Back to 1999: From operating surgeons to becoming a top doctor

Chapter 130

When Lin Gaoyang heard that the nurse did not bring a tracheotomy bag, his heart skipped a beat.

Unable to intubate, without a tracheotomy bag, and unable to open the airway for a long time, what awaited the wounded was only endless despair and death.

"Save... me."

The strong desire to survive suddenly woke up the originally unconscious wounded.

The man's expression was hideous and terrifying, and his eyes still showed his desire for life.

As long as he was still alive, he would fight for his life.

For his elderly parents, for his wife and daughter at home, he, as the pillar of the family, must not die.

At this time, a firm voice sounded in his ears, and in the dim light, under the dazzling sunlight, a motionless figure stood in front of him.

"Don't panic, help me prepare the syringe, saline, guide wire..."

Xiao Chenguang remained calm in the face of danger and directed the nurses on the car to prepare relevant supplies.

The moment he saw Xiao Chenguang take out the puncture needle, Lin Gaoyang beside him suddenly thought of a possibility.

Cricothyroidotomy.

This is a puncture method used to open the airway as quickly as possible in emergency upper airway obstruction.

The new version of the textbook clearly states this, but there are many difficulties in actual operation.

Positioning, materials, and operation are all indispensable.

In Lin Gaoyang's opinion, it seems that Shengli Hospital has not yet introduced relevant technologies and equipment for these items.

For surgeons, even if they are good at operation, everything is in vain if they don't have the right tools.

"Boss, are you going to do cricothyroidotomy?"

Lin Gaoyang asked uncertainly.

"That's right!"

Xiao Chenguang put on gloves and quickly disinfected the skin on the wounded's neck.

"Since there is no incision, use cricothyroidotomy technology instead. As long as it can relieve the wounded's airway obstruction, any method can be tried."

One of the indications for cricothyroidotomy is that it is a method used in emergency situations when there are no conditions for tracheotomy on site.

However, this technology needs to be used with a special cricothyroid membrane puncture kit.

But in this era, the popularity of special kits in hospitals is far from meeting the requirements.

So Xiao Chenguang's idea is also very simple.

If there are no conditions, create them, and use whatever is needed.

"Director Xiao, the saline is ready."

The nurse prepared all the items according to Xiao Chenguang's requirements.

Although she didn't know what cricothyroid membrane puncture was and how difficult it was to operate.

But if Xiao Chenguang did it, there would be no problem.

"Okay, disinfect these items with iodine and keep them ready for later."

After Xiao Chenguang gave his instructions, he turned sideways and looked at Lin Gaoyang.

"Gaoyang, put the patient in a supine position, put a pillow under the shoulder blade, and tilt the head back as much as possible to fully expose the trachea."

"Understood."

Lin Gaoyang didn't dare to delay. He found a pillow, held the back of the wounded's neck with one hand, and lifted it up with force.

The strong explosive force almost lifted the wounded's entire upper body.

A body weighing nearly 200 kilograms was lifted up with one hand, which made Xiao Chenguang's eyelids jump.

"Gently, gently, good, good, it's done, save some strength."

Xiao Chenguang supported the injured and adjusted the position with Lin Gaoyang.

I have to say that strength really works.

Originally, according to the injured's condition, the operation of placing a pillow under the shoulder required at least two or three people to work together.

But at this moment, Lin Gaoyang did it alone, not only fast, but also the angle and position of the pillow were just right.

This allowed Xiao Chenguang to quickly carry out the next operation.

Press the index finger on the injured's Adam's apple, slide up and down, and start to locate the puncture point.

"Boss, his neck is so swollen, can he still touch the thyroid cartilage and cricoid cartilage?"

As a doctor of thoracic and cardiovascular surgery, Lin Gaoyang's understanding of airway structure is much more solid than other doctors.

Generally, cricothyroid membrane puncture is performed on the thin membrane between the thyroid cartilage and cricoid cartilage.

Normal people touch their throats and can press down to cause nausea and cough. The soft tissue is usually the cricothyroid membrane.

But the wounded man in front of him has a short neck, and his skin is burned and swollen, so the original physiological structure is covered.

It is very difficult to accurately locate the wounded man.

Facing Lin Gaoyang's concerns, Xiao Chenguang did not speak. The touch from his fingers made him realize that the usual positioning method did not work for the wounded man in front of him.

Xiao Chenguang immediately stood up his palm, closed his fingertips, and quickly found the wounded man's suprasternal fossa with his little finger.

And the concave point where the lower edge of the clavicle connects to the upper part of the sternal manubrium.

With gentle downward pressure, the area pointed by the adjacent index finger at this moment is the cricothyroid membrane.

"What kind of positioning method is this?"

Lin Gaoyang on the side was stunned. He had never seen it in the textbook. At this timeThe positioning method used by Xiao Chenguang.

"Syringe, blade, prepare for puncture."

Xiao Chenguang reminded, and the empty needle handed over by the nurse was now filled with sterile saline.

Remove the needle cap and insert the needle at a 45° angle according to the positioning point.

The steel needle pierced the skin, passed through the tissue, and went down until the needle tip was halfway into the neck, and suddenly bubbles began to appear in the lumen of the sterile saline.

The tiny bubbles gradually gurgled and grew larger, and like boiling hot water, white mist appeared.

"Gao Yang, give me the catheter."

After verifying the puncture results and confirming that it was in the trachea, Xiao Chenguang picked up the blade and gradually cut and expanded the skin according to the positioning needle.

Scarlet blood began to flow down along the neck.

Everyone present did not dare to look directly at it, and they were terrified.

Only Xiao Chenguang was full of confidence, and the tip of the knife quickly separated the swollen tissue around the cricothyroid membrane.

"Catheter!"

"Okay."

As the cricothyroid area was cleaned, Xiao Chenguang took the tracheal tube from Lin Gaoyang's hand and inserted it directly through the cricothyroid membrane into the main trachea of ​​the injured.

Seeing this, Lin Gaoyang, who was assisting at the side, connected the breathing bag that had been prepared long ago to the tube exposed at the neck.

The nurse next to him grabbed the bag, squeezed and loosened it with her fingers.

Suddenly, a stream of clear water flowed into the injured's lungs that were about to burn out.

Whoosh!

The cool gas was exchanged quickly in the lungs, and the injured, who had originally had a ferocious expression, suddenly felt like he was reborn.

He opened his mouth, sucked in the fresh air greedily.

His dark face also had a little red glow.

"Director Xiao, the patient's blood oxygen saturation has increased!"

The nurse on the car, who was pinching the ball and observing the vital signs of the injured, excitedly reported the situation.

The blood oxygen saturation, which was originally at a critical value, has climbed to more than 90% in just a blink of an eye.

Lin Gaoyang, who was standing by, was even more shocked.

Accurate positioning and blind insertion techniques, as well as the intact thyroid cartilage and cricoid cartilage above and below the catheter.

The boss is worthy of being the boss, with sufficient experience and high medical skills.

In this kind of on-site treatment with "lack of food and clothing", he can still maintain such superb skills.

Lin Gaoyang knew in his heart that even if the injured was hospitalized with a tube, it would not affect his speaking in the future.

After solving the problem of airway obstruction, Xiao Chenguang found that the skin temperature of the injured was very hot, and looked up and shouted to Gong Liang not far away.

"Gong Liang, can't 120 get in?"

"It can't get in. The roads on both sides are blocked by small stalls. I searched for a long time and couldn't get through."

"Director Xiao, if it really doesn't work, I can only ask the driver to take a detour."

Gong Liang seemed very anxious.

While treating the patient, Xiao Chenguang assigned Gong Liang a task, asking him to help clear the passage so that the ambulance could come in to pick up the patient.

But the narrow streets in the shantytown were full of debris, and Gong Liang tried his best, his voice was almost hoarse, but it was still useless.

"It's too late to take a detour, forget it, go find a water pipe, the injured need to be cooled down urgently."