MTL - Doctor’s Life Simulator-Chapter 44 Isn't this bullshit! Wu Youtu's concerns

Soon Qin Lang entered the operating room.

The tracheal neck segment is located between the inferior border of the cricoid cartilage and the suprasternal notch. The front of the tracheal neck is from superficial to deep, followed by the skin, superficial fascia, deep cervical fascia, suprasternal space and jugular venous arch.

It also involves the inferior thyroid vein, the thyroid azygos plexus, and the recurrent laryngeal nerve in the trachea paraesophageal groove of the lowermost thyroid artery. The lower end of the neck segment of the trachea has large vessels at the root of the neck and the pleural roof. requirements are very high.

The surgeon is required to have a good understanding of the anatomy of the entire neck, and the patient is severely burned, so the entire operation is very difficult, and even ordinary resident physicians dare not do it rashly.

Therefore, in the operating room, anesthesiologists, itinerant nurses, and equipment nurses also have a trace of worry in their hearts.

"Local anesthesia, because the patient had difficulty breathing, so he first took a semi-recumbent shoulder pad, and after I was separated to the trachea, I lifted his head back with me..."

However, in response to them, Qin Lang gave very calm and precise instructions.

"Okay, Dr. Qin."

In the operating room, all the medical staff began to follow the instructions of the chief surgeon at the same time.

Generally speaking, the tracheotomy site is usually located in the 3rd to 5th tracheal ring, so Qin Lang directly from the middle of the lower border of the cricoid cartilage to a little 4cm above the suprasternal notch. The incision site is almost an inverted triangle, with the cricoid cartilage as the bottom and the top It is the suprasternal notch, with the anterior border of the sternocleidomastoid on both sides.

Qin Lang's hand holding the knife is very neat, and it is simply a horizontal incision.

Under the perfect level of incision, the skin and subcutaneous tissue are quickly separated longitudinally.

"...1: 500,000 epinephrine injection of Licardoine, retractor..."

Under the fast rhythm, the equipment nurses cooperated quickly, and it was indeed Dr. Qin, with a vigorous frequency of movements!

The retractor is evenly retracted on both sides, and the white line connecting the anterior cervical muscles on both sides in the midline is clearly exposed, which is the anterior jugular vein.

"...sutures, needle pliers..."

Qin Lang cut it off and ligated it very neatly. Since a small amount of Licardoine was injected in advance, there was very little bleeding.

Immediately afterwards, Qin Lang continued to separate up and down along the white line, and separated and retracted the anterior neck muscle to both sides, and then he saw the thyroid isthmus, which covered the 2nd-3rd tracheal ring.

Qin Lang observed it carefully, and then adopted blunt dissection, separating the posterior capsule from the anterior tracheal fascia, and pulling it upwards.

The equipment nurse on the side is also well-informed, but he is still a little surprised. Dr. Qin is too powerful, and the trachea is fully exposed, laying a solid foundation for the next steps.

"...fine needles, 11-gauge sharps..."

After Qin Lang completed the separation, he incised the anterior tracheal fascia, and then used the thumb and **** of his left hand to fix the larynx.

After checking to make sure the trachea is centered, a local anesthetic is injected into the trachea with a thin needle.

The anesthesiologist on the side sighed slightly: "Dr. Qin, this operation is really meticulous. Generally, only some old doctors who have been immersed in it for more than ten years will join this step of micro-operation, which can reduce the irritation of the trachea."

Sure enough, genius is different.

In the operating room, Qin Lang quickly used the No. 11 sharp knife to reach under the cartilage ring to be incised, pierced the trachea, and opened up the 3rd to 4th cartilage rings.

The whole action was completed in one go, flowing smoothly.

"...tracheal spreader, tracheal cannula..."

Qin Lang gave an order in a loud voice, and the little nurse on the side responded to the sound, cooperating with Qin Lang's high-speed movements, racing against time to cooperate.

Only Qin Lang used a tracheal spreader to insert into the tube, opened the tracheal ring incision, sucked out the secretions, and inserted the tracheal sleeve into the trachea together with the tube core, then took out the tube core, and carefully checked the wound again to confirm that there was no active bleeding point. .

Seeing Dr. Qin, he moved like a tiger coming out of the mountains, roaring in the mountains and forests, as fast as Zhao Yun went in and out seven times, and the delicate and gentle part was like a breeze blowing across his face, a hint of admiration and admiration flashed in the little nurse's eyes.

Immediately afterwards, Qin Lang tied the cannula with a surgical knot on the side of the neck to prevent it from being too tight or too loose. It was very standard to pass a finger.

After that, the surrounding skin is sutured in place.

"...Vaseline oil gauze..."

...

...

When Qin Lang performed a tracheotomy for Ling Sheng, Wu Youtu also completed the emergency rescue of a patient. After coming out of the operating room, he started to inspect the situation of the little doctors under him, and at the same time, he went to check the conditions of the wounded. .

Wu Youtu looked at them one by one, and soon came to the bedside of the patient where Cheng Yunfeng was.

Cheng Yunfeng and the nurse were monitoring various rehydration data together, and when he saw Wu Zhizhi, he was nervous for no reason.

It was very unconvincing that he reported the situation to Wu Youtu. After all, he was not very experienced in this kind of personalized rehydration program.

Wu Youtu checked it. Due to the Jinling burn formula and technique, the overall performance was good, but there were still some individual adjustments. Due to Cheng Yunfeng's lack of ability, he did not adjust it.

Wu Youtu frowned, why is that boy Qin Lang not here? If Qin Lang was monitoring, there would not be such a problem.

However, the main thing is to rescue the wounded now. Wu Youtu compared various monitoring data and said to Cheng Yunfeng: "Take the pen and paper and make fine adjustments according to what I wrote in a while. The overall completion is still good."

"Due to hemorrhagic shock in the early stage, the patient suffered a lot of bleeding, so concentrated red blood cells and balanced salt solution were replenished in time, but after waiting for a sufficient amount, the quality of the fluid needs to be improved, and fresh plasma, human blood protein and other colloidal components should be added in an appropriate proportion..."

While writing, Wu Youtu patiently imparted his experience to Cheng Yunfeng:

"The maintenance of colloidal osmotic pressure mainly relies on albumin, and the albumin content in the exudate is relatively high, which is equivalent to 80-90% of plasma albumin, so timely supplementation of albumin plays an important role in maintaining osmotic pressure..."

"...And after the body's function is gradually restored and the circulatory function is restored, the amount of water supplementation can be appropriately reduced, the infusion rate can be slowed down, excessive water retention can be avoided, and the occurrence of tissue edema and pulmonary edema can be reduced... "

After Wu Youtu's explanation was completed, a synchronized rehydration list for fine-tuning was also handed over to Cheng Yunfeng~www.novelbuddy.com~ Thanks to the assistive technology, I only need to look at the data after a period of time, and then I can give suggestions for fine-tuning , instead of being able to pay attention all the time, stay beside the patient, and estimate based on experience. It really saves a lot of manpower and material resources, and also improves the fault tolerance rate. "

After getting Cheng Yunfeng's bed, Wu Youtu asked, "Where are Qin Lang and Qian Liang?"

Cheng Yunfeng looked up and returned: "Originally, Dr. Qian asked Qin Lang to go with him to perform eschar incision and decompression for the patient. However, because Qin Lang was competent enough, Dr. Qian stayed with Qin Lang. On his own, he went to support another operation."

"However, just ten minutes ago, Qin Lang completed the eschar decompression operation that day with Dr. Qian, and then encountered a new patient sent by the fire brigade who was in urgent need of tracheotomy. The head nurse originally thought I wanted to go to other departments for help, but I didn't expect that Qin Lang came out and took over this tracheotomy."

Cheng Yunfeng kept an eye on various trends, especially Qin Lang's every move, and his words were full of envy and admiration.

However, it was a shock to Wu Youtu. It was a tracheotomy. Even Qian Liang had to be guarded by him, so Qin Lang went to the main operation himself?

"Isn't this nonsense, how did Zhao Qiufang do it!"

Wu Youtu calculated the time. Under normal circumstances, it should not be long before the operation. With a small doctor like Qin Lang, it must be slower.

"I hope it's in time."

For patients with this inhalation injury, after tracheotomy, it is easy to destroy the airway barrier, thereby aggravating complications such as infection and suffocation. very dangerous!