super anesthesiologist

Chapter 8 Neonatal Resuscitation (please collect, recommend, thank you!!!)

Midwives are experienced and familiar with first aid procedures.As soon as Lin Xiaobei finished speaking, she immediately prepared the disinfection bag and the umbilical artery and umbilical vein catheter.

The most critical step in neonatal resuscitation is the rapid establishment of airway.

Although newborns have faster blood circulation, high nutrient content in cells, and stronger hypoxia tolerance than adults, they are more prone to complications because they do not have enough oxygen reserves, especially damage to brain tissue.

Lin Xiaobei skillfully picked up the laryngoscope and pried open Xiaobao's mouth, which was the size of a ballpoint pen holder. The tissues in her mouth were less developed. The tongue was like a small piece of triangular konjac, and the epiglottis was only a little bit. A small polyp.

Just now Dabao inserted a 2.5mm endotracheal tube, and Lin Xiaobei prepared a 2mm endotracheal tube the first time he saw Xiaobao.

His prediction was correct, even though the inner diameter was only 2.0mm, the endotracheal tube looked extremely thick in Xiaobao's mouth.

When the tip of the trachea passes through the glottis, it seems to be stuck, and there is a lot of resistance.In order to prevent damage to Xiaobao's airway, Lin Xiaobei gently turned the end of the catheter before slowly screwing it in.

Unlike Dabao, Xiaobao did not respond when the endotracheal tube was stimulated.

Her condition is critical!
After inserting the tube, Lin Xiaobei was immediately connected to pure oxygen, gently squeezed the ball, and at the same time, he used one free hand to gently press on Xiaobao's manubrium (chest compression) to help her return to normal heartbeat as soon as possible.

The midwife saw that Lin Xiaobei had handled the airway well, and immediately began to intubate Xiaobao's umbilical vein.She straightened Xiaobao's umbilical cord with vascular forceps and sterilized the stump.

The diameter of the umbilical cord of a normal newborn is about the size of the middle finger of an adult male, and that of a baby is less than 2/3 of that of the little finger.

The midwife found the entrance of the umbilical vein and slowly inserted the tip of the catheter. It went smoothly at first, and she frowned when it entered about 5cm.

"What's wrong?" Lin Xiaobei asked.

"I can't get in, it's a big resistance."

She should have reached the navel chakra (commonly known as the "belly button"), where there are many wrinkles, and the direction of the catheter is not easy to grasp.

"Pull the umbilical cord down the abdominal wall, tilt it at 50°, and try it toward the head." Lin Xiaobei instructed.

The midwife tried it, but there was still a lot of resistance, and the front end of the catheter seemed to be discounted. She didn't dare to use any more force, "No, Teacher Lin, why don't you try it?"

If the umbilical vein channel is not established, Xiaobao cannot be infused with fluids or given medication, and there is no delay.

"Liu Xu, come and help me."

Xiaobao's lung capacity is estimated to be 6-8ml, Lin Xiaobei can't trust the midwife.He handed the simple respirator to Liu Xu, and taught her to pinch it slightly with his thumb, as long as the ball is slightly dented.

She has just given Dabao a pass and has actual combat experience.

"Come and press." Lin Xiaobei ordered the midwife again.

Let Liu Xu give Xiaobao oxygen and press his heart at the same time like him.

He took the umbilical vein catheter, gently retreated to a depth of 3cm, and then slowly entered, gently and slowly rotating the tail end of the catheter as he advanced.

Indeed, the resistance suddenly increased at the position of the umbilical chakra. Lin Xiaobei lifted the stump of the umbilical cord, and also pulled the umbilical cord down the abdominal wall to 50°, and slowly rotated towards the head.

Different people will have different results for the same operation. It cannot be explained in exact words, just two words: feel!

Insert it at 7cm, and withdraw it with a 3ml syringe with built-in heparin water (to prevent blood coagulation in vitro), which has two functions: one is to check whether the catheter is in the umbilical vein; the other is to remove air.

The bright red venous blood filled the syringe in an instant, and the withdrawal was smooth without resistance, and the catheterization was successful.

Liu Xu was a little surprised, she wanted to speak but didn't say anything, she didn't dare to speak too much because there were so many people on the field.

Lin Xiaobei understood her question, but didn't have time to explain it in detail.He fixed the catheter firmly on the stump of the umbilical cord with sutures, and then made an "H"-shaped bridge on Xiaobao's belly with hypoallergenic adhesive tape.

Immediately after the establishment of the venous channel, a balance solution (a solution close to the normal extracellular fluid of the human body, commonly used in vitro venous crystalloid) was connected, and then adrenaline (1:10000) was dripped.

The effective and timely rescue measures quickly made Xiaobao's condition better, and his red-purple complexion had turned rosy.

叮！林小北的脑海里像课间铃声响了一下：【新生儿抢救成功，气管插管术：+10；静脉置管术：+5；基础理论知识掌握水平：+10奖励:能量药水：1支；金手环 2只】

Wow, there are quite a lot of rewards, Lin Xiaobei was secretly delighted, when suddenly a few words popped up on the panel: [Keep on working hard]!
make persistent efforts?Is there any risk to the patient?
Little Treasure's current vital signs are different than when she was just born. Careful observation can even reveal that she has weak struggling movements. At this time, her Apgar score has reached at least 5 points.As far as the current state is maintained, at least her life is not in danger for the time being.

Who would have an accident then?Li Mengxia?
Lin Xiaobei was thinking about it secretly, Zhang Wei nodded in satisfaction after auscultating Xiaobao's heart and lung area and said, "Yes, the heart rate has risen to 130 (beats/min)."

Xiaobao weighs only 0.8kg.

The midwife quickly wrapped Xiaobao, handed it over to Zhang Wei, and transferred him to the neonatal intensive care unit.

Both big and small treasures left the operating room safely, and now the main target of protection is the oversized man lying on the operating bed---Li Mengxia.

Lin Xiaobei looked at the monitor, her vital signs were very good: BP 145/89, HR 78, SPO2 99%.

She has no problems so far and the anesthesia is working well from the look of comfort on her face.

"Mr. Lin, can I ask you a question?" Liu Xu quietly asked Lin Xiaobei after everything returned to normal.

"What, you said?" He knew she had something on his mind just by looking at her like that.

Liu Xu seemed a little apprehensive, and whispered in Lin Xiaobei's ear, "Just now, why was that little treasure's veins so red?"

Lin Xiaobei smiled slightly, this girl is still thinking about that matter, which also proves that she is smart, studious and careful.

"Because the umbilical vein flows arterial blood!" He told her easily.

"Ah? Why?" Liu Xu was puzzled.

Arterial blood in normal people supplies oxygen, so it is bright red, and it is the same reason why people's whole body is black and purple when they are hypoxic; while venous blood removes waste and does not contain oxygen, so it is dark red.She still understands this common sense.

But there are some exceptions.

"The umbilical vein is formed by the confluence of capillaries on the fetal side of the placenta. It transports the oxygen and nutrients provided by the mother to the fetus and promotes the growth and development of the fetus. Therefore, although it is a vein, what flows in it is arterial blood."

"Oh, so the umbilical artery is flowing venous blood?" Liu Catkin made the analogy.

Lin Xiaobei nodded appreciatively, "The umbilical artery originates from the fetal heart and travels to the placenta. It mainly transfers the fetal metabolic waste and carbon dioxide produced by respiration from the placenta to the mother's body. Although it is an artery, what flows in it is Venous blood.”

"I see!"

"Actually, there are two such unusual arteries and veins in our adult body."

Liu Xu was immediately aroused, "Which two are they?"

"Go back and read the book yourself." Lin Xiaobei played tricks on the discrepancy, she couldn't answer whatever she asked, and let her develop the habit of asking questions and answering them herself.

"Humph!" Liuxu hit a snag and was a little unhappy.

Li Xiumei on the stage suddenly asked, "Doctor Lin, how is the patient's blood pressure?"

"Fortunately, 146/88, heart rate---" Lin Xiaobei paused, Li Mengxia's heart rate was changing, from 81 to 102.

Catkin re-measured blood pressure, 110/72.

Lin Xiaobei clicked the blood pressure button again, inflated, 106/65, HR 123.

"Director Li, how is the bleeding at this time?"

Li Xiumei stopped what she was doing, "It seems a little too much."

"Li Qiong, look at the suction tank, how much is there?" Lin Xiaobei was worried after asking, so he went to check it himself, 1800ml.

"Hu Shuang, how much saline (0.9% sodium chloride, normal saline) did you drink?"

"About 300 (ml)."

Lin Xiaobei looked at the pieces of gauze on and off the stage, several pieces had already been dyed red, it is estimated that Li Mengxia had already produced more than 1600ml at this time (hemorrhage).

The blood pressure is still dropping, and the heart rate has risen to 130 beats/min.

"Doctor Lin, hurry up and apply for blood!" Li Xiumei forced herself to be calm, but Hu Shuang kept handing gauze pads to oppress her.

"You go to get the artery pierced, and check your blood gas after the piercing is done." Lin Xiaobei turned on the blood transfusion system and applied for 6 units of suspended red blood cells.

"Ms. Lin, I, I haven't worn it." Liu Xu said awkwardly.

"Oh." Lin Xiaobei smiled secretly. She was still a student who had just entered the clinic, and vascular puncture was indeed too inscrutable for them.

This skill needs to be trained slowly and cannot be taught overnight.

After Lin Xiaobei applied for the blood, he hurriedly started to do it himself. Under Liu Xu's surprised and envious eyes, he smoothly threaded the right radial artery, connected to the blood pressure monitor, 85/56mmHg.

At this moment, Li Mengxia suddenly moaned: "Doctor, I'm panicked!"

　Yuan Lei, Liu Xinghun******, Yindan Shilin Lan Ingenuity and Dictatorship, etc., thank you for your support!

　　


(End of this chapter)