v3 Chapter 2765： Three Generations of Explorers
The key to the operation of balloon mask ventilation technology is closed and open airways.
If ventilation is unsatisfactory during single-person operation, two-person pressurized assisted ventilation should be considered, and the airway, oropharyngeal or nasopharyngeal airway should be used in conjunction with the method. This technique is mainly used when the patient is at risk of aspiration and reflux, and at the same time compresses the ring cartilage.
Even the laryngoscope and light rod guidance technology are used. The basic operation of a single balloon mask has been ruled out by Zheng Ren and will not be considered.
However, the double balloon mask was ventilated with small tidal volume and high frequency and high pressure oxygen, and it was found that the chest ribs of the patient were not obvious.
"Laryngeal mask!" Zheng Ren growled in a deep voice.
At the same time, he had put on sterile gloves, his gaze moved back and forth between the ECG monitor and the patient, but he did not make a tracheotomy immediately.
The current situation of the patient for tracheotomy is a high-risk tracheotomy, which Zheng Ren tried in the system operating room. Even if there is a lucky aura, even if there is a +10 bonus bonus for surgery completion, even if it is only a small operation, the final surgery completion is only 65%.
This means that patients may not be able to go offline with ventilator-assisted breathing, or even go to the operating table at all.
Zheng Ren tried it many times, and the 65% success rate was already the highest.
In fact, patients with high-risk tracheotomy are not uncommon.
Mainly short neck, obesity, sitting in the back, inability to recline the head, agitation, wide or occupied thyroid glands, high mediastinum, tracheal deflection, fall of the tongue, severe breathing difficulties, and intubation or oral intubation Those who were intubated but had no spontaneous breathing had poor coagulation function, sudden suffocation before surgery, and those with unclear cervical and thoracic bones and cartilage signs belonged to the high-risk tracheotomy group.
Under normal circumstances, it can be compensated by methods, but the patients in front of them are in a special situation. Zheng Ren is very helpless. This time he encountered a particularly difficult thing.
Fortunately, the effect of oxygen supplied by the mask is good, and it has been tested in the system operating room.
An anesthesiologist quickly opened the laryngeal mask and handed it to Zheng Ren.
After starting, Zheng Ren pulled the patient's jaw with his left hand and was about to send in the laryngeal mask. He was surprised to see that it was the second-generation laryngeal mask!
Strangely, three generations of laryngeal masks are obviously used in the system operating room. What is going on?
There is a big difference between the second and third generation explorer laryngeal masks. Even the third-generation laryngeal masks have a final completion rate of only 98%. Zheng Ren dare not care.
"Three generations of explorers!" Zheng Ren said immediately.
Director Xu froze for a while, three generations of explorers ... is the laryngeal mask?
The patient's blood oxygen saturation has dropped to 70%. Why is Boss Zheng picky about the second and third generation laryngeal masks ...
He just wanted to explain something, Feng Xuhui was standing outside the operating room and immediately said loudly, "General Zheng, wait a minute!"
He held the mobile phone in his left hand and made a call. It took almost a second. Feng Xuhui said swiftly: "Emergency emergency box!"
As he spoke, Feng Xuhui quickly walked to the door of the operating room in the footsteps of "咚 啋".
Opening the door of the operating room, Liu Xiaojie, more than ten meters away, pushed the box hard. The heavy trolley case glides on the marble floor, almost at the moment Feng Xuhui opened the door.
After taking the box, the door was closed and the whole process took 3.2 seconds.
Director Xu has always been behind Feng Xuhui, and he remains calm. After all, it is the director of the Department of Anesthesiology. I have seen too many similar situations.
But today's patients are a bit more special, if they were done under a common laryngoscope.
Boss Zheng did not perform tracheotomy, Director Xu also knew that this was a high-risk patient. Once the incision was made, he might face more troubles. This trouble is not all from the patient's family, but more from the patient itself.
It is not uncommon for patients to get worse after high-risk tracheotomy, so he also prefers to use a laryngeal mask.
But the 912's laryngeal mask is not bad. That type of model has been used for many years. Boss Zheng actually wants 3 generations of explorers. This laryngeal mask has only been heard at academic conferences, and the anesthesia department of 912 has not yet evolved to this step.
The small consumables supplier who has been following Boss Zheng seems to be ... the manager involved in the consumables manufacturer, what did he just roar? First aid kit? !!
After Director Xu saw a medium-sized trolley case “flying in”, the small consumables dealer immediately crouched on the ground to open the case.
The trolley case is neatly arranged with a variety of emergency and emergency supplies.
He didn't look at it, and stretched his hands inside, it seemed that dozens of consumables were clear everywhere.
A sterile-packed bag was immediately caught by Feng Xuhui, and when Director Xu was standing not far away looking at himself, Feng Xuhui threw the bag in his hand.
"Director Xu!"
Don't be polite and don't have time to be polite in emergency department. Every minute and every second is extremely precious.
Director Xu catches the aseptic package, and the goal is a 3 generation explorer laryngeal mask.
"..."
What a special thing, Director Xu felt that his face was hot.
But too late to think about it, turn around and run, tearing the outer packaging of the laryngeal mask while running.
Zheng Ren took the laryngeal mask and placed it by conventional blind detection.
Traction the mandible with the left hand to widen the gap in the mouth, hold the laryngeal mask with the right hand, with the mouth facing the patient's jaw, and place it down the back of the throat along the midline of the tongue until it can no longer be advanced.
After the laryngeal mask was placed, positive pressure ventilation was performed. Zheng Ren observed that the degree of thoracic undulations returned to normal. He grabbed a stethoscope, and on both sides of the auscultation, the breathing sounds were symmetrical and clear, and there was no air leakage murmur in the anterior neck area.
Even if it has been done more than 10 times in the system operating room, even if it is covered by a lucky halo after it comes out, Zheng Ren is still very careful to check whether there is any error in the operation.
After finishing the laryngeal mask, Zheng Ren placed the gastric tube under the guidance of the laryngeal mask to exhaust the gas, which solved the problem that the large amount of gas in the stomach swelled, causing the diaphragm muscles to rise and reducing the lung capacity.
"40mg of propofol!"
"Midazolam 2mg!"
"Dexamethasone 10mg!"
Zheng Ren watched the patient's ECG monitoring and continuously issued medication instructions.
"Intravenous infusion of aminophylline 0.25g + 5% glucose 250mL!"
The patient's blood pressure fluctuated at ~ www.novelhall.com ~ The heart rate fluctuated at 60-98 beats / min.
"0.05 mg of nitroglycerin and 15 mg of uracil." Zheng Renshen said.
Seeing the continuous rise in blood pressure and heart rate and oxygen saturation, the air in the operating room eased a little.
Boss Zheng's doctor's order was executed perfectly without any doubt, even Director Xu.
If he wasn't there, Director Xu would prepare the mask for the next step, but Boss Zheng was standing there. Director Xu felt relieved, instead of being snatched away by the emergency department, he felt that his authority had been received. challenge.
At this time, with technical speaking, and the mask of the 3 generations of explorers like Fei Xian Fei Xian, Director Xu had no thoughts for a long time.
List of chapters in high-speed text manual surgery room
If ventilation is unsatisfactory during single-person operation, two-person pressurized assisted ventilation should be considered, and the airway, oropharyngeal or nasopharyngeal airway should be used in conjunction with the method. This technique is mainly used when the patient is at risk of aspiration and reflux, and at the same time compresses the ring cartilage.
Even the laryngoscope and light rod guidance technology are used. The basic operation of a single balloon mask has been ruled out by Zheng Ren and will not be considered.
However, the double balloon mask was ventilated with small tidal volume and high frequency and high pressure oxygen, and it was found that the chest ribs of the patient were not obvious.
"Laryngeal mask!" Zheng Ren growled in a deep voice.
At the same time, he had put on sterile gloves, his gaze moved back and forth between the ECG monitor and the patient, but he did not make a tracheotomy immediately.
The current situation of the patient for tracheotomy is a high-risk tracheotomy, which Zheng Ren tried in the system operating room. Even if there is a lucky aura, even if there is a +10 bonus bonus for surgery completion, even if it is only a small operation, the final surgery completion is only 65%.
This means that patients may not be able to go offline with ventilator-assisted breathing, or even go to the operating table at all.
Zheng Ren tried it many times, and the 65% success rate was already the highest.
In fact, patients with high-risk tracheotomy are not uncommon.
Mainly short neck, obesity, sitting in the back, inability to recline the head, agitation, wide or occupied thyroid glands, high mediastinum, tracheal deflection, fall of the tongue, severe breathing difficulties, and intubation or oral intubation Those who were intubated but had no spontaneous breathing had poor coagulation function, sudden suffocation before surgery, and those with unclear cervical and thoracic bones and cartilage signs belonged to the high-risk tracheotomy group.
Under normal circumstances, it can be compensated by methods, but the patients in front of them are in a special situation. Zheng Ren is very helpless. This time he encountered a particularly difficult thing.
Fortunately, the effect of oxygen supplied by the mask is good, and it has been tested in the system operating room.
An anesthesiologist quickly opened the laryngeal mask and handed it to Zheng Ren.
After starting, Zheng Ren pulled the patient's jaw with his left hand and was about to send in the laryngeal mask. He was surprised to see that it was the second-generation laryngeal mask!
Strangely, three generations of laryngeal masks are obviously used in the system operating room. What is going on?
There is a big difference between the second and third generation explorer laryngeal masks. Even the third-generation laryngeal masks have a final completion rate of only 98%. Zheng Ren dare not care.
"Three generations of explorers!" Zheng Ren said immediately.
Director Xu froze for a while, three generations of explorers ... is the laryngeal mask?
The patient's blood oxygen saturation has dropped to 70%. Why is Boss Zheng picky about the second and third generation laryngeal masks ...
He just wanted to explain something, Feng Xuhui was standing outside the operating room and immediately said loudly, "General Zheng, wait a minute!"
He held the mobile phone in his left hand and made a call. It took almost a second. Feng Xuhui said swiftly: "Emergency emergency box!"
As he spoke, Feng Xuhui quickly walked to the door of the operating room in the footsteps of "咚 啋".
Opening the door of the operating room, Liu Xiaojie, more than ten meters away, pushed the box hard. The heavy trolley case glides on the marble floor, almost at the moment Feng Xuhui opened the door.
After taking the box, the door was closed and the whole process took 3.2 seconds.
Director Xu has always been behind Feng Xuhui, and he remains calm. After all, it is the director of the Department of Anesthesiology. I have seen too many similar situations.
But today's patients are a bit more special, if they were done under a common laryngoscope.
Boss Zheng did not perform tracheotomy, Director Xu also knew that this was a high-risk patient. Once the incision was made, he might face more troubles. This trouble is not all from the patient's family, but more from the patient itself.
It is not uncommon for patients to get worse after high-risk tracheotomy, so he also prefers to use a laryngeal mask.
But the 912's laryngeal mask is not bad. That type of model has been used for many years. Boss Zheng actually wants 3 generations of explorers. This laryngeal mask has only been heard at academic conferences, and the anesthesia department of 912 has not yet evolved to this step.
The small consumables supplier who has been following Boss Zheng seems to be ... the manager involved in the consumables manufacturer, what did he just roar? First aid kit? !!
After Director Xu saw a medium-sized trolley case “flying in”, the small consumables dealer immediately crouched on the ground to open the case.
The trolley case is neatly arranged with a variety of emergency and emergency supplies.
He didn't look at it, and stretched his hands inside, it seemed that dozens of consumables were clear everywhere.
A sterile-packed bag was immediately caught by Feng Xuhui, and when Director Xu was standing not far away looking at himself, Feng Xuhui threw the bag in his hand.
"Director Xu!"
Don't be polite and don't have time to be polite in emergency department. Every minute and every second is extremely precious.
Director Xu catches the aseptic package, and the goal is a 3 generation explorer laryngeal mask.
"..."
What a special thing, Director Xu felt that his face was hot.
But too late to think about it, turn around and run, tearing the outer packaging of the laryngeal mask while running.
Zheng Ren took the laryngeal mask and placed it by conventional blind detection.
Traction the mandible with the left hand to widen the gap in the mouth, hold the laryngeal mask with the right hand, with the mouth facing the patient's jaw, and place it down the back of the throat along the midline of the tongue until it can no longer be advanced.
After the laryngeal mask was placed, positive pressure ventilation was performed. Zheng Ren observed that the degree of thoracic undulations returned to normal. He grabbed a stethoscope, and on both sides of the auscultation, the breathing sounds were symmetrical and clear, and there was no air leakage murmur in the anterior neck area.
Even if it has been done more than 10 times in the system operating room, even if it is covered by a lucky halo after it comes out, Zheng Ren is still very careful to check whether there is any error in the operation.
After finishing the laryngeal mask, Zheng Ren placed the gastric tube under the guidance of the laryngeal mask to exhaust the gas, which solved the problem that the large amount of gas in the stomach swelled, causing the diaphragm muscles to rise and reducing the lung capacity.
"40mg of propofol!"
"Midazolam 2mg!"
"Dexamethasone 10mg!"
Zheng Ren watched the patient's ECG monitoring and continuously issued medication instructions.
"Intravenous infusion of aminophylline 0.25g + 5% glucose 250mL!"
The patient's blood pressure fluctuated at ~ www.novelhall.com ~ The heart rate fluctuated at 60-98 beats / min.
"0.05 mg of nitroglycerin and 15 mg of uracil." Zheng Renshen said.
Seeing the continuous rise in blood pressure and heart rate and oxygen saturation, the air in the operating room eased a little.
Boss Zheng's doctor's order was executed perfectly without any doubt, even Director Xu.
If he wasn't there, Director Xu would prepare the mask for the next step, but Boss Zheng was standing there. Director Xu felt relieved, instead of being snatched away by the emergency department, he felt that his authority had been received. challenge.
At this time, with technical speaking, and the mask of the 3 generations of explorers like Fei Xian Fei Xian, Director Xu had no thoughts for a long time.
List of chapters in high-speed text manual surgery room
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