godfather of surgery

Chapter 368 Endotracheal Intubation
During the competition, Director Gao still often went to the general orthopedics department. In addition to observing the operation, listening to the case discussion, he also thoughtfully asked what kind of help was needed here.

His concern does not stay in words, but in action. Lao Gao dispatched several young and capable doctors to support the comprehensive orthopedics department and help write medical records.

Knowing that arthroscopic surgery is the highlight of the first season of the national competition, Lao Gao mobilized the outpatient doctors in the department long in advance to send suitable cases to the general orthopedics department.

During such a competition, there are a large number of cases in the comprehensive orthopedics department to choose from.

After Lu Gang's surgery plan was finalized, Yang Ping began to refine the details.

The embankment of a thousand miles was destroyed by an ant nest. Surgery is a job that pays attention to details.

One failed detail can destroy an entire surgical effort.

Yang Ping is a rational person, he has a passion, but he never achieves his goals by passion, but uses scientific methods to achieve his goals.

According to Lu Gang's objective condition, he solved the detailed problems bit by bit, helping Lu Gang strive for the greatest surgical effect, and at the same time make the operation as safe as possible.

Even with the system, Yang Ping did not dare to be careless or relax in every operation.

Still maintain an attitude of walking on thin ice and riding a horse on a precipice.

Lu Gang's surgery required general anesthesia, which required tracheal intubation.

So the first level, endotracheal intubation is a difficult problem.

The intubation for the first operation must be completed while Lu Gang is awake.

Lu Gang's cervical spine was severely arched and deformed, and his body was folded like a twist, making it extremely difficult for the catheter to enter the airway.

Although bronchoscopy can be used as a guide, there is a possibility that intubation cannot be performed.

Once intubation is not possible, anesthesia cannot be performed, and without anesthesia, subsequent operations cannot be carried out.

Therefore, Yang Ping not only had to solve the problem of surgery, but also help Fatty Liang solve the problem of anesthesia.

When necessary, he took action himself to complete the endotracheal intubation.

Even if the intubation lasts only a few minutes, as long as it is inserted, it does not matter if it causes pressure on the inner wall of the throat and trachea.

The osteotomy and release of bilateral knee joints and hip joints were quickly completed, which widened the distance between Lu Gang's head and torso.

Only in this way can Lu Gang do the second step, orthopedic cervical spine.

After completing the cervical spine correction, obtaining a normal curvature, and lifting Lu Gang's head up, it is possible for him to achieve a proper prone position.

The third step is to complete the correction of the thoracolumbar spine in the prone position.

In the final fourth step, artificial joint replacement of bilateral hip and knee joints is performed.

Due to the long-term contracture of Lu Gang's bilateral hip and knee joints in the flexed position, double joint stiffness has been formed: the soft tissue contracture outside the joint, and the bony fusion has formed inside the joint.

Only artificial joint replacement can allow him to obtain normal hip and knee joints and restore normal walking ability.

Every detail, Yang Ping repeatedly pondered and perfected it, trying to make it as tight as possible.

Fatty Liang has not been idle these days. After get off work, he stays in the laboratory to study Lu Gang's endotracheal intubation.

The few rabbits suffered, and the fat man fixed the rabbits in a twisted and aggrieved position, and used the baby's endotracheal intubation kit to repeatedly train on the rabbits.

If animal protectionists see this scene, they must be so angry that they vomit blood, and they must beat the fat man in groups.

"Brother Tu, I'm sorry, in order to save people, I, Fatty Liang, have no other choice. After the operation, I will provide you with good food and drink, and I won't let you suffer any more."

After getting it for a long time, the rabbit sizzled, but still couldn't get it in. The fat man was a little discouraged, so he hid in the bathroom and took a root, and continued to practice.

Using a live rabbit as a training model is more realistic. The fat man’s bronchoscope went in, and the rabbit could bear it. When the laryngoscope went in, it immediately bit the laryngoscope because of the stimulation and struggled desperately.

Fatty told himself repeatedly that if Dr. Yang's Everest-level surgery was affected by the failure of tracheal intubation, then Fatty Liang's reputation would be completely ruined. Now Fatty Liang's reputation in the hospital is very famous. Introduce him to a girlfriend.

Seeing that he failed many times, Yang Ping put on rubber gloves, walked over to help him, and taught him while demonstrating: "You must have a spatial image from the mouth to the throat, and then from the throat to the trachea in your mind, and you must have a pair of images in your hand. The touch of anatomy, you see, the rabbit is tied up by you, the airway is tortuous and complicated, it is no longer a normal intubation, not to mention the catheter, it is difficult to go in with a fiberoptic bronchoscope."

Fujiwara Miyuki was practicing arthroscopy in the laboratory, stopped training, and leaned over to listen to Yang Ping's explanation, very seriously.

Yang Ping has tried many times in the system space, and he is now teaching Fatty how to complete intubation in such extreme situations.

"Open the mouth a little bit to expose the epiglottis, see if there are two holes, look for the hole, and don't make a mistake. The front enters the airway, and the back enters the esophagus. The airway is curved, but there is still a gap, otherwise how would it breathe? ?
"Did you see the gap in the glottis?" Yang Ping asked the fat man to look at it, and Miyuki also took a closer look.

The bronchoscope is like a snake exploring the way in the deep and tortuous pipeline.

On the screen, like Counter-Strike from the first perspective, advance, pause, advance again, pause again, and go deeper all the way.

Under the guidance of the fiberoptic bronchoscope, Yang Ping held the laryngoscope in his left hand and inserted it lightly and quickly along the dorsum of the tongue until the epiglottic cartilage was gently lifted at the base of the tongue, exposing the glottis on the electronic screen.

"When it inhales, you go deeper, seize the moment of inhalation, and make the detailed movements smooth and free."

The rabbit inhaled, the glottis opened, and the tracheal tube of Yang Ping's right hand was quickly inserted into the trachea, 4 cm past the glottis. According to the scale of the tube, it was about 18 cm from the incisors, which was very good.

Yang Ping pulled out the tube core, placed the dental pad, and withdrew the laryngoscope and bronchoscope.

"Stethoscope!"

Yang Ping auscultated the lungs on both sides for normal breath sounds, confirmed that the intubation was correct, fixed the catheter and tooth pad, injected 5ml of air into the catheter balloon, and closed the gap between the catheter and the tracheal wall.

The endotracheal intubation was successfully completed, and Yang Ping took off his gloves: "The difficulty lies in the fact that the mouth, throat and trachea are not in a straight line, forming some bends, and some parts are in a flat state. Every bend must be crossed carefully. Be careful expanding."

"The movement should be gentle, try not to damage the inner wall, and reduce irritation even with topical anesthesia, because the topography of the airway is complicated, and topical anesthetics are difficult to put in place. Due to insufficient anesthesia, it will still cause irritation."

"The deeper you go, the more sensitive you are. The throat will cause a gag reflex, and the tracheal mucosa will cause a cough reflex. These reflexes cause restlessness and contractures, making it impossible for you to go deeper. Sufficient proficiency and flexibility are the prerequisites for you to go deeper."

"The instrument must be spiritual in the hand, adjust it according to the pipeline, and don't rush in rigidly."

Yang Ping told Fatty clearly the key points, and Fatty kept it in mind.

Zhang Lin and Xiao Wu were also studying Lu Gang's body position after the operation, how to pass through the bed, how to position himself, and how to pull the hook to show up after several operations.

In this team, it is not easy to pull the hook.

There are more than a dozen 3D-printed models, including full-scale models of the entire human body, small models, models of the spine, and models of the upper cervical spine and skull base.

Zhang Lin and Xiao Wu are now using Lu Gang's full-scale model to demonstrate how to position themselves.

Zhang Lin and Xiao Wu had to study repeatedly for several surgeries, each with a different posture.

The fat man practiced endotracheal intubation for a long time, and was a little tired. He wanted to rest for a while and study the body position with Zhang Linxiaowu.

Fujiwara Miyuki put on rubber gloves, took over the fat man's equipment, and tried to practice intubation in this extreme state.

After inserting it several times without success, she asked Yang Ping for help, but Yang Ping had to turn around and teach her again, and took her fiberoptic mirror.

Fujiwara opened the rabbit's mouth, and Yang Ping looked at the screen of the bronchoscope while instructing her: "Pry up as much as possible, and open it a little, otherwise it won't go in."

In the case of not damaging the teeth, the mouth should be opened as much as possible to expose the throat area before intubation can be performed. This special position requires high exposure skills.

"Don't be afraid, open it a little more, yes, it's about to go in, don't move around, it's very good, it's in."

Under Yang Ping's guidance, Miyuki tried several times and finally succeeded.

"Go in now, don't move around, and experience it yourself." Yang Ping asked her to experience the feeling of the catheter passing through the glottis and entering the trachea.

"It hurts a bit!" Miyuki changed her hand to hold the catheter, moved her wrist, and began to fix the catheter.

During the endotracheal intubation just now, many movements were very awkward, and the range of motion of the wrist was relatively large, reaching the limit. After several attempts, it was naturally sore and painful.

"I'm too nervous, relax!" Yang Ping comforted her.

Zhang Lin Xiaowu and the fat man figured out the best position, and asked Yang Ping to see if it was suitable.

Everyone did not rest after get off work. Song Zimo had to prepare for the surgery in the first season, and Xu Zhiliang had to plan for the surgery in the next few seasons.

Especially for robotic surgery, Xu Zhiliang will arrange a certain number of cases for Yang Ping to conduct warm-up training, and Takahashi will help them with their work.

But Yang Ping forbids them to stay up late, preferring to slow down the surgery a bit, and don't stay up late to sacrifice their health.

Sometimes it’s the same thing to have no solution. If you can adjust it, try to protect your health so that you can work better.

Before ten o'clock in the evening, Yang Ping asked them to stop their work.

Yang Ping also arranges his time well, and has to go to Boss Cheng for surgery every Saturday.

The Gleneagles Hospital in Malaysia also invited Yang Ping to go for surgery, and Yang Ping said that he would be free after the Golden Knife Award.

Although learning and training can be done in the system space, things in reality need to be done one by one, so time management is very important.

The duel between Song Zimo and Lin Hao also took place soon, and each of them was fully prepared.

In the first season, arthroscopy of the six major joints of the whole body will be performed, followed by transforaminal surgery, and finally multi-ligament reconstruction of the shoulder and knee joints.

Doctors who love arthroscopies can't bear it, and Lao Gao is like this, very excited.

Especially the multi-ligament reconstruction of the shoulder and knee joints, everyone is looking forward to it.

This kind of operation is at the tip of the pyramid of arthroscopic surgery. It is too difficult and the effect is very poor. It was not a competition event before.

This year, it was added as a competition event, so everyone will wait and see.

(End of this chapter)