Ren Haitao''s nerves, which had just eased a little, suddenly became tense, and the levels of various hormones in his body soared instantly, exceeding the threshold.
Originally, the corner of his eye had been aiming at Wu Mian, who was chatting with Chu Zhixi in the opposite corner, but after feeling the resistance of manual ventilation, Ren Haitao''s vision was all focused on the patient, and all the surroundings became a blind area.
iron lung! It must be iron lung!!
Ren Haitao made a judgment in an instant.
Iron lung, also known as silent lung, is an anesthetic complication, which is generally common in patients with bronchial asthma.
Ren Haitao had asked the patient before the operation that he had no history of bronchial asthma and basically ruled out this rare possibility. Although the patient complains that he often has a cold and cough, he has not been ill recently.
Moreover, the most common time period of silent lung is about 30 minutes to 1 hour after the operation. Now I''ve just given a sedative and induced anesthesia. How can I be silent directly?!
The hairs on his back stood up. Ren Haitao immediately asked his assistant to pinch the ball and ventilate manually. He picked up the stethoscope around him to auscultate.
There was no breath sound in both lungs... The stethoscope listened repeatedly for 3 times, and no breath sound was heard in both lungs of the patient.
No breathing sound is really terrible. At this time, even a little wheezing sound is OK. Ren Haitao is extremely eager for the stethoscope to hear a trace of life.
If he hadn''t checked all the equipment, including the stethoscope, before the operation, he must think the equipment was broken.
"Brother Ren, the airway resistance is large, and there is no way to effectively give oxygen to the mask." the assistant said anxiously, "is it outside the airway..."
The so-called extraairway intubation does not mean that the trachea is punctured, but the endotracheal intubation that should have been lowered into the trachea enters the esophagus.
Sometimes when the ventilator blows, the patient''s stomach bulges first, which is the case.
I shouldn''t. I''ve taken it very seriously. This can''t happen. Besides, if you intubate outside the airway, you will never hear a breath sound in your lungs.
"Have you brought the fiberoptic bronchoscope?" a cold voice sounded in Ren Haitao''s ear.
"Yes!" Ren Haitao subconsciously stood at attention and answered.
Wu Mian didn''t say anything else. He crossed his left foot to the patient''s head, put his hands on the ball, and squeezed Ren Haitao''s assistant away with his left shoulder.
At the same time, Chu Zhixi held the patient''s jaw in the shape of e with his middle finger, ring finger and little finger, while his thumb and index finger pressed both ends of the mask in the shape of C.
Wu Mian squeezed the balloon with both hands and sent more oxygen to the patient''s lungs as much as possible.
The standard double hands E-C method buckle the mask to give oxygen, and the action is accurate, like a textbook. Wu Mian and Chu Zhixi have a tacit understanding. They have no language communication, but their actions match incomparably.
Everyone present except Ren Haitao and his assistant did not know what had happened and had begun rescue.
"Miss Wu, laryngoscope!"
Ren Haitao had no time to lament the perfect and tacit understanding of the rescue operation between Wu Mian and Chu Zhixi. He carried a box from the corner where he never got in the way and said anxiously.
"What model?"
"Pv112042, a product of Canada''s verathon medical ULC."
Wu Mian handed the ball to Ren Haitao, quickly but not disorderly opened the box, and took out the electronic visual laryngoscope from inside.
With the fastest speed, Wu Mian completed endotracheal intubation under direct vision of glottis. After confirming that the endotracheal tube is located in the airway, the resistance of squeezing the respiratory sac with both hands is still great, still showing the hand feeling of "iron lung", and there is no respiratory sound in both lungs during auscultation.
Then Wu Mian began to connect the ventilator.
Ren Haitao''s assistant wanted to stop it in surprise. In his opinion, it was a useless operation. Emergency first aid, every minute and every second may determine the patient''s life and death. Why do you have to do invalid operation?
But before he spoke, Ren Haitao completely squeezed his assistant away and helped Wu Mian connect the ventilator.
Mechanical controlled volume ventilation, no end tidal carbon dioxide waveform appeared on the screen of the ventilator.
"Silent lung, ready for rescue!" Wu Mian said in a deep voice.
The cool energy in the voice disappeared, but it was still cold and cold.
"Batch number and model of sevoflurane." Wu Mian asked.
"Production batch number: s044c829, Baxter healthcare, Spain." Ren Haitao replied quickly.
"When the concentration reaches 8%, the fresh oxygen flow increases to 8lmin."
"Salbutamol aerosol batch number, model."
At this time, one hand handed the bottle of salbutamol spray, and Ren Haitao took the aerosol.
"Production batch No.: k63j, produced by glaxowellcomes S.A. in Spain."
"Intraairway administration, 3 presses."
While directing the operation, Wu Mian put the stethoscope on the patient''s chest for auscultation.
After salbutamol injection, the patient still had no respiratory sound in both lungs.
"Intravenous injection of adrenaline, 1mg."
"Production batch number: 1709301, Tianjin Jinyao Pharmaceutical Co., Ltd." Ren Haitao reported the dosage form and production company while pushing the medicine.
Ren Haitao knows what Wu Mian means. The silent lung for inexplicable reasons may be caused by drug allergy, although it is unlikely. The core doctor directing the rescue should master all the information, even including the manufacturer and batch number of each drug.
Such a meticulous thing can''t be done by others, but it doesn''t mean that Mr. Wu can''t do it either.
Ren Haitao doesn''t understand the difference between the efficacy of different manufacturers and batch numbers. As long as Wu Mian needs it, he will try his best to do it well.
With the injection of adrenaline, irregular ETCO2 waveform gradually appeared on the screen of the ventilator, and wheezing sound appeared in both lungs during auscultation.
Then, every 2 minutes, Wu Mian would inject 1mg of epinephrine intravenously, giving 3mg of epinephrine. At the same time, he would cut off the injection of salbutamol aerosol into the endotracheal tube, pressing twice each time for 4 times.
With the increase of drug concentration, more regular ETCO2 waveform gradually appeared on the ventilator screen. At this time, Wu Mian heard that the patient''s lung cloth was no longer dead, but full of wheezing.
Although this is also a particularly difficult situation for anesthesiologists, as long as there is a sound, it is better than silence!
"Hydrocortisone."
"Production batch number: 021703066, Tianjin Biochemical Pharmaceutical Co., Ltd." Ren Haitao still reported the drug batch number and the production company while adding drugs.
"100mg dissolved in 100ml normal saline was injected intravenously."
"Adrenaline 1mg."
"Sputum suction."
"Pay attention to the depth of sputum suction."
"Intravenous injection of methylprednisolone 80mg and aminophylline 125mg."
"Stop pumping propofol and remifentanil, dilute 20ml with 1mg adrenaline, drip 0.3mg endotracheal tube, and continue manual breathing."
Wu Mian stood at a later position. Throughout the audience, everyone was his hand and every detail was under control.
After 10 minutes, the airway resistance of hand-controlled breathing decreased slightly, the respiratory sound of double lung auscultation was very low, and there was occasional wheezing.
The patient had a blood pressure of 16590mmhg, a heart rate of 142 beats and minutes, and spo290%.
After intravenous injection of esmolol 15mg and pantoprazole 40mg, Wu Mian finally became silent.
Ren Haitao constantly sucks sputum. He doesn''t trust his assistant to do this "simple" operation. At this time, any detail is very important and must not be underestimated.
Gradually reduce the sevoflurane inhalation concentration and oxygen flow, and the patient''s state gradually stabilized.