My medical skills are a billion points

Tracheotomy should be performed as soon as possible to ensure safety.

Gao Yingjun has already performed a thorough debridement on the patient.

The purulent secretions were completely removed, and tetanus antitoxin was injected.

At this time, the patient's family members also rushed to the hospital.

Xiao Chu explained to them in detail again, and the family members finally understood the horror of this disease.

And asked them to sign the consent form for tracheotomy, and at the same time they were critically ill.

Tetanus can be said to be a disease with a high mortality rate.

Except for rabies, the mortality rate is [-] percent.

This tetanus is infected, and the mortality rate can be ranked first.

Percutaneous tracheostomy is an operation often performed by intensivists.

For critically ill patients, unconscious, and severe pulmonary infection, tracheotomy is generally required.

More than ten years ago, surgeons performed ordinary tracheotomy.

Due to the development of medical science and technology, the most convenient percutaneous tracheotomy has been developed.

Of course, doctors in the emergency department and critical care doctors look down on such small operations that cannot be smaller.

Because everyone can.

But it was the first time for a doctor like Wang Panpan who came from a county-level hospital to perform percutaneous tracheostomy.

This kind of operation is simple and quick, with less pain and less trauma for patients. It is currently the most ideal choice for tracheotomy for critically ill patients.

Xiao Chu saw that Wang Panpan loved learning more and was more serious, so he wanted to take her with him.

At the very least, after she finished her studies and returned to the local hospital, she could carry out this kind of operation by herself.

It's not like studying in a higher-level hospital for a year and knowing nothing.

Of course, when Xiao Chu wanted to lead someone, it mainly depends on the person's learning attitude.

For example, Liu Qing and Wang Li, who have already transferred to another department, are definitely not good at this kind of operation.

Chapter 295 Percutaneous Tracheostomy

Because there are three areas in charge of the entire emergency department.

The intensive care unit is one of them.

Therefore, the intensive care unit of the emergency department is quite special.

Because it is not an independent department, but a small department under the jurisdiction of the entire emergency department.

But like the comprehensive ICU, neurological ICU and respiratory ICU of the hospital, they are all independent departments.

Whoever sends a patient to their department, the patient will be under the full management of the doctors in their department, and will no longer have anything to do with outside doctors.

But emergency cases are different.

If a critically ill patient comes to the emergency department, if he is sent to the intensive care unit, then whoever receives the doctor first will still be in charge of diagnosis and treatment even if he is admitted to the intensive care unit.

Although there are doctors in the intensive care unit, in the eyes of outside doctors, the intensive care doctor is at best a gatekeeper.

They are only responsible for the stabilization of critically ill patients' vital signs and emergency rescue.

For the usual treatment and examination, I have no right to speak, and I still need to listen to outside doctors.

Therefore, there are generally no doctors who want to go to the emergency department for severe cases.

After all, after entering this serious illness, you can't manage the patients, just take care of the patients, which is not much different from the role of the nurses inside.

Moreover, there are only three intensive care doctors, and there are relatively few people.

Usually there is one person on the day shift and one on the night shift.Rest alone.

This never-ending rotation of three people.

Today, Wang Wei was on duty for the critically ill. When he saw Xiao Chu and Wang Panpan coming in, he directly put forward his thoughts.

"Director Xiao, since this patient has tetanus and has frequent convulsions, should he perform a tracheotomy as soon as possible?"

If the emergency department is an independent department, they have their own right to speak.

Then Wang Wei would not take the initiative to ask Xiao Chu whether to perform a tracheotomy.

He can make a decision by himself and directly operate on the patient without asking Xiao Chu.

But there is no way, he is not directly in charge of the bed doctor, he can only ask questions.

So sometimes the three doctors who are seriously ill always feel that they can't hold their heads up in front of other doctors.

As a doctor, it is really aggrieved not to be able to manage patients directly.

Xiao Chu has been in the emergency department for so long, and he also knows the disadvantages of the intensive care unit.

But this is a rule that has been formed since the establishment of the academy, and he can't change it.

After all, the intensive care unit in the emergency department is just a small intensive care unit, with only five or six beds in it.

Unlike other independent severe cases, all of which start with [-] beds, emergency severe cases cannot compare with them.

The director of the department, Chen Bin, actually understood this matter in his heart.

But after all, the emergency department is too small to be independent.

Otherwise, a special director of critical care should be set up.

But the problem is that even if the emergency department is independent, no doctor wants to be the director.

After all, once any doctor enters the emergency department, he can no longer take care of the patients. If things go on like this, his profession will be neglected, and he will almost become a useless person.

In that case, which doctor wants to go?

However, there is something better about emergency and severe cases.

That is, the patients are heavy, the cost is high, and the doctors inside have relatively high bonuses.

Therefore, some doctors who are short of money will take the initiative to apply for admission to the emergency intensive care unit.

It doesn't matter whether he cares about the patients, whether he is a cripple or not, as long as he can make money, why think so much?

It can be said that the three doctors who were seriously ill, except Wang Wei, were forced to come in.

The other two doctors asked to come in.

It's not shabby to earn money.

In addition, intensivists don't care about patients, and the pressure is much less.

As a critically ill doctor, although Wang Wei does not directly manage patients, he is quite active in treating them.

Sometimes I will actively express my own treatment views.

For example, this tetanus patient, he realized from the very beginning that this patient might need a tracheotomy.

That's why he asked this question when he saw Xiao Chu coming in.

This tetanus patient is under the supervision of Gao Yingjun.

Logically speaking, if a tracheotomy is performed, the cooperation of Gao Yingjun and Wang Wei is required.

But Xiao Chu had already greeted Gao Yingjun just now, and he wanted to take Wang Panpan to study.

Do your duty as a teacher.

So Gao Yingjun went to work on other things.

Xiao Chu said: "I just came to do a tracheotomy for him."

Wang Wei was stunned for a moment.

"Aren't Senior Brother Gao coming? Do you want to do it yourself?"

Xiao Chu has been the deputy director of the emergency department for some time.

Of course Wang Wei is also aware of his deeds.

He also admired Xiao Chuna very much.

At a young age, he has become the deputy director of the emergency department, and he has superb medical skills and outstanding operations.

He naturally thought that asking Xiao Chu to do the tracheotomy would be like shooting mosquitoes with an anti-aircraft gun, and it would be overqualified.

Xiao Chu pointed to Wang Panpan.

"Dr. Wang has never done a percutaneous tracheotomy, so I will take her to familiarize herself with the procedure so that she can learn this operation as soon as possible."

Wang Wei finally understood.

It turned out that Xiao Chu came to teach and train doctors.

Originally, he wanted to do gas cutting, but when he saw that Xiao Chu was going to take him to train a doctor.

It also gave up the idea of ​​​​doing it yourself.

The patient's blood oxygen saturation was affected due to frequent convulsions.

So after Gao Yingjun transferred him to the critical condition, he was intubated and put on a ventilator.

Sufentanil and midazolam are currently used for analgesia and sedation.

Now the patient's vital signs are stable, almost as if he is asleep, and he no longer suffers from convulsions.

Hearing that Xiao Chu was going to teach as a doctor, Wang Wei had already gone to the instrument room to get a disposable tracheostomy kit.

Xiao Chu began to guide Wang Panpan carefully.

"If you want to perform a percutaneous tracheotomy on a patient, you must first position yourself. The patient needs to lie on his back with a pillow under his shoulders to open the airway as much as possible."

Xiao Chu said, first adjust the patient's position.

Together with Wang Wei, he lifted the patient's upper body, put a small pillow between the patient's shoulders, and tilted his head back to fully expose the neck.

After the patient's position was set, Xiao Chu didn't rush to disinfect and put on sterile gloves.

Instead, let Wang Wei stand at the head of the patient's bed.

Then Wang Wei released a part of the air bag in the endotracheal tube to decompress it, and then slowly extubated the tube.

Xiao Chu looked at Wang Panpan and said, "This is some of the steps we need to prepare in the early stage. First, we need to position ourselves, and then we do what Dr. Wang does. Do you know why we do this?"

This is the first time Wang Panpan has seen a percutaneous tracheotomy. How could she know why Wang Wei had to remove the intubation, so she shook her head immediately.

Xiao Chu then explained: "Patients with endotracheal intubation need to have a percutaneous tracheotomy, and part of the endotracheal tube must be pulled out.

This is because the tracheal intubation is inserted relatively deep, blocking the site where we perform the tracheotomy. "

Xiao Chu changed the topic.

"How deep is the endotracheal tube inserted? Do you know?"

Chapter 296 Trainee Physician's Clinical Experience Increases Slowly

Wang Panpan has already learned how to intubate the endotrachea, and has performed several cases. She is no stranger to the depth of endotracheal intubation.

So he replied without hesitation: "The depth of intubation for adult males is 22 to 24 cm from the incisors, and the depth of intubation for adult females is 21 to 23 cm from the incisors. The pressure of the airbag is 25 to [-] centimeters of water column."

It has to be said that Wang Panpan's theoretical knowledge is fairly solid.

At least some common sense theoretical knowledge, she understands pretty well.

Unlike some trainee doctors who don't know anything after coming here, they don't know anything, just like interns.

Some are even worse than interns.

I don't know how such a trainee doctor got into the county hospital.

Wang Wei stood at the head of the bed and inflated some of the airbags.

Then I began to slowly pull out the endotracheal tube until the scale was eighteen centimeters from the front teeth, and then stopped.

Inflate the endotracheal tube balloon again and fix it again.

Wang Panpan came to him and looked at it very carefully, but he still didn't understand.