Since 1981 Health School

  Chapter 481 Tracheostomy in emergency

   "Where did Chen Qi go? Look for it, hurry up and find someone."

  When Qi Yunming was yelling hysterically, all the doctors in Huaguo went to the camp to find someone, and they almost dug the camp three feet?

   It is not that there are no surgeons in the camp, but such a critically ill patient is obviously not something that ordinary people can bear?

  The doctors in the Africa Medical Mission, like their counterparts in Africa, naturally, the first thing that comes to mind is the genius doctor Chen Qi.

  From this aspect, we can see that Chen Qi has become the core of everyone without knowing it. This is the advantage of technical authority, but it is also a disadvantage.

  The disadvantage is that when Chen Qi is not around, everyone is like headless chickens.

  The patient was in danger, but the attending doctor could not be found. This made Teodoro's family members who rushed over almost crazy, and the black soldiers also left violently. The hospital was in chaos for a while, and the atmosphere became tense.

  At this time, the little nurse Chen Li quietly raised her hand:

   "Qi Chu, Dean Chen said he was going outside to find weapons to defend our hospital, so he drove out."

  Qi Zhiming slapped his head:

"Yes, yes, he meant to go out. I'm confused. How could this guy look for weapons? Where can he find them? He must be lazy again. Hurry up, go to the beach and look for them. He often eats there. Seafood takes a nap."

   Immediately, a group of soldiers drove a car and left along the coast as fast as possible to find someone.

  Qi Yunming directed again: "The patient is an order. We can't just wait for Director Chen to arrive. Yi Zewen, Zhang Xing, you start to rescue the patient immediately."

  Yi Zewen was the older member of the surgical team, so he immediately took over the temporary command.

"Old He, perform endotracheal intubation immediately; Chen Li, monitor vital signs immediately; Yang Xiuxiu, immediately open the channels for opening the channels, first open two channels, first administer 0.9% sodium chloride, and then we wait for Dean Chen to arrive .”

   Is there anything wrong with this command?

  That’s right, it conforms to the emergency procedure, but a problem arises. What they are dealing with is not an ordinary patient, but a severely burned patient, which is a roast duck. Then the problem arises.

   It was Chen Li who had the problem first. The little nurse was about to put on the blood pressure cuff, but it was a little tighter, and pieces of skin and flesh fell off.

  Chen Li screamed in fright.

   I really can’t blame her, she has received professional training, and she usually doesn’t scream, but the pieces of human flesh fall off easily, and anyone would be disgusted.

   It wasn't just Chen Li who had the situation, Yang Xiuxiu was crying too:

   "Doctor Yi, I, I can't find the veins. Look at the hands and feet, where there is still intact skin. There is no way to **** the needle."

  For accumulated burns, most of the body surface veins have been destroyed, especially in the shock period, it is necessary to replenish a large amount of fluid in a short time, and it is necessary to build a venous channel that can ensure a relatively smooth flow rate.

   This creates a contradiction.

  On the one hand, a large amount of fluid replacement is required, and one channel is not enough, and two or three infusion channels are often required.

  On the one hand, the skin has turned into black carbon, especially the four feet, because people must use both hands and feet to escape in the fire, and the skin is exposed, so the burns are more serious, and it is more likely to use needles.

  Yi Zewen was already sweating profusely after hearing the nurse's report. This patient couldn't even monitor his basic vital signs, and he couldn't even get infusion. How can he be rescued?

  It is very difficult to rescue burn patients, such as support of vital signs, infection, and finally skin grafting. The first stage is very complicated and fatal.

   Even the first test could not pass, Yi Zewen thought that this black soldier must be dead and could not be rescued.

  The room was leaking and it was raining all night. When the doctors in China and Serbia were having a headache about how to rescue them, the anesthesiologist He Fule also had a problem with his endotracheal intubation.

   "Doctor Yi, the patient's airway can't be opened, even the mouth can't be opened, I, I can't insert the tube, what should I do?"

  You can’t complete the infusion for a while, and you can’t die for a while, but your airway can’t be opened, and the patient’s airway is blocked and causes suffocation, that is to say, he will die immediately.

  Let’s not talk about Yi Zewen now, even Qi Yunming next to him, the president of Freetown National Hospital Bagley, director Mombetto, and Piet were sweating profusely.

  The family members of the patient had obviously seen that Doctor Hua Guo was also at a loss, so they began to mourn again.

   "Doctor, where did the double director doctor go? Why didn't he come to save people? Does he need money? We have dollars, we have gold, as long as we can save him, we are willing to support enough rewards~~~"

  Qi Yunming listened, and roared:

   "Why are you still standing there in a daze, go get normal saline, and debride the patient first."

   The China-Serbia Friendship Hospital is busy soon...

  Chen Qi was discovered on a hillside by the sea.

   It’s hard not to notice it, because his cool Lamborghini LMA002 civilian armored vehicle is so conspicuous, it can be seen from a distance when parked on the mountain road.

  Chen Qi was sleeping soundly when he suddenly heard the sound of cars, motorcycles, and a group of people commotion.

  When he opened his eyes, his heart almost jumped out of fright, because all around him were real guns and live ammunition, with menacing militants on their faces.

"What, what's the matter? The rebels have already hit Freetown? Well, I am a doctor, a doctor from Huaguo, we are neutral, and we are here to serve the great Sierra Lean people and for the friendship between the two countries. here."

  Chen Qi hesitated for a second, and only took out the small flags of the two countries to wave a few times.

  Since ancient times, it has been thought that Qiu Ba is just a murderer. If he flies over here, his life will be confessed here.

   While Chen Qi was thinking about how to get out, a Hua Guo doctor crawled over from the foot of the mountain:

   "Chen, Dean Chen, hurry up, a big man has come to our Friendship Hospital. He was burnt to charcoal all over by the incendiary bomb. Now he is still alive and needs emergency treatment. Everyone is waiting for you."

   "Burn?"

   "Yes, at least over 80% of the body has extensive burns, almost all of which are 2 or 3 degrees deep."

   "Hey, you can still survive after this, the Chosen One, the halo of the protagonist, let's go and ask for help."

  Chen Qi just ran a few steps, turned around and said to the soldiers: "This super big steamer has to be taken away for me. If you lose it, you can't even buy it in your country."

   "Ah, Dean Chen, when are you still thinking about eating, he is the commander of the army, a big shot."

  The place where Chen Qi takes his afternoon nap is actually not far from the China-Serbia Friendship Hospital. The straight-line distance is only 3 kilometers. If you step on the gas pedal to the bottom, you will arrive in 7 or 8 minutes.

  Chen Qi jumped out of the car and ran to the emergency room. When he saw the patient undergoing debridement, he felt a toothache.

   Don’t forget that Chen Qi was a hepatobiliary surgeon in his previous life, and he also majored in hepatobiliary surgery when he was studying for a master’s degree and a Ph.D.

   Now that such a seriously ill patient came, Chen Qi said that it is impossible not to pressure, not to mention that this is an important political figure in Serbia.

  Yi Zetian wanted to kneel down when he saw Chen Qi running in, and hurriedly shouted:

   "Dean Chen, hurry up, hurry up, the patient urgently needs tracheal intubation, and Lao He and I can't figure it out."

  Deep burns, especially deep burns on the head and face, on the surface of the patient, the mouth is swollen and protruding, which is called "fish mouth sign".

  Accompanied by a deep burn in the neck with circular or semicircular eschar, which can interfere with endotracheal intubation.

  The most terrible thing is that it will also cause severe internal laryngeal burns and severe glottic edema leading to laryngeal obstruction. This is also an important reason why He Fule and Yi Zewen, an anesthetist and a surgeon, cannot insert the tube.

  Chen Qi became popular when he saw it:

"Insert the fart tube, look, the patient is obviously in respiratory distress, and the black man can't see his face. If he is yellow or white, he will already be blue and purple at this time, and he will suffocate to death soon. Since it is necessary to rescue it, we must Be adventurous."

   "Ah, it's so serious, what if we don't intubate?"

"What to do, of course, the trachea is cut directly, although the operation risk is higher, but this is the only way, Lao He, you need local anesthesia immediately, never mind the general anesthesia, it's too late, I'll talk to the family. "

  As soon as Chen Qi arrived, everyone started running like a precision machine.

  Chen Qi found the wife of the commander-in-chief who was crying loudly:

   "Ma'am, the situation is critical now. I need to cut this part of the patient, otherwise he won't be able to breathe, and it won't last half an hour."

  Ms. Teodoro was already lost at this time, Teodoro's father, Chief Raodoro nodded firmly:

   "Doctor, you can do whatever you think is beneficial. We have no objection. Our only hope is to save my son."

  Doctors like this kind of family members of patients who are considerate, courteous, and good at communicating. If they really encounter those entangled family members who are hesitant and hesitant, when they make up their minds, they will probably be completely chilled.

  The family members agreed, Chen Qi took the scalpel from the equipment nurse without further ado, touched the lower edge of the thyroid cartilage to the place close to the suprasternal fossa, and cut along the anterior midline of the neck.

  The moment the trachea was cut, the blood in the trachea gushed out like a beautiful blood mist,

  The family members next to each other screamed and bang, and two of them passed out.

  Chen Qi became angry: "Kick out all irrelevant personnel. The most feared thing for burn patients is infection. So many people want him to die."

  President Bagley and Mombetto, the two big bosses of the Sierralian health system, also acted as assistants and security guards at this time, driving non-medical personnel out of the emergency room.

  The trachea was opened, and there was a creepy sound of tubular breathing from the incision, but the respiratory distress caused by suffocation disappeared immediately.

  Yi Zewen immediately took the tracheal incision dilator to open the tracheal incision, and Chen Li immediately handed over a tracheal tube.

  Chen Qi quickly inserted the outer tube into the tracheal incision, immediately took out the tube core, then put it into the inner tube, sucked up the secretions, and began to check for bleeding.

  Zhang Xing tied the **** the tracheal tube to the neck and tied it into a dead knot for firm fixation.

  The surgical team cooperated tacitly and had a clear division of labor, and finally passed the first difficulty. Before Chen Qi could take a breath, Yang Xiuxiu shouted again:

   "Dean Chen, almost all the superficial veins of the patient are burned out, I, I can't find the blood vessels needed for the venous access, what should I do?"

  Chen Qi sighed in his heart, thinking that in the 1980s, grassroots doctors and nurses were too lacking in high-end medical care knowledge, and their level was really not enough.

   "Zhang Xing, you go and push the ventilator I brought back from the country, and use it for the patients. Yi Zewen, you and I use surgical methods to open the venous access."

  The main pathophysiological basis of burn shock is the deep-induced loss of body fluid, as well as abnormal cardiac function and vasomotor function.

  A large amount of plasma-like body fluid leaks from the blood vessels to the wound surface and interstitial space, resulting in a sharp decrease in effective circulating blood volume and microcirculation disturbance, as well as dysfunction and structural damage of important tissues and organs.

  So severely burned patients need a large amount of crystal solution and colloid solution to implement fluid resuscitation quickly, and antibiotics, high-energy nutrient solution, life support drugs, etc. are needed to maintain clinical treatment.

  If you can't even find an intravenous access, rescue is out of the question.

  Chen Qi looked at the patient up and down, no wonder the little nurse couldn't find the place where the needle was inserted. There are still a few good pieces of meat on this body, especially the burns on the hands and feet are very serious.

   Then you can’t take the conventional route.

   "Chen Li, prepare the aseptic bag for the puncture needle for me right away. In addition, call all the young doctors over. Today I will teach you a few tricks, which can save lives at critical moments."

  As soon as I heard that Dean Chen was going to teach on-site, there was a splash. Doctors and nurses who were wearing surgical gowns and had done simple disinfection work all gathered around.

"Yang Xiuxiu, Chen Li, and Yi Zewen and Zhang Xing, the reason why I focus on the names of the four of you is because you are a member of my surgery team. Even if I am not here, your handling today is still a loss of points. I want to criticize .

  The superficial veins on the hands and feet cannot be found, what should I do? Simple, there are deep veins in the human body, the blood vessels are thicker, and the smooth flow can be guaranteed, which is conducive to the administration of fluids. Watch and learn. Let me do a vigorous external venipuncture to show you. "

  Chen Qi chose the 1/3 point on the line connecting the midpoint of the mandible and the upper edge of the clavicle as the puncture point, fixed the skin on the left, and inserted the needle at a 15° angle with the skin on the right.

  After returning, fix the cannula of the puncture needle on the left, pull out the puncture needle on the right, then quickly connect the connector end of the catheter with the guide wire to the cannula, insert the catheter slowly, and remove the detachable connector.

  Fix the catheter on the right, withdraw the puncture sleeve from the end of the catheter on the left, and finally take out the guide wire, and quickly connect the catheter to the infusion device.

  Chen Qi explained while performing puncture, and then chose to demonstrate a deep vein puncture in the femoral vein and subclavian vein respectively.

  In this way, three venous channels were quickly established, laying the most solid foundation for rescuing patients.

  It is rare for young doctors and nurses in Huaguo to observe deep vein puncture at such a close distance, and they understand the selection of the site, operation process, precautions, etc., and the rest is to practice.

   Medicine cannot be lazy, it can only be practiced continuously, and finally practice makes perfect.

   As a result, the venous channel was opened, but another very headache problem was encountered, that is, what kind of liquid should be infused? What is the dosage?

   This involves a set of very complicated calculation formulas, which almost made Chen Qi collapse...

  (end of this chapter)