Lin Yi pointed to the patient's Adam's apple and said:

"Percutaneous tracheostomy positioning, generally the choice is to choose the subthyroid annulus, the second to the fourth tracheal annular incision."

"That is to say, starting from the thyroid ring bone under the thyroid cartilage, between the second and fourth, you can make an incision."

After a pause, Lin Yi said again:

"I'll teach you an easier way to locate yourself."

"First we determine the location of the thyroid cartilage, which is the Adam's apple, and then we determine the suprasternal fossa."

"These two body surface signs are easy to distinguish, aren't they?"

Wang Qiaoya used her right index finger and middle finger to gesture the position on the patient's neck.

Lin Yi pointed to the patient and said to her:

"Do you see, in the middle, at the midpoint of the thyroid cartilage and the suprasternal fossa, it can also be cut."

"This positioning method is relatively simple, do you remember?"

Wang Qiaoya gestured twice on the side and nodded vigorously.

She has a deep memory of the positioning method that Lin Yi taught her.

After all, there are patients who make teaching materials and experience them themselves, unlike just imagination as they read in textbooks.

The site of the tracheostomy has been chosen.

Lin Yi drew a marker on the patient's neck.

In fact, it doesn't matter whether he paints or not, the main thing is to make Wang Qiaoya more impressed.

Subsequently, Lin Yi first opened the outside of the sterile bag, then put on sterile gloves, poured iodophor into the sterile tray, and clamped iodophor gauze with curved forceps to begin to disinfect the patient's neck.

After three times of strict disinfection, the carbon black mark has been relatively light, but it can still be distinguished.

Wang Qiaoya looked at Lin Yi's movements, and was faintly excited in her heart.

She even wanted to go up and do it herself.

But after all, she didn't know the complete steps of this surgical operation, so she could only wait patiently for Lin Yi's detailed teaching.

Once the disinfectant towel is done, the next step is to start the tracheotomy.

Lin Yi looked at the nurse who was on call on the side and said:

"Push sufentanil three milliliters intravenously and midazolam intravenously five milliliters."

Wang Qiaoya couldn't understand Lin Yirang's push medicine.

He asked directly: "Brother Yi, isn't the patient already sedated and analgesic now?" Why do I need to increase the dosage of the drug? ”

Lin Yi wiped the surgical site clean with clean gauze and said:

"He is going to have a tracheotomy soon, and the current amount of drug sedation and analgesia is relatively small, and the amount of medicine we add to him is to play an anesthetic role."

"When you cut it open for him, you don't need to give lidocaine, and if you hit a pichu on the neck with lidocaine, it will affect your operation."

"Oh...... I see. ”

Wang Qiaoya nodded as if she didn't understand.

After all, she had never seen this operation, nor had she done it herself.

If you can't experience it yourself, you can't fully understand the Tao in it.

After she does a few more examples, with her experience, she will understand more and more the details of what Lin Yi said.

Lin Yi picked up the scalpel and made an incision about 1.5 centimeters at the site where he had just made the mark, and cut it under the skin, so that it would not go deeper.

After the skin was cut, blood quickly seeped out.

Lin Yi took the gauze pad and pressed it on it.

pressed for a while, and explained the process to Wang Qiaoya.

"When you have this surgery in the future, remember that the scalpel only needs to cut under the skin, and don't cut deep, otherwise, it will be troublesome to hurt the blood vessels."

Lin Yi used a gauze pad on the incision site and pressed it for twenty or thirty seconds, and then it stopped bleeding.

After all, it's just capillary bleeding, and a single pressure can stop the bleeding.

Lin Yi picked up a five-milliliter syringe filled with lidocaine injection and plunged it into the middle of the incision.

The movement is slow, and the syringe is kept under negative pressure.

In the blink of an eye, I saw bubbles coming out of the syringe.

This means that the needle has entered the trachea.

Continuing to pump back, a large number of bubbles came out, and Lin Yi pushed about one or two milliliters of lidocaine into the trachea.

"We inject one or two milliliters of lidocaine injection into the trachea, mainly to paralyze the inner wall of the trachea, so as to alleviate the patient's choking reaction and facilitate our operation."

Lin Yi said as he pulled out the needle.

Then, with a 14G trocar, puncture the trachea.

The needle is tilted slightly towards the head and the needle is inserted diagonally downward until the bubble is withdrawn.

Immediately afterwards, Lin Yi said:

"When you remove the puncture needle, you must leave the cannula in place and only remove the needle."

Lin Yi fixed the plastic sleeve with his left hand, and slowly pulled out the puncture needle with his right hand.

Then with the syringe with the needle removed, a few milliliters of saline were withdrawn, and the plastic cannula was installed again and withdrawn, and a large number of bubbles came out to confirm that the plastic cannula was in the trachea.

With a guidewire guide, the guidewire is fed into the cannula.

The guidewire enters into the first marker, which is located at the skin plane.

Withdraw the plastic sleeve and leave the guidewire in place.

Then Lin Yi took the skin dilator and sent it into the skin along the guidewire.

The dilator dilates the subcutaneous tissue and the anterior wall of the trachea.

A patented medially slotted dilator clamp is clamped onto the guidewire, along which the dilator forceps are slid into the anterior wall of the trachea.

Open the forceps to expand the soft tissue in front of the anterior wall of the trachea.

Remove the expansion forceps while keeping them open.

Repeat the above steps to stretch the forceps to dilate the tracheal wall.

Lin Yi only repeated the above actions twice.

You can see gas coming out of the incision, and there is blood spurting out of the incision.

And Lin Yi had already blocked the incision with gauze blocks, in order to prevent blood from splashing.

In this place, Lin Yi specifically emphasized to Wang Qiaoya.

"See? When you do this operation in the future, be sure to cover the incision with gauze in advance, otherwise, it is easy to be sprayed with blood. ”

Even small incisions can bleed, and it is not uncommon for a ventilator to blow and spurt blood and sputum from the incision.

Lin Yi reinserted the expansion forceps and forcefully penetrated the anterior wall of the trachea.

Extend the forceps handle and push it toward the patient's head.

Keep the longitudinal axis of the dilator forceps parallel to the longitudinal axis of the patient's body so that the tip of the dilator forceps is further into the trachea.

Open the dilator forceps to dilate the trachea, and with the dilator forceps open, remove the dilator forceps.

Place the tracheosection cannula with the inner core along the guidewire.

First, the inner core of the gas cut cannula and the casing introducer are completely locked. jújíá?y.?? m

Along the guidewire and introducer tube, insert the tracheomy cannula.

For patients with this type of tracheostomy, an eight-millimeter endotracheal cannula is usually chosen, and rigid endotracheal cannula is avoided.

Then separate the introducer from the tracheomy cannula, and withdraw the guidewire and die in the natural direction.

The tracheal cannula is placed into the trachea, and the operation is complete.

Lin Yi gave the tracheal cannula airbag in time, put enough pressure, and then used adhesive tape around the neck to fix the tracheal cannula.

Wang Wei connected the ventilator tube to the tracheal cannula mouth.

Then he also pulled out the previous mouth cannula.

This process seems to be very long, and Lin Yi is explaining and doing operations at the same time.

"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.