super anesthesiologist

Chapter 139 Just ask if you accept it or not? (Please subscribe, please recommend, thank you!)
Chen Chao was taken aback, what are you doing with the ultrasound?
He also watched Lin Xiaobei's live broadcast in the emergency department, and knew that Lin Xiaobei's ultrasound nerve block was very good, and the target injection was also very precise.

But bro, is this patient undergoing thoracic surgery?
As a junior doctor, Chen Chao didn't say much, and went straight to the equipment room to bring over the ultrasound with the highest definition.

He wanted to see what new tricks Lin Xiaobei could play, not to mention paravertebral block, and now young doctors with a little experience in the anesthesiology department can do it.

"Ms. Lin, do you want ultrasound for target injection?" He asked tentatively.

Lin Xiaobei said, "No, what kind of target injection is this patient doing, it's better to do paraspinal block."

"Negative value from Chao Chen, +30."

However, Lin Xiaobei did not immediately perform a paravertebral block on the patient, but instead slid the ultrasound probe over the patient's neck.

"Mr. Lin, you?" Super Chen asked in surprise.

The patient is still conscious, so Chen Chao is quite cautious when speaking.

Wouldn't Lin Xiaobei give the patient cervical plexus or brachial plexus or cervical and thoracic spinal anesthesia?Nerve block is a bit of a nonsense, although Lin Xiaobei has high attainments in this area, but as far as this patient is concerned, he doesn't need it at all!

As for spinal anesthesia, there are several veterans in the department who received high-level epidural anesthesia when they were young due to limited conditions, but this technique has long been eliminated.

Does Lin Xiaobei want to "return to basics"?

Chen Chao found it very interesting. He had only heard of it, but had never seen anyone perform epidural surgery above T4.

"Maybe Lin Xiaobei can do it.",

However, Lin Xiaobei just passed the ultrasound probe over the patient's neck, then put it away and handed it to Chao Chen.

"Try conscious intubation under spontaneous breathing?" Lin Xiaobei said to Feng Baoguo.

Feng Baoguo: "..."

"You mean inserting a double-lumen tube?" He asked further.

Are you kidding me, inserting a double-lumen tube while awake?It seems that there is no such precedent!

Tracheal intubation to preserve spontaneous breathing while awake is mainly used for patients with difficult airways, and try to choose a smaller tracheal tube. Feng Baoguo has been a doctor for so many years and has never heard of anyone who is awesome enough to intubate a patient while awake. I have never seen a lumen tube.

If someone else was in charge of the anesthesia, he might watch and study with great interest, just like the excited Chen Chao who was beside him at the moment.

But this is the anesthesia that he is responsible for, and he must be held responsible.

A joke made on others is entertainment, but a joke made on oneself is sarcasm.

From the bottom of his heart, Feng Baoguo did not want Lin Xiaobei to "take risks" on the patients he was in charge of. If something happened, no one would be able to bear the responsibility.

"Yes." Lin Xiaobei replied affirmatively.

"This..." Feng Baoguo hesitated.

Lin Xiaobei knew what he meant, and said with a smile: "Try it first, if it doesn't work, insert a single-lumen tube."

Only then did Feng Baoguo take a reassurance.

Chen Chao rushed to perform cricothyroidotomy on the patient, but Lin Xiaobei did not stop him.This kind of mobile phone opportunity is actually very rare and precious for junior doctors.

After the injection of local anesthesia, the patient coughed several times in discomfort and felt that his throat was already numb.

The next step was Lin Xiaobei's thrilling performance.

Both Feng Baoguo and Chen Chao looked at Lin Xiaobei without blinking, watching how he inserted such a thick double lumen tube into Lei Gongzui's trachea.

Lin Xiaobei calmly asked Chen Chao to administer a little sedative to the patient. The dose used was very limited and would not affect the patient's spontaneous breathing at all.

A prerequisite for awake intubation is that it does not interfere with the patient's spontaneous breathing.

A small amount of sedative is used to prevent the patient from becoming agitated due to discomfort.

After the patient calmed down, Lin Xiaobei tried to insert a 32F double-lumen tube into his small mouth, then held the patient's mandible with his left hand, and gently rotated the double-lumen tube with his right hand, moving in while turning.

Under the astonished gazes of Feng Baoguo and Chen Chao, Lin Xiaobei's hand had already passed through the patient's glottis.

When passing through the glottis, the patient still felt uncomfortable and coughed a few times.

"Chen Chao, listen to the lungs." Lin Xiaobei said to Chen Chao.

At this time, the more accurate positioning is actually to use ultrasound, which is more reliable and can clearly see the specific position of the double-lumen tube in the trachea.

Chen Chao listened with a stethoscope: "It seems, it seems that the breath sounds from the right lung are almost worse."

Feng Baoguo corrected: "You first listen to whether it is in the trachea, and then adjust."

He still couldn't believe that Lin Xiaobei inserted the double-lumen tube in so easily, this is too awesome.

Just ask you if you agree?

Lin Xiaobei was connected to the ventilator and monitor, and the waveform of end-tidal carbon dioxide appeared regularly and continuously on the screen.

"I think it should be all right?" Lin Xiaobei said lightly.

"Negative value from Feng Baoguo, +30."

After his own auscultation, according to the data of the monitor, Feng Baoguo still admitted that Lin Xiaobei succeeded in taking the risk, and inserted a double-lumen tube into the patient while he was awake.

I don't know how Director Lin Chaobing should look at this matter after knowing about it?
With Director Lin's character, this patient is absolutely not allowed to take the risk of inserting a double-lumen tube.

Lin Xiaobei helped Feng Baoguo insert the double-lumen tube, positioned it with the help of a bronchoscope, and prepared to leave and return to his operating room.

Feng Baoguo took a piece of gauze and stuffed it into the patient's mouth, in front of the dental pad, and began to wrap it tightly with adhesive tape to fix it.

Lin Xiaobei smiled slightly: "It's not necessary."

Feng Baoguo: "..."

"I think this patient's mouth is so small that there is no need to fix the double-lumen tube. If you wrap it so tightly, it will be troublesome to adjust it later."

Whether immobilization is required after successful double-lumen tube insertion is inconclusive.The traditional point of view is definitely in favor of fixing it like Feng Baoguo's to prevent it from falling off during the operation.

But in practice, some careful anesthesiologists find that it is okay to not fix.Because the double-lumen tube is thicker than ordinary endotracheal tubes, the mobility after being inserted into the patient's airway is very poor, and it will generally not be displaced unless under strong violence.

In addition, even if the double-lumen tube is displaced, it is obviously much more convenient to adjust it without fixation than after fixation.

As for worrying about the double-lumen tube falling off during the operation, how much violence does the surgeon need?According to the statistics of some anesthesiologists, the main reason for the detachment of the endotracheal tube during the operation is related to the position change of the patient during the operation.

When changing the surgical position during the operation, if the anesthesiologist cannot pay attention to the protection of the tracheal tube, then it can only be said that such an anesthesiologist has too thick nerves and is not suitable to be a doctor, let alone an anesthesiologist.

But once a person's concept is formed, it is difficult to change it.

Feng Baoguo felt that Lin Xiaobei's words were a bit unbelievable, the double-lumen tube is not fixed, are you kidding again?He didn't listen to Lin Xiaobei's advice, and firmly fixed the double-lumen tube with adhesive tape, and wrapped it around many times.

Lin Xiaobei didn't care about him. He had already helped those who needed to be helped. He didn't say anything and went directly back to the operating room in charge of him.

Doctor Yang Hongzhen was stopping the bleeding on the stage, when he saw Lin Xiaobei coming in, he smiled and said, "You guys are so busy tonight!"

"Yeah, that's why our night shift is much harder than yours." Lin Xiaobei took the opportunity to complain, saying that anesthesiologists don't have to manage patients or write medical records.In fact, anesthesiologists are really harder than surgeons, and much harder.

"Let's work hard too, okay? Haven't I been busy with you all the time?"

"Nonsense, you are busy occasionally. Besides, you can go back to rest after the operation, and we may perform other operations. Before you came, we have performed several operations, you know?"

Yang Hongzhen: "Hehe!"

Lin Xiaobei was upset, I ah your sister!

The patient's condition is stable, and the surgeon is relaxed, so he likes to chatter, which is said to relieve fatigue.

Lin Xiaobei and Yang Hongzhen were competing against each other when suddenly Chen Chao hurried over and said, "Teacher Lin, hurry up and go to Room 16."

(End of this chapter)