63: Chapter 63 The airway is almost completely blocked and is rapidly deteriorating.
Three-concavity sign.
Lu Chen stood up.
Pushing the wheelchair were a man and a woman, both looking to be in their early forties; judging by their attire, they were business people.
The woman's face was streaked with tears, and the man was also extremely anxious.
"Doctor! Doctor! My dad can't catch his breath! He's not going to make it!"
The triage Nurse had already started registering them.
"Name, age, any underlying medical conditions?"
"Zhao Guoqiang, fifty-four years old. He has asthma; he's been wheezing for years!"
"How did it start today?"
"He was working at the construction site at noon when he suddenly started wheezing. At first, he could still talk, but then he wheezed more and more until he couldn't speak, so we rushed him over!"
Lu Chen had already walked to the front of the wheelchair.
He squatted down and took a look at the patient's face.
His lips were severely cyanotic, and his complexion was ashen.
The patient was still conscious but clearly agitated, gripping the wheelchair armrests with both hands, his fingernails also purple.
Lu Chen reached out and felt the carotid artery.
The pulse was rapid and thready.
He placed his stethoscope on the patient's chest.
Both lungs were filled with wheezing sounds, and breath sounds were extremely diminished.
This was a severe asthma attack.
And not just an ordinary severe one.
Lu Chen activated Eye of Truth.
[Eye of Truth scanning complete]
[Patient information: Male, 54 years old]
[Chief complaint: Progressive dyspnea for 3 hours, aggravated for 1 hour]
[Eye of Truth diagnosis: Status asthmaticus (near-fatal asthma), complicated by respiratory acidosis, imminent respiratory failure]
[Danger level: Extremely high (Red Alert)]
[Current symptoms: Severe bronchospasm, airway almost completely obstructed, oxygen saturation continuously dropping, severe carbon dioxide retention, progressive aggravation of acidosis]
[Recommendation: Immediately establish an advanced airway, perform Tracheal Intubation to establish effective ventilation, simultaneously administer high-dose bronchodilator nebulization and intravenous medication, mechanical ventilation if necessary]
[Warning: Patient will enter respiratory and cardiac arrest within 8 to 12 minutes. Window of opportunity is extremely short; must act immediately]
Lu Chen's pupils constricted slightly.
8 to 12 minutes.
This window of time was terrifyingly short.
"Dr. Lu, what's the situation?"
Meng Yan walked over.
"Status asthmaticus, near-fatal attack, respiratory failure is imminent."
Lu Chen's voice was quick but very steady.
"Push him into the Resuscitation Room, notify Sister Zhao."
Meng Yan's expression changed instantly.
"Xiao Zhou, prepare Resuscitation Bed No. 3! Xiao Lin, notify Dr. Zhao to come over immediately!"
The wheelchair was quickly pushed into the Resuscitation Room.
The patient was lifted onto Resuscitation Bed No. 3.
The ECG monitor was connected.
The numbers popped up.
Heart rate: 138 beats per minute.
Oxygen saturation: 78%.
This number made everyone present change color.
78%.
A normal person's oxygen saturation should be above 95%.
78% means this person's body is severely hypoxic.
Every second, he is suffering from oxygen deprivation.
"Establish intravenous access!" Lu Chen directed while working.
He picked up the mask, turned up the oxygen flow, and put it on the patient.
However, mask oxygenation for this degree of airway spasm had extremely limited effect.
Air simply couldn't get in.
The airway was almost completely closed off.
Mask pressurized oxygen was given for thirty seconds.
Oxygen saturation did not rise.
Instead, it dropped from 78% to 76%.
"80 mg Methylprednisolone IV push! Salbutamol nebulization!"
Meng Yan executed rapidly.
But Lu Chen knew that medication takes time to take effect.
Bronchodilator nebulization takes at least several minutes to take effect, and intravenous steroids are even slower.
And this patient might not have several minutes left.
At this moment, Zhao Yaqin rushed in.
"What's the situation?"
"Status asthmaticus, oxygen saturation 76%, mask oxygen ineffective, airway almost completely obstructed, rapidly deteriorating."
Zhao Yaqin took a look at the monitor, and her expression darkened.
"Has the medication been administered?"
"Methylprednisolone and salbutamol have both been administered, but the medication won't take effect in time."
"What do you mean it won't take effect in time?"
"Sister Zhao, this patient needs Tracheal intubation."
Zhao Yaqin looked at Lu Chen.
"Are you sure?"
"Sure. Mask oxygen won't hold up; his airway spasm is too severe. We must establish an advanced airway for mechanical ventilation, otherwise, he will go into cardiac arrest within minutes."
Zhao Yaqin hesitated for less than two seconds.
"Okay, prepare for Tracheal intubation."
"Sister Meng, laryngoscope, 7.5 tracheal tube, guiding wire, syringe, and have an emergency cricothyroidotomy Puncture kit ready."
Lu Chen listed all the necessary equipment in one breath.
Meng Yan didn't hesitate at all and turned to get them.
Zhao Yaqin took a look at Lu Chen.
"You're doing the intubation?"
"I will."
"How many times have you done it?"
"This is my first time."
Zhao Yaqin's eyebrows twitched.
"First time?"
"Sister Zhao, trust me."
Zhao Yaqin looked into his eyes.
In those eyes, there was no nervousness, no hesitation, only an absolute, calm certainty.
It was the exact same look as last time in the Operating Room.
"Alright, you go ahead, I'll assist you."
Meng Yan had all the intubation equipment ready.
Lined up on the operating table.
Laryngoscope.
7.5 tracheal tube.
Guiding wire.
10 ml syringe.
Stethoscope.
Fixation tape.
The whole set was ready.
By this time, there were a few more people in the Resuscitation Room.
Wu Fan and Sun Ji had heard the commotion and rushed over.
Wu Fan took a look at the numbers on the monitor.
Oxygen saturation had already dropped to 74%.
"Who's doing the intubation?"
"Lu Chen," Zhao Yaqin said.
Wu Fan's eyebrows raised, but he didn't say anything.
He had seen Lu Chen's surgical level; although intubation and surgery were two different things, he chose to trust Zhao Yaqin's judgment.
Sun Ji stood to the side, clearly a bit nervous.
As a Resident Physician, he had performed Tracheal intubation a few times, but every time his hands shook from nervousness.
The pressure of this procedure was too great.
If you can't get it in, it's a human life.
The patient's consciousness began to blur.
From agitation to lethargy.
This was a sign of worsening carbon dioxide retention.
In a little while, he would fall into a coma.
After the coma, breathing would stop.
And then the heartbeat would stop.
Lu Chen walked to the head of the bed.
He adjusted the angle of the head of the bed to put the patient in a standard sniffing position.
Then he picked up the laryngoscope.
From the moment he picked up the laryngoscope, his whole person changed again.
Just like every time he stood on the operating table.
That gentle, low-key temperament completely disappeared.
Replaced by an extreme focus and calmness.
In his eyes, there was only the patient in front of him.
Only this airway.
Everything else—Zhao Yaqin's gaze, Wu Fan's observation, Meng Yan's nervousness, the family crying outside the door.
All disappeared.
In his world, only one thing remained.
Insert the tube.
Lu Chen held the laryngoscope in his left hand and supported the patient's jaw with his right.
He gently opened the patient's mouth.
There were large amounts of secretions in the oral cavity.
"Suction."
Meng Yan immediately handed over the suction catheter.
Lu Chen took it and quickly cleared the secretions in the oral cavity.
Three seconds, cleaning complete.
Then he slid the laryngoscope blade into the oral cavity along the right side of the patient's tongue.
The tip of the laryngoscope blade reached the base of the tongue.
This position was key.
In a standard intubation procedure, at this step, one would lift the laryngoscope to expose the glottis.
But this patient's condition was not ordinary.
Lu Chen's system had already told him that this patient's airway condition was a difficult airway.
There were two reasons.
First, the patient had a short neck and a receding chin; the Mallampati classification was at least grade three.
Second, the status asthmaticus caused severe airway edema and spasm, and the tissue around the glottis was significantly swollen.
These two factors combined meant that exposing the glottis was very difficult.
If it were an ordinary Resident Physician performing this intubation.
The success rate would be around 30 percent.
Or even lower.
But Lu Chen was not an ordinary Resident Physician.
He possessed Master Level Tracheal Intubation.