Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

It is generally used for blood transfusion and infusion of critically ill patients, as well as patients who are difficult to puncture peripheral veins due to various reasons but need long-term intravenous infusion.

This operation is not a surgery, but it can be regarded as a basic skill of a doctor.

However, most doctors in the hospital can't do it.

Only those doctors in special departments, such as the anesthesiology department and the intensive care unit, will perform this catheterization.

However, calling someone from the anesthesiology department, or calling someone from the intensive care unit, takes about 5 minutes at the fastest.

In 5 minutes, no medicine has been given to the patient. It can be said that the risk of these 5 minutes is very high.

But Wu Jiang didn't know how to do this operation, and he didn't dare to do it rashly, so he had to take the risk of asking someone from the anesthesiology department to come over.

Lin Yi was at the side, but he could see clearly.

In 5 minutes, I am afraid that the patient in front of me would have been rescued long ago, so why wait so long without taking medicine.

So Lin Yi had no choice but to stand up and say, "I'll do the deep vein catheterization!"

In fact, deep vein catheterization is not a technically difficult operation.

However, there are not many clinicians who really know how to operate it.

It is mainly this way of infusion, which is mainly used for critically ill patients.

The general wards are full of ordinary patients, and there is no need for deep vein catheterization for infusion.

Deep vein catheterization is, after all, an invasive operation.

A thicker catheter is inserted into a deep vein.

Ordinary patients only need an intravenous needle or an indwelling needle.

It is obviously unreasonable for ordinary patients to use this kind of deep vein catheterization, and it is impossible for patients to agree.

Only the intensive care unit or anesthesiologist will do this kind of operation.

Hearing that Lin Yi could do deep vein catheterization, Wu Jiang was a little surprised again.

"Brother Yi, you can also do this operation, you are really good."

The main reason why Wu Jiang does not have deep vein catheterization is disdain.

Look down on this kind of operation without technical content.

If you let him practice for a while, he will definitely do this kind of operation.

However, the matter is urgent right now, and it is not feasible to ask him to perform deep vein catheterization.

While preparing the equipment, Lin Yi said with a smile, "I've operated this before, so it should be fine."

Lin Yi quickly prepared the required equipment, and then began to perform deep vein catheterization on the patient.

The first step is to position the patient.

Use a head-plantar-foot-high position of 15°C, place a small pillow behind the shoulders (dorsiflexion), and turn the head to the opposite side.

The lower border of the clavicle is taken as the puncture point 1-2cm medial to the midpoint of the clavicle (or between the midpoint of the clavicle and the inner 1/3).

Generally choose the right side.

Routinely disinfect the skin three times and spread a disinfectant towel.

Local anesthesia was infiltrated with 2% lidocaine, and the needle was inserted at the selected puncture point.

The needle tip points to the head, and is about 45° to the longitudinal axis of the sternum, and 10°-30° to the skin.

When inserting the needle, the tip of the needle touches the clavicle first, then retracts, and then raises the tail of the needle, and inserts the needle close to the lower edge of the clavicle with negative pressure, the depth is generally 4-5cm.

If the dark red venous blood is drawn out smoothly, remove the syringe and introduce the guide wire.

Insert the expansion tube along the guide wire to expand the skin and subcutaneous tissue.

Withdraw the dilation tube, and send the indwelling catheter into the vein along the guide wire, and the insertion length is about 12cm.

Withdraw the guide wire and connect the infusion catheter.

Place a small gauze pad at the needle entry point, cover it with sterile gauze, and fix it with adhesive tape.

Lin Yi's actions were very quick, and it took no more than 5 minutes from the beginning to the end.

Moreover, he inserted the needle once into the subclavian vein, and directly drew out the dark red venous blood.

Unlike some doctors who puncture several needles, they still cannot draw back blood.

Lin Yi's quick operation surprised Wu Jiang.

"Lin Yi, your skills are too high! The speed is simply too fast!"

"And it's so accurate, even if you call someone from the intensive care unit or the anesthesiology department, it's not as fast as you!"

Wu Jiang said in surprise, and gave Lin Yi a thumbs up.

"Sure enough, you are still amazing!"

Now that the subclavian vein catheter has been put in place, the nurse hastily infused the patient with the medicine that Wu Jiang had given before.

Since the patient is in septic shock, the infusion rate is very fast.

The main treatment is a large amount of rehydration, replenishing blood volume, anti-infection and raising blood pressure.

Subclavian vein catheterization is just a simple episode.

The follow-up treatment all depends on the medicine, which is beyond Lin Yi's control.

However, some test results of the patient have also come out.

His white blood cell count was particularly high, and he also had wound infection problems.

Basically, it can be determined that it is septic shock.

It belongs to the kind of severe sepsis, mainly anti-inflammatory treatment, and blood pressure control.

For this kind of disease, as long as the inflammation is controlled and the patient no longer has a fever, he can usually recover within a week or so.

Just after Lin Yi finished his work and returned to the consultation room, a couple walked in with their child in their arms.

Generally, when parents see a doctor, they will let the doctor see how to treat it.

But as soon as the couple entered the door, they yelled for Lin Yi to prescribe the medicine directly, and did not ask Lin Yi to show the child what was going on.

Lin Yi didn't see what was going on with the child, so of course he wouldn't prescribe medicine casually.

This is not only responsible for yourself, but also for the patient.

If you do not see what the patient is like, do not make a correct judgment on the condition, and prescribe medicine indiscriminately, it may cause adverse consequences.

Of course Lin Yi would not make such a low-level mistake.

"Doctor, hurry up and give me some antipyretics. My child just has a little fever. Don't worry about it. I'm afraid he will catch cold again, so I wrap it tightly. Please give me some antipyretics!"

However, the man didn't let Lin Yi see what was going on with the child, and yelled that he only asked Lin Yi to prescribe medicine.

Seeing that Lin Yi didn't prescribe the medicine, the woman hugged the tightly wrapped child, leaned over and shouted:
"What kind of doctor are you? Are you still a doctor if you don't even prescribe any medicine? What kind of service attitude?"

Lin Yi was also a little impatient.

What kind of parents and what qualities are these!
Is it so irresponsible for the child's life to let the child not let him see what's going on, but to prescribe the medicine directly?

Lin Yi refused again.

"You don't let me see what's going on with the child. I will never prescribe you any medicine. If you just want to buy anti-fever medicine, you can go to the pharmacy and buy it. Then why come to the hospital?"

When Lin Yi said a word, the two of them were speechless.

The two hugged the child, turned around and left.

He was still cursing.

"What kind of doctor! He doesn't even prescribe any medicine, and he has no medical ethics at all!"

Lin Yi saw that the two were holding the child and were about to leave the outpatient room, and felt that something was wrong with the parents.

Just when they went out with the child in their arms, a corner of the blanket wrapped around the child's head was exposed.