super anesthesiologist

Chapter 138 Double Lumen Tube Meets Lei Gongzui (Please subscribe, please recommend, thank you!!!)

Lin Xiaobei said helplessly, "I don't want to do this either!"

Liu Qin ignored him and went to call the assistant classmate.

Here, the general inpatient and the resident doctor go together.

In the dead of night, the bustling city finally fell silent.But at this moment, the anesthesiology department attached to the first branch was extremely lively.

Lin Xiaobei is still in charge of thermal burn patients in his unit.And Wang Jianguo used to help residents prepare anesthesia for extracerebral and thoracic surgery.

On Lin Xiaobei's side, the surgeon has already started to take the stage.For this kind of thermal burn operation, it is very tricky.

First of all, it is very difficult to judge which parts of the patient's muscle tissue have undergone necrosis, which is different from fire burns, water scalds, or electrical injuries.Those with physical injuries had obvious signs of trauma, such as black scabs.

And this kind of thermal burn, the surface skin of the patient is still normal, even rosy, except that the local body temperature is higher than normal.

In the second case, the necrotic muscle tissue must be correctly identified and removed in time.Because these necrotic tissues will release toxins and cause poisoning of the patient's internal environment, leading to a series of multiple organ failure and endangering the patient's life.

This is also one of the reasons why such patients should not be taken lightly even if their vital signs are normal and stable after treatment.

But these are not Lin Xiaobei's special sessions.There is a specialization in the surgery industry, and it is impossible for him to know all the medical knowledge well.

Lin Xiaobei looked at the burn doctor Yang Hongzhen quietly. He carefully checked in front of the image reading window, and then selected several incisions based on the results of the image examination.

Fortunately, the patient's skull was swollen like a pumpkin, but his head did not suffer from second-degree burns.The head has rich blood flow, so as long as the temperature is cooled in time for protection, necrotic tissue will not form.

The operation is proceeding in an orderly manner, and the patient's vital signs can still remain normal.When Lin Xiaobei was leisurely, Wang Jianguo ran over and said, "Teacher Feng Baoguo called you to go and have a look."

Feng Baoguo is the hospital chief this month, and is in charge of chest surgery.

Lin Xiaobei asked Wang Jianguo to guard his patient and came to Room 16 of Feng Baoguo.

"Ms. Lin, this patient can't have a double-lumen tube inserted!" Feng Baoguo said in embarrassment.

Lin Xiaobei still didn't know what the patient's condition was. When he opened the electronic medical record, it turned out that it was a stab wound to the chest. The patient's lung was punctured with a knife, resulting in an open pneumothorax.

The purpose of the operation now is to repair the ruptured part of the patient's lung in time, otherwise the situation will become more and more dangerous.Because there is a very special feature of this type of disease that "mediastinal flutter" will occur.

Normal people's lungs are even and symmetrical, and breathing is consistent on both sides.But in some patients, for example, if one lung has a lesion that causes poor tension, it will cause the lung on that side to collapse.

In patients with open pneumothorax, because the pleura is connected to the outside world, the pressure in the bilateral pleural cavity is unbalanced. When the pressure in the pleural cavity on the affected side is significantly higher than that on the healthy side, it can cause the mediastinum to move to the healthy side, further limiting the expansion of the lungs on the healthy side. , manifested by the mediastinum shifting to the healthy side when inhaling, and moving back to the affected side when exhaling, causing its position to swing left and right with breathing.

The danger of mediastinal flutter is that it not only affects lung ventilation, but also squeezes the heart. The danger is self-evident.

The patient had been initially treated in the emergency department, and the stab wound site was packed with gauze.This is what turns an open injury into a closed injury.

Before the development of minimally invasive techniques, the development of thoracic surgery was greatly restricted. Not only was the operation difficult, but also a very important point was that the surgical incision was too long, and the postoperative recovery of patients was very slow and the pain was unbearable.

After the introduction of laparoscopic thoracic surgery, surgical wound problems have been greatly improved.Laparoscopy only requires a few holes in the chest, and the operation can be completed by using a TV to guide the ultrasound scalpel to operate in the chest cavity. The principle is similar to laparoscopic cholecystectomy.

This is indeed a great boon for patients with chest disorders.After all, compared with making a few holes in the chest and making an incision tens of centimeters long, it is really incomparable.

Therefore, for all thoracic problems that can be solved with laparoscopy, doctors also strongly recommend patients to choose laparoscopic surgery.Although the cost is expensive, patients recover quickly after surgery.

There is no need to decide which is more important, money or life.

Undoubtedly this knife stabbed patient is the standard indication for thoracoscopic surgery.

But thoracoscopic surgery is not the same as laparoscopy.Thoracoscopic surgery requires the patient's operative side lung to be completely collapsed. On the one hand, the collapsed lung is convenient for surgical operation, and on the other hand, it can make the exposed field of view clearer.

To solve this problem is to reflect that one of the major characteristics of thoracoscopic surgery anesthesia is "double lumen tube".

As the name suggests, the dual-lumen tube has two openings, one for the left lung and one for the right lung.When the patient's left lung is operated on, the left lung opening is closed and the right lung is ventilated; when the right lung is operated on, the right lung opening is closed and the left lung is ventilated.

Generally, the internal diameter of an ordinary endotracheal tube is about 70-75mm. For clinical convenience, it is customary to call it "No. 7.0 and No. 7.5."

But the double-lumen tube is not so quantitative. It is divided into 32F, 35F, 37F, and 39F models according to the depth and inner diameter of the trachea.

Due to these characteristics, the inner diameter of the double-lumen tube is thicker than that of ordinary endotracheal tubes, which is equivalent to the 8.5 and 9.0 types of ordinary endotracheal tubes.

Then, one of the main problems in inserting a double-lumen tube into a patient is that the patient's mouth opening is required to be high, and intubation will be very difficult when encountering a difficult airway.

Now this patient has this problem that stumps Feng Baoguo.

The patient's mouth was so small that Lin Xiaobei wondered if he had plastic surgery.It is a sense of beauty for a woman to have a "small cherry mouth". It is said that a man with such a small mouth feels awkward no matter how he looks at it.What's more, this buddy is Lei Gongzui, a typical sharp-billed monkey cheek, with a chin like a small red heart, with the tip pointing down.

The current problem is not to discuss why the patient has such a "small" mouth, but to consider how to insert the double-lumen tube through the patient's mouth.

Feng Baoguo felt that it would be difficult for this patient to have a double-lumen tube inserted, even an ordinary endotracheal tube.

But the surgeon Zhao Jingjing insisted that the anesthetist insert a double-lumen tube, otherwise they would not be able to perform thoracoscopy.

It is really not cost-effective to open the chest for such a repair operation, and the surgeon is not happy.

Lin Xiaobei gestured with the 35F double-lumen tube and managed to pass, but the problem was that a laryngoscope was needed to guide it.

"Doctor Lin, can you think of a way, such as inserting a laryngeal mask."

Zhao Jingjing followed Yu Zhendong, and heard that Lin Xiaobei used a laryngeal mask for chest surgery anesthesia.

"No way, this patient's mouth opening is so small that he can't even put the endotracheal tube in, how can he insert a laryngeal mask?" Lin Xiaobei shook his head and said.

The laryngeal mask has higher requirements for the patient's mouth opening than the endotracheal tube, at least the patient's mouth can accommodate it, right?
Zhao Jingjing said dissatisfiedly: "Then we have no choice but to open the chest?"

He wanted to do laparoscopic surgery on the patient, but he was not willing to change the thoracotomy suddenly due to anesthesia.

This kind of surgery with obvious indications for laparoscopic surgery is really not cost-effective, even Lin Xiaobei can't bear it.

Comparing heart to heart, if this patient has any friendship with him, or relatives, or friends, he will definitely find a way, and will not agree to open chest surgery unless it is absolutely necessary.

"I'll give it a try, try my best." Lin Xiaobei said tactfully.

He didn't know the general situation of this patient at all, even if he was sure that he could quickly insert the double-lumen tube to the endotracheal tube by hand, he didn't dare to guarantee it.

When Zhao Jingjing heard Lin Xiaobei let go, she immediately smiled and said, "Just wait until you start anesthesia, hurry up."

Lin Xiaobei did not panic, and said to the resident doctor Chen Chao: "Go and bring the ultrasound."

(End of this chapter)