187: Chapter 187 Course Arrangement: Specialized Training in Airway Management

The fifth day of training, 6:40 AM.

When Lu Chen opened his eyes, Zhou Haoran was still snoring.

He got up to wash and checked today's course schedule.

8:30 AM to 12:30 PM, Specialized Airway Management Training.

The location is the Clinical Skills Center in Building B of the Training Center.

The course name was written very formally, but when the evening class ended yesterday, Instructor Sun Gubei, who was in charge of the practical training, gave a specific instruction.

"Tomorrow's airway class isn't standard training; it's a progression assessment, so prepare yourself mentally."

Progression assessment.

The word itself carried the implication of elimination.

Lu Chen got dressed and took out his phone to check his messages.

As usual, there were five or six messages from Shen Xiaoning.

[Xiao Ning: Good morning, Dr. Lu!]

[Xiao Ning: How is the weather in Beijing today? It's raining in Jiangcheng.]

[Xiao Ning: I was on night shift yesterday, and three people came in drunk after a fight. Sun Ji handled it, and he said it would have been better if you were there.]

[Xiao Ning: What is your course schedule today?]

[Xiao Ning: No matter the class, you'll definitely be the best again!]

[Xiao Ning: Good luck! Good luck!]

Lu Chen replied to one.

[Lu Chen: Specialized Airway Management Training, progression assessment.]

Three seconds after the message was sent.

[Xiao Ning: A challenge! That sounds so cool! Is it the kind where you go up level by level?]

[Lu Chen: More or less.]

[Xiao Ning: Then you'll definitely be able to pass all the levels, right!]

[Lu Chen: Yeah.]

[Xiao Ning: So concise, but I believe in you!]

Lu Chen put down his phone.

He really wasn't nervous.

Tracheal Intubation, Master Level, progress 87.

Adding the practical experience gained during the training these past few days, the progress had already risen to 89.

Handling difficult airways and various complex Tracheal intubation operations, the skill memories directly written by the system gave him enough confidence to face any airway scenario.

However, he didn't intend to rush out at the beginning.

It was the fifth day of training, and he had already attracted enough attention.

Textbook-level evaluation in the morning anatomy class, breaking Professor Luo Zhenyu's deadlock in the afternoon theory class.

He got the highest score again in the trauma practical class on the second day, and his performance in the comprehensive emergency drills on the third and fourth days was equally eye-catching.

He had already shown his edge enough.

For today's airway assessment, he planned to go last.

He would first observe others' levels and take the opportunity to observe Instructor Sun Gubei's grading criteria and question style.

Then he would make his move.

At 7:10 AM, Zhou Haoran was woken up by his alarm.

He sat up in bed, rubbing his eyes, and glanced at Lu Chen, who was already reading the textbook.

"Do you not need to sleep?"

"I slept for six and a half hours."

"You can be this energetic after six and a half hours?"

"It's enough."

Zhou Haoran took a deep breath and climbed out of bed.

"For today's airway challenge, have you learned about the specific details in advance?"

"Instructor Sun Gubei didn't go into details yesterday."

"I heard from Huang Zhiyuan in the first group that it's a ten-stage difficult airway exam, passing level by level, each one harder than the last, and you're eliminated if you fail."

"Yeah."

"Is that all you have to say, just a 'yeah'?"

"What else can I say?"

Zhou Haoran looked at him for two seconds.

"Fine, whatever makes you happy. I'm going to wash my face."

At breakfast, the atmosphere in the Cafeteria was clearly different from previous days.

The students sat in twos and threes, and the whispering was much louder than usual.

Clearly, everyone had heard about today's assessment format.

"I heard the ten stages include laryngospasm, airway burns and edema, and blind intubation with cervical spine immobilization; these are extreme situations in clinical practice."

"I encountered a laryngospasm in normal clinical practice once; at the time, our director and two associate chief physicians were present, and the three of them handled it together."

"They want us to handle it alone?"

"Didn't you understand? It's a challenge, you go up level by level, and if you fail, you're off."

"Then what level do you have to reach to pass?"

"I don't know, they didn't set a passing line."

Lu Chen heard these conversations, but he didn't participate.

He ate three eggs, a bowl of porridge, and a steamed bun, then quietly cleaned up his tray and left.

Zhou Haoran followed with his tray.

"What number are you planning to go in today?"

"Last."

"Why?"

"I'll see how others do it first."

Zhou Haoran thought for a moment and nodded.

"That's true. Although you are low-key, you always save your best for last."

"I'm not being low-key."

"Then what are you?"

"I am waiting."

"Waiting for what?"

"Waiting for the most appropriate moment."

Zhou Haoran didn't ask anymore.

8:25 AM.

Fifty students gathered at the Clinical Skills Center.

The Clinical Skills Center was quite large, occupying the entire first and second floors of Building B.

Today they were using the "Airway Management Simulation Room" on the first floor, which was about 150 square meters.

In the center of the room was a high-fidelity airway simulator, and next to it was a full set of airway management equipment.

This included laryngoscopes, tracheal tubes, video laryngoscopes, cricothyroidotomy kits, fiberoptic bronchoscopes, laryngeal masks, etc.

The simulator was highly realistic.

Lu Chen scanned it and noticed that the simulator's mouth, throat, and glottis were made of the latest silicone material, capable of simulating airway changes under various pathological conditions.

Instructor Sun Gubei stood at the front of the room.

Over fifty, with a military background, he was burly, stood straight, spoke with a loud voice, and didn't waste a single word.

"Today's course is called Specialized Airway Management Training, but in reality, it's an exam."

He got straight to the point.

"Ten stages, increasing in difficulty. Each stage is a scenario, and every scenario is extracted from real clinical cases."

"The rules are simple: everyone goes up in the order of the draw, starting from the first stage. If you fail, you step down; if you succeed, you move to the next stage."

"There are three grading criteria: operation success rate, operation time, and complication control."

"Each stage has a time limit; exceeding it is considered a failure."

Instructor Sun Gubei paused.

"Most of you have performed Tracheal intubation; some may have done it dozens or even hundreds of times."

"But I can tell you that among today's ten stages, at least three of the scenarios are ones you rarely encounter in clinical practice."

"Those who can reach the fifth stage demonstrate solid basic skills."

"Those who can reach the seventh stage demonstrate excellent technique."

"Those who can reach beyond the eighth stage."

He looked around the room.

"I have yet to see it."

After saying this, the expressions of several students clearly changed.

"Alright, let's draw lots."

The teaching assistant brought up the ballot box.

Fifty lots, fifty positions.

Lu Chen reached in and drew one.

Number 49.

Second to last.

That's far enough back.

He had originally wanted to draw the very last one, but number 49 was close enough.

Zhou Haoran drew number 18.

Chen Hao drew number 31.

After the draw, Instructor Sun Gubei didn't waste any words.

"Number one, come up."

The first one to go up was an Attending Physician from Wuhan who had worked in the Emergency Department for six years and had relatively rich experience in airway management.

The first stage's scenario was a standard difficult airway; the simulator was set to Grade 3 laryngeal exposure, limited mouth opening, and an enlarged tongue.

This scenario is not rare in clinical practice and should be manageable for an experienced emergency doctor.

The Attending Physician from Wuhan completed the intubation in 48 seconds, succeeding on the first attempt.

Instructor Sun Gubei nodded.

"Pass. Proceed to the second stage."

The second stage's scenario was upgraded; based on the first stage, it added massive oral bleeding, obstructing the view.

The Attending Physician took one minute and twelve seconds in the second stage, attempted it twice during the process, and finally succeeded.

"Barely acceptable. Continue."

Third stage.

Cervical spine injury with mandatory immobilization; the head could not be tilted back, and only a video laryngoscope could be used for midline positioning intubation.

The Attending Physician from Wuhan took one minute and forty seconds in the third stage; he accidentally entered the esophagus once, but after discovering it in time, he readjusted and completed it successfully.

"Not bad. Continue."

Fourth stage.

Laryngospasm.

The simulator suddenly developed a laryngospasm during the intubation process, the glottis closed tight, and the tube could not pass through.

The difficulty of this scenario lay in how to judge and treat the laryngospasm, rather than forcibly inserting the tube.

The Attending Physician from Wuhan ran into problems in the fourth stage; he tried to deepen sedation before re-inserting the tube, but excessive force caused the simulator's glottis mucosa to show a damage signal.

Instructor Sun Gubei shook his head.

"Eliminated. Glottis damage. In a real patient, this would lead to glottic edema or even tearing."

The first student made it to the fourth stage.

Not bad at all.