Ren Haitao's nerves, which had just been slightly relieved, suddenly tensed, and the levels of various hormones in his body instantly soared, exceeding the threshold.

Originally, the corner of his eye had been looking at Wu Mian who was chatting with Chu Zhixi in the opposite corner, but after feeling the resistance of manual ventilation, Ren Haitao's vision was all focused on the patient, and all the surroundings became blind spots.

Iron lung! Iron lung!

Ren Haitao made a judgment in an instant.

Iron lung, also known as silent lung, is a complication of anesthesia that is commonly seen in patients with bronchial asthma.

Before the operation, Haitao had asked the patient whether he had a history of bronchial asthma, and basically ruled out this rare possibility. Although the patient complains of frequent colds and coughs, he has not recently become ill.

In addition, the most common time period for silent lungs is about 30 minutes to 1 hour after the surgeon opens the stage. Now I just gave a sedative to induce anesthesia, how can I just be silent?!

The hairs on his back stood up, Ren Haitao immediately called an assistant to pinch the ball, manually ventilated, and he picked up the stethoscope next to him to do auscultation.

No breath sounds in both lungs...... The stethoscope was repeated three times, but not a single breath sound was heard in either of the patient's lungs.

No breath sound is really terrible, even a little wheezing sound is fine at this time, Ren Haitao desperately longed for the stethoscope to hear a hint of life.

If he hadn't checked all the equipment, including the stethoscope, before the operation, he would have thought it was broken.

"Brother Ren, the airway resistance is high, and there is no way to effectively provide oxygen through the mask. The assistant said anxiously, "Is it an extra-airway ......?"

The so-called external airway intubation does not mean that the trachea is punctured, but that the endotracheal tube that should have been lowered into the trachea enters the esophagus.

Sometimes when the ventilator is blown, the patient's stomach bulges first, which is the case.

No, I watched it very seriously, and this situation could not have happened. In addition, if you have an extraherently intubated airway, you will never hear the slightest breath sound in both lungs.

"Do you have a fiber bronchoscope?" a cold voice sounded in Ren Haitao's ears.

"Bring it!" Ren Haitao replied subconsciously.

Wu Mian didn't say anything else, his left foot was crossed to the patient's head, his hands were on the ball, and his left shoulder squeezed Ren Haitao's assistant away.

At the same time, Chu Zhixi supported the patient's jaw in an E-shape with the three fingers of the middle finger, ring finger and little finger of both hands, while the thumb and index finger held down the ends of the mask in a C-shape.

Wu Mian squeezed the balloon with both hands to deliver as much oxygen as possible to the patient's lungs.

The standard two-handed E-C method buckles the mask to give oxygen, and the movements are precise, like a textbook. Wu Mian and Chu Zhixi cooperated tacitly, there was no verbal communication, but the actions were extremely compatible.

Except for Ren Haitao and his assistant, everyone present didn't know what was going on, and they had already started to rescue them.

"Teacher Wu, laryngoscope!"

Ren Haitao didn't have time to sigh at the perfection and tacit understanding of Wu Mian and Chu Zhixi's rescue operation, he brought a box from the corner that was out of the way, and said anxiously.

"What model?"

PV112042, a product of Verathon MedicalULC, Canada. ”

Wu Mian handed the ball to Ren Haitao, opened the box quickly and unhurriedly, and took out the electronic video laryngoscope from it.

With the fastest speed, Wu Mian completed the tracheal intubation operation under the direct sight glottis. After confirming that the endotracheal tube is located in the airway, the resistance to squeeze the breathing bag with both hands is still very large, and it still has an "iron lung" feel, and there is no breath sound in both lungs on auscultation.

Wu Mian then began to connect to the ventilator.

Ren Haitao's assistant was surprised and wanted to stop it, in his opinion, this was a useless operation. In emergency first aid, every minute and every second may make the difference between life and death of a patient, so why do you have to do ineffective operations?

But before he could speak, Ren Haitao completely squeezed out his assistant and assisted Wu Mian in connecting to the ventilator.

Mechanically controlled volume ventilation with no end-tidal carbon dioxide waveform on the ventilator screen.

"Silent lungs, prepare to rescue!" Wu Mian said in a deep voice.

The coldness in his voice was gone, but it was still cold and cold.

"Sevoflurane batch number, model. Wu Mian asked.

"Production Lot Number: S044C829, Baxter Healthcare, Spain. Ren Haitao replied quickly.

"The concentration is 8% and the fresh oxygen flow rate is increased to 8 L/min. ”

"Albuterol aerosol batch number, model. ”

At this time, one hand handed over the bottle of albuterol spray, and Ren Haitao took the aerosol and looked at it.

"Production lot number: K63J, produced in Glaxo, Spain. ”

"Intra-airway administration, 3 puffs. ”

While directing the operation, Wu Mian held a stethoscope and placed it on the patient's chest for auscultation.

After spraying albuterol, there are still no breath sounds in both lungs.

"Intravenous bolus epinephrine, 1 mg. ”

"Production batch number: 1709301, Tianjin Jinyao Pharmaceutical Co., Ltd. Ren Haitao pushed the medicine while reporting the drug dosage form and production company.

Wu Mian means Ren Haitao understands, and the silent lungs for inexplicable reasons may be from drug allergies, although it is unlikely. The core doctor directing the rescue must have all the information, even the manufacturer and batch number of each drug.

Others can't do such a meticulous thing, but that doesn't mean that Mr. Wu can't do it either.

What is the difference between the different efficacy of specific manufacturers and batch numbers, Ren Haitao does not understand. As long as Wu Mian needs it, he will do his best to do it.

As the adrenaline bolus is injected, irregular EtCO2 waveforms gradually appear on the ventilator's screen, and wheezing appears in both lungs on auscultation.

Subsequently, every 2 minutes, Wu Mian would give an intravenous bolus of 1 mg of epinephrine, a total of 3 mg of epinephrine, and at the same time, albuterol aerosol was injected into the endotracheal tube, 2 puffs each time, a total of 4 times.

With the increase of drug concentration, a more regular EtCO2 waveform gradually appeared on the ventilator screen, and Wu Mian heard that the patient's lungs were no longer dead silent, but full of wheezing sounds.

Although this is a particularly tricky situation for anesthesiologists, as long as there is a voice, it is better than a dead silence!

"Hydrocortisone. ”

"Production batch number: 021703066, Tianjin Biochemical Pharmaceutical Co., Ltd. Ren Haitao still reported the drug batch number and production company while adding medicine.

"100 mg dissolved in 100 ml of normal saline intravenous infusion. ”

"Epinephrine 1 mg. ”

"Sputum suction. ”

"Pay attention to the depth of suction. ”

"Intravenous methylprednisolone 80mg, aminophylline 125mg. ”

"Stop pumping propofol and remifentanil, give 1 mg of epinephrine diluted 20ml, 0.3mg tracheal tube instilled, and continue to control breathing. ”

Wu Mian stood in the back position, looking at the audience, everyone was his hand, and every detail was under control.

After 10 minutes, there is a slight decrease in airway resistance for hand-controlled breathing, and breath sounds are very low on auscultation of both lungs, with occasional wheezing.

The patient's blood pressure is 165/90 mmHg, heart rate is 142 beats per minute, and SpO2 is 90%.

After giving intravenous esmolol 15mg and pantoprazole 40mg, Wu Mian finally fell silent.

Ren Haitao kept sucking phlegm, and he didn't worry about his assistant doing this kind of "simple" operation. At this point, every detail is crucial and should never be taken lightly.

The sevoflurane inhalation concentration and oxygen flow were gradually reduced, and the patient's condition gradually stabilized.