■ In many hospitals in Wuhan, the team of doctors for intubation is called the "intubation daredevil team". If you describe their work in one sentence, it is to "live alive" for the patient. But for this vitality, they often become the closest to danger. But in the eyes of these doctors, compared with the life of the patient, the "possibility of being infected" is less important. "I inserted this tube, and he may have survived it. The patient still beats 'value'. "

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Doctors are aware that the most dangerous place for patients with new coronary pneumonia is the mouth: When the mouth is opened, a high concentration of aerosol with virus will gush out of the airway. The doctor who performed the tracheal intubation for the patient bears the brunt of this moment, becoming the person closest to the danger-a distance of twenty to thirty centimeters, the largest range of exposure.

In many hospitals in Wuhan, the team of doctors for intubation is called the "intubation daredevil team". This job requires the caution of an enemy, and a little courage to look back at death.

Just like Wang Jiafang, an anesthetist and an anesthesiologist of Wuhan First Hospital intubation team, said: Even if the N95 mask filtered 95% of the virus, as long as the virus multiplied, the remaining 5% was equivalent to 100%.

Wang Jiafang's colleague Liu Yufeng had intubated more than 10,000 patients in 19 years of medical practice, but he was also nervous, and his palms would sweat and even tremble slightly during operation, "like returning to the beginning of intubation".

"Strive for life"

For anesthesiologists, intubation is actually a basic skill that can be accumulated over time, and every day is almost a subconscious act: inject a patient with anesthetic drugs, open the mouth, reach into the laryngoscope, and the laryngoscope will shine A small shadow area, which is a small hole with a diameter of 78 mm, is called the glottis. The two vocal cords are on both sides of the glottis, and the transparent hose is moved between the vocal cords. It can slide without much effort. Into the respiratory tract.

The inner diameter is 7 mm and the length is 26 cm. After such a transparent hose is connected to oxygen, it is a life-saving straw for the patient. If the patient is a child, the size will be smaller to allow passage through a narrower area.

Luo Mengqiang, a member of the National Emergency Medical Team supported by Wuhan and an anesthesiologist at Shanghai Huashan Hospital, said that critically ill patients with new coronary pneumonia are manifested as respiratory failure with refractory hypoxemia, and often need to rely on tracheal intubation to keep the last line of life. .

Liu Yufeng also described his work as "striving for life".

According to a study by the Chinese Centers for Disease Control and Prevention on more than 40,000 confirmed cases as of February 11, the overall mortality rate of neo-coronary pneumonia was 2.3%. Critically ill patients accounted for 5% of the confirmed cases, but the fatality rate of these patients was 49%.

Liu Yufeng said that critically ill patients with new coronary pneumonia who need tracheal intubation are generally "severely severe," most of whom are between the ages of 50 and 80, and there are many basic diseases such as cerebral infarction, hypertension, and diabetes and complications. Coupled with the torture of the virus, the patient's cardiopulmonary function has been impaired, and a slight stimulus in the intubation may cause the patient to exacerbate the failure. Some people are already conscious when they come to the operating table. Intubating them at any time may cause them to drop their blood pressure too quickly and even cause a sudden cardiac arrest.

For this vitality, the Anesthesiology Department of Wuhan First Hospital has specially prepared a "intubation process".

"Patients can't wait, we also try our best to make our entire process faster. As soon as we are one minute, the patient has more hope." Wang Jiafang participated in writing this process. He consulted the practice of many hospitals and reduced the time that can be compressed. They will dispense the medicine in advance and inhale the syringe, put it within reach, and inject it into the patient at any time.

But there is no sloppy protection.

Normally, the hospital's requirement for the intubation doctor is that it must be arrived within 5 minutes of receiving the task. Now, the time has been extended to 30 minutes, and the extra 25 minutes is for doctors to wear various protective equipment.

As the "person closest to the patient's mouth", the intubation doctor took the highest level of protection from medical staff. In addition to protective clothing, gowns, goggles, and masks, the only positive-pressure protective headgear in Wuhan First Hospital was given to the "intubation daredevil", whoever in charge of intubation would use it. Due to the pressure difference between inside and outside, it is almost impossible for the virus to enter the positive pressure head cover. The hood is also equipped with a fresh air system, which can ensure that doctors can breathe smoothly and prevent fogging of goggles from affecting the sight.

I want to rush time, thanks to concentration and effort.

Before the first shift, Liu Yufeng and his partner simulated the exercise until around 10pm. They faced the process, familiarized all the instruments, counted the intubation equipment and medicines one by one, and thought about the conceivable emergencies. They need to be foolproof.

On February 16, they completed the rescue work of the first case of tracheal intubation in patients with new coronary pneumonia in the whole hospital. Taking off his protective clothing, Liu Yufeng took a deep breath and made a happy announcement in the team's WeChat group. Only then did he realize that his back was already wet a lot.

"Golden 30 Seconds"

When intubating, the doctor's biggest concern is that the patient may have a sudden cardiac arrest. Intubate patients with new coronary pneumonia and worry about coughing during tracheal intubation. That means that the risk will be significantly higher-when humans sneeze on the table, oral droplets are like galloping trains at speeds of up to 177 kilometers per hour.

The function of muscle relaxant is to suppress breathing. About 1 minute after the medication, the patient will not be able to breathe spontaneously. This medicine is usually not commonly used for intubation. It is mainly used to improve the conditions of intubation and reduce the chance of choking in patients with new coronary pneumonia.

However, the injection of muscle relaxants is also the most stressful part of Wang Jiafang. After the patient's spontaneous breathing is inhibited, it is all supported by the oxygen storage in the body. Patients with new coronary pneumonia due to impaired cardiopulmonary function and poor physical condition, the oxygen storage is only about one third of ordinary people. "After taking the medicine, their blood pressure and heart rate fluctuations will be much larger than ordinary people, especially some sensitive people. Even if you push the medicine, your heart will be at risk of stopping."

There is a "golden minute" for tracheal intubation. This 1 minute is very important for saving lives and doctors' own safety. Another saying is "golden 90 seconds"-from the beginning of the injection of anesthetic to the end of the intubation, control within 90 seconds, otherwise it may cause the patient to die of hypoxia.

Because muscle-relaxing drugs narrow the time window for rescue, after the drug has taken effect, the intubation doctor has at most 30 seconds left.

But there was still trouble in their mouths waiting for them.

Sputum is present in the mouth of patients with new coronary pneumonia, especially in severe cases, where the sputum is thick and sticky. "The sputum will block the trachea. If the catheter is inserted at this time, the sputum will not be able to drain out of the trachea and it will also cause suffocation of the patient."

Liu Yufeng encountered a patient who had thick sputum to suck a sputum suctioner and it took a lot of effort. At that time, he was only allowed to intubate for five or six seconds, and the moment he was inserted into the catheter, he felt almost collapsed.

Each time he completed the intubation, Luo Mengqiang also became nervous and his heart rate increased from 70 to 80 times per minute to 130 to 40 times, which caused a huge physical exhaustion. "If the airway is opened for one second, the patient and the medical staff are at risk for one second, so it can be completed within 10 seconds, and we will never drag it to 20 seconds," he said.

Keep hope

Luo Mengqiang is a member of the "Intubation Squad" in the Optics Valley of Wuhan Tongji Hospital. His Shanghai Huashan Hospital took over the intensive care unit of the Guanggu District of Wuhan Tongji Hospital. The intensive care unit concentrates the most critically ill patients, with up to 80% -90% of patients receiving tracheal intubation.

On one occasion, Wang Nan, an anesthesiologist at Wuhan Tongji Hospital, intubated a patient. About ten minutes later, she found that the patient's heart rate suddenly dropped from 110 times per minute to more than 30 times, and the trend continued to decline. She didn't think much, and went to give the patient a chest heart compression. After two minutes of pressing, the patient's heart rate gradually returned to normal as the rescue medication took effect. This move seemed unusual. It could be regarded as a "dangerous action" in the high-concentration virus space. If the action range was too large or too fast, it would easily cause damage to protective clothing, but she said: "The situation was urgent at the time, I just thought that we could not let The patient's heart stopped. "

Qi Zhong, an anesthesiologist at Wuhan First Hospital, said that compared with the patient's life, "it is possible that he was infected." He said that he was still young, and even if he was unfortunately infected, the probability of sacrifice was relatively small, but "I inserted this tube, and he may survive it. In this way, it is worthwhile to fight for the patient."

Qi Zhong was on duty on the first day and experienced an accident. A patient in his 60s was intubated for more than 40 minutes and a sudden cough occurred and the hose fell off. When he finished wearing protective equipment again and rushed to the ward, the scene in front of him moved and feared: The doctor on the bed had been dragging the face mask of the ventilator to help the patient to breathe. The doctor only had ordinary protective equipment. "Unlike us, we have face screens and positive pressure hoods, which are operated with bare hands. The risk of infection is extremely high." Qi Zhong quickly took over the work of the doctor in bed and asked him to go Disinfection and cleaning.

He said that the patient could be rescued. Thanks to the doctor in bed. At that time, the drugs that inhibited breathing were not completely metabolized, the patient's lung function was already poor, and spontaneous breathing was weak. If no one was supplying oxygen next to him, he would die within minutes.

Qi Zhong has always felt that as long as the patient's lung function is at its worst, he can help with blood oxygen saturation and the patient's own immune system can carry it over, they can stay in the world.

What made Luo Mengqiang and colleagues feel encouraging is that after the intubation, some patients improved significantly after being actively treated. Later, the root canal was successfully removed, and the chances of recovery increased greatly.

"We have retained their hope for survival," Luo Mengqiang said.

China Youth Daily • China Youth Daily reporter Zhang Junbin and Sun Qingling Source: China Youth Daily