super anesthesiologist

Chapter 12 The F4 corner is nothing but that (4000 words, please support, please recommend, please bookmark!!!)
Another day at work.

Lin Xiaobei was assigned to operating room No. 3, in charge of general surgery: two partial thyroidectomy and three radical mastectomy.

Nothing challenging, ordinary general anesthesia will do.

He took Liu Xu, a graduate student, at ease, and even took a break from his busy schedule to popularize the history of anesthesiology for her.

Although modern anesthesiology techniques were introduced from Western countries, our ancestors are the originators of anesthesia.

"It is recorded that Chinese anesthesiology began with Shennong. There is a folk saying that 'Shennong tasted a hundred herbs and encountered seventy poisons in one day.' Later, "Liezi·Tang Wen Pian" and "Historical Records·Bian Que Biography" mentioned the famous medical science in the Spring and Autumn Period. There are records of Bian Que's surgical operations. Hua Tuo invented 'Ma Fei Powder' at the end of the Eastern Han Dynasty. Later, "The Chronicle of the Three Kingdoms·Book of Shu·The Biography of Guan Yu" scraped bones to treat poison——"

Suddenly Zhang Xiang from No. 4 ran over and said, "Ms. Lin, come and help me."

Zhang Xiang is in the emergency department and is in charge of emergency surgery, which has the most uncertainties.

In such a rush, Lin Xiaobei thought he had encountered a very critical patient. When he entered the operating room he was in charge of, he found that the patient lying on the bed was still awake, with his eyes open, but listless.

An old male, visually aged, at least 85 years old, with gray hair, sparsely resembling dry grass on dry land; lower eyelids are partially everted, eyes dull and dull; lips are tightly closed, and cheeks are sunken at the chin.

The whole person is skinny.

"Grandpa, what's the matter with you?" Lin Xiaobei asked the old man, actually wanting to see his reaction.

These elderly people are usually delirious and prone to dementia.

"Mr. Lin, this patient is acutely incarcerated hemorrhoids." Zhang Xiang misunderstood his meaning and reported the patient's basic condition directly.

"Oh, then spinal anesthesia, spinal anesthesia, epidural anesthesia, and sacral anesthesia are all okay, right?" Lin Xiaobei suggested.

The advantage of this anesthesia method is that it has a good anesthesia effect and little interference with the patient's physiology, which is especially suitable for such elderly people.

But Zhang Xiang showed embarrassment: "Mr. Lin, this patient is 95 years old."

"Oh!" Lin Xiaobei immediately understood why he hesitated.

Spinal anesthesia is a very big technical challenge for anesthesiologists at such an advanced age.

Because with the growth of age, the elderly are prone to osteoporosis, calcification, and uncoordinated hyperplasia of bone, and the entire lumbar vertebrae are fused into one piece, commonly known as "tortoise shell".

There is almost no intervertebral space in such a spine. Whether it is spinal anesthesia or epidural anesthesia, the failure rate of puncture is very high.

Generally choose general anesthesia directly.

But this patient is 95 years old. There are many concerns for such an elderly patient to accept general anesthesia.First of all, his cardiopulmonary function is not good, especially after his breathing is disrupted, it is very difficult to recover independently and requires long-term ventilator support, which is extremely detrimental to the patient's postoperative recovery.

In addition, most patients' liver and kidney functions are in a decompensated state, which can easily lead to drug accumulation and serious postoperative complications, such as respiratory depression, delayed awakening, disturbance of consciousness, etc.Especially for patients with Alzheimer's symptoms, the possibility of delayed recovery after surgery is very high, and they may even have to be transferred to the ICU to be maintained on a ventilator.

Lin Xiaobei looked through the medical records, trust me, the patient also had multiple cerebral infarctions, lower extremity venous thrombosis, carotid atherosclerotic plaque, essential hypertension III very high risk...

The only thing that is acceptable is normal coagulation.

"Dr. Lin, this grandpa has a serious lung infection." The surgeon Zheng Kui made matters worse.

"What should we do? Can you do local anesthesia?" Liu Xu asked on the side. Like Zhang Xiang, such patients do not need to consider spinal anesthesia in their eyes.

"Are you kidding, how many rounds of anesthetic do you need for such a big incarceration? Are you not afraid of being poisoned?" Zheng Kui flatly refused.

"Then what should I do? I'm completely numb, but---" Before Liu Xu could express her concerns, she was interrupted by Zheng Kui.

"Listen to Teacher Lin's opinion first." Obviously, he didn't want to give the old man general anesthesia.

"Mr. Lin, you are an expert in this field, try it!" Zhang Xiang complimented without losing the opportunity.

Lin Xiaobei gave him a blank look, boy, you are so skilled at killing people with borrowed knives!

"Doctor Lin, please evaluate it. If it doesn't work, you will be given general anesthesia and sent to the ICU after the operation. Anyway, I have discussed it clearly with his family before the operation." Necrosis is a big problem."

Lin Xiaobei's heart is full of fucks, you're going to be a woolen yarn, it's all numb, you said it lightly.

General anesthesia is definitely not the first choice. Old age, cerebral infarction, and severe lung infection. Even if the operation goes well, the patient will not be able to get out of the ventilator after the operation, and the cost alone will be a bottomless pit.

Lin Xiaobei is Zhang Xiang's superior doctor, and no one dares to speak out unless he expresses his opinion.

"Okay, I'll try." He wanted to see the old man's spine before making a decision.

"Okay, Dr. Lin, if this patient's anesthesia is done, I'll ask my wife to publicize it for you in the whole hospital. She's in the Publicity Department." Zheng Kui said temptingly, but it was actually encouraging.

"Don't! Don't! Don't! I am a Yun Xin Yue Xing person. This patient is treated by Dr. Zhang Xiang, I am just helping." Lin Xiaobei quickly refused, he was not giving in.It’s okay to help, but the responsibilities must be clearly defined.No matter how good the surgery is for this patient, the prognosis is unpredictable at such an old age.

He prepared the anesthesia kit and medicine, and asked Zhang Xiang to help position him. When the old man turned his side, he suddenly cursed inwardly: Fuck!
The old man has severe scoliosis!

This is an absolute contraindication to neuraxial anesthesia! !
The only thing that comforted Lin Xiaobei was that the scoliosis of this old man's spine was above chest 4 (T4).

The advantage of this is that the puncture is not greatly affected, and the spinal nerve will not be damaged due to the lesion of the spine itself.Of course, the premise is that the operating level of the anesthetist is no problem.

However, a possible hidden danger is that the diffusion of local anesthetics in the spinal cavity is limited, and it is prone to "anesthesia separation phenomenon" (the anesthesia effect of a small area is quite perfect, but other segments feel normal, which usually cannot meet the anesthesia requirements required for surgery) .

Another potential risk is that local anesthetics will spread with changes in body position. Spreading to the chest will cause total spinal anesthesia (all spinal nerves are anesthetized, which is a serious anesthesia complication and will cause rapid paralysis of the patient's circulatory and respiratory systems. shock death).

How to do?
Lin Xiaobei could retreat decently at this time, but if he did so, not only would his previous efforts be in vain, but this old man might never see the sun of tomorrow again.

Although it has been rainy these days.

What if the old man is his own relative?
Lin Xiaobei asked himself, there is no doubt that he would take the risk without hesitation.

But now is a legal society, everything is based on the law.

He took the risk that if complications from the anesthesia occurred, it would be entirely his fault.

And even if the anesthesia goes well and the operation is completed, if the patient's family members know even superficially, as long as they talk about it, he can't escape the responsibility.

"Doctor Lin, hurry up. Grandpa's intestines are about to change color." Zheng Kui urged anxiously on the side.

Lin Xiaobei turned his head and saw that the old man's anus was covered with a large growth, which had indeed turned dark red.

"Just one risk! Saving a life is better than building a seven-level pagoda!"

Lin Xiaobei gritted his teeth and encouraged himself.Unpacking, disinfecting, and spreading towels, he did this set of procedures very neatly.

At this time, Liu Xu also came to help, handing over the local anesthetic.

When touching the old man's back, Lin Xiaobei secretly regretted that he shouldn't have shown such bravery.The old man's spine is like a fully fused iron rod. Where is the intervertebral space?

It can only be roughly positioned by the iliac crest joint.

Lin Xiaobei touched it for a long time, using a No. 5 small needle to test it, as if poking it on an iron plate.

He kept calm, thinking of the [Super Anesthesiologist Peak Experience Mode] the night before, and regretted that there were too few experiences, and he should have chosen a longer one.

The experience of that night is still fresh in his memory, especially the "needle insertion direction: deviation ≥ 30°; angle adjustment ability: poor" made him deeply concerned.

Maybe that's my own shortcoming.

Lin Xiaobei felt secretly while probing, inserted the needle, and adjusted.

Suddenly his hand sank, and the probe plunged into the bone!

There is hope if you find a gap, Lin Xiaobei picked up the waist needle and tried it on directly.

It is so difficult to try on the No. 5 probe, not to mention the epidural puncture needle several times larger than that, it is like nailing a nail in the wall.

Lin Xiaobei stared straight ahead, but his mind was all on his hands.

Insert the needle and adjust.

Insert the needle and adjust.

Insert the needle and adjust.

He was muttering something, and suddenly heard a "boom".

arrive!The feeling was all too familiar, the feeling of breaking through the dura when reaching the subarachnoid space.

It is usually most obvious in healthy young people, but I did not expect to feel it in the spine of such an old grandfather.

A stream of cool liquid trickled out from the buttocks of the spinal anesthesia needle.

There was a sudden ding in my mind, and a line of prompts flashed on the panel: Spinal anesthesia operation skills +2; reward: 1 gold bracelet.

Another reward, but where is the prize?Lin Xiaobei hasn't seen what the so-called gold bracelet is until now.

"The system automatically saves it for you!" The panel disappears automatically after the prompt is completed.

"Wow, it's a success! It's a success! Teacher Lin, you are amazing!" Liu Xu clapped her hands and praised, her admiration was beyond words.

"Luck, luck." Lin Xiaobei said modestly, the system is really awesome, although the experience that night was bad, it benefited him a lot.

He was secretly delighted, with such a set of super invincible magic weapons, as long as he devotes himself to training in the future, he will definitely become a generation of famous doctors who are famous both at home and abroad!
After injecting 10mg of 0.75% bupivacaine, he slowly pulled out the spinal anesthesia needle, which was very tight, as if stuck in a stone crevice.

Lin Xiaobei worked hard secretly, adjusting while retreating.When he pulled out the complete spinal anesthesia needle, Liu Xu and Zhang Xiang all opened their mouths into an "O" shape in shock.

The waist anesthesia needle as thin as a hair was folded into an S shape!
What kind of curved route does this need to take in the narrow intervertebral space of the grandfather?
"Teacher Lin, how did you get in?" Liu Xu asked dumbfounded.

"Mr. Lin, do you know how to control needles with qi?" Zhang Xiang probably got poisoned after watching "Legend of Sword and Fairy", and his imagination is unusually rich.

Liu Xu: "Mr. Lin, are you just looking for a needle?"

Zhang Xiang: "Mr. Lin, do your needles have light guides?"

Liu Xu: "Mr. Lin, you're really good!"

Zhang Xiang: "Mr. Lin, you are so awesome!"

Liu Catkin: "Teacher Lin..."

Zhang Xiang: "Teacher Lin..."

"Okay, okay, okay!" Facing the two chirping little sparrows, Lin Xiaobei foolishly said, "Maybe, maybe it got stuck when pulling out the needle."

Anesthesiologists with a little common sense know that this is impossible. If there is no force, how can the needle body be broken when the needle is pulled out?What's more, Lin Xiaobei's technique of withdrawing the needle just now was very gentle and very slow.

But Zhang Xiang and Liu Xu seemed to believe it.

"This old man's spine is so strange." Liu Xu was still surprised.

"The F4 track is nothing more than that!" Zhang Xiang said exaggeratedly.

"It's not surprising when you're used to it." Only Lin Xiaobei remained calm.

He asked the grandfather to turn over and lie down, and then tried to block the plane with a No. 3 needle, up to T12-L1, but he could not feel any sensation from the lower limbs to the perineum.

The effect is quite good!
"Ms. Lin, how did you do it just now?" Back in her operating room, Liu Xu secretly asked Lin Xiaobei.

She stared into his eyes, trying to find out the answer.

Catkins is beautiful, with fair skin, a small nose, thin and red lips, especially those big and piercing eyes.

Lin Xiaobei was stunned for a moment, then he came back to his senses.

"Practice makes perfect." Apart from explaining this, he really didn't know how to answer.

Liu Xu was a little disappointed by Lin Xiaobei's perfunctory, and kept asking: "Mr. Lin, why do others use the epidural needle first, but you directly use the spinal anesthesia needle?"

This is a serious question, because strictly speaking, what Lin Xiaobei did just now was against the rules.

It was like everyone was patiently waiting for the red light, but he rushed straight there in a hurry, but there was no accident.

"Shh, don't tell anyone." Lin Xiaobei warned.

"Hmph, Zhang Xiang saw it just now."

"Zhang Xiang won't talk nonsense."

Liu Xu mischievously said: "Unless you teach me, otherwise——"

"Otherwise what?"

"Otherwise, I'll inform you!"

Lin Xiaobei asked in surprise, "Informant? Who?"

Liu Xu smiled lightly: "Director Lin!"

"How dare you!" he threatened.

Director Lin is known for his super strict requirements on the staff of the anesthesiology department.Anyone who violated the operating standards set by the department was discovered by him. At the least, he would review and admit his mistakes, and at the worst, he would report to the medical department to suspend work.

"Hmph, are you afraid? If you are afraid, teach me!" Liu Xu said triumphantly.

"Pull it down, who is afraid of whom!" Lin Xiaobei didn't take it seriously, he knew this girl's character, if she really had that kind of heart, she would never say it.

"Oh, just teach me, please!" Sure enough, like a snake being pinched seven inches, Liu Xu saw that it was too hard, so she came to be soft, and began to show beauty invincible and beg for merit.

"Actually, I just felt it with my heart."

"Feel it with your heart?"

"Yes, that's it!" Lin Xiaobei said while looking at her, holding a pen in his hand and simulating forward.

Liu Xu blushed to the root of her neck and lowered her head shyly.

　This chapter has been revised and revised several times. It was originally made into two chapters, but later it was streamlined and published as one chapter.We don't know the word count, so we are worthy of book friends.

　　
　
(End of this chapter)