super anesthesiologist

Chapter 25 Anesthesia of a complex chest patient

"teacher LIN!"

Just after arriving at the entrance of the surgery building, I heard Liu Xu calling from afar.

Lin Xiaobei turned her head, and she caught up with three steps in two, complaining, "Why are you walking so fast? I can't even keep up with you!"

"Haha, I've always been like this, professional fault. You may walk faster than me in the future." He teased.

"Ha, can't it fly?" Liu Xu also laughed and laughed.

"So early?" Lin Xiaobei asked with a smile.

Catkin looks good, her face is rosy, and her skin is as tender as a peach that can be squeezed out of water.

She recovered quickly.

This is the charm of youth, staying up all night is like playing.

"Aren't you the same?" The little girl spoke mischievously.

Lin Xiaobei didn't want to be poor with her, and asked with concern: "Is it okay to have a rest yesterday?"

"Well, I slept through the day. How about you?"

"Me? Well, it's okay." Lin Xiaobei responded simply.

It's really hard to describe. First, I met a patient with abortion syndrome, and then I had a life-and-death rescue in the infusion room. After supper at night, I met an aunt who was stuck in a fishbone.

Liu Xu would definitely not believe it, how could he encounter so many things in one day?Is he a genius?
I don’t know what happened to that aunt yet.

Today's surgery is a thoracic surgery, two bullae resections and one atelectasis lobectomy.

Because he overslept during the day and had something to do at night, Lin Xiaobei didn't know the basic condition of the patient.

This is also the reason why he hurried on the road in the morning.

He seized the time to browse through the electronic medical records. There was nothing special about the bullae patient, the cardiopulmonary function was normal, and the clinical symptoms were not obvious. They were all discovered during the physical examination.

But the patient with atelectasis was very bad. The medical records showed that he was 76 years old, had a history of coronary heart disease (nearly half a year), and had a very high risk of grade III hypertension. The current oral antihypertensive drugs were controlled at 150/86mgHg.Pulmonary ventilation limitation ≥ 50%.

ECG (electrocardiogram) suggested sinus rhythm, HR 65 beats/min.

Blood routine Hbg (hemoglobin, commonly known as hemoglobin) 95g/L, mild anemia.

These are all good, the physical condition of the elderly over 70 years old is not bad.

But the problem is that his CT and MRI showed a large area of ​​cerebral infarction, and the ultrasound also showed carotid atherosclerotic plaque 18.2mm×6.9mm (huge plaque).

Such elderly surgery is a great test for anesthesiologists.

First of all, the surgical trauma alone is a big blow to the elderly. Even the simplest pectus excavatum surgery is unbearable.

In addition, due to the huge atherosclerotic plaque, the control of blood pressure is very strict. It should not be too high or too low.

The last headache is that even if the operation goes well, it is unknown whether the elderly can return to the ward smoothly after the operation.Patients with cerebral infarction are prone to postoperative disturbance of consciousness, delayed awakening, severe and even poor breathing and unable to leave the ventilator, and a series of subsequent complications due to tracheal tube.

The first two operations went smoothly as expected. The patient woke up quickly after the operation. After removing the double-lumen tube (special endotracheal intubation for chest patients), he was observed for 20 minutes and then transferred to the ward.

It was about three o'clock in the afternoon when the third patient came in.

Surgeons at this point feel tired.

And the patient is weaker due to the fasting of water.

Lin Xiaobei frowned from the moment the patient entered the operating room.

The old man was sluggish, and his consciousness was a little confused while lying on the bed. To communicate with him, he had to speak loudly and say it several times.

What is also unbearable is that the breath he exhales is very smelly, and the smell is unbearable.

Lin Xiaobei held back, Liu Xu stood aside and finally couldn't hold on anymore, she held her nose and said, "Mr. Lin, I'm going out to drink some water."

All anesthetics and equipment are ready.

Lin Xiaobei was still hesitating.

Do you want to take the risk?
The intermediate peak experience that started last night was a super failure. Two model specimens were damaged in a row, which made the system very angry.

The system blamed Lin Xiaobei for not caring about humanity.

Lin Xiaobei was very wronged. If the model was a real person and he yelled out in time if he felt uncomfortable, he would not have hurt him.

But he kept silent all the time, Lin Xiaobei didn't know what to do, it all depended on his touch.

He has always been very confident in his own touch, but in the eyes of the system, he is completely a fool, his actions are extremely rude.

Hastily ended with the most embarrassing record of 0 points.The system still gave Lin Xiaobei some face, let Lin Xiaobei continue to experience the primary peak mode, and helped him regain his confidence.

Lin Xiaobei did not continue to choose neuraxial anesthesia.He has practiced this project for a long time, from 30 cases in the first 8 minutes to the highest record of 165 cases.

Although the assessment given by the system is an introduction, Lin Xiaobei thinks that he has reached his limit.Bolt can run 9 seconds for 26 meters, but no matter how fast you make him, even 1/100th of a second, it will be difficult to reach the sky.

This is the limit of human beings at present.Lin Xiaobei is still very confident in his puncture skills. In reality, there are only a handful of anesthesiologists who can find out faster than his hand speed.

Then you should start to experience the peak mode of other skills, no longer hanging on a tree.

Lin Xiaobei chose "precise target injection of local anesthetic".

This skill may seem simple, but it requires a lot of skill.

This name also makes many people who do not understand anesthesia mistakenly think that it is local anesthesia, referred to as "local anesthesia".

Of course, it is reasonable to say that this technique does belong to the scope of local anesthesia, because its basic idea is to inject local anesthetics into local tissues for anesthesia.

But the four words "precise target" embody its essence: accurate!

The simplest analogy is shooting. Although they all hit the target, the gap between 0 ring and 10 ring is obvious.

Lin Xiaobei chose the 60-minute experience, but what made him ashamed was that it was worse than the result of the comprehensive test of spinal anesthesia skills.

[Super Anesthesiologist Peak Mode Skill Operation Experience Results Table]

Operator: Lin Xiaobei

Operation skills: precise target injection of local anesthetic (T3-4 paravertebral nerve block)

Experience time: 60min
Number of completed cases: 155 (normal ≥ 500)

Aseptic operation qualification rate: 85% (obvious progress)
Qualification rate of Pichu injection: 90% (significant improvement)
Needle direction: Deviation ≥ 10°
Angle adjustment ability: Poor
Positioning accuracy: ≤10%
Target injection success rate: ≤5%
Comprehensive experience evaluation: unqualified (not entry level)

Already accustomed to receiving negative reviews, Lin Xiaobei has now become extremely shameless in front of the system and accepts the evaluation results calmly.

As soon as he opened the old man's medical records in the morning, he was thinking about whether he should perform T3-4 paravertebral nerve block.

Is it really such a coincidence?
Just accepted the devil-like experience last night, and you are learning and selling today?
Is it intentionally guided by the system, or is it preordained in the dark?
None of this is important. What is important is how to anesthetize the old man lying on the operating bed, cooperate with the doctor to complete the operation smoothly, and then return to the ward safely.

"Mr. Lin, what are you still thinking about?" Liu Xu had already "drinked the water" and came back, standing by the side, waiting for Lin Xiaobei to issue orders.

Lin Xiaobei directed the previous two operations, and she performed them herself.Two cases of double-lumen endotracheal intubation were completed gracefully, and she was full of confidence and eager to try the third one.

"We won't insert a double-lumen tube in this one." Lin Xiaobei said lightly.

Liu Xu couldn't believe it, "Mr. Lin, you---"

It is not appropriate to make such jokes at this juncture.

His words aroused doubts from the surgeons and nurses, and all eyes were staring at him like an alien.

"Liuxu, position yourself!" Lin Xiaobei decided to put all his eggs in one basket. If he succeeds, the patient will get unexpected results. If he fails, it's okay to change the anesthesia method.

"Put, what position are you in?" Liu Xu asked stammeringly, she couldn't keep up with Lin Xiaobei's rhythm at all.

The two have always cooperated tacitly and have a tacit understanding.But ever since the old man came in, Liu Xu felt that her thinking had gone off track with Lin Xiaobei.She had no idea what he was thinking, what he was going to do, what was his purpose for doing it.

This feeling made her very depressed.

"Neuraxial anesthesia!" Lin Xiaobei said while preparing an epidural puncture kit.

(End of this chapter)