So Wang Qiaoya said truthfully:

"Brother Yi, I have never encountered such a case in our hospital."

"Although I have learned its clinical symptoms before, I still can't combine it with the actual situation."

"I've seen this case now, and if I encounter it again in the future, I should be able to diagnose it."

So Lin Yi continued to ask her:

"Can you do a tracheostomy?"

After hearing this, Wang Qiaoya immediately shook her head and said:

"This ......... I haven't done it. ”

"Okay, let's go and do a percutaneous tracheotomy for this patient in a while."

"Percutaneous tracheostomy?"

Wang Qiaoya blinked, a little incomprehensible.

"Brother Yi, what does percutaneous tracheostomy mean? Isn't it a regular tracheostomy? ”

Lin Yi shook his head. Explains:

"Conventional tracheotomy is usually a longitudinal incision in the neck made by the surgeon."

"This kind of tracheostomy is traumatic for the patient, easy to infect, and not easy to heal."

"The percutaneous tracheostomy that we're going to do later is a transverse incision. It only takes a 1.5 cm incision, and I'll take you to do it in a while, and you can feel it slowly. ”

This is because the patient has a high fever and significant muscle tension.

The intensivist has sedated him.

To prevent the patient from having dyspnea and suffocation,

A tracheostomy should be performed as soon as possible to ensure safety.

Song Borui has done a thorough debridement of the patient, completely removed the purulent secretions, and injected tetanus antitoxin.

At this time, the patient's family had already rushed to the hospital.

Lin Yi explained the patient's situation to them in detail, and the family immediately felt the horror of the disease after listening to it.

So they signed the tracheostomy consent form.

At the same time, Lin Yi also issued a critical illness notice.

Tetanus can be said to be a disease with a high mortality rate.

Except for the rabies mortality rate that I encountered the other day, it is 100 percent.

This tetanus infection has one of the highest mortality rates.

Percutaneous tracheostomy is a procedure often performed by intensivists.

For critically ill patients, unconscious, severe lung infection, tracheotomy is generally required.

In the past, it was the surgeon who did a general tracheotomy.

Later, due to the development of medical technology, the most simple percutaneous tracheostomy has been developed.

Generally, the doctors in the emergency department are not eye-catching for this kind of small and no longer small surgical operation, because they can!

However, Wang Qiaoya has not been in the hospital for a long time, has no experience, and percutaneous tracheostomy is the first time to see her.

This kind of surgery is simple and fast, less painful and less traumatic for patients, and is the most ideal tracheostomy option for severe patients.

The patient's oxygen saturation was affected by frequent convulsions.

So after transferring the patient to the ICU, he was intubated and put on a ventilator.

At the same time, he was given sufentanil and midazolam analgesic sedation.

Now the patient's vital signs are stable, almost as if he was asleep, and there are no more convulsions.

Seeing that Lin Yi was going to bring Wang Qiaoya this time, Song Borui brought a disposable air-cut bag.

Subsequently, Lin Yi began to carefully guide Wang Qiaoya:

"If you want to do a percutaneous tracheostomy on a patient, you first have to get your body in the right position."

"The patient needs to lie flat with a pillow under the shoulders and try to keep the airway open."

As he spoke, Lin Yi first straightened the patient's position.

Together with Song Borui, he lifted the patient's upper body and placed a pillow between the patient's shoulders to tilt his head back and fully expose his neck.

After the patient's position was set, Lin Yi was not in a hurry to disinfect and wore sterile gloves.

Instead, Song Borui stood at the head of the patient's bed.

Then Song Borui put the air bag of the endotracheal intubation, released a part of the air to decompress, and then slowly extubated it.

Lin Yi glanced at Wang Qiaoya and said:

"That's some of the steps that we need to prepare for in the early stage, first of all, it's positioning, and then it's like Borui doing this, do you know why we do it?"

This is the first time Wang Qiaoya has seen a percutaneous tracheotomy, how did she know why Song Borui pulled out the tube, and immediately shook her head. jújíá?y.?? m

Lin Yi explained to her:

"Patients with endotracheal intubation, for percutaneous tracheostomy, must pull out a part of the endotracheal intubation."

"This is because the endotracheal intubation is inserted relatively deeply, which blocks the part where we did the tracheotomy."

Immediately after, Lin Yi continued to ask:

"What is the depth of endotracheal tube insertion? Do you know? ”

Endotracheal intubation Wang Qiaoya has learned, and has also been intubated in several cases, and she is no stranger to the depth of endotracheal intubation.

Therefore, without hesitation, he replied:

"Adult male intubation depth, twenty-two to twenty-four centimeters from the incisors."

"Adult female cannula depth, twenty-one to twenty-three centimeters from the incisors. The pressure of the air bag is 25 to 30 centimeters of water. ”

Wang Qiaoya's theoretical knowledge is quite solid.

Lin Yi couldn't help but nod after hearing this.

At least some common-sense theoretical knowledge, she understands it well.

At this time, Song Bo was standing at the head of the bed, and he had already released part of the airbag.

Then I started to slowly pull out the endotracheal intubation until the scale was still eighteen centimeters from the incisors, and then stopped.

The endotracheal intubation balloon was reinflated and re-fixed.

Wang Qiaoya came to the front and looked very carefully, but she still didn't understand a little.

After all, she had never done this operation, and she was both excited and a little confused about these steps.

Lin Yi looked at her puzzled eyes, and explained to her in detail:

"After decompressing the endotracheal intubation balloon, pull it out to a distance of 18 centimeters from the incisors, and you're good to go.

And when you pull it out, there is still a resistance in your hand, which means that the airbag is not completely deflated, and it has reached the position of the glottis.

Do not pull it out again, otherwise, it is easy to get out of the tube, and then you need to re-intubate the patient.

And very critical patients, if out of the tube, is very detrimental to the condition, this must be remembered. ”

Lin Yi emphasized again:

"Memorize the scale, feel the resistance on your hands, and you're good to go, just pull the endotracheal tube out to this position."

"The tracheostomy that we are going to do next is completely exposed. That's what we're going to do in the early stages. ”

Lin Yi said, his right index finger pointing at the patient's suprasternal fossa.

"When we are in a good position, we have to cut the position. Do you know the positioning of the aircut? ”

Wang Qiaoya still shook her head.

She had not previously focused on percutaneous tracheostomy.

For this operation, it was completely blank, and today was the first time she had seen it, so naturally she didn't understand anything.

"Brother Shen!"

"Hmm!"

Shen Changqing walked on the road, and when he met someone he knew well, he would say hello to each other or nod his head.

But it doesn't matter who it is.

There was no superfluous expression on everyone's face, as if they were very indifferent to everything.

on this.

Shen Changqing is used to it.

Because this is the Demon Suppression Division, it is an institution that maintains the stability of Great Qin, and its main responsibility is to kill demons and monsters, and of course there are some other side jobs.

Arguably.

In the Demon Suppression Division, everyone has a lot of blood on their hands.

When a person is accustomed to seeing life and death, then he will become indifferent to many things.

When he first came to this world, Shen Changqing was a little uncomfortable, but over time he got used to it.

The Demon Suppression Division is huge.

The people who can stay in the Demon Suppression Division are all powerful masters, or people who have the potential to become masters.

Shen Changqing belongs to the latter.

Among them, the Demon Suppression Division is divided into two professions, one is the town guard and the other is the demon exterminator.

Anyone who enters the Demon Suppression Division starts with the lowest level of demon slayer.

Then step by step, he is expected to become a town guard.

Shen Changqing's predecessor was a trainee demon slayer in the Demon Suppression Division, and he was also the lowest level of the demon slayer envoys.

Have memories of the predecessor.

He is also very familiar with the environment of the Demon Suppression Division.

It didn't take long for Shen Changqing to stop in front of an attic.

Unlike other places full of slaughter, the attic here seems to stand out from the crowd, and in the bloody Demon Suppression Division, it presents a different tranquility.

At this time, the attic door is open, and there are occasional people entering and exiting.

Shen Changqing only hesitated for a moment, and then stepped in.

Access to the attic.

The environment has changed in vain.

A burst of ink fragrance mixed with the faint smell of blood came to his face, making his brow furrow instinctively, but quickly stretched.

The smell of blood on everyone's body in the Demon Suppression Division is almost impossible to clean.

.jujiazy.