Xiao Huang, an undergraduate intern in anesthesia, was arranged to the "double room" for the first time. The so-called double room refers to an operating room, two sets of hand anesthesia systems (two medical cranes hanging down, the four sides of the crane tower are full of power plugs and oxygen, carbon dioxide, laughing gas, vacuum suction and compressed air jacks; the front of the crane tower is a modern anesthesia machine; the front of the anesthesia machine is a remote control operating bed; there are two fixed rods erected next to each operating bed; two to four electronic micro pumps are installed on each fixed rod), and two operations can be carried out at the same time.
From theory to practice, from simple to complex, it is the only way for every medical student. The residency standardized training teacher instructed the previous afternoon that according to the surgery of the patients visited the day before, the next day it is necessary to go to the operating room early to prepare for anesthesia.
According to the routine, Xiaohuang checked the anesthesia machine, oxygen source, and power supply in the morning, prepared the endotracheal intubation general anesthesia appliances, smoked anesthetics and emergency drugs, and waited for the itinerant nurse to pick up the patient and start work with the teacher.
"Dr. Huang, this medical record is missing a consent form for the basic medical insurance self-payment program." The door to the operating room had just opened, and the teacher came in with an open medical record clip. Behind the teacher, the nurse held up a hanging bottle and led the patient in. "You have to run hard, go to the storage room to find a consent form and come to sign it." Xiao Huang gladly took the order, withdrew and ran outside the door.
Who knew that the sound of "Whoops..." was a surprise to Xiao Huang. When I looked back, it turned out that I was only trying to speed, and my foot was tripped by the power cord. The power cord is inserted at one end of the wall, and the other end is connected to the micro pump fixed to the infusion pole, and the micro pump is connected to the infusion pole and trip to the ground. Fortunately, the glass hanging bottle hanging from the infusion rod was empty, and the micro pump did not seem to break.
The nurse screamed, and the ear roots behind the little yellow mask also turned red. He had secretly warned himself that he must be careful in doing things, and he could not be as hot and furious as usual, who knew that he had stumbled in the morning. The teacher calmly comforted and said: Didn't hit anyone? Watch out for the glass!
After the patient lay on the operating table, the teacher patiently said: The amount of surgery is getting larger and larger, and we must adapt to this kind of work of paying attention to the double stage at the same time. There are more and more modern operating room anesthesia facilities, anesthesia machines, monitors, micro pumps, blood recovery machines, electronic barometric tourniquets, heating felt hair dryers, liquid (blood) pressurized infusion instruments, endoscopic systems, computers (OA systems), etc., their input and output ends, are bundled pipelines. For example, a large blood vessel surgery, just the monitoring and monitoring system of various wires, catheters, not easy to clean up, will be chaotic, not to mention the extracorporeal circulation system. If anesthesiologists and nurses can't follow the vine and follow the tussock, it will inevitably greatly reduce the efficiency.
Checking, induction, intubation, maintenance, anesthesiologist's golden half hour, Xiao Huang followed the teacher to handle the anesthesia operation of the two surgeries like a stream, to a moment when he could "catch his breath". Xiaohuang has been able to use the hand anesthesia system to record electronic anesthesia records more skillfully, with the teacher to pay attention to the monitor and the process of surgery, while guiding Xiaohuang to make a record of surgical anesthesia.
"After the operation in the afternoon, I will tell you about what happened in this double operating room." The teacher said. Xiao Huang's interest was suddenly hooked: "Is it related to anesthesia?" Willing to hear its details, willing to smell its details! Thank you teacher first. ”
In the afternoon, in the anesthesia rest room, both the master and apprentice were holding a bottle of water and lying half on the pig skin sofa. The teacher told Xiao Huang a story that happened in the double surgery room:
"This story, if not found and handled in time, may be a big accident." Before the lecture, he deliberately sold a pass.
"It was a very tense and busy morning, and I took a real doctor to administer two anesthesias in the double room today. The one next to the door is a 19-year-old boy who has done orthopedic surgery on the lower limbs. Due to excessive tension from multiple surgeries, at the request of the surgeon, he was given endotracheal intubation and inhalation compound general anesthesia. Leaning on the operating table inside, the emergency surgery of the night shift continued, and at 10 o'clock, the operation was over and the stage was closed.
At this time, an emergency caesarean section was anxiously pushed in by the co-ordinating nurse and obstetrician. "Natural delivery fails, fetal intrauterine distress, fetal heartbeat is not good, need to be opened immediately!" The obstetrician said urgently. "Inside the table, the towel has been laid out. Hurry up and get in! The co-ordinating nurse greeted the itinerant nurse.
Peripheral rehydration has been opened, over the bed, on the monitor, posture, saw anesthetic, puncture pack, a series of actions in one go. Although the maternal coordination was poor due to contracture pain, we completed the lumbar-hard combination anesthesia within minutes. Disinfect, spread towels, peel, and oxygenate the maternity mask when treating supine syndrome.
At this time, the midwife pushed the newborn delivery truck in and stopped at the wall on the right side of the entrance door. The intern supervised the orthopedic surgery on the side of the door, and I handled the emergency cesarean section. "Cooperate with the pressure, press hard!" The obstetric surgeon ordered the assistant, and in about five minutes, the fetus came out, and the midwife took the fetus, bypassed the orthopedic operating table, and placed the newborn on the delivery truck for treatment. The midwife was sucking on phlegm, the neonatal doctor was listening to the heart and lungs, and I was giving oxygen to the newborn with my breathing sac and mask. The fetus is slightly bruised, but the fetal heart is normal. While the neonatal doctor and midwife were doing apgar scores, I used a mask to give the newborn a snap of oxygen. Suddenly, I felt that something was wrong! ”
Xiao Huang swallowed a large mouthful of water and almost choked up. "What's wrong? teacher! She asked nervously.
The teacher continued: "I suddenly thought that there are two anesthesia machines in this room, only two oxygen source interfaces, one on the crane tower, the other in the center of the wall to inhale oxygen, orthopedic general anesthesia to use one, maternal mask oxygen to use one, how can this newborn oxygen tube still have a high flow of oxygen in the spray? The midwife must have pulled out one of the oxygen joints!
"Dr. Xu! Let's see if the anesthesia machine here in orthopedics has any oxygen? I anxiously called out to the intern.
"Ah! No..., no," the intern replied nervously.
"Who unplugged the oxygen source of this anesthesia machine?" The intern then asked.
The teacher continued: "Sure enough, someone pulled out the oxygen source of the orthopedic patient and connected it to the respiratory sac on the newborn car. I immediately went to the crane tower to pull out the oxygen source of the anesthesia machine connected to the maternal operating table, and plugged in the oxygen joint of the orthopedic anesthesia machine. When looking at the monitor, the pulse oxygen saturation of the orthopedic patient is still 100, other vital sign parameters are normal, and the invasive radial artery manometry waveform is still strong and regular...
"After knowing the reason, the surprise of the big guys is needless to say. The orthopedic surgeon scolded a few times rudely. Through the mask, the midwife's tender face was red to the roots of the ears and neck. In the history of anesthesia, the lesson of patients who have suffocated for a long time to become vegetative is not unheard of. If it is not found in time, the consequences are unimaginable...
"So, the anesthesia machine has cut off the oxygen source, won't it call the police?" Xiao Huang asked.
"You're right." The teacher praised him. "It's an old anesthesia machine that has been used for more than a decade and has now been eliminated, and the anesthesia machine bellows is still doing its work, but on the oxygen flow meter, it is zero."
The teacher didn't have to talk a lot more, Xiao Huang was already sighing, and his mind seemed to reproduce the shocking scene that had happened.
So, how to avoid some human accidents in equipment?
Teach the teacher patiently:
First of all, every time we must carefully do a good job before anesthesia, and do a good job of checking the machinery and equipment.
Second, the busier you are, the less you can. Man is alive, machine is dead, and we can't rely entirely on machines and wait for instruments to come and call you an alarm.
Again, even if the alarm parameters are set, when the blood oxygen on the monitor has changed and the alarm is alarmed, it means that the patient has been hypoxic for a long time. Because under mechanical ventilation, the patient has been supplied with high concentration oxygen for a long time, even if the oxygen supply is temporarily interrupted, the pulse oxygen saturation on the nursing device can still be displayed as basically normal.
Finally, as an anesthetic, others are messy, and you can't follow the chaos. For example, all the indoor pipelines are like the inextricable threads of our anesthesia: they must be neatly organized, like the house decorators planning his water pipes and wires. Which equipment line should be assembled into a bundle, which equipment line pipe should be attached, should have a reasonable arrangement, and form a habit. Over time, you will be able to come without chaos...
"Beep..." The teacher's cell phone rang suddenly. Over the phone: Emergency surgery...
"Go, to be taken to the 22nd operating room, there is an emergency, traumatic spleen rupture!" The teacher said quickly.
Hearing this, Xiao Huang stood up with a "poof". Immediately behind the teacher, he walked quickly toward the emergency passage. But a series of aphorisms suddenly appeared in my heart: like walking on thin ice, like approaching the abyss...
【Warm tips】Point to pay attention, here is a lot of professional medical science, for you to decipher those things about surgical anesthesia ~