godfather of surgery

Chapter 283 Acidosis

Brothers and sisters Huang Jiacai, they don't lose the chain at critical times. This set of equipment is really unique in the city, because it was customized by Huang Jiacai. The connecting rod between the guide and the steel plate is lengthened, which is suitable for particularly obese patients.He also customized some other more exotic instruments, such as extended steel plate screws, in case of emergency.

After the fracture was reduced, the plate was successfully placed, and the locking screw was placed under the guidance of the guide.Long steel plates, high spans, stresses are distributed and fractures are bridged.

"Why do other people have equipment, but yours doesn't? Are you trying to dismantle it?"

On the stage, Director Ouyang was made ashamed and embarrassed, and lost his temper at the equipment dealer and the stage.

Just now he was asked to dig three feet to get the equipment, but he still couldn't get it. Several larger companies have asked, who is okay to make a set of equipment for patients with [-] catties, and it is useless to scold people to death .But Yang Ping's equipment dealer has it, and it has been delivered. Director Ouyang has reason to suspect that the equipment dealer is not interested.

If it wasn't for Yang Ping's rescue, if it wasn't for Yang Ping's equipment dealer, this operation would really be impossible.

"I'm sorry, I'm sorry, I'm sorry, our work is not in place, our manager will be here soon, and he will personally come over to make an apology." The equipment dealer who followed the stage did not dare to refute.

Director Ouyang is not bad, but if you meet Director Bai and the equipment falls in front of you, you can only nod and bow to apologize.

At this time, no matter whether there is a mistake or not, it can only be like this, until Director Ouyang is smooth, and now the equipment dealer is a punching bag, a sandbag for being beaten, who does this business, and has no ability to pretend to be a grandson. Difficulties, equipment is not easy to use, and scolding is inevitable.

After the screw is drilled, the C-arm X-ray machine has no problem. Dr. Jin uses the electric knife line to measure the force line of the lower limbs, the anterior superior iliac spine, the center of the patella, and the middle of the first and second toes. It is the same as aiming with a gun, three points and one line ,normal.

This kind of surgery is an innovative result of fracture treatment technology, called biological fixation, and is suitable for fractures of long bones of the limbs. Of course, this cannot be done for fractures of the radius and ulna. Because of the precise rotation function of the radius and ulna, it is treated as an intra-articular fracture, which requires anatomical reduction and strengthening. fixed.

And this kind of femoral shaft fracture does not require anatomical reduction or restoration, as long as the length and force line are restored to normal, even if the goal is achieved, the messy bones in the middle can be ignored. Treatment, in fact, the blood supply is protected, and eventually they all grow into one piece, and the human body shapes it again. In the future, the femur will not be different from the normal shape, and will not have any impact on function.

This is the progress of medicine, the innovation of concepts, the innovation of surgical methods and instruments, and finally the improvement of treatment effect.

"What a broken thing, don't bring this thing with you in the future." Director Ouyang fiddled with the original guide a few times, and threw it directly into the trash can, so that his anger was relieved.

The manager of the device dealer, speaking of which, he really wanted to come, hurried to the operating room, bowed his waist all the time: "Director Ouyang, our service has not kept up, and I have caused you trouble. Look, give me a chance, and we will go to work together after get off work." Juju, let me apologize to the brothers?"

Being scolded like a grandson, let the director calm down, and then please eat and drink, this is indispensable, and the grade of this meal cannot be low.

I feel comfortable in all aspects, and I have to do business as I should. After all, this is not a subjective error, but that I really don't have this equipment, and I have transferred goods to my brother company, and I don't have any.

The manager whispered to the follower about the situation, and only then did he know that the equipment sent by a small company responded to Director Ouyang's urgency. The manager glanced at Huang Jiahui, a girl who didn't know much about the world.

Looking at the special guide placed on the instrument table, I didn't want to understand how there is such a strange guide. I have been in the industry for so many years, and I can be regarded as an expert in equipment.

Director Ouyang took off the surgical gown, the manager rushed up to apologize, helped to untie the laces, moved the stool with the stage, and adjusted the height. Director Ouyang did not go to sit, but went to the film reading light to watch the film, and Yang Ping stood there.

"Old Jin, explain clearly to the family members that these bone fragments do not need to be replaced and will not affect the function." Director Ouyang explained to Dr. Jin.

The most difficult part of this kind of operation is the family members. The family members don't understand. Seeing the X-ray after the operation, they think that the doctor's level is too poor, the operation is not done well, and the bones are in a mess.

The doctor explained a lot of medical principles, but the family members didn't understand anything. The last sentence: These bone fragments are similar to those before the operation on the X-ray.

In fact, doing so will heal the fracture faster and better than cutting the bones together.

Joint fractures cannot be operated in this way. Joint fractures must be done piece by piece, honestly, so that the broken mirror can be reunited.

Director Ouyang came over and planned to ask Yang Ping how to successfully pry and reset once, but the equipment manager was beside him, so it was hard to speak out because of face.

Yang Ping has no impulsiveness in lectures, so naturally he will not take the initiative to explain. Some people like to learn, and some people don't like to learn. Feel free to ask him if you want to know more. He will explain. If you don't ask, he will not take the initiative to explain. You say, except for Song Zimo.

After the operation, the patient's bed is also full of challenges.

When entering the operating room, the flat car is not wide enough, so the bed is directly pushed in.Now the bed is not wide enough, the width of the bed sheet is not enough, the nurse thought of a way to use a few sheets to spread horizontally, so that it can work.

Six people, three on one side, pulled hard on one side and sent on the other side. The patient moved a little until the lumbar disc herniated.

We had to add two more young men, and the five of them pulled together to pull the patient to the bed.

The manager of the equipment manufacturer and the attendants also participated in it and worked very hard. At this time, they wanted to prove their efforts to Director Ouyang.

The patient received general anesthesia with endotracheal intubation. The commonly used anesthesia for this operation is sciatic nerve and femoral nerve block, or combined spinal-epidural anesthesia, but no matter which one, because the fat is too thick, positioning is extremely difficult.

Combined spinal epidural anesthesia requires anesthesia to be injected into the spinal canal. The conventional lumbar puncture needle used by an anesthesiologist may not reach the spinal canal at all. The puncture path is too thick, and the conventional puncture needle is relatively too short.

"Wei Danian, wake up!" The anesthesiologist slapped the patient's face, hoping to wake him up through stimulation, and prepare to extubate.

Dr. Jin reminded the anesthetist: "To put it another way, not long ago, in the emergency department of a hospital, an old lady suffered cardiac arrest. Slap in the face, damn it, people are like this, you still hit people, and you hit people in front of me, you are so bullying, bullying me, idiot."

The anesthetist was so scared that he stopped his hands. This habit is not good, so he still moved his mouth without moving his hands. He raised his voice and shouted at the patient: "Wei Danian, wake up, the operation is over."

The patient was in a daze, opened his eyes as a response, then closed his eyes again, opened his eyes, breathed spontaneously, and could extubate. The anesthetist used a suction device to remove the secretions from the respiratory tract again, and successfully pulled out the endotracheal tube.

"Blood pressure is down!"

Dr. Jin kept staring at the monitor, and his blood pressure unexpectedly dropped to 76/35mmHg, and his breathing also became deep, and the patient inhaled and exhaled violently.

"Ketoacidosis?"

The patient had diabetes, took deep breaths, and his blood pressure dropped. The anesthetist immediately thought of ketoacidosis.

"Re-intubate!" The anesthesiologist swiftly re-inserted the endotracheal tube.

"Check fingertip blood sugar with a blood glucose meter, draw blood to check blood routine, biochemistry, liver and kidney function, and blood gas analysis—" the anesthesiologist reported a series of oral doctor's orders.

He has rich experience and takes deep breaths. This is acidosis. The patient has diabetes, and his blood sugar was 38mmol/l when he was admitted to the hospital. He dared to operate only when he was satisfied with insulin.

In the operating room, the anesthesiologist is responsible for the safety of the patient's life, so the anesthesiologist is naturally nervous.

"Blood sugar 6.2mmol/l" the nurse looked at the data on the blood glucose meter.

"Not high? What's going on?" the anesthesiologist was puzzled.

Director Ouyang and Dr. Jin also became nervous. They suspected that fat embolism caused pulmonary embolism, but the blood oxygen level was not low.

"Check the blood lactic acid!" Yang Ping suggested.

"Well, check the blood lactic acid." The anesthesiologist ordered the nurse.

Emergency specimen transportation does not require manual transportation. The hospital has a dedicated automated logistics system. Nurses only need to label the specimens, scan them into the computer, and then put them into the logistics tube. It will be automatically sent to the laboratory through the transportation pipeline.

The results came out soon, the bicarbonate ion was 8mmol/l, the pH value was 7.14, and the blood lactic acid concentration was 2.8mmol/l.

"Acidosis is right, it's lactic acidosis, not ketoacidosis!"

Lactic acidosis has a critical prognosis and a high mortality rate.

(End of this chapter)