My medical skills are a billion points

After all, she had never done this operation before, and she was as pleasantly surprised and puzzled about these operation steps as Grandma Liu entered the Grand View Garden.

Xiao Chu looked at her puzzled eyes, and explained to her in detail:

"After decompressing the endotracheal intubation balloon, pull it out to a distance of [-] centimeters from the front teeth, and that's it.

And when you pull it out, there is still a resistance in your hand, which means that the air bag has not been completely deflated and has reached the position of the glottis.

Do not pull it out again, otherwise, it is easy to get off the tube, and then the patient needs to be re-intubated.

For very critically ill patients, if the tube is removed, it will be very unfavorable to the condition, and this must be clearly remembered. "

Xiao Chu emphasized again: "Remember the scale, feel the resistance on your hand, it's all right, just pull out the endotracheal tube to this position.

The tracheotomy site we are going to do next has been completely exposed.This is the work we have to prepare in the early stage. "

As Xiao Chu said, the index finger of his right hand was pointing at the patient's suprasternal notch.

"Put yourself in position, and we're going to position the air cut. Do you know the position of the air cut?"

Wang Panpan still shook his head.

She had not previously focused on percutaneous tracheostomy.

She was completely blank about this operation, and today was the first time she saw it.

Of course I don't understand anything.

Pointing to the patient's Adam's apple, Xiao Chu said: "Percutaneous tracheotomy is generally selected under the thyroid ring bone, and the second to fourth tracheal rings are incised.

That is to say, counting from the thyroid ring bone under the thyroid cartilage, the incision can be made between the second to the fourth. "

After a pause, Xiao Chu said again: "I'll teach you another easier way to position yourself.

First, we determine the position of the thyroid cartilage, which is the Adam's apple, and then determine the suprasternal fossa. "

"These two body signs are easy to distinguish, aren't they?"

Wang Panpan used the index finger and middle finger of his right hand to trace the position on the patient's neck.

Xiao Chu pointed at the patient: "Did you see that in the middle, at the midpoint between the thyroid cartilage and the suprasternal fossa, it can also be cut.

This positioning method is relatively simple, do you remember? "

Wang Panpan gestured twice and nodded fiercely.

She has a deep memory of the positioning method Xiao Chu taught her.

After all, there are patients who make the teaching materials themselves and experience it personally, unlike what they just read in textbooks, relying on imagination alone.

The site for tracheotomy has been selected.

Xiao Chu drew a line on the patient's neck with a marker.

In fact, it doesn't matter whether he paints or not, the main reason is to impress Wang Panpan more deeply.

Since he wants to be a contemporary teacher, Xiao Chu naturally wants to teach with all his strength.

He first opened the outside of the sterile bag, then put on sterile gloves, poured iodophor into the sterile tray, clamped the iodophor gauze with curved forceps, and began to disinfect the patient's neck.

After being strictly sterilized three times, the carbon black mark has faded, but it can still be distinguished.

Watching Xiao Chu's actions, Wang Panpan felt faintly excited.

She even wanted to go up and do it herself.

But after all, she still doesn't know the complete steps of this operation, so she can only patiently wait for Xiao Chu's detailed teaching.

After the disinfection and draping are completed, the tracheotomy will begin next.

Xiao Chu looked at Wang Jing who was on call at any time and said, "Inject sufentanil three milliliters and midazolam five milliliters."

Wang Panpan couldn't understand Xiao Churang pushing the medicine.

Then he asked directly: "Mr. Xiao, isn't the patient already sedated and analgesic? Why do we need to increase the dose of medicine?"

While wiping the surgical site clean with clean gauze, Xiao Chu said: "He will be tracheotomized soon, the amount of sedative and analgesic drugs is relatively small, and the amount we add to him is to anesthetize him. .

When you cut him open later, you don’t need to use lidocaine. If you hit Pichu on the neck with lidocaine, it will affect your operation.This is also a detail point. "

"Oh!"

Wang Panpan nodded half understanding.

After all, she has never seen this operation before, nor has she tried it herself.

If you can't experience it yourself, you can't fully understand the truth here.

After doing a few more cases, she will understand more and more the details Xiao Chu said when she has gained experience.

Xiao Chu picked up the scalpel, and made an incision of about [-] cm at the spot where the mark was made just now. The incision was made under the skin, and no further incision was made.

After the skin was cut open, blood soon oozes out.

Xiao Chu held the gauze cushion and pressed it on it.

After pressing for a while, he explained the process to Wang Panpan.

"When you perform this operation in the future, remember that the scalpel only needs to cut under the skin. Don't cut deep, otherwise, it will be troublesome if you hurt the blood vessels."

Xiao Chu used a gauze pad on the incision site, and pressed it for 30 seconds, and the bleeding stopped.

After all, it is only capillary bleeding, and the bleeding can be stopped with a single press.

Xiao Chu picked up the [-]ml syringe filled with lidocaine injection, and stuck it in the middle of the incision.

Move slowly and keep the syringe under negative pressure.

In the blink of an eye, air bubbles were seen coming out of the syringe.

This shows that the needle has entered the trachea.

After continuing to draw back, a lot of air bubbles came out, Xiao Chu pushed about one or two milliliters of lidocaine into the trachea.

"We inject one or two milliliters of lidocaine injection into the trachea, mainly to paralyze the inner wall of the trachea, so as to reduce the patient's coughing reaction and facilitate our operation."

Xiao Chu said while pulling out the needle.

Then with a 14G trocar, puncture the trachea.

Tilt the needle slightly towards the head, and insert the needle with the bevel down until the air bubbles are drawn out.

Then came the point.

Chapter 297 Are You Abandoned?

Xiao Chu said: "When pulling out the puncture needle, you must keep the cannula in place, just pull out the puncture needle."

Xiao Chu fixed the plastic sleeve with his left hand, and slowly pulled out the puncture needle with his right hand.

Then I used the syringe with the needle removed to draw a few milliliters of saline, and put it on the plastic cannula again to draw back. A lot of air bubbles came out, confirming that the plastic cannula was in the trachea.

Using the wire guide, guide the wire into the cannula.

The guide wire is advanced to the first mark, at the level of the skin.

Withdraw the plastic sheath, leaving the guidewire in place.

Then Xiao Chu took the skin dilator and sent it into the skin along the guide wire.

The dilator dilates the subcutaneous tissue and the anterior wall of the trachea.

Clamp the internally slotted patent dilator on the guide wire, and slide the dilator into the anterior wall of the trachea along the guide wire.

Spread the forceps to expand the soft tissue anterior to the anterior wall of the trachea.

While keeping the spreader open, remove the spreader.

Repeat the above steps to expand the forceps to expand the tracheal wall.

Xiao Chu only repeated the above action twice.

From the incision, you can see that there is gas coming out, and there is also blood spraying out from the incision.

And Xiao Chu had already used gauze to block the incision, in order to prevent the blood from splashing.

At this point, Xiao Chu specifically emphasized to Wang Panpan.

"See? When you do this operation in the future, you must cover the incision with gauze in advance, otherwise, you will easily be sprayed with blood."

No matter how small the incision is, it will bleed, and it is common for the ventilator to spray blood and sputum from the incision.

Xiao Chu put the expansion forceps back in, and forcefully pierced through the front wall of the ventilation tube.

Push the handle of the expansion forceps toward the patient's head.

Keep the longitudinal axis of the expansion forceps parallel to the longitudinal axis of the patient's body, so that the tip of the expansion forceps can further enter the trachea.

Open the dilator to dilate the trachea, and remove the dilator with the dilator open.

Place a gas cutting cannula with an inner core along the guide wire.

First, completely lock the air-cut sleeve with the inner core and the sleeve introducer.

Insert the tracheotomy cannula along the guide wire and guide tube.

Patients with this kind of tracheotomy usually choose an [-]mm tracheal tube, and avoid using a rigid tracheal tube.

Then separate the introducer and the gas cutting sleeve, and withdraw the guide wire and stylet along the natural direction.

The tracheal cannula is put into the trachea, and this operation is considered complete.

Xiao Chu applied the air bag to the tracheal tube in time, applied sufficient pressure, and then wrapped the adhesive tape around the neck to fix the tracheal tube.

And Wang Wei connected the ventilator tube to the mouth of the tracheal tube.

Then he also intubated the previous mouth and pulled it out.

This process seems to be very long, and Xiao Chu is doing the operation while explaining.

In fact, from the beginning to the end, it took a total of 3 and a half minutes.

If Xiao Chu didn't teach Wang Panpan, he could do this operation by himself, and it would take only 2 minutes to complete it.

After all, this kind of tracheotomy is a surgery in name, but it is really not a surgery.

At most, it is a slightly more complicated operation.

But these things, in Wang Panpan's eyes, his eyes widened in shock.

How could Xiao Chu complete the tracheotomy so quickly?

She remembered that in her hospital, if a surgeon performed a tracheotomy, it usually took two people and half an hour to complete it.

What she didn't expect was that this improved percutaneous tracheotomy would be so fast.

Moreover, the patient has less bleeding and less trauma, which is really convenient.

Wang Panpan was originally a doctor in the emergency department in their hospital.

So I also chose to study in the emergency department of the provincial hospital.

No one in their hospital has performed percutaneous tracheotomy.

So this operation opened her eyes.

I also made up my mind in my heart that I must learn this technology well and be proficient, so that I can develop new technologies after I go back.

Seeing Wang Panpan's eager eyes, Xiao Chu told her a few more details.

Regardless of this operation, it is not even considered a real operation, but there are many doctors who stumble over it.

Xiao Chu looked at the confident Wang Panpan and asked: "I see that you are not familiar with this operation, is it possible that your hospital has not developed this technique?"

Wang Panpan nodded quickly.

"Yes, Mr. Xiao, our county-level hospitals have not carried out this kind of technology.

This is the first time I have seen such a tracheotomy.In the past, our patients with tracheotomy were all performed by surgeons.

And it takes about half an hour, and it is a vertical long incision.The current percutaneous tracheotomy is really good for patients. "

A smile appeared on the corner of Xiao Chu's mouth.

"Actually, this operation is very simple, much simpler than conventional tracheotomy. It also takes a short time.

If you study hard, you must be familiar with this technology.After returning home, it will be carried out in your department, which will definitely be convenient for patients and also beneficial for your doctor's work. "