"Do you suspect it's due to phlegm blockage?" Su Yun asked. He didn't look like it and was a little confused.
Zheng Ren didn't say anything. He took the sputum suction tube and tried it twice. The tube was unblocked, and then he put it into the patient's tracheal tube.
The suction tube made a hissing sound, and only a small amount of secretions were sucked out. It seemed that the sputum was not blocking the trachea.
As he continued to push the suction tube in, Zheng Ren was suddenly startled.
"Boss, what's wrong?"
"There's something inside, and the suction tube can't get it in," Zheng Ren said.
"..." Su Yun and the resident in the ICU were stunned for a moment. Lin Yuan stood behind and didn't understand the meaning of Boss Zheng's words for a moment.
This situation is beyond anyone's imagination.
Su Yun immediately recalled the patient's preoperative chest X-ray and chest CT.
There can be no problem. If something happens before the operation, the ventilator will also alarm during the operation.
"What treatment did you give me?" Su Yun asked seriously looking at the resident in the ICU.
People who are admitted to the ICU are always confused.
Nothing was given. The patient was sent back slightly agitated after the operation, but no treatment was given at first. According to the advice of the anesthesiologist Lao He, he was observed for 6 hours and prepared for extubation.
However, as time went by, the patient became more and more agitated, and finally several people could no longer hold it down, so they gave propofol out of desperation.
Continuing to sedate will prolong the time of decontamination, but it will not work if the patient is agitated.
The ICU resident thought it over carefully and called the nurse over to ask, but at this moment, Zheng Ren suddenly said in a deep voice: "No! The endotracheal tube is broken!"
"Uh..." Su Yun took a look at the tracheal intubation tube. It was an enhanced type. broken? impossible.
The resident in the ICU was also stunned. She immediately explained: "Boss Zheng, enhanced tracheal intubation..."
"Prepare fiberoptic bronchoscopy and bedside chest X-ray!" Zheng Ren directly gave the doctor's orders without discussing with them.
"Okay." Su Yun did not hesitate and pulled the ICU resident to push the X-ray machine.
Pushing the bedside X-ray machine over, Zheng Ren began to take pictures of the patient.
They positioned themselves, placed the film box, took the film, and then asked Lin Yuan to carry the film box and run to the radiology department to develop the film.
At this time, the hospital chief had prepared the fiberoptic bronchoscope.
Zheng Ren removed the ventilator and pulled out the tracheal tube.
During extubation, it was found that the tracheal tube was severed, leaving only about 12cm of the tail fragment of the tube, and the rest must have remained in the patient's trachea.
The foreign body in the trachea indicated by the big pig's hooves turned out to be part of the enhanced tracheal intubation!
After seeing this situation, not only Zheng Ren, but also Su Yun and the ICU resident were stunned.
What the hell is going on? Can the reinforced endotracheal tube be broken? ! How was it broken? Misoperation while transporting the patient? How much force does it take to break the enhanced endotracheal tube
The ICU resident carefully checked the location of the broken endotracheal tube and whispered: "Boss Zheng, Brother Yun, it doesn't look like a quality problem."
Zheng Ren had already seen the incomplete condition of the broken end of the tracheal intubation tube. He had a guess in his mind and said solemnly: "The trachea did not break on its own, but the patient grinded it off with his teeth."
“…”
"Urge Lin Yuan to ask the radiology department to upload the film quickly." Zheng Ren squinted at the patient's ECG monitoring.
Although there is a foreign body in the trachea, the tracheal intubation itself is a tube. It only causes severe stimulation and will not directly block the tube lumen, causing the patient to suffocate and die.
Soon, bedside X-rays were uploaded, and Zheng Ren saw the patient's first-hand information.
X-ray shows that the anterior endotracheal tube has entered the right bronchus...
Looking at the images on the computer, several people sighed.
This "medical accident" came out of nowhere and caught people off guard. If you find out, take out the tube and hope there won't be any more trouble.
"Boss, do you still remember what the patient's family said that day?" Su Yun suddenly asked.
Zheng Ren recalled that he remembered the man squatting on the curb and crying bitterly. He remembered that he said something about the patient's condition, and he also remembered that he said that the patient refused treatment.
During the operation, the patient's face looked very ugly. Only after the persuasion of the patient's family and Chang Yue did he enter the operating room.
It should be that after waking up from general anesthesia, the patient's subconscious obsession was at work - he refused to spend money. Instead of spending money on surgery, it would be better to die directly.
I didn't expect the obsession to be so heavy, and Zheng Ren didn't understand it. After being a doctor for so many years, I have seen a lot of weird patients.
However, the strange thing about the patient in front of him is that he also has this obsession. Generally speaking, the desire to survive is very strong.
Those old people who usually say that they will die when they are old and will not be a burden to their children, when such a day comes, almost no one will keep their promise.
There is great terror between life and death. Until that moment, few people can feel how terrifying the threat of death is.
Generally speaking, unless the situation is exhausted or no one cares about it, few people will have such a firm belief that they only want to die.
"Ask Chang Yue...just call her...forget it, take out the tube first. The patient can be taken offline and watched. After waiting, let the patient's family and Chang Yue do his work." Zheng Ren was particularly helpless. said.
Su Yun nodded. Faced with such a patient who wanted to die, no one could do anything.
Zheng Ren also lamented the vicissitudes of life and the uncertainty of things. He began to use a fiberoptic bronchoscope to remove the broken front half of the reinforced endotracheal tube from the trachea under propofol anesthesia.
Comparing the broken positions of the endotracheal tube with each other, it is more certain that the patient broke it with his own teeth after waking up from anesthesia.
A good operation ended up causing such trouble, Zheng Ren couldn't laugh or cry. However, the success of the operation was also proved from the side - the patients had the courage to grind off the enhanced endotracheal tube with their teeth.
Contacted Ringer and the medical office, and also called Chang Yue and the patient's family to explain the matter clearly.
The operation was successful, and he was said to be able to go to the ground tomorrow. He was discharged from the hospital a week later. The patient's family was overjoyed. But after seeing the endotracheal tube broken by his teeth, he was stunned for a long time and apologized to Zheng Ren with tears in his eyes.
This was left to Chang Yue. Zheng Ren was afraid that the patient would do something stupid again, so he simply made a chair and sat on the bedside of the patient, staring at him without blinking.
Postoperative endotracheal tube rupture is extremely rare, especially the rupture of reinforced endotracheal tubes has not been reported clinically. The situation in this case is extremely special. Through the stump of the catheter, it can be confirmed that the catheter was broken by repeated grinding by the patient's teeth.
This was discovered too early. If it had been later, there would probably have been more twists and turns.
Two echocardiograms were performed intermittently, and the patient's left ventricular ejection fraction increased to about 60%. The surgical effect was completely beyond imagination.
Four hours later, the patient fully regained consciousness. Seeing that all indicators were satisfactory, Zheng Ren transferred the patient out of the ICU, and the patient's family and Chang Yue were responsible for the guidance.
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Note: This is a true story. I heard it from a teacher many years ago. Regarding the rupture of the reinforced endotracheal tube, I heard and encountered such a case.