Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

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

So Lin Yi continued to ask her:

"Can you do a tracheostomy?"

Wang Qiaoya immediately shook her head and said:
"This... I haven't done it before."

"Okay, let's go and perform a percutaneous tracheotomy on this patient later."

"Percutaneous tracheostomy?"

Wang Qiaoya blinked, a little confused.

"Brother Yi, what does percutaneous tracheotomy mean? Isn't it a conventional tracheotomy?"

Lin Yi shook his head.explained:

"A conventional tracheotomy is usually done by a surgeon making a longitudinal incision in the neck."

"This kind of tracheotomy is very traumatic for the patient, prone to infection, and difficult to heal."

"The percutaneous tracheotomy we will do later is a transverse incision. It only needs an incision of [-] cm. I will take you to do it in a while, and you can feel it slowly."

Because this patient has a high fever and obvious muscle tension.

Intensive care doctors have sedated him.

In order to prevent the patient from having difficulty breathing and suffocation,
Tracheotomy should be performed as soon as possible to ensure safety.

Song Borui had already performed a thorough debridement on the patient, completely removed the purulent secretions, and injected tetanus antitoxin.

At this time, the patient's family has also come to the hospital.

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

So they directly signed the tracheotomy consent form.

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

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

Except for the case of rabies that was encountered a few days ago, the mortality rate was [-]%.

This tetanus is infected, and the mortality rate can be ranked first.

Percutaneous tracheostomy is an operation often performed by intensivists.

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

In the past, surgeons performed ordinary tracheotomy.

Later, due to the development of medical technology, the most convenient percutaneous tracheotomy has been developed.

Doctors in the general emergency department look down on this kind of small surgery, because they know it!
But Wang Qiaoya has not been in the hospital for a long time, she has no experience, and this is the first time she has seen a percutaneous tracheotomy.

This kind of operation is simple and fast, with less pain and less trauma for patients. It is currently the most ideal choice for tracheotomy for severe patients.

The patient's blood oxygen saturation was affected due to frequent convulsions.

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

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

Now the patient's vital signs are stable, almost as if he is asleep, and he no longer suffers from convulsions.

Seeing that Lin Yi was going to take Wang Qiaoya with him this time, Song Borui brought a disposable gas cutting bag.

Afterwards, Lin Yi began to guide Wang Qiaoya carefully:

"If you want to perform a percutaneous tracheostomy on a patient, you must first correct your body position."

"Patients need to lie on their back with a pillow under their shoulders to open the airway as much as possible."

With that said, Lin Yi adjusted the patient's position first.

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

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

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

Then Song Borui released a part of the air bag in the endotracheal tube to depressurize it, and then slowly extubated the tube.

Lin Yi glanced at Wang Qiaoya and said:
"This is some of the steps we need to prepare in the early stage. First of all, we need to position ourselves, and then we do it like Borui. Do you know why we do this?"

It was the first time for Wang Qiaoya to see a percutaneous tracheotomy. She didn't know why Song Borui had to remove the intubation, so she shook her head immediately.

Lin Yi then explained to her:

"Patients with endotracheal intubation need to undergo percutaneous tracheotomy, and part of the endotracheal tube must be pulled out."

"This is because the tracheal intubation is inserted relatively deep, blocking the site where we perform the tracheotomy."

Immediately afterwards, Lin Yi continued to ask:
"How deep is the endotracheal tube inserted? Do you know?"

Wang Qiaoya has learned how to intubate the endotrachea, and has performed several cases. She is no stranger to the depth of endotracheal intubation.

So without hesitation he replied:
"The depth of intubation in adult males is 22 to 24 cm from the incisors."

"The depth of intubation for adult females is 21 to 23 centimeters from the incisors. The air bag pressure is 25 to [-] centimeters of water column."

Wang Qiaoya's theoretical knowledge is fairly solid.

Lin Yi couldn't help but nodded after listening.

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

At this time, Song Bo was standing at the head of the bed, having let go of part of the airbag.

Then I began to slowly pull out the endotracheal tube until the scale was eighteen centimeters from the front teeth, and then stopped.

Inflate the endotracheal tube balloon again and fix it again.

Wang Qiaoya leaned forward and looked at it very carefully, but she still didn't understand.

After all, she had never done this operation before, so she was both excited and confused about these operation 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 [-] centimeters from the front teeth, and that's it.

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

Do not pull it out again, otherwise, it is easy to get off the tube, and then the patient needs to be re-intubated.

For very critically ill patients, if the tube is removed, it will be very unfavorable to the condition, and this must be clearly remembered. "

Lin Yi emphasized again:
"Remember the scale, feel the resistance on your hand, and that's it. Just pull out the endotracheal tube to this position."

"The tracheotomy site we are going to do next has been completely exposed. This is the work we have to prepare in the early stage."

As Lin Yi said, his right index finger rested on the suprasternal notch of the patient.

"Put yourself in position, and we're going to position the air cut. Do you know the position of the air cut?"

Wang Qiaoya still shook her head.

She had not previously focused on percutaneous tracheostomy.

Regarding this operation, she was completely blank. Today was the first time she saw it, so naturally she didn't understand anything.