64: Chapter 64 Angkor, Talent Does Exist
After the laryngoscope blade reached the base of the tongue, Lu Chen did not pull it straight up as written in the textbooks.
He first made a slight adjustment to the angle of the laryngoscope blade, tilting it about five degrees to the left.
Then, following the curve of the base of the tongue, he precisely embedded the tip of the laryngoscope blade into the vallecula.
This operation was extremely precise.
A millimeter too much, and it would press against the epiglottis, causing a reflex.
A millimeter too little, and the glottis would not be exposed.
Lu Chen's hand was so steady that it didn't seem like the hand of someone performing this operation for the first time.
After the laryngoscope blade was embedded in the vallecula, he pulled it forward and upward in the direction of the laryngoscope handle.
It was not a prying motion upward.
It was a forward and upward pull.
Many beginners get this detail wrong.
Prying upward would cause the laryngoscope blade to press against the patient's upper teeth; at best, it would damage the teeth, and at worst, it would cause the teeth to fall out and enter the airway.
Pulling forward and upward is the correct direction of force.
The glottis was exposed.
But it was not fully exposed.
Just as Lu Chen had anticipated, due to airway edema and the patient's own anatomical conditions, only the posterior commissure and a small portion of the vocal cords could be seen.
Cormack-Lehane grade, three.
This exposure condition is tricky even for many experienced anesthesiologists.
Grade three exposure means you can barely see the glottic fissure.
You have to rely on experience and tactile feel to guide the tube in.
Zhao Yaqin, standing nearby, also saw the exposure situation.
Her heart suddenly skipped a beat.
Grade three exposure.
If it couldn't be intubated, it would be a problem.
The patient's blood oxygen had already dropped to 72%.
There was no second chance.
But Lu Chen's expression didn't change at all.
His left hand steadily maintained the pulling force of the laryngoscope.
His right hand picked up the tracheal tube that had already been fitted with the guiding stylet.
The tip of the tube was bent by the stylet into a specific angle.
This angle was not the standard angle from the textbooks.
Instead, it was the optimal curvature that Lu Chen had instantly calculated in his mind based on the patient's glottic exposure.
Master Level Tracheal Intubation is not just muscle memory.
It also includes the ability to make immediate judgments and adaptations to various complex airway conditions.
Lu Chen aimed the tip of the tube toward the posterior commissure of the glottis.
Then, he performed a maneuver.
His right hand applied a slight rotational force to the end of the tube.
At the same time, his left hand slightly adjusted the angle of the laryngoscope, expanding the exposure range just a little bit.
Just that little bit.
But it was enough.
Guided by the rotational force, the tip of the tube slid precisely into the trachea along the edge of the posterior commissure.
There was no resistance.
There was no stuttering.
Success on the first attempt.
"It's in."
Lu Chen's voice was calm.
He withdrew the guiding stylet and injected 8 milliliters of air into the cuff.
Then he picked up the stethoscope and listened to both lungs.
Left lung breath sounds.
Present.
Right lung breath sounds.
Present.
Gastric area.
No gurgling sounds.
Position is correct.
"Secure the tube."
Meng Yan immediately stepped forward and secured the tube to the patient's face with tape.
Lu Chen connected the ventilator.
He set the parameters and started mechanical ventilation.
The ventilator started running.
Oxygen was delivered directly into the patient's lungs through the tube.
Everyone was staring at the monitor.
Blood oxygen saturation.
72%.
73%.
75%.
78%.
The numbers started to jump up.
82%.
85%.
88%.
The atmosphere in the Resuscitation Room noticeably relaxed.
91%.
93%.
95%.
Zhao Yaqin let out a long sigh of relief.
"It's stabilized."
Wu Fan stood to the side, his mouth slightly agape, unable to close it for a long time.
He looked at the numbers on the monitor, then looked at Lu Chen.
"You just said this is your first time intubating?"
"Yes."
"First time?"
"Yes."
"Are you sure?"
"I am."
Wu Fan fell silent.
He had performed Tracheal intubation at least a hundred times.
But he wouldn't dare say he could succeed on the first attempt every time with a difficult airway of grade three exposure.
And this person said it was his first time.
Wu Fan suddenly felt that his dozen-plus years of medical experience had been insulted to some degree.
But he didn't show it.
Because he knew, this guy was truly impressive.
Sun Ji stood to the side, unable to say a word.
In his three years as a Resident Physician, he had performed Tracheal intubation over a dozen times.
But until now, he would still panic when encountering a difficult airway.
Lu Chen's operation just now, from picking up the laryngoscope to finishing the tube fixation, took less than thirty seconds in total.
Thirty seconds.
A difficult airway with grade three exposure.
Success on the first attempt.
Sun Ji felt he might need to go back and relearn Tracheal intubation.
The patient's blood oxygen had stabilized at 96%.
The heart rate had also dropped from 138 to 112.
The ventilator was running steadily.
Vital signs were recovering.
Lu Chen began to handle the follow-up medication.
"Continue the methylprednisolone intravenous drip, combine salbutamol and ipratropium bromide for nebulization, administer through the ventilator circuit, and add 0.25 grams of aminophylline to 250 milliliters of normal saline for a slow intravenous drip."
Zhao Yaqin nodded from the side.
"Well handled."
"Sister Zhao, we should consider transferring this patient to the ICU later."
"Why?"
"Since they are on a ventilator for status asthmaticus, we need to observe them for at least 24 hours to confirm that the airway spasm has completely resolved before considering weaning and extubation. The ICU's monitoring conditions are more suitable than our Red Zone."
Zhao Yaqin thought for a moment.
"You're right, I'll contact the ICU."
Zhao Yaqin turned and went to make the call.
Lu Chen continued to observe the patient's vital signs by the bedside.
The ventilator parameters were all within the normal range.
The patient's cyanosis was fading; the color of the lips slowly changed from deep blue to light purple, and then began to show some ruddiness.
The family members at the door were allowed to come in.
The daughter rushed in, and seeing her father with a tube inserted and connected to a ventilator, tears fell again.
"Doctor, how is my dad?"
"He is temporarily stable."
Lu Chen stood up and faced the family.
"Your father is in a state of status asthmaticus. When he arrived, his airway was almost completely occluded, and his blood oxygen was very low. We have performed a Tracheal intubation and connected him to a ventilator for assisted ventilation. His vital signs are currently recovering."
"Then, will he be okay?"
"He needs to be transferred to the ICU for observation. Once the airway spasm is completely controlled, we will evaluate the timing for weaning and extubation. The specific prognosis depends on the situation over the next 24 to 48 hours."
The daughter nodded while crying.
The male family member beside her pulled her.
"Stop crying for now, let the doctor work."
Then the male family member looked at Lu Chen.
"Doctor, thank you."
"You're welcome, this is what we should do."
When Lu Chen finished saying this, a system prompt flashed in his mind.
But he didn't look at it in front of the family.
The family members were guided to the waiting area.
The ICU called back; there was an available bed, and they could accept the patient.
Zhao Yaqin arranged for the transfer.
Meng Yan, along with two Nurses, began preparing the transfer equipment.
In the interval while waiting for the transfer, Wu Fan walked over to Lu Chen.
"Lu Chen."
"Brother Wu."
"Where did you learn that intubation?"
"I learned it by reading books."
Wu Fan looked at him, the expression on his face very vivid.
"Learned it by reading books?"
"Yes."
"Grade three exposure, success on the first attempt, and you're telling me you learned it by reading books?"
"Brother Wu, such a thing as talent exists."