"The four-chamber cardiac section under the xiphoid process shows an annular aneroid dark area in the pericardial cavity, which excludes cardiac tamponade. ”

The anesthesiologist did the B-ultrasound as quickly as possible according to Wu Mian's requirements, and reported the results loudly as soon as possible.

Wu Mian is more satisfied, this anesthesiologist's level is really good.

"Keep looking for the blue spot. ”

"That...... This teacher, I can't do it well, you teach me. "The anesthesiologist is very frank, and there is no room for falsehood in the emergency rescue, he said directly.

Although he didn't know who Wu Mian was, he couldn't pretend to be that compelling momentum and full of heritage. Especially in the face of tricky serious rescue, people who have no ability will not come forward at all.

This teacher's call is sincere.

"BOTH HANDS, EXCLUDING THE THUMB, ARE PLACED ON THE ANTERIOR CHEST WALL OF THE PATIENT'S SIDE, THE LITTLE FINGER OF THE UPPER HAND IS CLOSE TO THE LOWER BORDER OF THE CLAVICLE, THE FINGERTIPS ARE IN THE MIDDLE OF THE STERNUM, THE LITTLE FINGER OF THE LOWER HAND IS ABOUT THE LOWER ANTERIOR EDGE OF THE LUNG, AND THE AREA COVERED BY THE HANDS IS EQUIVALENT TO THE UNILATERAL LUNG AREA; ”

Wu Mian said while the anesthesiologist was doing it, and at the same time, Wu Mian had simulated several rescue methods in his mind.

The anesthesiologist did so, Wu Mian said, and his movements were left behind. The overall movement is fast and orderly, and it seems that this anesthesiologist has learned or is learning, and has a certain foundation.

For the first time, Wu Mian felt the difference after the "upgrade", and he also adjusted himself in a short period of time.

Even Wu Mian himself couldn't tell what was different, but he felt that it was clearer in front of him, and the values displayed by various instruments were no longer static pictures, but continuous dynamic images.

Despite this, my mind is not as dizzy as before, but it is extremely cool.

Director Xu stood aside and watched in a daze, he didn't understand what Ren Haitao and Wu Mian were communicating at all.

Bedside ultrasound is a diagnostic technique that has emerged in recent years to diagnose the condition and adjust the fluids, and it is quite sophisticated. Not many people have heard of it, let alone know how to do it.

"Hands, be steady!"

"The probe angle is tilted 15° downwards to the right. ”

"Bat sign, pleural sliding sign, visible B-line, excludes pneumothorax and tension pneumothorax. ”

"There is no dark fluid area between the pleural cavity at bilateral diaphragmatic points to exclude hemothorax, and there is no dark area of fluid in the spleen-gastric space and hepatogastric space, which excludes hemorrhage in the liver and spleen. ”

"The four-chamber cardiac section of the apex of the parasternal long and short axes found that the heart shape and movement were normal, and the pulse was strong, but it was empty. ”

The anesthesiologist is still constantly reporting the situation.

"There is a high probability of anaphylactic shock. Wu Mian looked at the various instruments calmly, and did not care much about the value of the high pressure of 35 mm Hg.

Hearing Wu Mian's words, Director Xu of the Department of Anesthesiology almost didn't cry.

Mr. Wu, you are my brother, it took more than 1 minute for you to come to such a conclusion?

Although the differential diagnosis is important, it can be ...... What are the patients, and how can you still treat this kind of emergency rescue as a teaching!

"Immediately discontinue hydroxyethyl starch, discontinue dexmedetomidine and remifentanil, and replace all infusion lines. ”

"Director Xu, help, the infusion pipeline on your right hand side is quickly replaced. ”

Director Xu was still complaining in his heart, and Wu Mian's medical advice was smashed on his head.

"Intravenous pumping of dopamine 10~15μg·kg-1·min. ”

"Epinephrine 0.2~0.4μg·kg-1·min-1. ”

"Dobutamine 10~15μg·kg-1·min-1. ”

"Norepinephrine 0.3~0.5μg·kg-1·min-1. ”

"The whole process is maintained, and the special person is watching. ”

"Prepare ultrasound to guide fluid resuscitation. ”

A series of medical orders, as if the nuclear power chamber was activated, all the people in the operating room moved instantly.

The basic quality of the medical staff of the Second Hospital of the Medical University is excellent, and they can quickly complete Wu Mian's medical orders with the help of their instinctive memory under unknown circumstances.

Director Xu turned a blind eye, and only thought about one thing in his mind, B-ultrasound to guide rehydration? What the hell is this!

Rehydration is rehydration, so why do you need B-ultrasound guidance?

Generally, when faced with shock and blood pressure, the doctor will definitely give a large amount of fluids, regardless of hypovolemic shock or other shocks, anyway, low blood pressure is likely to be due to insufficient fluids.

However, an experienced doctor will judge that the patient with anaphylactic shock has been given several times of epinephrine and other symptomatic treatments, but the effect is not good.

Just now, anesthesiologist Ren Haitao used B-ultrasound to judge whether the patient was not a pneumothorax and made a differential diagnosis, which Director Xu had heard.

In Director Xu's memory, ultrasound cannot be used to diagnose pneumothorax, because there is a white expanse under the probe, and nothing can be seen, how to diagnose it?

This is already the latest technology for Director Xu, and he doesn't understand what Wu Mian said next.

It doesn't matter if Director Xu understands it or not, because there is only one king in the operating room.

The rescue under the command of Wu Mian continues.

"Methylprednisolone was given 40mg intravenously and an ice cap was put on the head. ”

"The patient is in the left decubitus position, anesthesiologist, you are very attentive, look for a four-lumen section of the apex to understand the function of the left heart. ”

Wu Mian saw on the B-ultrasound screen that the ventricles at the end of systole were approximately emptying, and there was an extreme situation where the muscles were almost in contact, and the patient's condition was particularly critical.

"The rate of rehydration is accelerated, and the plasma is needed, fresh. ”

"Anesthesiologist, subxiphoid IVC section. ”

Hearing the English abbreviations that popped out of Wu Mian's mouth from time to time, Director Xu was about to cry.

He is the director of the anesthesiology department, and he is quite dedicated, often staring at various journals and papers. As long as there is time, Director Xu will participate in domestic academic conferences.

Director Xu didn't want to be eliminated by the times so early, and with the technology of more than ten years ago, he became a stumbling block to the progress of the anesthesiology department.

Witnessing the rescue of Teacher Wu Mian and listening to various words that he didn't understand, Director Xu had a feeling that he was an intern.

He also had the luxury of hoping that he could stand at the forefront and lead the anesthesiology department of the Second Hospital of the Medical University to cross the provincial level, at least in terms of technology, to become the first-class in China.

But the harsh truth silently told him that he was just a flat front wave on the beach, and the back wave was in front of him...... Waves, waves.

"Mr. Wu, I'm not familiar with IVC facets. The anesthesiologist said.

"Probe, under the xiphoid process, the landmark point is facing the patient's head. ”

The anesthesiologist immediately adjusted the position and angle of the ultrasound probe according to the cold voice.

"Shake it...... Anesthesiologist, listen to me. You first rock the right atrium to the center of the screen to show the point where the inferior vena cava joins the right atrium and the hepatic vein joins the inferior vena cava. ”

"Wrists, pay attention to the strength. Almost, no, come again. ”

"What we want to do is show the full length of the inferior vena cava, and the anterior and posterior walls of the vein need to have clear and sharp echoes. Sharp, remember is sharp. Wu Mian said patiently while controlling the overall situation.

Rescue needs a lot of people, it takes a collective effort like a machine, if Wu Mian himself is thrown here, even if he knows all the rescue steps, his hands and eyes are like electricity, the rescue will still not be successful.