super anesthesiologist

Chapter 31 Telephone Guidance
Lin Xiaobei was lying on the bed safely. Tonight, he was neither the assistant shift nor the superior teacher of the doctor on duty. Even if the hospital was overwhelmed at this point, it was impossible to come to him.

Is there a problem with the system?Where can I quickly accept the task at this time?
But the phone rang untimely, especially loud and piercing in the quiet small house.

Lin Xiaobei picked it up and saw that it was Wang Xuguang, a trainee doctor in the department.

"Why would he call me at this time? Did he make a mistake?" Lin Xiaobei wondered secretly.He has brought Wang Xuguang several times, but the relationship between the two is not very close.

He only knew that Wang Xuguang was from a small township hospital in the outer suburbs.

"Hello?" Lin Xiaobei still answered politely.

Wang Xuguang's eager voice for help immediately came to his face: "Mr. Lin, where are you?"

"I'm resting at home, what's the matter?"

"Mr. Lin, come and save me, I'm doomed." He cried mournfully.

Lin Xiaobei quickly comforted him: "Don't worry, what happened? Take your time."

Wang Xuguang's voice was trembling: "I just induced a patient with general anesthesia and inserted an endotracheal tube, but found that the anesthesia machine was not working."

"You, you didn't check whether the anesthesia machine is working properly?" Lin Xiaobei asked in surprise. This is the most basic idea an anesthesiologist should have.

"I, I forgot." Wang Xuguang said nah.

grass!Lin Xiaobei cursed in his heart.

Those trainee doctors used to be lazy and careless in their original units, often rushing to give all the general anesthetics to the patients without adequate examination and preparation, but when preparing for endotracheal intubation, they found that either one was missing or the other was missing .

The most bizarre thing is that once a trainee doctor pushed the muscle relaxant without even preparing the laryngoscope.

In a large anesthesia department of Lin Xiaobei's level, due to the large number of people and well-equipped equipment, making some careless mistakes will generally not lead to catastrophe.

But in township hospitals like Wang Xuguang's, there is a lack of everything from professional technicians to advanced first aid equipment, and a little negligence may bring fatal risks to patients.

Because of this, every time before Lin Xiaobei takes trainee doctors for anesthesia, he asks them to prepare all first aid drugs and equipment, check the function of the anesthesia machine, and replace the soda lime in time.

Let them develop the philosophy of not fighting unprepared battles.

Wang Xuguang improved a lot under his strict requirements, but he didn't expect to return to his original condition only a few days after returning to his hospital.

At this time, blame has no meaning, but it will make him more flustered.

Lin Xiaobei comforted him over the phone: "Don't panic, haven't you already inserted the endotracheal tube?"

This is the crux of the problem, as long as the airway is maintained, all problems will be solved.The most fearful thing is that the muscle relaxant is pushed and the patient is found to have a difficult airway.

For most anesthesiologists in hospitals of Lin Xiaobei's level, severe difficult airway is a very difficult problem, let alone Wang Xuguang and his like.

"But, but the anesthesia machine can't work, it's useless. I pushed 50mg of rothium ammonium." Wang Xuguang was so flustered that he had no idea at all.

I just wanted to curse, and gave the patient a sufficient amount of muscle relaxants without preparing anything.

"It doesn't matter if the anesthesia machine is not working, you can pinch the airbag to help the patient breathe!" Lin Xiaobei guided calmly, trying not to put pressure on him.

Normal anesthesia machines are divided into two modes: manual and machine-controlled breathing according to the power source.The manual mode is mainly used for oxygen supply during the induction period or to assist patients in recovering spontaneous breathing after surgery. Its advantages are that it can follow the patient's breathing rhythm, better control the tidal volume, and provide sufficient oxygen.

The disadvantage is that it is too tiring, and it will make people's hands sore and cramped after a long time.

Machine-controlled breathing is to forcibly send oxygen into the patient's lungs by setting a series of parameters on the ventilator with the support of power supply.This purely mechanical operation is unavoidable to be simple, rough and not fine enough, but it saves trouble.The anesthesiologist only needs to adjust the breathing parameters according to the vital signs of the patient, and generally it will not have adverse effects on the patient.

"No, pinching the ball doesn't work at all, this rotten anesthesia machine can't give oxygen at all. Fucking parallel imports..." Wang Xuguang cursed on the phone.

"It's really impossible, you can blow the patient into the endotracheal tube! Don't you even know how to breathe mouth-to-mouth?" Lin Xiaobei asked angrily. On the phone, he heard the monitor's SPO2 alarm sound getting louder and louder, and his heartbeat The sound is fast and loud.

Wang Xuguang's patients began to show symptoms of hypoxia.

Cardiopulmonary resuscitation, especially initial cardiopulmonary resuscitation (Basic Life Support; BLS) is a basic first aid skill that every medical staff must master, mainly in three aspects: keeping the airway open (A, airway); establishing effective artificial respiration (B , breathing); establish an effective artificial circulation (C, circulation), medically referred to as ABC resuscitation.

The core of this is effective artificial respiration and artificial circulation.There were no medical tools to assist in the outdoor first aid. The ambulance personnel gave the patient mouth-to-mouth oxygen, and then pressed the chest to maintain the heartbeat.

This scene can be seen in many first aid posters.

As a regular anesthetist, Wang Xuguang even forgot this basic skill in a panic.His condition is actually much better. No matter how poor the condition is, he is still in the operating room of the hospital. Basic rescue equipment should still be available, and he even inserted an endotracheal tube for the patient.

He just needs to find a way to maintain oxygen for the patient.

Lin Xiaobei woke up the dreamer, Wang Xuguang paused on the phone, and said to himself as if enlightened: "Yes, I was really confused, why didn't I think of this?"

It seems that he blew a few breaths on the patient according to Lin Xiaobei's instructions and achieved good results. The alarm sounds were much weaker. Judging from the sounds, the SPO2 should have returned to more than 90% (no hypoxia).

"Just support like this, pay attention to the patient's blood pressure, and use some antihypertensive drugs if necessary." Lin Xiaobei continued to guide.Although this kind of operation solves the problem of hypoxia, but because the operation directly faces the trachea, the airway stimulation of the patient is very strong, and it is easy to cause an instantaneous spike in blood pressure.

If the patient is an elderly patient or has a history of high blood pressure, it will be even worse, which is likely to stimulate cerebral blood vessel rupture.

That is not a serious problem, but a major medical accident that will kill people.

"Ms. Lin, we don't have urethane (an ordinary antihypertensive drug with a mild effect), only nitric acid (a strong antihypertensive drug), and we don't have an infusion pump." Wang Xuguang said hesitantly on the phone.

His concerns are not unreasonable. The use of nitrous oil is very refined, and a little more will cause the patient's blood pressure to drop sharply.Generally, for accurate quantification, a designated syringe (50ml) is used to configure the target-controlled infusion according to a mathematical formula (the electronic infusion pump accurately administers the drug according to the set parameters).

"It doesn't matter, you first dilute a nitrate oil into 100ml of saline, then draw out 10ml with a 1ml syringe, and then dilute this 1ml with clean saline to 10ml. Push 2ml to the patient first, and observe the effect, if it is not obvious Increase the dose."

正常的配置是将硝**油30mg加入5%G.S稀释至50ml注射器内，按体重计算，相当于1ml/h=0.1μg/kg.min（常用剂量：0.1-0.2μg/kg.min ）。

Without the help of precision medical instruments, one of the basic principles for the safe use of highly potent drugs is: test administration of low concentrations and small doses, and increase slowly.

The biggest safety hazard of drug action is the word "concentration".Just like drinking alcohol, you can't stand Erguotou at 62° for one or two drinks, but you can mix one bottle with cold boiled water into 10 bottles, and drink a few more bottles.

There was silence on the phone for a while, and Wang Xuguang could be heard directing the nurses.

After a while of busyness, Lin Xiaobei guessed that the process was about the same, and asked, "How is it going?"

"Well, it's much better. At this time, the blood pressure is 130/79 (mmHg), the heart rate is 98, and the blood oxygen saturation is 96%." His tone was much calmer, and he seemed less anxious than before.

"Ding!" [Use of basic knowledge: +2].

Is this the so-called host quick acceptance task?Not even a reward.

Lin Xiaobei was a little disappointed, and was about to hang up the phone, but Wang Xuguang continued: "Mr. Lin, you should come here quickly, I need your guidance."

He reported an address in the outer suburbs of the city.

　Thanks to Cai Xueming Mingxue, Endless Medical Road, 2019***0535 and other relatives for their recommendation tickets.

　　There are more than 8 words, and there will be [-] in the collection soon. Although no one recognizes me, Zuo An is still a little excited. Thank you for your support!
　　Pujiezi encourages himself, haha!

　　


(End of this chapter)