Sleepless Doctor

　　 "The four-chamber heart section below the xiphoid process shows an annular dark area in the pericardial cavity, which excludes pericardial tamponade."

　　 The anesthesiologist used the fastest speed to do B-ultrasound in accordance with Wu Mian's requirements, and reported the results loudly as soon as possible.

　　 Wu Mian is quite satisfied, this anesthesiologist is really good.

　　 "Continue to find the blue point."

　　 "Um... this teacher, I can't do well, you teach me." The anesthesiologist is very open and can't tolerate falsehood during emergency rescue, he said directly.

　　 Although he doesn't know who Wu Mian is, he can't pretend that compelling aura and full of background. Especially in the face of a difficult and critical rescue, the incompetent will never get ahead.

　　 The teacher screamed sincerely.

"Both hands, with thumbs removed, placed on the chest wall of the patient's side, the little finger of the upper hand is close to the lower edge of the clavicle, the fingertip is in the middle of the sternum, and the little finger of the lower hand is about the lower front edge of the lung. The area covered by both hands is equivalent to that of a single Lateral lung area; the 3rd and 4th metacarpophalangeal joints of the upper hand are the upper BLUE point, and the lower hand is the lower BLUE point."

　　Wu Mian said while the anesthesiologist did it, and at the same time, Wu Mian had simulated several rescue methods in his mind.

　　 The anesthesiologist followed suit, Wu Mian said, his actions were left alone. The overall movements are quick and orderly. It seems that the anesthesiologist has studied or is studying, and has a certain foundation.

　　 And Wu Mian felt the difference after the "upgrade" for the first time, and also made self-adjustment in a short time.

　　 Even Wu Mian himself didn’t know exactly what was different, but he felt that his eyes were clearer. The values ​​displayed by various instruments were no longer static images, but continuous dynamic images.

　　 Despite this, my mind doesn't have the same headaches and dizziness as before, but it is exceptionally cool.

　　 Director Xu stood aside and stared blankly. He had no idea what Ren Haitao and Wu Mian were communicating.

　　Using bedside B-ultrasound to diagnose the condition and adjust the fluid supplement is a new diagnostic technique that has emerged in recent years and is quite sophisticated. There are not many people who have heard of it, let alone know how to do it.

　　 "Hands, be steady!"

　　 "The probe angle is tilted 15° to the lower right."

　　 "Bat sign, pleural sliding sign, visible B-line, pneumothorax and tension pneumothorax are excluded."

　　 "There is no dark fluid area between the pleural cavities on both sides of the diaphragm, and hemothorax is excluded; no dark fluid area is seen in the spleen-gastric space and hepatogastric space, and liver and spleen hemorrhage is excluded."

　　 "The four-chamber view of the apex of the long and short axis near the sternum showed that the heart shape and movement were normal, and the heart was beating vigorously, but it was empty."

　　 The anesthesiologist continues to report the situation.

　　 "The possibility of anaphylactic shock is high." Wu Mian looked at the various instruments calmly, and was not very concerned about the value of the high pressure 35 mm Hg.

　　 Hearing these words from Wu Mian, Director Xu of the Anesthesiology Department almost didn't cry.

　　 Teacher Wu, you are my own brother. It took more than 1 minute to come to such a conclusion?

　　Although differential diagnosis is very important, but...what are the patients, how can you still regard this kind of emergency rescue as teaching?

　　 "Hydroxyethyl starch should be stopped immediately, dexmedetomidine and remifentanil should be stopped, and all infusion lines should be replaced."

　　 "Director Xu, help, get a new one for the infusion pipe on your right."

　　 Director Xu was still complaining in his heart, and Wu Mian's doctor's order was smashed on his head.

　　 "Dopamine is injected intravenously with a pump of 10～15μg·kg-1·min."

　　 "Adrenaline 0.2～0.4μg·kg-1·min-1."

　　 "Dobutamine 10～15μg·kg-1·min-1."

　　 "Norepinephrine 0.3～0.5μg·kg-1·min-1."

　　 "The whole process is maintained, with a dedicated person to guard."

　　 "Prepare B-ultrasound to guide fluid resuscitation."

　　 A series of medical orders, like the nuclear power module activated, everyone in the operating room moved instantly.

The medical staff of the Second Hospital of 　　 Medical College have excellent basic qualities, and they can quickly complete Wu Mian’s medical orders by relying on the instinctive memory of the body without knowing why.

　　 Director Xu turned a blind eye. There was only one thing in his mind, B-ultrasound guided rehydration? What the **** is this!

　　Rehydration is fluid rehydration. Why do I need ultrasound guidance?

　　 Ordinary doctors, when faced with shock and blood pressure, they will definitely give a lot of fluids, regardless of hypovolemic shock or other shocks, anyway, low blood pressure is most likely due to insufficient fluids.

　　 But experienced doctors will judge that the patient with anaphylactic shock has been given adrenaline several times and other symptomatic treatments have been done, but the effect is not good.

　　 Just now, the anesthesiologist Ren Haitao used B-ultrasound to judge that the patient is not a pneumothorax and make a differential diagnosis. Director Xu has heard of this.

　　 In Director Xu’s memory, B-ultrasound cannot be used to diagnose pneumothorax, because there is a vast white under the probe and nothing can be seen. How to diagnose? But I seem to have heard of similar technologies recently.

　　 This is already the latest technology for Director Xu, and he doesn't understand what Wu Mian said next.

　　 Director Xu understands it doesn’t really matter, because there is only one king in the operating room.

　　 The rescue under the command of Wu Mian continues.

　　 "Give methylprednisolone 40 mg intravenously and put an ice cap on the head."

　　 "The patient is lying on the left side, the anesthesiologist, you are very focused, look for the apical four-chamber view to understand the left heart function."

　　 Wu Mian saw on the B-ultrasound screen that the ventricle was almost emptied at the end of systole, and there was an extreme situation in which the muscles were almost in contact. The patient's condition was particularly critical.

　　 "The speed of rehydration is accelerated, and the blood is needed, fresh."

　　 "Anesthesiologist~www.wuxiaspot.com~ IVC section under the xiphoid process."

　　 Director Xu almost cried when he heard Wu Mian’s English abbreviations popping out from time to time.

　　He is the director of the anesthesiology department, and he is quite dedicated himself, often staring at various journals and papers. As long as there is time, Director Xu will participate in domestic academic conferences.

　　 Director Xu doesn't want to be eliminated so early by the times. With the technology of more than ten years ago, he has become a stumbling block to the advancement of the anesthesiology department.

　　 I can witness Wu Mian's rescue, listening to various vocabulary that I don't understand pops up, Director Xu has a feeling of being an intern.

　　 He also had extravagant hopes that he could stand up to the forefront and lead the Anesthesiology Department of the Second Hospital of Medical University across the provincial level, and at least become the first-class in the country in terms of technology.

　　 But the harsh facts told him silently that he was just the front wave that was smashed on the beach, and the back wave was in front of him...waves and waves.

　　 "Ms. Wu, I am not familiar with the IVC section," the anesthesiologist said.

　　 "Probe, under the xiphoid process, with the marking point toward the patient's head."

　　 The anesthesiologist immediately adjusted the position and angle of the B-ultrasound probe according to the cold voice.

　　 "Shake it... the anesthesiologist, listen to me. You first shake the right atrium to the center of the screen; it shows the point where the inferior vena cava enters the right atrium and the hepatic vein enters the inferior vena cava."

　　 "Wrist, concentration. Almost, wrong, come again."

　　 "What we have to do is to display the full length of the inferior vena cava and require clear and sharp echoes on the front and back walls of the vein. Sharp, remember that it is sharp." Wu Mian said patiently while controlling the whole situation.

　　 Rescue requires a lot of people. It requires a collective effort like a machine. If Wu Mian himself is thrown here, even if he knows all the rescue steps and his hands and eyes are like electricity, the rescue will still not be successful.