains and forests, entering and exiting seven times as fast as Zhao Yun, and being delicate and gentle like a breeze blowing on the face, the little nurse's eyes flashed a hint of admiration and admiration.

Immediately afterwards, Qin Lang tied the sleeve fixing lace with a surgical knot on the side of the neck to prevent it from being too tight or too loose, and it can pass through a finger in a very standard way.

After that, the surrounding skin is sutured and fixed.

".Vaseline Oil Gauze"

When Qin Lang performed a tracheotomy for Ling Sheng, Wu Youtu also completed the emergency rescue of a patient. After leaving the operating room, he began to inspect the situation of the little doctors below him, and at the same time, he went to check the conditions of the wounded. .

Wu Youtu looked over one by one, and soon came to the patient's bedside where Cheng Yunfeng was.

Cheng Yunfeng and the nurse were monitoring various fluid replacement data, and when he saw Wu in charge, he became nervous for no reason.

He was very unconfident and reported the situation to Wu Youtu, after all, he was not very experienced in this kind of personalized rehydration plan.

Wu Youtu checked it. Because of the Jinling burn formula and PICC technology, the overall progress was good, but there were still some personalized adjustments. Due to Cheng Yunfeng's lack of ability, he did not make adjustments.

Wu Youtu frowned. Why isn't that boy Qin Lang here? If Qin Lang was monitoring him, this kind of problem wouldn't happen.

However, the focus is still on rescuing the wounded. Wu Youtu compared the various monitoring data and said to Cheng Yunfeng: "Bring the pen and paper here, and fine-tune it according to what I wrote later. The overall completion is not bad."

"Due to hemorrhagic shock in the early stage, the patient was bleeding heavily, so concentrated red blood cells and balanced salt solution were replenished in time, but after the sufficient amount, the quality of the fluid replacement needs to be improved, and fresh plasma, human blood protein and other colloid components should be added in an appropriate proportion."

While writing, Wu Youtu patiently imparted his experience to Cheng Yunfeng:

"The maintenance of colloid osmotic pressure mainly depends on albumin, and the albumin content in exudate is relatively high, equivalent to 80-90% of plasma albumin, so timely supplementation of albumin plays an important role in maintaining osmotic pressure"

".After the body's function gradually recovers and the circulatory function returns, the amount of water replenishment can be appropriately reduced, the infusion speed can be slowed down, excessive water retention can be avoided, and the occurrence of tissue edema and pulmonary edema can be reduced."

After Wu Youtu finished explaining, a synchronously fine-tuned rehydration list was also handed over to Cheng Yunfeng.

"Thanks to the PICCO assistive technology, I only need to look at the data once in a while, and then I can give fine-tuning suggestions, instead of always paying attention, staying by the side of the patient, and relying on experience to estimate. It really saves money. The huge manpower and material resources also increased the fault tolerance rate.”

After finishing Cheng Yunfeng's bed, Wu Youtu asked, "Where are Qin Lang and Qian Liang?"

Cheng Yunfeng raised his head and returned unequivocally: "Dr. Qian asked Qin Lang to go with him to perform escharotomy and decompression for the patient. However, because Qin Lang was competent enough, Dr. Qian left Qin Lang behind. He was on his own, and he went to support another operation."

"However, just about ten minutes ago, Dr. Qin Lang completed the escharotomy and decompression surgery for that day, and then met a new patient sent by the fire brigade who urgently needed a tracheotomy. The head nurse originally wanted to I was going to ask for help from other departments, but Qin Lang stepped forward and took over the tracheotomy."

Cheng Yunfeng was always paying attention to various trends, especially Qin Lang's every move, and his words were full of envy and admiration.

It's just that Wu Youtu was shocked, it was a tracheotomy, even if it was Qian Liang, he had to check it out, so Qin Lang went to perform the surgery himself?
"Isn't this nonsense, what did Zhao Qiufang do!"

Wu Youtu calculated the time. Under normal circumstances, the operation should not be long. With a small doctor like Qin Lang, it must be slower.

"I hope it's in time."

For patients with this kind of inhalation injury, after tracheotomy, it is easy to damage the airway barrier, which will aggravate complications such as infection and suffocation, especially postoperative sputum suction intervention is required, otherwise the airway secretions will be irritated, which is a serious problem. Very dangerous!
(End of this chapter)