On Monday morning, just after the morning meeting, the orthopedic director came to knock on the door.
As soon as he entered the door, he said: Received a femur neck fracture, the lower hospital does not do it, said that the lungs are not good, you give it a look.
When we encounter a problem, we should not give in. Over the years, it is this mutual support that both surgery and anesthesiology have developed rapidly. In response to the saying, "You trust me, and I will do my best."
Then, a group of us came to the ward.
When we saw the patient, we were still a little surprised: the old man was very weak and lay flat there. From a distance, it was like there was nothing on the bed. There was a weak voice that made our hearts cold at once.
The inquiry learned that the old man had been lying at home for a day after being injured. After the family summed up, they decided to send it to the hospital for treatment.
From this, we can see the attitude of the family: it may mean that the old man is old and cannot be tossed.
However, their "no tossing" made the situation of the elderly take a sharp turn. After coming to the hospital, there was already a fallen pneumonia. Check the blood gas, it is also a mess.
Considering that patients do not have general anesthesia, we have developed two sets of protocols: first try mild severe lumbar anesthesia in the spinal canal. In this way, the anesthesia is concentrated on one side of the lower limb, which can reduce circulatory fluctuations; the second set of protocols, the implementation of nerve block.
Although nerve blocking is currently the trend of the times, it also has drawbacks. Elderly people like this, originally insensitive to pain, coupled with communication barriers, no one dares to say that the effect must be perfect. If the effect is not good and you can't do general anesthesia, it will be difficult to ride the tiger.
During the procedure, water for injection (i.e. distilled water) is added to the local anesthetic. The purpose of adding water for injection is to control the anesthesia plane as much as possible on the affected side.
Some people will ask: Why not use heavy weight?
The effect of heavy specific gravity is certainly no problem, but there are two major drawbacks: when puncture, the affected side is under, and the patient will be very painful. At the very least, it hurts before the anesthesia takes effect; in addition, after the anesthesia effect comes out, the affected side must be flipped over.
Another point must be said: studies have shown that even if one side of the abdomen has been lying in the position for tens of minutes, when the body is flipped, the anesthetic will still spread to the other leg. This means that intraoperative blood pressure will also fluctuate due to this reversal.
For a 95-year-old super-elderly person, every detail should be paid attention to to ensure the success of the operation.
Although the elderly have bone calcifications, it is difficult for our long-experienced anesthesiologist to puncture in a few minutes.
With the promotion of light heavy reflex anesthetics, the pain of the elderly decreased significantly.
The benefit of this anesthesia is that once it takes effect, a decrease in pain can be felt almost instantaneously.
Seeing the anesthesiologist's technique of "pointing to which to fight", the orthopedic doctor complimented: It's amazing, how to do it?
The anesthesiologist was also not polite: floated up.
A difficult problem, in this way, was "easily" solved.
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