If the patient is really a COVID patient, then endotracheal intubation will directly expose the patient to the high concentration of virus exhaled from the patient's mouth, so the intubator also uses tertiary protection.

He changed his clothes in the locker room in the semi-polluted area, dressed like an alien. Awkwardly entered the negative pressure operating room.

It was found that the relevant departments of the hospital, including obstetrics, neonatology, brain surgery, thoracic surgery, anesthesiology, infectious diseases, and CT departments, have set up a multidisciplinary collaborative diagnosis and treatment team according to the plan.

Xiong Shengnan, the head nurse, has arranged for experienced specialist instrument nurses to come to the stage to cooperate with the operation, and two itinerant nurses have been identified. One person is responsible for the tour work in the operating room, cooperating with the anesthesiologist to complete the operation and provide the required items on the table, and the other is responsible for the supply and contact of temporary special items outside the operating room.

The surgeons, instrument nurses, and anesthesiologists involved in the operation all wore work clothes, N95 masks, hats, protective glasses, isolation gowns, protective clothing, disposable shoe covers, double gloves, and protective face shields in accordance with the three-level protection.

The itinerant nurses who enter the operating room use secondary protection, which is less isolation gown and protective face shield than the former.

The anesthesiologist walked over, smiled apologetically at Dai Yunyang, and said in a low voice: "Doctor Dai, let me remind you, it is best to succeed in intubation at one time, because repeated attempts to intubate will lead to disorder of the patient's physiological state and increase the danger of the patient. ”

Dai Yunyang looked at him with some dissatisfaction, thinking to himself who doesn't want to succeed at one time? Why are you asking for support? I'm here, and you tell me this, what's the point of increasing my psychological burden?

Thinking in his heart, he didn't say anything, but nodded without smiling, anyway, wearing an N95 mask, goggles and a protective face shield, his expression couldn't be seen by the other party.

The anesthesiologist continues, "I pre-oxygen, which removes nitrogen from the residual capacity of the woman's lungs and increases the oxygen reserve in the lungs during apnea during intubation. Normally, an adult only has enough oxygen stored in the lungs for one minute, but I give five minutes of pre-oxygen to allow the lungs to denitrogenate, which can last up to eight minutes. ”

"Normally, intubation is sufficient. However, this patient is a trauma patient, with trauma to the larynx and lungs, and he is a new coronavirus patient, and he has respiratory distress, so I assess that the patient's breathing time is only two minutes at most due to intubation. You must be intubated and ventilated within two minutes. ”

The anesthesiologist said all this with great difficulty, as an anesthesiologist, it was necessary for him to explain the danger, but he was worried that Dai Yunyang would be afraid, so he looked at Dai Yunyang with a loss, for fear that he would pick on him.

Dai Yunyang, as the intubation champion, not only tested the intubation technique, but also included the written test of relevant knowledge, of course he knew all this, so he nodded again.

The anesthesiologist secretly breathed a sigh of relief, said thank you, and then began to instruct the itinerant nurse to inject anesthetic drugs through the intravenous access, and need to wait for the anesthesia to take effect before intubating, so as to avoid coughing and sputum spurting and causing contamination.

After Dai Yunyang studied the head and neck films of the mother Tan Yuanyuan, he found that she had severe maxillofacial trauma and an upper respiratory tract hematoma, and decided to implement retrograde guided intubation that he was best at. This avoids the difficulty of tilting the head back and largely guarantees first-time success with fewer complications.

After everything was ready, Dai Yunyang did a tracheal puncture below the level of the cricoid cartilage, placed a hollow bougie, entered the airway through the mouth through the retrograde introducer tube, and then pulled out the thin introducer to guide the endotracheal intubation with the central control bougie.

This is a new intubation method created by Dai Yunyang, which can make the endotracheal tube easier to be pulled into the trachea and avoid complications such as bleeding and vocal cord damage.

Although wearing a very obstructive level 3 protective suit and a very troublesome and difficult airway, Dai Yunyang still completed all the intubations in only about one and a half minutes, restored ventilation, and stabilized the patient's physical signs.

The next thing to do is not his business, and the airway management is left to the anesthesiologist. He exited the operating room with the anesthesiologist looking at him gratefully.

When he took off his protective clothing, he found that his armpits and back were wet with sweat, and he didn't know if it was covered by this airtight isolation suit, or if it was leached out of high tension.

………………

The cesarean section of the mother Tan Yuanyuan went smoothly, and the head and chest trauma were also surgically treated. However, her condition was very dangerous, so as soon as she got off the operating table, she was transferred to the intensive care isolation unit. Wu Hao designated Dai Yunyang to be in charge of her treatment.

Due to the new crown pneumonia and trauma, Tan Yuanyuan suffered severe pulmonary edema, and the chest CT showed that the lungs had become white lungs, white and vast, and the normal lung tissue could not be seen, and the lung water leaked very badly.

Dai Yunyang glanced at the monitor, her heart rate was 120 per minute, her blood pressure was dangerously low, and her oxygen saturation was only 78%, which meant that her heart was already extremely dangerous and could stop beating at any time.

Due to the destruction of Tan Yuanyuan's lungs by the new coronavirus, a large amount of inflammatory exudate was produced in the alveoli, which filled the tracheal intubation, and went up and down with the respiratory airflow, and the entire sputum suction tube was full of pink bloody sputum, which was very terrifying.

It must be rescued immediately.

Dai Yunyang immediately adjusted the ventilator to pure oxygen, and muttered in his heart, how much PEEP (positive end-expiratory pressure) should be set? 15 or 18?

He decided to set 15 first, which was already very high, and ventilator support for oxygenation was almost at its peak. He had never used such a high PEEP on that patient, it was all caused by the new crown, and with the trauma, the patient's lungs quickly collapsed, so it could only be so.

Wu Hao asked ICU doctor Fu Quan to be Dai Yunyang's assistant. Dai Yunyang was still a little uncertain in the ICU rescue, and asked for his opinion: "Do you think you can use muscle relaxation and then re-open the lungs?" ”

Fu Quan hesitated for a moment, but still shook his head: "The unconventional means of lung recruitment cannot be used until the last moment, and now the patient's blood pressure is too dangerous, so he should not be reopened immediately, or take vasopressor drugs first, we have to suppress the lung water first." ”

Dai Yunyang thought for a while, and then said, "Maybe you can try it with pressure 45 and pressure 45 seconds?" Maybe there will be pneumothorax, maybe there will be circulatory failure, but if you don't use means, in this state, the mother will die sooner or later, it is better to fight. ”

Fu Quan was stunned, this is the truth, he can't be sure, such a critical illness coupled with the mysterious and weird virus of the new crown makes a ghost from it, and many problems have become complicated and unknowable.

In the end, he chose to play football: "You are the ruler, you decide." ”

Dai Yunyang glanced at the other party, but there was no meaning to blame the other party in his eyes, at this time, Mingzhe self-preservation has become the wisest choice for many doctors, he fully understands. And as the main ruler, you do have to be responsible.

So, he slowly spit out three words: "Lung re-expansion!" ”

Fu Quan and Wang Bingbing both nodded, their expressions solemn, and the decisive battle was about to begin.

Dai Yunyang turned his head and gave a verbal order to nurse Wang Bingbing: "Muscle relaxation, albumin, diuretic!" We need to reduce our lung fluid as much as possible. ”