chapter 2

“Is he a child or something? Do I have to sit and watch him while he

plays with his friends?” He grumbled childishly, his eyes still glued to

the computer screen. I thought something was strange. I don’t know if

it’s because the patient has an unusual condition I’m unfamiliar with,

or if the resident doctor who wrote this report just haphazardly

submitted the information.

[Everyone else’s fans are coming, why can’t P’Fah’s boyfriend come

too?]

“So, in short, you have a boyfriend just to show off to your friends,

huh?”

[Fah definitely has more to show off than just being proud, but his

boyfriend is totally worth showing off! We rarely get to see each other

like this.

Knock, knock, knock.

“I have to go now, P’Fah, work has to come in,” I cut him off

immediately when I heard a knock on the door. The person who had

been whining and complaining stopped immediately. Even though he

often acts like a child, P’Fah never makes things difficult for me at

work. He swallowed all his words and replied, “Okay, get back to work.

I’ll bother you again later,” and hung up easily, as if he hadn’t been

complaining at all.

“Please come.”

I responded, just as the door opened.

“Professor, the case I told you about this morning.”

“Hmm, what’s up?” I leaned back in my chair, trying to relax as much

as possible, knowing that these residents were quite intimidated (or

afraid) of me, even though I hadn’t threatened or scolded them at all.

Actually, I was the kindest person in the ward. But maybe it was

because I wasn’t particularly cheerful or smiling, especially when I waslow on energy; my face was even less welcoming. That’s why they

secretly liked to call me ‘Strict Brother.’

Which means exactly what it says: “Have you gone to pre-order yet?”

“It’s all done,” the third-year resident said hesitantly. Although her

communication was clear, her eyes and body language clearly indicated

her desire to leave the room as quickly as possible. “The patient is ASA

Class 32, BMI 403, intubated. It was a difficult procedure.”

“So, what’s your plan?”

“Let’s see how difficult it is to insert. We’ll try Ramp Position,

Adequate Oxygenation, HFNC for Apneic Oxygenation, and Video

Laryngoscopy.”

Pre- or Premed comes from the word Premedication, meaning the

administration of medication before anaesthesia. In the context of

anesthesiology, it broadly refers to Preanesthetic Evaluation and

Premedication, which includes evaluating the patient before anesthesia

and administering medication based on the evaluation results.

ASA Class stands for the American Society of Anesthesiologists

Classification. It’s a system for categorising patients into groups based

on their physical condition to assess surgical risk. There are six levels in

total (though in practice, only five are commonly used, as level 6 refers

to brain death). This sentence refers to ASA Class 3, meaning the

patient has severe underlying medical conditions that significantly

impact their daily life, such as hypertension, abnormal obesity,

hepatitis, or alcoholism. In the context of anesthesiology, where

anaesthesia is administered during surgery, patients in ASA Classes 3-5

are considered significant obstacles to anaesthesia and require careful

planning to ensure the best possible surgical outcome.

BMI, or Body Mass Index, is a measure used to assess obesity and

underweight in adults aged 20 and older. It can be calculated by

weighing the patient (in kilograms) and measuring their height (in

centimetres) using an obesity assessment program. In this case, thepatient has a BMI of 40, which is classified as severely obese (obesity

level 3), making intubation during surgery difficult.

A tube, or in this context, an endotracheal tube, refers to a breathing

tube.

Ramp Position: This positioning during endotracheal intubation

involves tilting the head higher, using pillows to support the head and

shoulders, so that the external auditory meatus is level with the sternal

notch to open the airway.

Adequate Oxygenation refers to ensuring the patient receives

sufficient oxygen to allow tissues and organs to function normally,

especially during surgery or procedures involving anesthesia or

sedation.

High-Flow Nasal Cannula (HFNC) is an alternative treatment for

patients with respiratory failure or hypoxia. It provides airflow of up to

60 litres per minute, along with humidification and optimal

temperature, through the nasal canal. It maintains a constant oxygen

concentration, helps remove carbon dioxide accumulated in the

nasopharynx, improves sputum drainage, and increases oxygen levels

in the body.

A video laryngoscope is a device similar to a regular laryngoscope

but with a camera attached to the end. This allows visualisation of the

larynx on a display screen and is useful for patients who cannot use

conventional devices.

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