Chapter 2315: 2236 Broken Reinforced Endotracheal Tube

"Do you suspect it's plugged by phlegm?" Su Yun asked; he looked and it didn't seem so, feeling doubtful.

Zheng Ren said nothing, took the suction tube, tried twice; the passage was clear, then he sent it into the patient's endotracheal tube.

The suction tube hissed, only a little secretion was drawn out; it appears not to be caused by phlegm blocking the trachea.

Continuing to push the suction tube in, Zheng Ren suddenly froze.

"Boss, what's wrong?"

"There's something inside; the suction tube won't go in." Zheng Ren said.

"……" Su Yun and the ICU Inpatient Chief both froze; Lin Yuan stood behind, momentarily not grasping Boss Zheng's meaning.

This situation exceeded everyone's imagination.

Su Yun immediately recalled the patient's pre-op chest X-ray and chest CT.

There couldn't be a problem; if there were something pre-op, the ventilator would have alarmed similarly during surgery.

"What treatment did you give?" Su Yun asked the ICU Inpatient Chief sternly.

The ICU Inpatient Chief was dumbfounded.

We didn't give anything; the patient was sent back post-op with slight agitation, initially no treatment was given. Following anesthesiologist Lao He's suggestion, observe for six hours then prepare for extubation.

But as time passed, the patient's agitation grew worse; finally several people couldn't control him, so in desperation they gave propofol.

Continuing sedation would prolong extubation time, but not giving it for that agitation is also not possible.

The ICU Inpatient Chief thought it over again, called a nurse over to inquire, but just then Zheng Ren suddenly said in a low voice: "Wrong! The endotracheal tube is broken!"

"Uh..." Su Yun glanced at the endotracheal tube; it's the reinforced type. Broken? Impossible.

The ICU Inpatient Chief also froze; she immediately explained: "Boss Zheng, the reinforced endotracheal tube..."

"Prepare the fiber bronchoscope and bedside chest X-ray!" Zheng Ren didn't discuss with them, directly gave the order.

"Okay." Su Yun didn't hesitate, pulling the ICU Inpatient Chief to push the X-ray machine.

Pushing the bedside X-ray machine over, Zheng Ren began to take images of the patient.

Positioning, placing the cassette, taking the image, then having Lin Yuan carry the cassette to run to the Radiology Department to develop the film.

By this time, the Inpatient Chief had already prepared the fiber bronchoscope.

Zheng Ren removed the ventilator and pulled out the endotracheal tube.

Upon extubation, it was found that the tracheal tube had broken off, leaving only about 12 cm of the distal remnant; the rest must remain in the patient's trachea.

The "Big Pig Trotter" indicated airway foreign body, which turned out to be a part of the reinforced endotracheal tube!

Seeing this situation, not only Zheng Ren, but also Su Yun and the ICU Inpatient Chief were stunned.

What the hell is this situation? Can a reinforced endotracheal tube even be broken?! How did it break? Misoperation during patient transfer? How much force would it take to break a reinforced endotracheal tube.

The ICU Inpatient Chief carefully checked the break point of the endotracheal tube, then whispered: "Boss Zheng, Yun Ge'er, it doesn't look like a quality issue."

Zheng Ren had long seen the irregular break end of the endotracheal tube, had a guess, and said in a low voice: "It's not that the tube broke on its own; the patient ground it off with his teeth."

"……"

"Urge Lin Yuan to have Radiology Department upload the film quickly." Zheng Ren narrowed his eyes at the patient's ECG monitor.

Although there is an airway foreign body, the endotracheal tube itself is just a conduit; it only causes strong irritation, not directly occluding the lumen to cause patient asphyxiation death.

Soon, the bedside X-ray was uploaded; Zheng Ren saw the patient's first-hand data.

The X-ray showed the proximal tracheal tube had entered the right bronchus……

Looking at the image on the computer, several people sighed.

This "medical accident" came out of nowhere, catching people off guard. Since we found it, let's remove the tube, hoping no further complications arise.

"Boss, do you still remember what the patient's family said that day?" Su Yun suddenly asked.

Zheng Ren recalled, remembering the man squatting on the curb weeping bitterly, remembering he said some things about the patient's condition, and also remembering he said the patient refused treatment and such.

When going into surgery, the patient's complexion was very poor; only after persuasion by the patient's family and Chang Yue did he enter the operating room.

It should be after waking from general anesthesia, the patient's subconscious obsession was at work—unwilling to spend money; rather than spend money on surgery, it would be better to just die.

I didn't expect the obsession to be so strong; Zheng Ren also didn't find it hard to understand. Having been a doctor for so many years, he's seen all kinds of strange patients.

However, the strange aspect of the patient before us is also this obsession.

Generally speaking, patients' will to live is strong; ordinary people say they'd rather die when old, not wanting to burden their children, but when that day actually comes, hardly anyone follows through.

Between life and death there is great terror; before that moment, few can feel how terrifying the threat of the grim reaper really is.

Ordinary patients, unless they are at the end of their resources or have no one to care for them at home, rarely have such a firm belief seeking only death.

"Ask Chang Yue… just call her… never mind, first take out the tube. The patient can go offline, keep an eye on him. Later, let the patient's family and Chang Yue do his work." Zheng Ren said helplessly.

Su Yun nodded; facing such a patient intent on death, nobody has a good solution.

Zheng Ren didn't dwell further on the vicissitudes of life; he began, under propofol anesthesia, using the fiber bronchoscope to extract the front half of the broken reinforced endotracheal tube from the trachea.

Comparing the break positions of the endotracheal tube makes it even more certain that the patient, after waking from anesthesia, ground it off with his own teeth.

A fine surgery ended up causing such a commotion; Zheng Ren laughed and cried. Yet it also indirectly proves the surgery's success—the patient had the strength to grind off the reinforced endotracheal tube with his teeth.

Contact Lin Ge and the Medical Department, also summon Chang Yue and the patient's family to explain the matter clearly.

The surgery was successful; they said he could get out of bed tomorrow and be discharged in a week. The patient's family was overjoyed, but upon seeing the endotracheal tube ground off by teeth, he stared blankly for a while, eyes wet, and apologized to Zheng Ren.

Hand this over to Chang Yue; Zheng Ren feared the patient might pull another stunt, so he simply set up a chair at the bedside and stared at him without blinking.

Postoperative tracheal tube breakage is extremely rare, especially for reinforced tubes, with no clinical reports. This case is highly special; through the tube remnant we can confirm the tube was repeatedly bitten and ground off by the patient's teeth.

This was discovered early; if it had been later, there would probably have been more complications.

Intermittent echocardiograms were done; the patient's left ventricular ejection fraction rose to about 60%, the surgical effect far exceeding expectations.

After four hours, the patient fully awoke; Zheng Ren saw all indicators satisfactory, so he transferred the patient out of the ICU, with the patient's family and Chang Yue responsible for guidance.

……

……

Note: True story, I heard a Teacher mention before, it was something that happened many years ago. Regarding the breakage of an enhanced endotracheal tube, I just heard of and encountered such a case.