medical road high rise

Chapter 487
Chapter 490
Qin Feng fell into a brief hesitation. There are two bronchoscopes for Qin Feng to choose from, one is fiberoptic bronchoscope and the other is rigid tube bronchoscope.

In the past, when the bronchoscope came out, the hard tube was commonly used, but now due to the development of science and technology, the fiber bronchoscope is developing rapidly, with large bendability and wide visual range. Many advantages make the fiber bronchus play a more clinical role. The larger the size, the more application scenarios.

However, the rigid tube is still not eliminated, because the rigid bronchoscope has more advantages in the elimination of mucus plugs and the removal of foreign bodies in the respiratory tract.

This is what Qin Feng is hesitant about. The fiber bronchus has one advantage, that is, it can operate on the distal bronchi, and the foreign body part of the patient already belongs to the distal bronchi.

If you insist on using a rigid bronchoscope, the requirements for the doctor's operation are also very high.

"Use a rigid bronchoscope." Qin Feng said.

When the rigid bronchus is operated, a sufficient open airway space and a large operating space can be reserved, and a special ventilation interface is provided for artificial ventilation.

The patient himself has relatively serious dyspnea. If a fibrous bronchus is used, breathing will definitely be affected. However, a separate ventilation interface of the rigid bronchus can effectively avoid this.

Although the fiber bronchus can operate on the distal bronchus, the operation requires constant flushing and suction, and repeated clamping is a great test for the operator's physical strength.

In addition, the age of the patient is relatively young, the airway is narrower than that of adults, and the lung function has also been affected by plastic bronchitis. If the patient is forced to perform multiple suctions and forceps, the irritation to the airway will be aggravated, causing airway spasm , Once the hypoxia will aggravate the condition, there will be a dangerous situation.

In contrast, rigid bronchoscopy is safer and more efficient. On the basis of using rigid bronchus, it cooperates with high-frequency jet ventilator to assist ventilation, and then gives high-pressure and high-frequency oxygen to maintain the basic blood oxygen concentration. Hypoxic conditions can be avoided.

At two o'clock in the afternoon, the operation began.

"Doctor Qin, general anesthesia or partial anesthesia?" the anesthesiologist asked.

"No need for anesthesia." Qin Feng said.

"Ah? No need for anesthesia?" The anesthesiologist looked at Qin Feng with some surprise.

Now there are too few surgeries that choose not to use anesthesia, and even some minor suturing surgeries will be assisted by lidocaine. , so as long as it is an operation in the operating room, it will basically be equipped with an anesthetist.

"Well, this operation is performed without anesthesia."

The anesthesiologist nodded, indicating that he understood.

No anesthesia and anesthesia, two surgical methods, each has its advantages and disadvantages.

Qin Feng chose no anesthesia because the surgery without anesthesia is safer for the patient. Since the foreign body is being removed, when the patient is conscious, Qin Feng can more accurately judge whether the foreign body in the lower respiratory tract will be removed through the patient's cough reflex. Using the power of coughing to flush out the foreign body helps to remove the foreign body, and the postoperative recovery is also better.

However, without anesthesia, it is also a test of the operator's technical level. If the delay is too long, it will cause postoperative laryngeal edema, inflammation, etc., and even cause respiratory failure.

"The operation begins, 5mm inner diameter bronchoscope, foreign body forceps." Qin Feng stretched out his hand.

The inner diameter of the bronchoscope is also selected based on age. Generally, the inner diameter of the bronchus is 3-3.5mm for those under one year old, 4mm for one to three years old, and 5mm for those over three years old.

Qin Feng carefully passed the bronchoscope through the glottis, and slowly entered it until he felt resistance, which was a foreign body.

However, Qin Feng did not directly grab the foreign body, but explored around the foreign body to determine the specific position, size, shape, etc. of the foreign body in the bronchi.

In the process of exploration, Qin Feng found that there are two places that are empty in the middle, which proves that the foreign object is a branch-like foreign object. Qin Feng found the gap in the branch and passed through it.

"Ventilator assisted ventilation, high-frequency oxygenation." Qin Feng ordered.

Waiting for the ventilator to buzz, Qin Feng picked up the foreign body forceps and slowly inserted it into the patient's throat, slowly approaching the end of the rigid bronchoscope along the respiratory tract, and stopped after feeling the resistance.

Qin Feng slowly adjusted the direction of the opening of the foreign body forceps, passed through the gap of the branch-shaped foreign body, and accurately clamped the branches on one side, then Qin Feng adjusted the position of the bronchoscope with the other hand, so that the tip of the bronchoscope was inclined to the Next, this is to protect the foreign body and prevent the foreign body from cutting the trachea and causing infection during the foreign body forceps pulling the foreign body.

Five minutes later, Qin Feng pulled the foreign object out of the patient's throat. He glanced at the operation time. In less than 5 minutes, Qin Feng also heaved a sigh of relief.

Putting the foreign object in the pathology tray, Qin Feng continued to speak, "After the operation, when you are nursing, remember to give long-acting bronchodilators and perform hypertonic saline atomization several times."

Long-acting bronchodilators are commonly used in the treatment of acute and chronic plastic bronchitis, which can dilate the bronchi and improve the function of mucous membranes and cilia, and at the same time inhibit the chemotaxis of eosinophils, inhibit the release of inflammatory mediators by mast cells in the respiratory tract, and relieve Respiratory hyperresponsiveness and humidification of the airways.

The atomization of hypertonic saline also increases the humidity of the respiratory tract, promotes the self-cleaning of cilia, increases the osmotic pressure of the surface of the respiratory tract and lung epithelial cells, makes the water in the cells penetrate into the surface of the respiratory tract, causes the change of osmotic pressure in the respiratory tract, and induces cough. During the treatment, the mucus and sputum in the patient's respiratory tract will also be coughed up, which is good for recovery.

After explaining, Qin Feng left the operating room directly, but after leaving the operating room, Qin Feng did not see the patient's parents.

"Where's the patient's parents?" Qin Feng asked the intern in charge of the patient's bed.

"They thought the patient was hopeless, so they went back early to prepare for the funeral." The intern lowered his head and said.

When Qin Feng heard this, he became a little angry.

"Aren't they planning to hospitalize patients?" Qin Feng suppressed his anger.

The current situation of patients is very difficult. If they do not breathe well, they will die when they go back.

Although the removal of the foreign body was just a minor operation, the patient had plastic bronchitis. Although the operation was successful, some unavoidable complications were also serious.

If nursing is carried out in the hospital, doctors and nurses can provide symptomatic treatment for possible complications at any time, prevent them in advance, and minimize the risk.

After returning home, once the child develops complications, it is a secondary injury, and it is definitely too late to send it to the hospital.

"Call the patient's parents and tell them directly that if the patient is brought back, the patient will undoubtedly die." Qin Feng also didn't care about the family's emotions.

If you worry about their emotions any more, they will be killed.

(End of this chapter)