super anesthesiologist

Chapter 108 Chapter [-]: Don't take it for granted

Lin Xiaobei was secretly startled, these people are really brave, with such a theoretical level, they dare to work part-time in anesthesia...

But when I think about it, I feel that there is nothing wrong with it. If it is really good, who would want to stay in that kind of hospital.Speaking of which, Wang Xuguang went back to the anesthesiology department of S University for advanced studies. After going to work, he felt that it was boring to stay there, so he resigned and went to a private hospital in the city.

These trainee doctors were lucky. At 02:30 in the afternoon, the city's 120 emergency center called. There was a major car accident at the intersection of the East Railway Station Expressway. Fortunately, there were no deaths at the scene.

As a special specialist in the emergency department, Lin Xiaobei didn't need to go out with the ambulance.But in order to teach this group of interns well, he took the initiative to ask for orders to "go out".

As soon as he asked for instructions, the six training doctors who were following him immediately geared up and volunteered to follow Lin Xiaobei to the scene for first aid.

Due to the large number of people injured in the car accident, the hospital leader gave Director Li Aiguo an all-out rescue order after receiving the notice.

So Director Li, Bian Wengang and other main doctors in the emergency department, including the eighteen trainee doctors who had just arrived, boarded the hospital ambulance and rushed to the place where the story happened.

East Station is not far from Annex [-], right next to Lin Xiaobei's home.In addition, there was no need to wait for traffic lights, and the ambulance arrived at the accident scene in ten minutes.

It turned out that two buses collided.It is said that the driver of the bus in front was driving tired, while the bus behind thought the car in front was running too slowly and was about to overtake.

Just at a corner, the driver in front didn't pay attention to the vehicle behind, and suddenly turned to the middle of the lane, but the bus behind had no time to brake, and the rear-end collision happened like this.

There was a serious rear-end collision at the scene. The bus in front had rolled over to the ground, and the rear of the bus was sunken; while the front of the bus behind was so damaged that the prototype could hardly be seen.

The two drivers were most seriously injured. The driver in front was sleepy and his forehead hit the front window when the car collided, and he was already unconscious. Although the driver behind him was prepared, the impact was too great and he was pressed against the window and fell unconscious. .

Lin Xiaobei, Director Li Aiguo, and Bian Wengang led teams to inspect the wounded, and formed up according to the injury, sent the seriously injured back to the hospital first, and debrided, disinfected and bandaged them on the scene with only skin friction injuries.

There are also some people who, although not fatally injured, have serious injuries to their arms and legs. They need to be bandaged briefly and then wait for the ambulance to arrive.

During this process, the new trainee doctors had never encountered so many wounded at the scene, and they seemed to feel very fresh and excited.

Lin Xiaobei told the group of 6 trainee doctors who followed him not to run around, and followed him to learn how to check the wounded.Particular care should be taken in patients with fractures, as the broken ends may be misaligned and damage nerves.

Especially for the wounded with cervical spine injuries, do not move the position easily, and try to make the wounded lie flat before moving, because a little carelessness may damage the spinal cord and lead to paraplegia or even cardiac arrest.

When encountering the wounded with open trauma, Lin Xiaobei asked the trainee doctors to stand aside to watch how he cleaned the wound, and then how to bandage it with a triangular bandage. He specially let the trainees feel the tightness when bandaging.

Bandaging trauma has several purposes. One is to protect the wound from further contamination; the other is to pressurize to stop bleeding. Trauma is usually accompanied by severe bleeding due to vascular injury; the third is to avoid easy transfer of patients; of course, there are other measures that may be taken according to specific circumstances. Not all are the same.

The knowledge points that Lin Xiaobei talked about are also available in the books, but these trainee doctors probably don’t like to read books very much, so many people didn’t understand them. They nodded like gulping dates, but they didn’t understand at all.

It is impossible for Lin Xiaobei to patiently and meticulously narrate these trainee doctors. After he, Li Aiguo, and Bian Wengang finished checking and treating all the wounded, they led the trainee doctors back to the hospital in an ambulance. The next step they had to do The job is to debride and suture these wounded patients in the emergency department operating room.

Since they had the experience of dealing with the wounded on a large scale before, it was not difficult for Lin Xiaobei and the others to deal with them this time, and they were not in a hurry.

But what is different this time from last time is that he still has to teach, that is, he can't just do it by himself, he has to explain and demonstrate to these students while doing it.

This is good clinical teaching.

Because everyone knows that Lin Xiaobei is good at nerve block surgery, including target injection.So as soon as they returned to the operating room, the trainee doctor in their group immediately brought the ultrasound over, hoping that Lin Xiaobei could give guidance on the spot.

Last time I was at the Provincial Hospital, I watched from a distance. Although I could see clearly, this time I was standing directly next to Lin Xiaobei. I was immersed in the scene, and the feeling was natural and different.

Lin Xiaobei's use of ultrasonic equipment is for teaching, but at his current level he doesn't need it at all.In order to let the students learn better, he still turned on the ultrasound and performed anesthesia under the instructions.

Unexpectedly, the basic theory of these trainee doctors was so poor. Lin Xiaobei thought that he had visualized all the nerve trees, but these students still said they did not understand, or kept asking about the anatomical structure of the visualization.

"Ms. Lin, is this a blood vessel?"

"Mr. Lin, is this the brachial plexus?"

"Mr. Lin, what kind of tissue is this black belt? Is it a muscle?"

……

Lin Xiaobei couldn't laugh or cry, it's like a university professor calling a primary school student, the difference in levels is too great.Lin Xiaobei didn't know how to explain it, these trainee doctors didn't even know the most basic anatomical structure.

And they don't know the basic principle of super-birth.

Lin Xiaobei's explanation was much more laborious than his own explanation, and it was very time-consuming to continue explaining in this way. Before the anesthesia was finished for one, Bian Wengang and Li Aiguo were already waiting for the next one at the operating table...

"Well, you watch me type first. I will explain to you while I am typing. Don't ask any of you, don't interrupt my thinking. As for the questions you want to ask, I think you should go back and read the book first. Review your basic knowledge carefully. Next time I have a chance, I will explain it to you in detail." Lin Xiaobei was inconvenient to directly condemn these trainee doctors for their poor foundation, so he said it very euphemistically.

There are still so many wounded waiting in line outside, they don't have extra time to study leisurely.

The trainee doctors seemed very embarrassed. They felt that some questions were really weak, but they were unwilling to ask them.These questions are very simple for Lin Xiaobei, and they can be understood immediately, but they are really difficult for people like them, otherwise they wouldn't have been troubled for so long.

The very intuitive reality is that most of these trainee doctors have gone through many years of repeated examinations for the medical practitioner examination.There are many rural doctors who only have a residency certificate for their entire lives.

Without the interference of the trainee doctors, Lin Xiaobei's anesthesia was done very quickly, like mass production.

These training doctors have more or less performed local anesthesia or nerve blocks at home, but they are far less relaxed than Lin Xiaobei.They looked at the amount of local anesthetic Lin Xiaobei pushed in and frowned secretly. Is this amount enough?

But what they had to believe was that the wounded soon stopped moaning and moaning after receiving Lin Xiaobei's anesthesia, but lay quietly on the bed.

"Mr. Lin, how do you mix the concentration of your local anesthetic?" Inert thinking, they felt that the volume used by Lin Xiaobei was too small, so the concentration must be high.

"I usually only use 0.5% chlorine and 0.2% rhodine, and the total amount does not exceed 20ml." Lin Xiaobei replied calmly.

This concentration is really low, especially for local anesthesia. Even for nerve block, at least 0.8% chlorine and 0.3% rheumatoidin are needed to meet the surgical needs.This is almost the consensus of many anesthesiologists.

If the concentration is too low, the blocking effect is often insufficient, and the onset of action is still very slow.

"But the dose and concentration we used are higher than yours, but why can't we achieve satisfactory results?" One of the trainee doctors asked with a puzzled face, "I did the same thing!"

This is the problem of following the gourd painting to get the shape but not the spirit, not grasping the essence of local anesthesia technology, and thinking that local anesthesia is a problem of pushing the local anesthetic with one injection and the problem is over.

In fact, no matter nerve block or precise target injection, this is indeed the case. In the eyes of laymen, it is ok to have a needle and then push some local anesthetic.Lin Xiaobei's perspective is even more so.

Faced with this problem of training doctors, Lin Xiaobei couldn't help but dampen his enthusiasm, because his problem almost represented the confusion faced by all low-level anesthesiologists.

Lin Xiaobei thought for a while, then smiled and said, "Maybe you think you've got it right, but in fact it's a little bit worse, so it's often effective but not perfect, right?"

Everyone nodded, "Yes, yes, that's it."

"So, don't think it's easy for me to fight, don't take it for granted."

(End of this chapter)