super anesthesiologist

Chapter 11 Pulmonary Surfactant (Please support, please recommend, thank you everyone!)

Lin Xiaobei was overjoyed, this was the time he received the most super system rewards and the fastest increase in experience points.

"What are you laughing at?" Li Xiumei couldn't help teasing when she saw Lin Xiaobei standing next to the anesthesia machine, secretly laughing.

The patient is now safe and sound and is almost completely out of danger. Judging from the current situation, there should be no risk of another accident.

She felt relaxed again, really relaxed this time.

"Ah, it's nothing, I was thinking that the blood transfusion department really cooperated today." Lin Xiaobei smiled and played sloppy.

"That's inevitable, and it's not for Dr. Lin's sake." Li Xiumei teased.

"Haha, it must be for Director Li's face!"

The coagulation function and thromboelastogram results were sent, and Lin Xiaobei took a look and it was close to the normal level (it is impossible to completely reach the normal level in a short time), and the platelets all rose to 98×109/L.

The two directors, Lin Chaobing and Yang Wenhai, also came to check and judged that Li Mengxia was almost completely out of danger, so they left the operating room quietly.

After the operation, Lin Xiaobei suggested to Li Xiumei: "Director Li, I think Li Mengxia should be transferred to the ICU."

He was able to restore Li Mengxia's spontaneous breathing and remove the endotracheal tube, but this patient had just come back from hell and there were too many unstable factors.She still needs a few days of transition before she can truly stabilize.

There are full-time nurses accompanying the ICU 24 hours a day, and any problems can be found in time, and the risk of this patient will double if there are any problems.

She couldn't stand the toss anymore.

"Okay, you have the final say." Director Li Xiumei now obeys Lin Xiaobei's advice.

Stop the drug, blow your lungs.

"Ms. Lin, do you want to extubate?" Liu Xu asked in surprise.She has practiced in the ICU, and the patients sent there generally require absolute sedation, mechanically controlled breathing, and easy management.

"Yes, it's better to let the patient resume breathing on his own."

"That's right, that's right, don't let the patient take a tube to the ICU." Li Xiumei hurriedly answered on stage.

Li Mengxia is so obese, relying entirely on the ventilator will easily lead to atelectasis, and the sputum in the airway will aggravate the lung infection.

Once the lungs of such obese people are infected, it is very troublesome to deal with, which will lead to a series of complications such as hypoxia and heart failure, and a vicious circle.

Doctors in almost all operating departments do not want their patients to be exhausted in the ICU, and the sooner they are transferred back to the ward, the better.

As for whether to transfer back to the ward, the first thing is to see how the patient's spontaneous breathing recovers.

Liu Xu stopped talking, and silently pinched the breathing balloon of the anesthesia machine to help Li Mengxia recover spontaneous breathing as soon as possible.

Ten minutes later, Liu Xu took the balloon and said to Lin Xiaobei: "Mr. Lin, has the patient's self-protective breathing started to recover?"

"Ah."

The balloon began to contract automatically without the help of hands. Looking at Li Mengxia's chest, it rose and fell very cooperatively - her spontaneous breathing recovered very well.

Lin Xiaobei began to suck the patient's sputum to prevent reflux and aspiration when the tracheal tube was removed.

Although the movement was very gentle, the patient was obviously intolerable to the stimulation and had a coughing reaction.

"Li Mengxia, open your eyes and wake up." Lin Xiaobei shouted.

"Ms. Lin, she's awake." Liu Xu said excitedly from the side.

Waking up with a yell is amazing.

Lin Xiaobei observed for 2 minutes. Under the condition of deoxygenation (the anesthesia machine was no longer used to give oxygen, and she was allowed to breathe air), Li Mengxia's blood oxygen saturation SPO2 remained at 99%, which has not dropped.

Extubated and transferred to ICU.

Before he could stop to take a breath, Lin Xiaobei's phone rang again, and it was Zhang Wei.

"Hello, Dr. Lin, I'm Dr. Zhang Wei from the Neonatology Department. The two babies transferred from your operating room just now need to be injected with pulmonary surfactant. I need your help."

Lin Xiaobei is very helpless, being a doctor is like this, when you are busy, there will be one wave after another, and you will not be given a chance to catch your breath.

"Are you going?" He prepared the newborn first aid kit and asked Liu Xu.

Encountering such a thrilling experience when she first entered the clinic was a purgatory of physical and mental exhaustion for a spoiled little girl.

"Go!" she replied firmly.

Lin Xiaobei gave her a thumbs up and vaccinated her first: "Don't cry later."

"Fuck you, it won't happen!"

"By the way, go get two special epidural catheters."

"..." Liu Xu was at a loss, expressing her perplexity.

Lin Xiaobei didn't explain, "You'll know when you go there."

The neonatology ward is in the second inpatient department, with direct access.

When Lin Xiaobei and the others rushed to the ward, Zhang Wei was watching at the door, "These two babies are too young, and the endotracheal tube is not easy to handle."

Entering the ward, Liu Xu's face immediately turned pale again.

Even though Lin Xiaobei had hinted in advance, even though she had prepared herself, even though she had seen Dabao and Xiaobao before, the moment she stepped into the ward, she was so shocked and panicked.

In a large room, cribs the size of desks are lined up along the walls, one after the other, like railway carriages, covered by tents, like niche cages.

A baby about 2-3 catties is lying in each crib, or on the scalp, or on the hands, or on the legs, or on the feet, a trocar is left, connected with a thin extension tube, extending out Connect to different marked syringes through the tee.The syringe was stuck in the infusion pump, which contained various medicines and nutritional solutions.

There are also babies who do not have any infusion tubes connected to them, so it is estimated that they can be fed milk directly.

Most babies do not need a ventilator to help them breathe, and lie quietly in it to sleep, and some babies have a twig-like endotracheal tube inserted and rely on a ventilator to maintain their breathing.

These babies look much bigger than Li Mengxia's Dabao and Xiaobao, but they are still very small and have hot eyes.

She could barely accept the sight of one or two premature babies, but suddenly seeing so many was like a sudden attack of trypophobia. She collapsed instantly and almost fell down.

Lin Xiaobei quickly supported her from behind and patted her shoulder lightly.

"I'm new to the clinic, so I'm not used to it yet." He explained to Zhang Wei with a smile.

"Would you like to help her go to the office to rest for a while?" The neonatologist seemed to be familiar with it, not surprised, but just suggested lightly.

"No, thank you teacher." Liu Xu opened his eyes, "It's all right."

Lin Xiaobei felt relieved when he saw that her face was slowly turning rosy, her breathing was even, and she was indeed much better than before.

"Let's start." He said to Zhang Wei.

"Okay, Zheng Lu, come and help Dr. Lin." Zhang Wei greeted, and immediately a little nurse came over with a medicine box.

Pulmonary surfactant is a mixture of phospholipids and proteins synthesized and secreted by alveolar epithelial cells (type II). It plays an important role in maintaining normal lung function in newborns. Its main function is to reduce the tension of alveolar fluid-air level.

Due to the imperfect development of lung tissue and lack of surfactant in the lungs of premature infants, the lungs cannot hold up, which can cause atelectasis, lung collapse, ventilation disorders, and affect the child's breathing.

The method of treatment is to prescribe the right medicine and make up for what is missing.

The drug that Zhang Wei is going to use for Xiaobao is a protein mixture extracted from animal lung tissue and artificially processed to achieve the effect of lung surfactant.

Save Xiaobao first.

It may be due to the timely supplement of nutrient solution. Compared with that in the operating room, her condition is much better, her skin color has changed a lot, and the blood vessels are covered with transparent free blood threads like needlepoints, which are clearly visible.

The "H"-shaped fixed frame on the abdomen is still there, and the umbilical vein catheter at the stump of the umbilical cord is connected to two thin extension tubes through a tee, and the end is connected to the syringe on the infusion pump. vascular drugs.

The endotracheal tube in her mouth was slightly displaced, which was the main reason why Zhang Wei called Lin Xiaobei for emergency treatment.Babies are too young, even if they specialize in the art, they are still helpless.

Lin Xiaobei gently lifted Xiaobao's jaw, loosened the tape wrapped around the endotracheal tube, readjusted the position of the tube, and then ordered Zhang Wei to listen to the breathing sounds of the lungs, and then fix it after both sides were even.

When ready, nurse Zheng Lu began to prepare the medicine.These medicines are required to be used immediately. She opened the aluminum cap, injected 10ml of normal saline, shook the ampoule (the common name for a small medicine bottle), and then drew it out. The saline had turned into a milky white glue.

"Prepare to inject medicine."

Zheng Lu put the catheter at the end of the syringe into Xiaobao's endotracheal catheter, and frowned after entering 3cm.

"I can't get in, it seems that the catheter is too thick." She said to Zhang Wei.

"Then what should we do? This is already the thinnest catheter." Zhang Wei felt troubled. Without a catheter to guide the medicine, it would be difficult to reach the surface of Xiaobao's lungs, which would be a huge waste.

This kind of medicine is very expensive, and a bottle costs several thousand.

"It's okay, don't worry." Lin Xiaobei calmly told Liu Xu, "Bring an epidural catheter."

The thinnest drug delivery catheter in the neonatology department is 1.0 (type), which is suitable for tracheal tubes above size 2.5.But Xiaobao is number 2.0, so he was prepared before he came.

Lin Xiaobei handed the epidural catheter to Zheng Lu, and asked her to connect it with a special connector for the epidural catheter, "Try again?"

The entry went smoothly this time. After reaching a certain depth, Lin Xiaobei asked Zheng Lu to push the medicine slowly.

Injecting neonatal pulmonary surfactant requires great attention to skill, and it is a delicate job that requires more endurance.It is required to stop and inflate the lungs every time 1ml is injected, and evenly blow the drug to both alveoli through the airflow.Then, the pediatrician will auscultate and compare the two sides to determine whether the two sides are consistent. If the drug distribution is uneven, there will be obvious moist rales on one side of the lung and mild on the other side.

Therefore, when blowing the lungs, the action of pinching the breathing airbag is very demanding, and the speed, strength, and direction must be coordinated.

It took almost half an hour to give Xiaobao the injection, but the effect was very obvious. After being connected to the ventilator and controlled breathing, her blood oxygen saturation SPO2 quickly rose to 96% and remained stable.

Dabao's condition is much better than Xiaobao's, and the injection is not so strenuous, and the injection is completed in less than 20 minutes.

"Ding!" [Use of basic knowledge +5; endotracheal intubation +2; reward: 2 energy potions; 2 gold bracelets].

Unexpectedly, there is an unexpected harvest!
　The seedlings are being cultivated, thank you everyone!

　　
　
(End of this chapter)