Chapter 2765

The key to the operation of balloon mask ventilation technology is to close and open the airway.

If the ventilation is not satisfactory during single person operation, it is necessary to consider double pressure assisted ventilation, combined with manual opening of airway, oropharyngeal or nasopharynx airway at the same time. This technique is mainly used when the patient has the risk of aspiration and reflux, and compression of cricoid cartilage is given at the same time.

Even laryngoscope and light stick guidance technology are used. The basic operation of single balloon mask has been excluded by Zheng Ren and will not be considered.

However, it was found that the fluctuation of the patient's chest was not obvious when the double balloon mask was ventilated with low tidal volume and high-frequency and high-pressure oxygen.

"Laryngeal mask!" Zheng Ren roared in a deep voice.

At the same time, he had put on sterile gloves and moved his eyes back and forth between ECG monitoring and patients, but he didn't do tracheotomy for the first time.

In the patient's current situation, tracheotomy is a high-risk tracheotomy, which Zheng Ren tried in the system operating room. Even if there is a lucky aura, even if there is a bonus of + 10 for operation completion, even if it is only a small operation, the final operation completion is only 65%.

This means that patients with ventilator assisted breathing may not be able to go offline or even go down to the operating table at all.

Zheng Ren has tried many times, and the success rate of 65% is the highest.

In fact, patients with high-risk tracheotomy are not uncommon.

It mainly includes short neck, obesity, end sitting position, inability to tilt back the head, restlessness, wide thyroid isthmus or space occupying, high mediastinum, trachea deflection, tongue falling back, severe dyspnea, and those who cannot intubate through mouth or intubate through mouth but have no spontaneous breathing, poor coagulation function, sudden asphyxia before operation, and unclear signs of neck and chest bone and cartilage.

In general, it can be made up by manipulation, but the patient's situation is special. Zheng Ren is very helpless. This time he encountered a particularly difficult thing.

Fortunately, the effect of mask oxygen is good, which has been tested in the system operating room.

An anesthesiologist quickly opened the laryngeal mask and handed it to Zheng Ren.

After starting, Zheng Ren pulled the patient's jaw with his left hand. Just about to send the laryngeal mask in, he was surprised to see that it was a second-generation laryngeal mask!

It's strange that 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 the third generation Explorer LMA. Even the final completion degree of the third generation LMA is only 98%. Zheng Ren dare not be careless.

"Three generations of explorers!" Zheng Ren said immediately.

Director Xu was stunned. Three generations of explorers... Laryngeal mask?

The patient's oxygen saturation has dropped to 70%. Why is boss Zheng picky about the second and third generation laryngeal masks

He just wanted to explain. Feng Xuhui stood outside the operating room and immediately said loudly, "President Zheng, wait a minute!"

With his mobile phone in his left hand, he made a call and answered it almost seconds. Feng Xuhui said in a rapid voice: "emergency rescue box!"

As he spoke, Feng Xuhui quickly came to the door of the operating room with the steps of "Dong Yuan".

Opening the door of the operating room, Liu Xiaojie, more than ten meters away, pushed the box hard. The heavy Trolley Case slid on the marble floor, almost in front of Feng Xuhui when he opened the door.

After receiving the box, the door is closed. The whole process takes 3.2 seconds.

Director Xu has been following Feng Xuhui. He keeps calm. After all, I'm the director of the University of anesthesiology. I've seen too many similar situations.

But today's patient's situation is more special. It would have been done under an ordinary laryngoscope.

Boss Zheng delayed tracheotomy. Director Xu also knew that this was a high-risk patient. Once it was cut, he might face more trouble. This trouble is not all from the patients' families, but more from the patients themselves.

It is not uncommon for patients with high-risk tracheotomy to get worse, so he also prefers to use laryngeal mask.

It's just that the 912 laryngeal mask is quite good. That model has been used for many years. Boss Zheng wants three generations of explorers. This kind of laryngeal mask has only been heard in academic conferences. The anesthesia department of 912 has not evolved to this step.

The small consumable supplier who has been following boss Zheng seems to be... The manager involved in the consumable manufacturer. What did he just shout? First aid kit?!

When director Xu saw a medium-sized trolley box "flying" in, the small consumables supplier immediately squatted on the ground to open the box.

A variety of emergency supplies are neatly placed in the trolley case.

He didn't look at it. He stretched his hand in. It seemed that he knew where dozens of consumables were.

Feng Xuhui grabbed a sterile bag and saw director Xu standing not far away looking at himself. Feng Xuhui threw the bag in his hand.

"Director Xu!"

You're welcome during emergency rescue, and you don't have time to be polite. Every minute, every second is extremely precious.

Director Xu caught the aseptic package and impressively entered the goal of a 3-generation Explorer laryngeal mask.

“……”

Really, director Xu felt that his face was hot.

But without time to think about it, he turned and ran, tearing open the outer package of the laryngeal mask while running.

Zheng Ren took over the laryngeal mask and placed it by conventional blind detection.

Pull the lower jaw with the left hand to widen the oral space, hold the laryngeal mask with the right hand, face the patient's lower jaw, and insert it downward along the middle line of the tongue and close to the posterior wall of the pharynx until it can no longer be pushed forward.

After laryngeal mask placement, positive pressure ventilation was performed, and Zheng Ren observed that the degree of chest fluctuation returned to normal. He grabbed a stethoscope and auscultated the respiratory sounds on both sides symmetrically and clearly. There was no air leakage noise in the anterior cervical area.

Even if he has done more than 10 operations in the system operating room, even if there is a lucky aura after coming out, Zheng Ren still carefully checks whether there is an error in the operation.

After the laryngeal mask, Zheng Ren placed a gastric tube for exhaust under the guidance of the laryngeal mask to solve the problem of increasing diaphragm and reducing lung volume due to a large amount of gas expansion in the stomach.

"Propofol 40mg!"

"Midazolam 2mg!"

"Dexamethasone 10mg!"

Zheng Ren looked at the patient's ECG monitoring and constantly issued medication instructions.

"Intravenous infusion of aminophylline 0.25g + 5% glucose 250ml!"

The blood pressure fluctuated from 184 to 110mmhg / 98 to 55mmhg, and the heart rate fluctuated from 60 to 98 beats / min.

"Nitroglycerin 0.05mg, urapidil 15mg." Zheng Ren said in a deep voice.

Seeing the continuous rise of blood pressure, heart rate and oxygen saturation, the air in the operating room eased a little.

Boss Zheng's medical advice was perfectly implemented without any doubt, even director Xu.

Without him, director Xu is going to remove the laryngeal mask next, but boss Zheng is standing there. Director Xu feels very relieved for no reason, rather than being robbed of the emergency rescue position, which makes him feel that his authority has been challenged.

At this time, director Xu didn't have any thoughts for a long time because of his technical speech and the laryngeal mask of the three generations of explorers who were flying like immortals that day.