godfather of surgery

Chapter 72 Sudden Shock
The patient has been anesthetized and the trachea is intubated under general anesthesia.Dr. Tao was ready to put on a posture, waiting for Director Tian to come in and give instructions.

This surgical position is very important, and the wrong position can make the surgery impossible.

The film was hung on the reading lamp in the operating room, and Director Tian read the film again.Although Dr. Tao marked the surgical site, Director Tian personally determined the left and right of the surgical site.

"Professor Tian, ​​how many people do you need?" Director Miao asked.

Director Tian said: "You and I are two, just take one more. Dr. Yang goes, and Dr. Song rests."

Song Zimo is in charge of driving. If you rush back at night, you can't be too tired and need to rest, so Song Zimo stayed as a reserve team.

Director Miao must come to power. He is the director, and the patient is his acquaintance. Even if he does nothing when he comes to power, it is still a must.So this arrangement is the most reasonable.

"Blood transfusion first!"

Director Tian gave medical orders to the anesthesiologist and the itinerant nurses, and then led everyone to put on a prone position.

This kind of complex fracture cannot be solved by the anterior or posterior approach alone, and the anterior and posterior approaches must be combined.

Director Tian had already made up his mind, and the operation was really difficult. This kind of broken pelvis and acetabulum were smashed and fractured, and there were not many hospitals that could be won, which represented the peak level of trauma orthopedics.

For the doctors of the county hospital, going out for further studies is an opportunity to learn, and it is also a learning opportunity to invite a professor from a higher-level hospital to perform surgery.

Orthopedic doctors, as long as they are free, come to the operating room to observe.

Everyone was impressed by Director Tian's professionalism when they were in the ward, and now they all want to see the professor's superb surgical skills.

There were already three people on the stage. Dr. Tao didn't know whether he was on stage or not. Four pelvic fractures were normal. He was struggling.

"Xiao Tao, you are pushing the C-arm machine under the stage." Director Miao helped him make a decision.

After the body position has been set, Director Miao takes Director Tian Yang Ping to wash his hands.

Anyone who can do things is full of energy. Director Miao is in his fifties, but he is still full of energy.

"How much blood did you prepare?" Director Tian asked.

"There are 12 units of suspended red blood cells and 1200 milliliters of plasma!" said Dr. Tao.

Enough, wash your hands and dress.

This kind of operation is out of reach for Dr. Tao. He usually only performs simple operations, and complicated fractures are all performed by Director Miao.

At present, the operation of this patient, Director Miao can't get it, not because of the special status of the patient, but because of the technical difficulties.

Surgery is not a child's play. This kind of surgery can't be won. If you bite the bullet, you will die.

Doctors can usually brag and brag, but no one is stupid enough to do surgery that they have no bottom, it is pure death.A single operation can ruin my life.

To be a department director, in addition to being able to support the department technically, there must be a certain amount of backup.Like Director Miao, the operation was too difficult to handle. One phone call, Director Han sent a team to the countryside to provide strong support. If it was another person, I am afraid it would not be possible.

Disinfection and laying, the routine process, the same size of the hospital.Yang Ping was the first assistant, and Director Miao was the second assistant.

One after another, the fracture of the posterior wall of the acetabular posterior column was reduced and fixed.

Director Tian is extremely skilled, standard incision, incision layer by layer, and steady progress.

Director Tian lifted weights lightly during the operation. It seemed that the movements were not rushed or slow, without giving people the feeling of rushing, but there were no redundant and ineffective movements, and the front and back were closely connected, so the operation time was very fast.

Usually Director Miao performs pelvic surgery, the large gauze is one after another, the white gauze goes in, and it is soaked with blood when it comes out.

Now only a large piece of gauze was handed over, and only a faint red flower was seen on it, and they all suspected whether it was a pelvic surgery, or the surgery had not yet started.

Several doctors were walking around, all looking for the best view, but no matter how they looked, they couldn't see anything, and they didn't dare to get close.

Unlike Sanbo Hospital, which also has high-definition cameras, you can watch videos. The operating room of Shipo People's Hospital does not have these equipment.

"Steel plate, prepare the electric drill!"

How long has it been, ten minutes, the posterior wall of the posterior column of the acetabulum has been reset, and the plate is about to be applied.

Look at him not in a hurry, why so fast?
When several doctors were discussing in private, the steel plate had been pre-bent, and screws were started.

Director Miao is amazing. He invited such an amazing professor to the provincial capital.

Dr. Tao was a little disappointed. At the same age, such a major operation was so easily won, and he was still in the secondary operation.

In half an hour, the fracture of the posterior wall of the posterior column of the acetabulum has been reduced, flushed, drained, and sutured.

perspective!

On the screen, the posterior wall of the posterior column of the acetabulum was fully reduced, and the plate and screws were well positioned.

"Turn over and be the way forward!" The faint words have already attracted countless admiring eyes.

In the eyes of the observing doctors, the technical gap is insurmountable in this life.

Re-disinfect your linen, wash your hands and dress.

The road ahead begins.

"There will be a lot of bleeding in the anterior path! Therefore, it is necessary to transfuse blood in advance, replenish blood, and dilute the blood." Director Tian explained.

Because CT angiography showed that many blood vessels in the pelvis were damaged, blood transfusion was used to stabilize blood pressure at the time of the injury, and now it is necessary to reach the fracture site, and the bleeding that had stopped is bound to be awakened again.

"The dead artery has been broken and retracted. You need to be quick and find the blood vessel within 10 minutes." Director Tian reminded Yang Ping that two people should cooperate well in the key steps.

The artery of death is the anastomosed branch of the obturator artery and the external iliac artery, also known as the crown of death. Once it breaks and bleeds, it will retract, just like a snake burrowing into a hole in the grass. It is difficult to find and the bleeding cannot be stopped. Dangerous, so it takes a terrifying name, which is a stumbling block that must be paid attention to in pelvic surgery.

Director Tian has rich experience, blood transfusion in advance, not only replenishing blood, but also diluting the blood, so as to reduce the blood loss of the patient itself.This patient is anemic and cannot withstand too much re-loss, otherwise the blood pressure will easily plummet.

Surgery is done with real knife and gun. With more experience, the risk can be predicted.Like a captain sailing in the ocean, relying on rich experience to avoid reefs and waves.

It is very difficult to do not only the acetabulum and iliac wing, but also the sacroiliac joint and sacrum. Even if the entire provincial capital can win this operation, it is only those big men who often show up at academic conferences. .

In order to take into account several fractures, Director Tian used an incision designed by himself.

Director Miao stayed aside, feeling like he was sitting next to a racing driver, with sweat in his hands.

There are many blood vessels and nerves here, be careful!But Director Tian avoided it perfectly; once the blood vessel is accidentally cut off, the bleeding will not stop, slow down!It was perfectly avoided by Director Tian again.

Just as Director Tian wanted to expose it upwards, the retractor had changed its position to help reveal it; the blood had just come out a little, but the assistant had already clamped it with a vascular clamp, and Director Tian's electric knife touched it perfectly to stop the bleeding.

Just as he was about to draw attention to the blood vessels and nerves, the assistant's blood vessel clamp was gently lifted to help him separate the blood vessels and nerves.

Originally, Director Tian was highly skilled, and Yang Ping cooperated so well. The operation was simply a perfect performance.

I didn't pay much attention to the posterior surgery just now. Now it seems that this assistant is too perfect. No wonder Director Han asked him to take him. Director Tian raised his head and glanced at Yang Ping.

Director Miao was already dazzled, unable to keep up with the rhythm at all, so he had to do nothing.

The operation enters a critical step, and immediately encounters the death artery!Before coming to Shipo, Director Han repeatedly reminded Director Tian to pay attention here!
"Controlled blood pressure!" Director Tian ordered the anesthesiologist.

Intraoperative controlled blood pressure reduction, also called low-pressure anesthesia, can control blood pressure to a lower but safe range. Low blood pressure leads to less natural bleeding, just like the low pressure of a water pipe, the water spray is much weaker.

"The dead artery is bleeding and has retracted. I wonder if it has self-embolized?" Director Tian reminded Yang Ping.

Although it is a discoloration, we must face it and solve it, otherwise the operation will not be able to reveal, let alone fracture reduction and fixation.

The left and right hands cooperate dexterously, and the scissors are skillfully separated sharply.

The adhesions opened, and the blood spurted out immediately, and I couldn't see where the blood vessels were.

Sure enough, the artery of death retracted and broke through the fragile self-clotting clot, but Director Tian was very calm. If it was someone else, he had completely collapsed at this time, or he didn't have the courage to continue.

But he is Director Tian, ​​and he only needs to help him buy 10 minutes of blood transfusion, and he can find the dead artery and successfully stop the bleeding.

It is not a problem to rely on the speed of blood transfusion for 10 minutes. This is what he has considered before the operation.

The suction device in Yang Ping's hand quickly attracted, keeping the surgical area clean and creating the best surgical field for Director Tian.

"The blood pressure is down, and I'm in shock!" the anesthesiologist shouted, his voice a little flustered.

shock?
Gauze, quick, gauze!
Director Tian immediately stopped the operation and temporarily stuffed it with gauze. He moved his hands very quickly and used gauze to fill the bleeding just now. Yang Ping had already taken over and pressed it tightly.Let Director Tian free his hands to do other things.

The blood pressure on the monitor screen dropped to 70/30, I was in shock, and it was still going down.

There wasn't much bleeding just now. Even if the death arterial hemorrhage has just been bleeding, blood transfusion and rehydration have been started long ago. Why did you suddenly go into shock?
Did the posterior reduction just involve a large artery or vein, such as the abdominal aorta, or the internal and external iliac arteries?cause tearing?
No, the whole process just now was clear, none of the movements were performed blindly, and I carefully studied the film before the operation, and the bone fragments were not adjacent to the great blood vessels.

A few possible hypotheses quickly flashed through my mind.

(End of this chapter)