super anesthesiologist

Chapter 41 "Three To" (Please recommend, please collect, thank you!!!)

On Saturday, the anticipated and exciting moment finally arrived.

Lin Xiaobei thought he came early enough, after all, this was the first time he was appointed by a surgeon, so he had to prepare well.

When he arrived in the operating room, Liu Xu was already sitting there.

On the table of the anesthesia machine, the tracheal tube, laryngeal mask, video laryngoscope, dental pad, and suction tube are all neatly and orderly placed there.

On the table of the anesthesia cart, muscle relaxation, analgesia, sedation, rescue, heparin water, and various drugs are diluted with syringes, and the names and concentrations of the drugs are written, and the rescue drugs are also labeled with red markers according to Lin Xiaobei's habit , lined up like pens in a stationery store.

Anesthesia baskets, arteriovenous puncture kits, epidural anesthesia kits, pressurized bags, and blood warmers are all good.

Ultrasound was also pushed aside.

She has prepared almost all the equipment and medicines that may be used in all anesthesia methods.

"You came so early?" Lin Xiaobei asked in surprise.

It's not a matter of time to prepare these things, it's only 7:45 now, this girl dare to rush to the hospital before 7 o'clock.

"I have to get ready first." Liu Xu said briskly.

"Don't be in such a hurry." Lin Xiaobei said with a smile.

Every medical student is like this. At the beginning, work is like a power machine with full power, and the enthusiasm is high.

Today's patient's anesthesia is of great significance to Liu Xu. This is the first time since she participated in the training that she has time to carefully prepare for an anesthesia of a difficult case.Although I had done many complex and dangerous cases with Lin Xiaobei in the past, most of them were emergency cases. They were all done at the last moment. I didn't know how to deal with it in a hurry, so I could only watch Lin Xiaobei at work.

There is plenty of time today, and the opportunity to do it has greatly increased, so she must cherish it.

"Has the soda lime been replaced?"

"It has been changed, and the anesthesia machine has also passed the quality inspection."

Lin Xiaobei nodded, this is the difference between Liu Xu and Wang Xuguang.The anesthesia machines in their department are inspected by engineers every night after get off work, so there are usually no problems the next day.However, Lin Xiaobei still has the habit of checking whether the tools are fully equipped and whether the anesthesia machine is working properly before anesthesia.

details make a difference.

After a while, the nurses also came, bringing a shy little girl, young and ignorant, who looked like an intern.

"morning!"

"Morning, Miss Hong!" Liu Xu's voice was very sweet.

"Which one of you is going on tour today?" Lin Xiaobei asked.

"I am on tour, and Ye Hui is on stage." Qiu Hong replied, and then directed the intern, "Come with me, check the instrument kit, the disinfection kit, and learn how to check and check. If the operation starts and you find something is wrong, it will be troublesome." .”

Here, Liu Xu began to discuss the specific anesthesia plan with Lin Xiaobei.

"Mr. Lin, what are you going to do?"

"Look at the specific situation of the patient first."

"You have to teach me later, let me try all the mobile phone opportunities first." She said playfully.

"Yes, but I only give you two chances for arteriovenous puncture." Lin Xiaobei said with a smile, which also had a hint of encouragement.

A local hematoma is likely to form after a failed vascular puncture, and it is difficult to find the arterial pulse after pressure and touch, and the trauma and stimulation will lead to spasm and occlusion, and the difficulty will increase sharply when the blood vessel is punctured again.

Generally, doctors who are in advanced training are only given one chance to try it on.

Lin Xiaobei gave Liu Xu two chances to save face. She did so much homework for this patient, which is a kind of reward.

"Thank you, Teacher Lin."

"Let's look at the medical records first, and see if the patient's condition has improved in the past few days." Lin Xiaobei suggested.

"Yes." Liu Xu opened the medical record.

The test results last night showed that Wang Yuansheng's postprandial blood sugar dropped to 13.8mmol/L, and his fasting blood sugar was 10.6mmol/L, still high, but much better than that day.

And as the endocrinologist said, because this kind of patient is usually used to high blood sugar, he should not drop it too much in a hurry, otherwise it will easily cause hypoglycemia coma.

The basic vital signs showed that the blood pressure was 155/82 beats/min, which was barely acceptable.

The patient did not enter the room until 8:30.

After a few days of recuperation, it seems to be better than that day, at least his complexion doesn't look bad.

The old man was helped to the operating bed, connected to ECG monitoring, HR 65 beats/min, BP 179/102mmHg, SPO2 93%.

"Mr. Lin, why is the patient's blood pressure so high?" Liu Xu asked in a low voice.

"Let's observe first." Lin Xiaobei calmly put the mask on Wang Yuansheng's mouth, let him inhale oxygen, and the SPO2 slowly rose to 98%.

It is not uncommon for blood pressure measurements to differ from those in the ward. Although most patients say they are not nervous, they still have fear in their hearts when they enter the operating room.This kind of emotional fluctuation can easily lead to violent fluctuations in blood pressure, which will slowly drop after quieting down.

Measured after 2 minutes, BP 168/95mmHg.

"Wang Yuansheng, do you know where you are now?"

"In the hospital." The old man was still a little vague.

"I know you're in the hospital, but you're in the operating room now, you're going to have surgery today, you know?"

"Ah, are you having surgery today?"

"Yes, don't panic, cooperate with us, try our best to do well for you, and recover soon."

Before the patient is about to be anesthetized, relevant language communication is a recently popular communication method between doctors and patients. It is called "literati care" in medicine. It seems unnecessary, but it can actually give patients great comfort and get unexpected benefits. Effect.

To Cure Sometimes, To Relieve Often, To Comfort Always.

This is the epitaph of Dr. Trudeau who died on the shores of Saranac Lake in Northeast New York, referred to as "Three To". The Chinese translation is: sometimes to heal;

When Lin Xiaobei was reading medical literature, he was deeply touched by these sentences and kept them in his heart.

"Listen to his lungs."

Liu Xu put the pendant under the collarbone and listened for a while, then listened along the midline of the collarbone.

"It's much better than that day, there seems to be no rales."

Lin Xiaobei also put on a stethoscope himself, and it was indeed a drum sound, which is characteristic of emphysema.

Turn the old man sideways, the bedsore on his back is still there, and there are small ulcers near several segments of the spinal cord, the infection is serious, so there is no need to consider giving him spinal anesthesia.

"Get ready for anesthesia," he said.

"Huh?" Liu Xu seemed to feel disinterested and disappointed.She was used to Lin Xiaobei's unexpected surprises.

"I have given the medicine, 2mg of milchlor, 7.5ug of sulphate," he said, and turned on the target control pump, and adjusted the speed of the acetaminophen pump to 0.3mg/kg/min.

Wang Yuansheng's consciousness slowly disappeared.

"I started to give muscle relaxants, 10mg of rothium ammonium, and pay attention to the oxygen supply through the mask."

"Mr. Lin, is your medicine missing?" Liu Xu questioned.

This is the induction dose for children, at least 50 mg for adults based on Wang Yuansheng's weight.

"Not a lot, just meet the intubation conditions."

"You don't want to insert a laryngeal mask?" She asked again. She was under general anesthesia in the supine position, and tracheal tubes are rarely inserted now, except for long-term operations.

"This patient needs a gastric tube during the operation."

"Oh." Liu Xu blushed, she really didn't expect this question.

The intubation went smoothly, and under the visual laryngoscope, the anatomical structures near the patient's glottis were clearly exposed.

This kind of laryngoscope is really a good thing, it is convenient and reliable to use, and it is the coveted thing of almost all trainee doctors.It is the most headache for director Lin of the department, because it is the easiest to lose.Wang Xuguang stole one.

"You go through the artery first." Lin Xiaobei moved the ultrasound.

His technique does not require visual guidance, but in order for Liu Xu to fully understand, he still exposed the visualization to her.

After the artery is pierced, the vein is continued.

Under Lin Xiaobei's guidance, or maybe because he had done enough homework, Liu Xu's blood vessel puncture today was very successful, and all the needles were in place.

She was very excited, and her little face was flushed like a peach blossom on a human face.

"Now you come to see me."

Lin Xiaobei opened the epidural bag, took out the lumbar puncture needle, and connected it to the syringe.

"Mr. Lin, you don't need nerve stimulation needles?" Liu Xu asked strangely when she saw that he was going to have a nerve block.

"No, it's a waste to use nerve stimulation needles with ultrasound guidance. A needle costs more than 200. Although this patient has medical insurance, it costs a lot. We can help him save a little."

After Lin Xiaobei finished speaking, he began to disinfect, placing the ultrasound probe on the patient's abdomen and sliding it back and forth, with gel on the surface.

"Look, this is the rectus abdominis, and what I'm going to do right now is block the transverse fascia."

"This is the liver, the empty gourd-shaped shadow is the gallbladder, next to it is the spleen, and the large black shadow below is the stomach. Going up is the lungs, and these two white lines are the lower edge of the lungs."

"See, this is the common bile duct, and the middle section is obviously thickened. This is a manifestation of expansion after being blocked, indicating that the bile does not flow back smoothly."

"This is……"

"This is……"

"This is……"

"..."

Lin Xiaobei kept sliding the probe, pointing at the screen and explaining carefully.

However, this knowledge is profound and difficult to understand. Although Liu Xu is a top student, it is difficult to accept it for a while.

It will not take a day to thoroughly understand these knowledge points, it needs to be accumulated and comprehended slowly.

"It's not enough to hit the transverse fascia, it can only play an analgesic effect. The dose of muscle relaxation I induced just now is very small, so it must rely on the effect of local anesthetic."

"See, this is the celiac plexus, this is the hepatic artery, and the left and right hepatic plexuses form a sheath around it. We can completely block this place to satisfy the operation."

"I'm also doing targeted injections around the nerve collaterals, and that's where the needle goes."

……

For example, almost no one can understand the scriptures except Lin Xiaobei himself, but he speaks clearly and logically, and he guides them well, which makes people feel not so boring, even Qiu Hong and Ye Hui couldn't help but come to watch.

As soon as they finished, the sensor door of the operating room opened automatically, and Hu Wenmao and Zheng Quan walked in with a large bag of equipment.So timely!

"Is hemp ready?" Hu Wenmao asked with a smile, he was full of confidence in Lin Xiaobei.

"The anesthesia is complete." Lin Xiaobei corrected.

"Okay, I knew that Dr. Lin has a solution." Hu Wenmao complimented, but when he saw the endotracheal tube in Wang Yuansheng's mouth, his face immediately turned gray, and he said disappointedly: "You, did you use general anesthesia for the patient? "

"Yes, but please don't worry, as long as your operation goes well, I can guarantee that he will wake up soon after the operation and will never go to the ICU." Lin Xiaobei promised.

　Thank you Fatty Yang, Master LDA, Sskura is good, 2020***6170, bustling ***, Xiaoyi, who is angry with the purple seal demon, Nocturne ecstasy.Thank you for the recommendation tickets from the Royal Academy 402 and others! ! !

　　please everyone

　　


(End of this chapter)