Laryngeal masks are commonly used in newborn resuscitations, which most practicing physicians can think of. The problem with this baby in front of us is fundamentally not about establishing an artificial airway.

The child, freshly born, is bradycardic and not breathing, and generally there is only one reason for this: airway obstruction. The blockage could be mucus, meconium, or something else.

Due to the baby’s heart rate quickly falling to dangerous limits, the doctors were forced to perform Cardiopulmonary Resuscitation (CPR) first during the emergency to maintain the baby’s heart. Then at an appropriate moment, they would address the airway issue.

Positive pressure ventilation to establish an artificial airway using a laryngeal mask, etc., is best performed on the basis of a clear airway. Otherwise, every ventilation attempt might push the obstruction further into the airway. Therefore, they were extremely cautious when using the breathing bag. Initially, Song Xueling did not use a breathing bag and used his own mouth to blow air, effectively trying to suck out the blockage from the baby’s airway.

The blockage in the mouth and nose had already been cleared by the obstetrician immediately upon receiving the baby. When Song Xueling took over, he conducted a quick check and indeed found no obstruction in the baby’s mouth and nose. The situation was quite tricky; the blockage was likely stuck deep in the child’s trachea, making it difficult to remove and resulting in the child’s current dangerous condition.

Frankly speaking, if intubation is needed, tracheal intubation is better than using a laryngeal mask. If tracheal intubation is successful, it would at least ensure that the tube is inside the trachea, allowing for a suction catheter connected to a negative pressure suction device to carefully attempt to remove the obstruction from the trachea.

This is not a hospital setting; there is no negative pressure suction device here. The special tracheal intubation equipment for neonates is not available even in Guoxie’s ambulances and emergency departments. Neonatal intubation is technically demanding. Emergency doctors on duty at tertiary hospitals are not specialized pediatric hospital doctors and lack the technical capability to intubate such small children. The only option is to return to the hospital and have a neonatologist perform it.

What to do? It’s correct to effort in reviving the baby’s heart. CPR compressions are performed on the chest, which, to some extent, provides momentum to the trachea.

It’s just that, up to now, these resuscitation efforts seem insufficient, possibly requiring doctors to take a gamble. The rigor of medicine prompts physicians to choose gentle measures first, and only if the patient or child is unsuccessful will they proceed with further risks. Any invasive medical procedure is a double-edged sword, coming with both benefits and drawbacks; it can save lives when good and hasten demise when not.

In the face of gambling, doctors must first calculate whether the previous measures have provided the body with sufficient reaction time. Song Xueling looked up and asked about the time: "How many minutes have we been doing this?"

Upon his question, Lin Hao and Li Qi’an looked at their watches and clocks, trying to recall and estimate: "Probably seven or eight minutes—"

"I’ve participated up to now for four minutes; before that, Doctor Song, you took the baby out for five minutes. Altogether, it’s approximately nine minutes and ten seconds." Xie Wanying responded.

Lin Hao and Li Qi’an, hearing her precise account of the time, couldn’t help but sigh inwardly: time had passed so quickly. As someone once said, Student Xie is no different from the seasoned doctors; on this point, they could barely keep up.

In Song Xueling’s slightly narrowed brown eyes glimmered a trace of brilliance. Partnering with Dr. Xie is the most comfortable; Dr. Xie never disappoints at crucial moments.

"Doctor Song, how about we switch, and I give it a try," Xie Wanying proactively suggested.