188: Chapter 188 Lu Chen Makes His Appearance! The Challenge Begins!

The subsequent trainees took the stage one by one.

The second trainee failed at the third stage, lacking proficiency in Tracheal intubation techniques while the cervical spine was immobilized.

The third trainee reached the fifth stage. The scenario involved edema following airway burns; the glottis had swollen until only a slit remained, requiring a thinner tube combined with a fiberoptic bronchoscope to successfully intubate.

This person chose the wrong tube and was disqualified for exceeding the time limit.

The fourth trainee reached the sixth stage.

The fifth trainee reached the fourth stage.

The sixth trainee was eliminated at the third stage.

More than half the morning had passed, and seventeen trainees had completed the challenge.

The best performance was the sixth stage, achieved by an Attending Physician from Nanjing.

But he failed at the seventh stage.

The scenario for the seventh stage was foreign body aspiration complicated by airway burns, requiring the establishment of an emergency airway while avoiding the foreign body.

The Attending Physician from Nanjing was not precise enough while avoiding the foreign body, touching it and causing it to shift, blocking the main bronchus; the simulated patient's blood oxygen dropped directly to zero.

"Eliminated."

Instructor Sun Gubei's tone remained devoid of any emotional color throughout.

He was a soldier; scoring was just scoring, with no comfort or encouragement.

The eighteenth person to take the stage was Zhou Haoran.

Zhou Haoran's basic skills were indeed solid.

He had worked in the Emergency Department of the Provincial Hospital for five years, performed Tracheal intubation hundreds of times, and handled many difficult airways.

He breezed through the first to the fourth stage, succeeding on the first attempt at every level.

For the fifth stage involving airway burn edema, he hesitated slightly on tube selection and the angle of entry, taking one minute and twenty seconds, but ultimately completed it successfully.

The sixth stage was airway hemorrhage complicated by coagulopathy, with blood continuously surging around the glottis and the view almost completely obscured by blood.

Zhou Haoran switched to guidance with a fiberoptic bronchoscope and completed the blind intubation within 1 minute and 45 seconds.

Instructor Sun Gubei said, "Not bad."

The seventh stage.

Foreign body aspiration complicated by airway burns.

It was the same as what the Attending Physician from Nanjing had encountered previously.

Zhou Haoran learned from the lessons of those who failed before him, and his movements were much lighter.

But when bypassing the foreign body, the angle of the tube was off by about two millimeters, and the tip of the tube grazed the edematous airway wall, triggering the "Mucosal Tear" alarm on the simulated patient.

"Eliminated."

Zhou Haoran stood up and took a deep breath.

"The seventh stage, so close."

He looked back at Lu Chen.

Lu Chen nodded slightly.

The seventh-stage result was already quite good for Zhou Haoran, currently the highest in the entire session.

But this was not the end.

The subsequent trainees continued the challenge.

Between the nineteenth and the thirtieth, the best performance was still only the seventh stage.

Chen Hao took the stage as the 31st.

One had to admit that Chen Hao had talent.

He had worked in the Emergency Department of Shanghai Ruihua Hospital for eight years and had seen all kinds of airway scenarios.

He breezed through the first to the sixth stage, his techniques smooth and decisive.

For the seventh stage involving foreign body aspiration complicated by airway burns, he handled it more steadily than Zhou Haoran, successfully avoiding the foreign body to complete the Tracheal intubation.

It took him 1 minute and 38 seconds.

A low gasp came from the surrounding trainees.

He reached the seventh stage.

He was currently tied for the highest with Zhou Haoran, but Chen Hao had succeeded while Zhou Haoran had failed.

The eighth stage.

Lu Chen noticed that Instructor Sun Gubei pressed the buttons several extra times while adjusting the parameters of the simulated patient.

This indicated that the settings for the eighth stage were much more complex than the previous ones.

The scenario popped up.

Severe facial trauma had completely destroyed the oral structure, making oral Tracheal intubation impossible, while cervical spine immobilization prevented the operator from performing a surgical airway.

The only option was nasotracheal intubation.

However, the simulated patient's nasal cavity was set with severe bilateral nasal septal deviation, making the effective passage extremely narrow.

Chen Hao's expression changed slightly.

Blind nasotracheal intubation was rarely used in daily clinical practice, and most Emergency Department doctors lacked sufficient accumulated experience.

He picked up the tube and attempted to enter through the right nasal cavity.

The tube got stuck when it reached the nasopharynx.

He changed the angle and pushed again, but it still wouldn't pass.

He switched to the left nasal cavity.

After pushing it in about six centimeters, the tip of the tube touched the bony protrusion of the deviated nasal septum.

Time was ticking away second by second.

Chen Hao adjusted the angle three times, and the tube finally passed through the narrow section of the nasal cavity and entered the oropharynx.

But problems followed one after another.

Nasotracheal intubation required guiding the tip of the tube into the glottis without direct visualization.

This required the operator to judge the position of the tube tip through auscultation and tactile sensation.

Chen Hao tried twice.

The first time, the tube entered the esophagus.

He pulled it out and readjusted.

The second time, the tip of the tube hit above the anterior wall of the glottis and did not enter the glottis.

Two minutes had already passed.

During the third attempt, Chen Hao's hand speed was noticeably faster.

But the faster one goes, the easier it is to make mistakes.

The angle of the tube tip was off the moment it passed through the glottis, and the simulated patient triggered the "Vocal Cord Injury" alarm.

"Eliminated."

Chen Hao's expression was very ugly.

When he stood up, his lips were pursed tightly.

He did not pass the eighth stage.

But reaching the eighth stage itself was already the highest record so far.

The highest record in the entire session.

The surrounding trainees did indeed give him applause.

Instructor Sun Gubei looked at Chen Hao.

"Your basic approach for the blind nasotracheal intubation in the eighth stage was correct, but your precision was insufficient."

"Under conditions of a deviated nasal septum, the force control when advancing the tube must be precise to the gram level."

"You used too much force."

Chen Hao didn't speak and retreated back into the line.

Among the subsequent trainees, from number 32 to 45, no one reached the eighth stage.

The best was only the seventh stage.

It was already approaching twelve o'clock at noon.

Numbers 46 to 48 took the challenge one after another, with results of the fifth, sixth, and fourth stages respectively.

Number 49.

Lu Chen.

When he walked out of the line, the atmosphere in the entire simulation room changed subtly.

The previous four days of training had already made every trainee know this person's name.

Textbook-level performance in anatomy class, breaking the deadlock of Professor Luo Zhenyu in the theory class, and continuous highest scores in the trauma practical class.

Now everyone was waiting for one thing.

Which stage this person could reach in the airway challenge.

Chen Hao leaned against the back wall with his arms crossed over his chest, his gaze fixed on Lu Chen.

He knew in his heart that if Lu Chen also fell at the eighth stage or before the eighth stage, then the gap from before would not be that exaggerated.

But if Lu Chen passed the eighth stage.

That would be different.

Instructor Sun Gubei looked at Lu Chen.

"Number 49, are you ready?"

"Ready."

"Begin."

The first stage.

Standard difficult airway, Grade 3 glottic view, limited mouth opening, hypertrophic tongue.

Lu Chen picked up the laryngoscope.

His first movement caused several trainees observing in the front row to raise their eyebrows.

He did not insert the scope directly, but first gently touched the mandibular angle and the base of the tongue of the simulated patient with his left hand.

This movement took less than a second, but it carried a huge amount of information.

The angle of the mandibular angle, the degree of tongue hypertrophy, the limit of mouth opening.

These pieces of information instantly formed a complete spatial judgment in his mind.

Then he inserted the scope.

The laryngoscope blade slid in along the base of the tongue, gently lifting the epiglottis.

The glottis was exposed.

The tube entered.

The cuff was inflated.

Auscultation confirmed.

The entire process took 22 seconds.

The fastest trainee before him took 38 seconds.

Instructor Sun Gubei's eyebrows moved slightly.

"Pass, continue."