The key to operating the bag-mask ventilation technique is sealing and opening the airway.
If ventilation is unsatisfactory when operated by one person, two-person pressurized assisted ventilation should be considered, which can be used simultaneously with manual opening of the airway and oropharyngeal or nasopharyngeal airway. This technique is mainly used when patients are at risk of aspiration and reflux, while applying cricoid cartilage compression.
Even the laryngoscope and light wand guidance technology were used. Basic operations such as single-person bag mask had been excluded by Zheng Ren and would not be considered.
However, when using double bag mask ventilation with small tidal volume and high-frequency high-pressure oxygen delivery, it was found that the patient's chest rose and fell not significantly.
"Laryngeal mask!" Zheng Ren shouted in a deep voice.
At the same time, he had already put on sterile gloves, and his eyes moved back and forth between the ECG monitor and the patient, but he did not perform a tracheotomy immediately.
The patient's current condition requires tracheotomy, which is a high-risk tracheotomy. Zheng Ren tried it in the system operating room. Even if there is a lucky halo, even if there is a bonus of +10 for surgery completion, and even if it is just a small operation, the final surgery completion is only 65%.
This means that patients who are assisted to breathe by a ventilator may not be able to wean themselves off the machine, or even get off the operating table at all.
Zheng Ren tried many times, and the success rate of 65% was the highest.
In fact, high-risk tracheostomy patients are not uncommon.
The main symptoms include short neck, obesity, upright position, inability to tilt the head back, agitation, wide or space-occupying thyroid isthmus, high mediastinum, tracheal deviation, backward tongue, severe dyspnea, and at the same time, inability or inability to intubate the orotracheal tube orally. Those who are intubated but unable to breathe spontaneously, have poor coagulation function, suddenly suffocate before surgery, and have unclear markers of cervical and thoracic bone and cartilage are all high-risk tracheotomy groups.
Under normal circumstances, it can be compensated for through manipulation, but the patient's situation in front of him is special. Zheng Ren is very helpless. This time he encountered a particularly difficult problem.
Fortunately, the mask's oxygen supply effect is good and has been tested in the system's operating room.
An anesthesiologist quickly opened the laryngeal mask and handed it to Zheng Ren.
After getting it, Zheng Ren used his left hand to pull the patient's jaw, and when he was about to put the laryngeal mask in, he was surprised to see that it was a second-generation laryngeal mask!
Strange, the third generation laryngeal mask is clearly used in the system operating room. What's going on
There is a big difference between the second generation and third generation Explorer laryngeal masks. Even the third generation laryngeal mask was only 98% complete in the end. Zheng Ren did not dare to be careless.
"Three generations of explorers!" Zheng Ren said immediately.
Director Xu was startled for a moment, the third generation explorer... a laryngeal mask
The patient's blood oxygen saturation has dropped to 70%. Why is Boss Zheng still picky about the second and third generation laryngeal masks...
Just as he was about to explain, Feng Xuhui stood outside the operating room and said loudly, "Mr. Zheng, wait a moment!"
He held the mobile phone in his left hand and made a call. The call was answered almost instantly. Feng Xuhui said quickly: "Emergency first aid kit!"
As he spoke, Feng Xuhui quickly came to the door of the operating room with "thumping" steps.
Opening the door to the operating room, Liu Xiaojie, who was more than ten meters away, pushed the box hard. The heavy trolley case slid on the marble floor and was in front of Feng Xuhui almost the moment he opened the door.
After taking the box and closing the door, the whole process takes 3.2 seconds.
Director Xu has been following Feng Xuhui, keeping calm. After all, he is the director of the University of Anesthesiology and has seen too many similar situations.
It's just that today's patient's situation is a bit more special. It could have been solved with a more ordinary laryngoscope.
Boss Zheng has been reluctant to perform a tracheotomy, and Director Xu also knows that this is a high-risk patient, and he may face more troubles once the tracheotomy is performed. This trouble does not all come from the patients' families, but more from the patients themselves.
It is not uncommon for patients to get worse after high-risk tracheostomy, so he also prefers to use a laryngeal mask.
It's just that the 912 laryngeal mask is pretty good. I've been using that model for many years, and Boss Zheng actually wants a 3rd generation Explorer. This kind of laryngeal mask has only been heard of in academic conferences, and the anesthesiology department of 912 has not yet evolved to this stage.
The small consumables dealer who has been following Boss Zheng seems to be... the manager of the intervening consumables manufacturer. What did he yell just now? First aid kit? !
After Director Xu saw a medium-sized trolley case "flying" in, the small supplies merchant immediately squatted on the ground and opened the case.
The trolley case is neatly placed with a dazzling array of emergency and first aid consumables.
Without even looking, he stretched his hand inside and seemed to know exactly where the dozens of consumables were.
A sterile packaged bag was immediately grabbed by Feng Xuhui. Seeing Director Xu standing not far away looking at him, Feng Xuhui threw the bag in his hand.
"Director Xu!"
There is no need to be polite during emergency rescue, and there is no time to be polite. Every minute and every second is extremely precious.
Director Xu caught the sterile package and saw a third-generation Explorer laryngeal mask.
“…”
It was so special, Director Xu felt that his face was invisibly burning.
But before he could think about it, he turned around and ran away, tearing open the outer packaging of the laryngeal mask as he ran.
Zheng Ren took the laryngeal mask and inserted it using the conventional blind probing method.
Pull the mandible with your left hand to widen the oral space. Hold the laryngeal mask with your right hand, with the mouth of the mask facing the patient's lower jaw, and insert it downward along the midline of the tongue against the posterior pharyngeal wall until it can no longer be advanced.
After inserting the laryngeal mask, positive pressure ventilation was performed, and Zheng Ren observed that the degree of chest rise and fall returned to normal. He grabbed a stethoscope and auscultated the breath sounds on both sides to be symmetrical and clear, and there was no air leakage murmur in the front of the neck.
Even though he had performed more than 10 operations in the system operating room, and even though he was surrounded by a halo of luck after coming out, Zheng Ren was still very careful to check whether there were any errors in the operation.
After the laryngeal mask was put on, Zheng Ren placed a gastric tube to exhaust air under the guidance of the laryngeal mask, which solved the problem of the expansion of a large amount of gas in the stomach, which caused the diaphragm to rise and reduce the lung capacity.
"Propofol 40mg!"
"Midazolam 2mg!"
"Dexamethasone 10mg!"
Zheng Ren looked at the patient's ECG monitoring and continued to issue medication instructions.
"Intravenous infusion of aminophylline 0.25g + 5% glucose 250mL!"
The patient's blood pressure fluctuated between 184 and 110 mmHg/98 and 55 mmHg, and his heart rate fluctuated between 60 and 98 beats/min.
"Nitroglycerin 0.05mg, urapidil 15mg." Zheng Ren said solemnly.
Seeing that the blood pressure, heart rate, and blood oxygen saturation continued to rise, the air in the operating room became a little calmer.
Boss Zheng's medical instructions were executed perfectly without any doubts, even by Director Xu.
If he hadn't been there, Director Xu would have prepared to remove the laryngeal mask next, but with Boss Zheng standing there, Director Xu felt at ease for no reason. Instead of being the one who only knew how to do emergency rescue, someone had taken away his position, which made him feel that his authority had been compromised. challenge.
At this time, with technology speaking and the laryngeal mask of the third-generation explorer who looked like a fairy from heaven, Director Xu had no idea at all.