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

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

"For percutaneous tracheotomy, the second to fourth tracheal rings are generally selected under the thyroid ring."

"That is to say, counting from the thyroid ring bone under the thyroid cartilage, the incision can be made between the second and fourth."

After a pause, Lin Yi said again:
"I'll teach you another easier way to position."

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

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

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

Lin Yi pointed at the patient and said to her:

"Did you see that in the middle, at the midpoint between 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 and nodded vigorously.

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

After all, there are patients who make teaching materials and experience themselves, not just relying on imagination as they just read in textbooks.

The site for tracheotomy has been selected.

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

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

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

After being strictly sterilized three times, the carbon black mark has faded, but it can still be distinguished.

Looking at Lin Yi's actions, Wang Qiaoya felt faintly excited.

She even wanted to go up and do it herself.

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

After the disinfection and draping are completed, the tracheotomy will begin next.

Lin Yi looked at the nurse who was on call at any time and said:
"Inject sufentanil three milliliters and midazolam five milliliters intravenously."

Wang Qiaoya couldn't figure out how Lin Yirang pushed the medicine.

Then he asked directly: "Brother Yi, isn't the patient already sedated and analgesic? Why do you need to increase the dose?"

Lin Yi wiped the surgical site clean with clean gauze, and said:
"His tracheotomy is about to be performed. The amount of sedative and analgesic drugs is relatively small now. The amount of drugs we add to him is to play the role of anesthesia."

"When I cut it for him later, I don't need to use lidocaine. If you hit Pichu on the neck with lidocaine, it will affect your operation instead."

"Oh I got it."

Wang Qiaoya nodded half-understood.

After all, she has never seen this operation before, nor has she tried it herself.

If you can't experience it yourself, you can't fully understand the truth here.

After she does a few more cases, she will gain more and more understanding of what Lin Yi said in detail.

Lin Yi picked up the scalpel, and made an incision of about [-] centimeters at the spot where the mark was made just now. The incision was made under the skin, but it did not go deep.

After the skin was cut open, blood soon oozes out.

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

After pressing for a while, he explained the process to Wang Qiaoya.

"When you perform this operation in the future, remember that the scalpel only needs to cut under the skin. Don't cut deep, otherwise, it will be troublesome if you hurt the blood vessels."

Lin Yi used a gauze pad on the incision and pressed it for 30 seconds, and the bleeding stopped.

After all, it is only capillary bleeding, and the bleeding can be stopped with a single press.

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

Move slowly and keep the syringe under negative pressure.

In the blink of an eye, air bubbles were seen coming out of the syringe.

This shows that the needle has entered the trachea.

A lot of air bubbles came out as he continued to draw back, 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 reduce the patient's coughing reaction and facilitate our operation."

Lin Yi said while pulling out the needle.

Then with a 14G trocar, puncture the trachea.

Tilt the needle slightly towards the head, and insert the needle with the bevel down until the air bubbles are drawn out.

Immediately afterwards, Lin Yi said:
"When pulling out the puncture needle, be sure to keep the cannula in place and just pull out the puncture needle."

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

Then I used the syringe with the needle removed to draw a few milliliters of saline, and put it on the plastic cannula again to draw back. A lot of air bubbles came out, confirming that the plastic cannula was in the trachea.

Using the wire guide, guide the wire into the cannula.

The guide wire is advanced to the first mark, at the level of the skin.

Withdraw the plastic sheath, leaving the guidewire in place.

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

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

Clamp the internally slotted patent dilator on the guide wire, and slide the dilator into the anterior wall of the trachea along the guide wire.

Spread the forceps to expand the soft tissue anterior to the anterior wall of the trachea.

While keeping the spreader open, remove the spreader.

Repeat the above steps to expand the forceps to expand the tracheal wall.

Lin Yi only repeated the above action twice.

From the incision, you can see that there is gas coming out, and there is also blood spraying out from the incision.

And Lin Yi had already covered the incision with a gauze piece, in order to prevent the blood from splattering.

At this point, Lin Yi specifically emphasized to Wang Qiaoya.

"See? When you do this operation in the future, you must cover the incision with gauze in advance, otherwise, you will easily be sprayed with blood."

No matter how small the incision is, it will bleed, and it is common for the ventilator to spray blood and sputum from the incision.

Lin Yi put the expansion forceps back in, and forcefully pierced through the front wall of the air duct.

Push the handle of the expansion forceps toward the patient's head.

Keep the longitudinal axis of the expansion forceps parallel to the longitudinal axis of the patient's body, so that the tip of the expansion forceps can further enter the trachea.

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

Place a gas cutting cannula with an inner core along the guide wire.

First, completely lock the air-cut sleeve with the inner core and the sleeve introducer.

Insert the tracheotomy cannula along the guide wire and guide tube.

Patients with this kind of tracheotomy usually choose an [-]mm tracheal tube, and avoid using a rigid tracheal tube.

Then separate the introducer and the gas cutting sleeve, and withdraw the guide wire and stylet along the natural direction.

The tracheal cannula is put into the trachea, and this operation is considered complete.

Lin Yi gave the airbag to the tracheal tube in time, applied enough pressure, and then wrapped the adhesive tape around his neck to fix the tracheal tube.

And Wang Wei connected the ventilator tube to the mouth of the tracheal tube.

Then he also intubated the previous mouth and pulled it out.

This process seems to be very long, and Lin Yi is doing the operation while explaining.