Back in 2002 as a doctor

"Director Wang, it's okay, I have both lungs?"

"Yeah." Wang Cheng's complaints were complaints, but the operation was done step by step without any hesitation.

Anesthesiologist Liu Wei started bilateral lung ventilation, and the ventilation parameters remained unchanged.

Wang Chengfa performed this operation very quickly, and it took 40 minutes to complete it.Laparoscopic surgery to close the chest is very simple, just 3 small incisions are sutured, and the work is done without too much difficulty.

Closed thoracic drainage was indwelling, and the operation was over.

After uncovering the sterile sheet, the itinerant nurse covered the patient with a sterile gown to keep warm.

Wang Chengfa turned and stepped down, "I'm leaving first, Liu Di will take the patient back."

"Go slowly, Director Wang." The anesthesiologist watched Wang Chengfa leave with a smile, and asked in a low voice, "Liu Di, your department has been playing like a dog these days."

Liu Di sighed in confusion, and turned to push the flat car without answering Liu Wei's question.

The patient recovered spontaneously 10 minutes after the operation. Liu Wei glanced at the ventilator, VT350ml, RR20 times/min, SpO298%.

Although he was a little curious about the major changes in the chest department, the patient had not been extubated and his attention had not been distracted.

After the patient regained consciousness, pure oxygen was inhaled through the mask at a flow rate of 2 L/min, and the endotracheal tube was removed.Following the action of pulling out the endotracheal tube, suctioning all the way, these details have been engraved in Liu Wei's muscles and become a kind of memory.

After the operation, Liu Wei's gossip was raging.

"Liu Di, what's your situation now?" the anesthetist Liu Wei asked during the interval after pulling out the endotracheal tube and preparing to observe for a minute.

"Don't mention it, I don't know about Corey's current situation." Liu Di was a little depressed. He still remembered Zhou Congwen's words - not to sign.

"Isn't Lao Wang still undergoing surgery? It's fine." Liu Wei said, "Director Li Qinghua must be here to take care of the elderly. It's really pitiful. The prince of the thoracic surgery department of the dignified People's Hospital can't take over, so he came to our hospital. If you want to talk about this person, It's all fate. Time and fate are also fate, there is no way. Even if you are capable, you can't help but a fate."

As he said that, Liu Wei's eyes stopped on the monitor, and his whole body seemed to be pinched by an invisible big hand, and he fell silent for an instant.

Liu Di noticed that the number of blood oxygen saturation on the monitor kept dropping, he was taken aback, and squatted down to look at the chest bottle.

The closed drainage of the thoracic cavity was unobstructed, and a small amount of bloody fluid and gas were drawn out without a large amount of gas overflowing.

what happened?

"Brother Liu, did you give me pure oxygen?" Liu Di asked in a low voice.

Liu Wei did not answer his question, but said to his assistant, "Increase the oxygen flow."

The oxygen flow rate increased from 2L/min to 3L/min, but the patient's blood oxygen saturation still did not rise.Although there was no cliff-like decline, the numbers continued to go down, firm and persistent, which made people panic.

"Liu Di, call Lao Wang and ask him to come back." Liu Wei said solemnly.

Liu Di was stunned for a moment, and an ominous premonition lingered around him.

"Blood gas needle."

When Liu Di went to call Wang Chengfa, he heard the anesthesiologist's voice.

What's going on here?

Liu Di has relatively few contacts with chest patients, so he is a little at a loss.

Ordinarily, after the operation is completed, anesthesia is fine, shouldn't you come down directly after suctioning? !Why does the patient's blood oxygen saturation continue to drop? !

Wang Chengfa was stunned when he received the call.

If it is a complicated car accident injury and cannot be offline, he also admits that it is a traumatic wet lung, and after the operation, the ventilator can assist the breathing and then give the hormone a shock.

If the patient is older, the lungs are so bad that the lung function is limited, and he can't recover to breathe spontaneously after anesthesia, he also agrees.

However, the patient was a young woman, and the surgery was done neatly, even Wang Chengfa was meticulous in the investigation, why didn't she come down to the stage? !

When he just had the operation, he still thought that God was looking after him, but at this moment, Wang Chengfa no longer had this kind of thinking.

What is the doctor most afraid of?

The failure to rescue critically ill patients is not the most feared, because it is in the cognition.What I am most afraid of is the situation in front of me!

do not know

do not understand

Don't understand

Wang Chengfa couldn't figure out why the patient couldn't get off the stage, so he hurried to the operating room again.

Chapter 0217

Wang Chengfa felt apprehensive, trotted all the way to the operating room, and was dumbfounded when he saw the patient's blood oxygen saturation value steadily dropping.

"Xiao Liu, what's the situation?" Wang Chengfa asked.

"Director Wang, I don't know either." The anesthetist Liu Wei smiled wryly, "I recalled your operation, and I don't think it's a problem with the operation. But my anesthesia is fine, it's weird. If it doesn't work...why don't you take the tube down and blow it?" How many days to see?"

Wang Chengfa glanced at Liu Wei cautiously.

He knew that this was just a suggestion, and it was biased toward suggestions that were beneficial to the anesthesiology department.

After getting off the operating table, the patient has nothing to do with the anesthesiology department, and he wants to... Thinking of the ventilator that he is not skilled in operating, Wang Chengfa turned his head into two big ones.

Should Li Qinghua be invited out of the ward?

No, absolutely not!

Wang Chengfa was silent, didn't say a word, but stared straight at the ECG monitor.

Fifty minutes after the endotracheal tube was removed, the blood oxygen saturation had dropped from 50% to 96%.

Anesthesiologist Liu Wei called the director and asked for consultation on stage.

At this time, the results of arterial blood gas analysis showed: pH value 7.12, PaCO276mmHg, PaO257mmHg, BE-6.1mmol/L.

"Director Wang, what should we do?" Liu Wei's hands and feet were numb.

"..." Wang Chengfa scolded his mother in his heart.

If you don't know what to do, does Lao Tzu know?Don't even know why, who the hell knows what to do!You ask me, who do I ask? !

Standing aside, Liu Di suddenly remembered Zhou Congwen's words before taking the stage.

He whispered, "Do you want the doctor in charge to take a look?"

Liu Di is very clear that this sentence is a rebellious suggestion from Wang Chengfa's side, but is there a better way now?

There was a medical accident, and the operation order was not signed by the director and the doctor in charge. This is a major liability accident. Not only Wang Chengfa can't run away, but he can't run away either.

Wang Chengfa remained silent.

Unless it is absolutely necessary, Wang Chengfa absolutely does not want to ask Zhou Congwen to point fingers.

However, the patient's blood oxygen saturation was still dropping. The director of the anesthesiology department came to see him, and the suggestion he gave was to put on a ventilator and keep it on for a few more days.

Wang Chengfa was helpless, and said in a deep voice, "Liu Di, call Director Li."

Liu Di hurriedly left the operating room to make a phone call.

A few minutes later, Zhou Congwen's familiar footsteps came, and Wang Chengfa was extremely angry.

Drinking cold water is really stuffy, Zhou Congwen is standing aside and pointing fingers, pointing fingers!

With quick footsteps, Zhou Congwen entered the operating room and calmly glanced at the ECG monitor, then raised his hand, "Anesthesia record sheet."

Two pieces of paper were handed over to Zhou Congwen.

At a quick glance, the anesthesia was not particularly problematic.

30 g of phenobarbital sodium and 0.1 mg of atropine were injected intramuscularly 0.5 minutes before anesthesia.

After entering the room, BP120/70mmHg, HR80 times/min, SpO298% were routinely monitored, and the left forearm venous access was opened.

静脉注射咪达唑仑3mg、异丙酚100mg、舒芬太尼50ug和罗库溴铵50mg行麻醉诱导，插入左侧F35双腔气管导管。

吸入氧浓度100%，氧流量2L/min，VT8-10ml/kg，I：E1：2，RR12~14次/min，维持PctCO235~40mmHg。

Anesthesia was maintained by intravenous infusion of propofol 200 mg/h and remifentanil 1 mg/h, and intravenous injection of rocuronium bromide 30 mg every 25 min.

This is all routine, Zhou Congwen put the anesthesia record sheet aside, picked up the stethoscope and started auscultation.

But before the stethoscope landed on the patient, suddenly the whole body of the patient started to twitch.

A large amount of pale yellow foam gushes out from the patient's mouth and nose, even at the beginning because of too much pressure, the foam was jet-like.

"Suction!" Zhou Congwen said in a deep voice, "Liu Di, hold the patient down."

No one in the operating room thought that the patient would suddenly spray out light yellow foam. Everyone was dumbfounded and subconsciously followed Zhou Congwen's instructions.

Wang Chengfa's hands and feet were cold, and he didn't know what happened to the patient.

Just because he didn't know, he was full of fear of the unknown.

Once such a young patient died on the operating table, or forced to die in the small intensive care unit, Li Qinghua didn't need to drive him away, he was finished.

"Intravenous injection of 3 mg of morphine and 10 mg of dexamethasone." Zhou Congwen's calm voice sounded.

"Furosemide 10mg IV."

"Tour, call echocardiography, ask for bedside."

"Get ready for intubation."

The anesthesiologist was preparing furosemide, and suddenly heard Zhou Congwen say the word intubation and immediately asked, "Now? Let's go back and insert it."

"Diagnosed with bilateral recruitment pulmonary edema, the case fatality rate is 20%." Zhou Congwen threw out a cold number.

After speaking, Zhou Congwen put the stethoscope on the patient's chest wall and began to auscultate.

Hearing the sound of vesicles in the right lung and the sound of scattered vesicles in the bottom of the left lung, Zhou Congwen confirmed his own judgment.

Anesthesiologist Liu Wei prepared the equipment for endotracheal intubation, and looked up at Wang Chengfa habitually.

"I'm the doctor in charge, and I'll preside over the rescue. How about I go down and you come?" Zhou Congwen said coldly.

Liu Wei didn't say a word of nonsense, and immediately lowered his head and began to perform endotracheal intubation.

"Positive pressure ventilation, inspired oxygen concentration 100%, oxygen flow rate 10L/min, pressure 8cmH2O."

"Tidal volume 8ml/kg, RR12 times/min."

"Dexamethasone, give another 5mg."

"You can't stop sucking sputum. There must be a lot of sputum, so you must suck it clean."

On the issue of sputum suction, Zhou Congwen talked a lot, and it was almost long-winded when he was in the emergency department.

The suction tube went in along the endotracheal tube, and a lot of light yellow foam was sucked out, and there was even a little light red foam behind.

After 15 minutes, the patient's blood oxygen saturation gradually stabilized and rose to 92%.

Although the numerical recovery seems to be a little bit better, everyone knows that this is just pure oxygen blown by the ventilator.Without a ventilator, patients don't know what would have happened.

"Liu Di, ask the head nurse to prepare the intensive care unit, the ventilator, and get ready to call to notify me, and go down immediately. Ask the subordinates to prepare the sputum suction device and check the medicines in the ambulance car again."

"Go down?! No way! Wait until the patient is stable in the operating room." Wang Cheng panicked.

Shouldn't it be waiting for the patient's condition to stabilize in the operating room before going down?

Faced with Wang Chengfa's questioning, Zhou Congwen squinted. This action was very similar to Wang Chengfa's, his eyes were full of disdain and contempt.

"I'm the doctor in charge, who are you?" Zhou Congwen asked coldly.

A cold sentence stumped Wang Chengfa.

"Have you ever issued a doctor's order for emergency treatment here?"

"Do you treat reexpansion pulmonary edema?"

"Shut up, just stay there, I'll wipe your ass, don't you see?"

One sentence after another hit Wang Chengfa's face with crackling noises.

Wang Chengfa's face turned red and white.

Zhou Congwen turned his head and continued to watch the ECG monitoring. With his right hand crossing his crew cut under the sterile cap, he said indifferently, "I don't even understand reexpansion pulmonary edema, so I know how to stand here and push the blame. It's shameless."

Chapter 0218 I don't care

Wang Chengfa felt oppressed for a while, his throat became sweet, and his eyes turned black.

He had thought that Zhou Congwen would criticize Sang and Huai, and would not give himself a step down, and he even thought that Zhou Congwen would be very "despicable" and threaten himself with patients.