super anesthesiologist

Chapter 6 Pregnant woman weighing 270 catties

Tuesday afternoon.

"Ms. Lin, there will be a caesarean section later." Liu Xu told Lin Xiaobei after receiving a call from the duty room. She was a little excited when she came to the emergency room the first time she was on duty with him.

"Ah."

"It's said to be twins."

"Ah."

"Still premature."

"Ah."

"28 weeks."

"Ah."

……

"Did you hear it?" After the report, Liu Xu was a little annoyed. Although she was a newcomer, she still knew that the patient's condition was not good.But why is Teacher Lin still so calm?

"I'm listening!" Lin Xiaobei said unhurriedly.

"Aren't you going to express your opinion?"

"What's your opinion? Just be on call at any time."

"This cesarean fetus is only 28 weeks old." Liu Xu reminded again.

"I know!" He had been waiting for a task prompt from the system last night, and what should come finally arrived.

"Teacher Lin!" Liu Xu was very dissatisfied with Lin Xiaobei's casual attitude. She didn't want to follow a teacher who didn't care about her work and neglected her duties.

"I'm almost ready!"

"What have you prepared?"

Lin Xiaobei asked back: "What do you think we should prepare for this operation?"

Liu Xu bit her lip and said after deep consideration, "Newborn rescue equipment, anesthesia kit, ventilator, um..."

"no yet?"

Liu Xu blushed, but couldn't speak.She has been watching "Modern Anesthesiology" recently, but there is too much content, and she can't figure it out for a while.

Lin Xiaobei counseled her and said: "The main part of what you said is correct, but there are still many important details that are not in place. It's not that you can't think of it, but that your thinking is wrong."

"Please enlighten me." Liu Xu bowed.

"You should reorganize your thinking, for example, analyze what preparations we should make from the two different perspectives of the patient and the doctor. What are the characteristics of this patient, what complications may occur during the operation, and how should we deal with it."

Liu Xu suddenly opened his eyes and said in an orderly manner: "We should fully communicate with the obstetrician. Amniotic fluid embolism, uterine hemorrhage, and fetal asphyxia may occur during the operation... For the patient, the risk of anesthesia must be explained to the patient and his family first. The anesthesia method may be changed during the operation, and the patient may need to be sent to the Intensive Care Unit (ICU) for observation after surgery..."

"Children can be taught!" Lin Xiaobei applauded. It is quite rare for a graduate student who has just started regular training to say so much at once.

Although she did not speak fully.

"We still need to contact the neonatology department. These two babies are only 28 weeks (normally about 40 weeks, the so-called "October pregnancy" is often said in the folks), and the development of each system is not perfect. After birth, they need to be given respiratory support. Transfer to neonatology department... and patients... and..."

Lin Xiaobei was eloquent, and Liu Xu pricked up his ears, concentrating on it, for fear of missing something.Every knowledge point in it seems commonplace, but it will definitely be of great benefit to her future career as a doctor.

"Stop talking, the patient will come down immediately, Room 16." Nurse Hu Shuang came to interrupt them, and disappeared after speaking.

All the nurses in the operating room of the anesthesiology department are good sprinters, with super-developed calves and gastrocnemius muscles, they run with clang and power, and the floor is trampled.

Lin Xiaobei and Liu Xu hurriedly packed up and went to Room 16.

"Ms. Lin, so you have already prepared it?" Liu Xu looked at the first-aid medicine and laryngoscope box in front of the anesthesia table, as well as two sets of first aid kits for newborns, and an endotracheal intubation kit. ...

She couldn't believe it.

"Otherwise!" Lin Xiaobei teased.

"When did you prepare?" She followed him in the morning, and he asked her to rest for a while when there was no operation at noon.

It must have been at that time, no wonder he was so calm, it turned out that he had a plan in mind!

"Ms. Lin, how did you know there would be a cesarean section?" Liu Xu asked curiously.

Lin Xiaobei pretended to be mysterious: "The secret of heaven must not be revealed."

"I bother!"

When the pregnant woman pushed in, Liu Xu's eyes widened like copper bells.

The pregnant woman is a super fat person. The wheels of the flat car are all crushed and skinned. They are crumbling and may be crushed at any time.The visual weight is more than 250 catties!
Female Hulk!

Lin Xiaobei, Liu Xu, Li Qiong and Hu Shuang helped her to the operating bed together.

Too fat, the pregnant woman is like a giant, and it is not an exaggeration to describe the head as "big as a bucket".Her two arms rested on the shoulders of Liu Xu and Li Qiong, thicker than an elephant's legs, making them grin their teeth.

The process of going to bed was really difficult, Lin Xiaobei and Hu Shuang lifted their legs, Catkin and Li Qiong supported their shoulders.The pregnant woman's legs are thick and heavy like concrete piers, and her body is like a huge, thick and raised wall.

Fortunately, she didn't fall down, otherwise Liu Xu and Li Qiong behind her would have been crushed into meatloaf.

After putting the pregnant woman on the bed, the four of them were exhausted and out of breath. Taking advantage of the rest time, Lin Xiaobei briefly checked the medical records:
Patient, Li Mengxia, female, 36 years old.

……

Weight 135kg!

The diagnoses in the informed consent form for surgery are: 1 Precious baby; 2 Twin pregnancy; 3 Pregnancy, 2 births, 0 Pregnancy 28 weeks; 4 Premature rupture of membranes; 5 Premature babies; 6 Pregnancy hypertension; Preeclampsia;  …

"Ms. Lin, this---" Liu Xu's scalp felt numb when she saw it. There are only 2-3 diagnoses in general, and the number of diagnoses for this pregnant woman is dizzying.

Her situation is far more complicated than imagined.

"I'll talk to the patient and sign. You come to prepare, first connect to the ECG monitoring."

"What are you going to do—anesthesia?" Liu Xu asked hesitantly. Generally speaking, spinal anesthesia should be chosen for cesarean section, but this Li Mengxia is too fat, can the thin waist needle do it?It feels like sticking a toothpick into a sponge.

"Try the numbness of the waist first." But Lin Xiaobei said it lightly.

After instructing Liu Xu, he took the medical record and printed the informed consent form for anesthesia, and walked up to the patient, "Li Mengxia, I am your anesthesiologist now, can you hear me clearly?"

"Yes, yes, doctor, hurry up." Li Mengxia was tired and anxious.

"Don't panic. Listen to me first. I'm your anesthetist, and I'm going to give you anesthesia from your back. This method of anesthesia is currently the most suitable for you, but it is possible to change the method of anesthesia during the operation. The risks and complications are agreed It is listed in the book, you can read it, and if you are willing to accept it, you can sign your name in the column of patients. In addition, you have many underlying diseases... Maybe you will be sent to the ICU for observation after surgery... Just take a look. "

"I'll sign, I'll sign." She couldn't wait, grabbed the pen and scratched a few strokes on the patient's signature, flying around, completely unclear.

As a soon-to-be mother of two children, the patient's mood is completely understandable.

"Get ready, I'll go out and communicate with her family." Lin Xiaobei instructed Liu Xu, then picked up the folder of the medical records and went out.This kind of complicated patients must be polite first, and all possible complications and treatment must be explained to the patient and his family in detail, and an informed consent should be signed.

I said the same thing to my anxious husband outside, and after signing, Lin Xiaobei hurried back to Room 16.

"Ms. Lin, it's up to you!" Liu Xu seemed to be saved.Yesterday, I followed Lin Xiaobei to try the puncture experience for spinal anesthesia. Today, I met such a fat man, and she really couldn't cope with this challenge.

Her small hand was stuck on Li Mengxia's fat back like a small stone sunk in the sand sea, and she couldn't feel the bony marks at all.

"Look at me." Lin Xiaobei waited for her to get out of the way and sat down, began to locate, mark, and then disinfect the towels...

This patient is really too fat, and local anesthetics injected with a No. 5 needle cannot penetrate the fat layer at all.It's no wonder that catkins can't find the feeling.

Lin Xiaobei directly punctured with a lumbar puncture needle, and the subcutaneous fascia was as thick as 5cm (the total length of the epidural puncture needle is only 10cm, and the part that can penetrate the skin is only 8cm; normal people can reach the subarachnoid space at this depth).He goes on needles, the supraspinous ligament, the interspinous ligament.

The layer of interspinous ligament is thicker, and Lin Xiaobei is already close to the tail of the lumbar needle.The length of the punctured part of the lumbar puncture needle is about 11 cm, which means that the thickness of the interspinous ligament exceeds 6 cm.

Lin Xiaobei pressed against Li Mengxia's back with the back joints of the index finger and middle finger of his left hand, compressing her subcutaneous fat like a spring. Pinch the tail of the needle with the pulp of the middle finger, and insert the needle slowly and forcefully.

This movement looks easy, but only those who have experienced it know how difficult it is. It requires the coordination of several fingers at the same time, and the strength in different directions at the same time.

Liu Xu was stunned, she saw Lin Xiaobei pressing Li Mengxia's needle insertion site into a deep dimple!

How much effort is required for this!

Finally reached the yellow ligament, Lin Xiaobei did not relax at all.Before Li Mengxia became pregnant, she should have been in good physical condition (except for being obese). Her ligamentum flavum was very tough and not easy to be punctured, especially when the lumbar puncture needle had almost reached the limit depth.

But this did not trouble Lin Xiaobei. He gently turned the needle tail, and there was a crisp "bang" sound!
The sound was actually very weak, but Liu Xu could clearly hear it, and she was amazed and pleasantly surprised to see a stream of cool cerebrospinal fluid trickle out smoothly from the tail of the lumbar puncture needle.

"Ding"! [Intraspinal anesthesia puncture skill +2; Reward: 1 gold bracelet]

It only took less than 3 minutes for the anesthesia to succeed, and Liu Xu couldn't help being dissatisfied, because she watched Lin Xiaobei directly puncture with a spinal anesthesia needle, then drove straight in, and then paused.This is a 270-jin fat man, and the waist anesthesia needle only barely exposed the tail of the skin in the end, and it might not be able to penetrate any deeper.

In fact, the puncture was not in place, and it was Lin Xiaobei who forcibly compressed Li Mengxia's subcutaneous fat, which was equivalent to indirectly extending the length of the lumbar puncture needle by 2cm.

This detail is hard to imagine as a newcomer, and Liu Xu didn't feel it.

The patient was lying on his back. In order to prevent supine hypotension syndrome in pregnant women, Lin Xiaobei asked Liuxu to increase the infusion speed, and at the same time, he turned the operating table to a left tilt of 30°.

The plane test is up to T5-6. Generally, the lower plane of the spinal anesthesia does not need to be tested, because it is definitely anesthetized from the foot to the hip.

"It's time to start!" Lin Xiaobei nodded to the surgeon and director of obstetrics Li Xiumei.

"Okay?" Director Li still didn't seem to believe it. She was talking about general anesthesia to the patient and his family.Of course, from the bottom of her heart, she is more willing to let the patient receive spinal anesthesia. General anesthesia has a great impact on the patient, especially the two pre-term babies in the abdomen.

The reason why she talked about general anesthesia with the patient was that she had consulted the general anesthesiologist in private.

"It should be fine!" Lin Xiaobei said confidently. The cerebrospinal fluid flowed so smoothly and the level of anesthesia was accurate. Is there any doubt about it?

"Well, notify the midwife and the neonatologist!" After speaking, Li Xiumei smiled at Lin Xiaobei: "Doctor Lin, please prepare two sets of emergency equipment for children."

Lin Xiaobei didn't make a sound, and pointed to the anesthesia table, not only for children, but even for adults, the rescue equipment is fully prepared.

"Okay! I'm starting to cut the skin!"

　Thank you Fluffy, Super Diamond, Mr. Yuer Ramen who can't run, and Cat for the recommendation tickets! ! !
　　Thank you!

　　Thanks a lot!

　　


(End of this chapter)