godfather of surgery

Yang Ping saw the patient lying on the operating table and counted. There were more than two steel bars on the body. There should be two with longer strokes, and there were three others with shorter strokes. Most of them went in from the waist and back and came out from the chest and abdomen. .

Everyone gathered firewood and the flames were high. Director Long joined the team of brushers without hesitation, and Director Wen immediately followed.

At this time, in addition to this rescue operation, there were other operations going on in the operating room, so it was brightly lit and bustling.

There were a lot of people inside and outside the emergency surgery operating room, especially there were many people standing outside. In order not to create obstacles to the rescue, everyone did not block the door or near the sink, but actively evacuated in an orderly manner.

The anesthesiologist had already administered general anesthesia to the patient. The young doctors moved quickly, positioned themselves, and completed the disinfection and draping. Director Xu put on the surgical gown and gloves, and then several doctors had already finished brushing their hands and started dressing quickly. wear gloves.

This kind of rescue surgery is no different from ordinary elective surgeries. Many things are informal. Even hand brushing is done in as short a time as possible. Sometimes, gloves are worn directly without brushing the hands.

Various instruments have been deployed, and the instrument nurse is already sitting on the stage. Director Xu is standing on the right side of the patient's abdomen. The other doctors quickly get into position, and the operation begins quickly.

"Anesthesiologist, we're opening the abdomen."

Even the pre-operative check-up is omitted. For such an obvious trauma rescue, the pre-operative check-up will only waste time.

There were many doctors standing on the stage at the same time, including doctors from the four departments of thoracic surgery, cardiac surgery, basic surgery, and orthopedics, so everyone tried to move as quietly as possible to avoid disturbing each other.

On the head side, neurosurgery doctors have prepared to open the skull, and operations on all four sides are being carried out at the same time. This requires extremely high organization and coordination skills, otherwise there will be chaos on the stage and "fighting" with each other.

"Have the firefighters come in?"

Director Xu asked while cutting open the skin on his abdomen.

"We're here, waiting outside." A doctor answered.

A doctor just followed this incident and accompanied the firefighters into the operating room carrying tools, gowns, masks and hats.

While in the emergency department, firefighters helped cut off the exposed parts of the steel bars as much as possible to facilitate transportation and reduce interference with the surgery.

During the operation, these steel bars cannot be pulled out in one piece. They must be fully separated from the surrounding tissue and removed in sections after sufficient hemostasis. This is safe.

Cutting the steel bars during the operation requires the help of firefighters, who have the tools and cutting experience.

Director Xu moved very quickly, holding the knife like a bow and opened the abdomen aggressively. The abdominal cavity was opened, and the suction device sucked out a large amount of blood. Some of it was already dark red, indicating that the bleeding was not recent.

"Speed ​​up the blood transfusion!"

The operation was a bit difficult. Several steel bars were intertwined in the abdominal cavity, which would block many operations. After Director Xu's hands explored inside, he understood how dangerous the situation was.

There are many injured parts, and steel bars are obstacles to the operation. Various factors are intertwined, so the operation time is definitely long. During the operation, only blood transfusion can maintain the patient's life and gain the most time window for rescue.

"Tissue scissors!"

Director Xu figured out the general situation in the abdominal cavity and began to use tissue scissors to separate, stop bleeding of various bleeding blood vessels, and separate around the steel bars.

"Chest opener!"

Doctors from thoracic surgery and cardiac surgery have also opened the chest.

We had to race against time to stop the bleeding, so everyone crowded together and operated at the same time. This was also an act of necessity.

The two longest steel bars now penetrate from the perineum, pass through the pelvic cavity, abdominal cavity, diaphragm, and chest cavity, enter the neck, enter the head through the neck, and then pass out from the top of the head. The path of this steel bar is the longest.

The other one is not much better, penetrating from the anus, moving forward and backward, diagonally from the bottom to the front and above, passing through the pelvic cavity and abdominal cavity, passing through the diaphragm, entering the chest cavity, then passing through the pericardium, and exiting from the chest.

The other three paths are short and complicated in the chest and abdominal cavity. Some of them pass through the liver and some pass through the gastrointestinal tract. None of them are easy to worry about. The situation is very dangerous and complicated.

This was an injury caused by several dangerous steel bars, as well as comminuted pelvic fractures, femoral shaft fractures, central dislocation of one hip and acetabulum fractures, comminuted spinal fractures, intracranial hemorrhage, and multiple ribs caused by falling from a height. Fractures, hemopneumothorax, etc., any one of them is fatal.

During the emergency, the thoracic surgery department had provided closed chest drainage; the orthopedics department had installed an external fixator on the pelvis.

These can be performed under local anesthesia, and are simple to operate and can be solved by a skilled doctor in a few minutes. Therefore, as soon as you enter the emergency room, the doctor will deal with it immediately.

If it hadn't been for the fire erupting from the ancestral grave, this fate would have been sealed at the scene of the injury.

Director Xu had never seen such a complex trauma before, and he was under great pressure. He had to take overall command of the operation based on his accumulated experience in emergency surgery.

Although Director Long and Director Wen have already put on surgical gowns, they are standing nearby as substitutes. They specialize in this kind of trauma surgery. They may not be as good as the doctor standing on the stage now.

These doctors are all experts in thoracic and abdominal trauma. They usually perform this type of surgery every day. Director Long probably has not been exposed to this kind of abdominal trauma for many years. The most common surgery he does is pancreatic cancer surgery, and Director Wen also performs coronary artery bypass surgery. Much more, he has seldom been involved in this kind of chest trauma, while the several doctors on the stage perform trauma surgeries every day, have rich experience and are in excellent condition. They are the backbone of Union Medical College Emergency Surgery.

Therefore, the two directors are very self-aware. In this case, even blind command will bring obstacles to them, let alone participating on stage.

Professor Liang did not say anything at the side, and found no principled errors or deficiencies. He would not interfere with everyone's rescue.

Other doctors, graduate students and training doctors, except for those who are involved in the rescue and have substantive positions, the others act according to the situation. The general principle is to help as much as possible, but do not help indiscriminately, let alone add chaos and obstruction.

For example, when I just went to pick up the firefighters, several doctors took the initiative to help. They got the tools together, planned the firefighters' standby position and the location of the tools, accompanied them and explained some simple rules in the operating room to prevent contamination of the operation.

Otolaryngologists, stomatologists and ophthalmologists also rushed over, because the steel rod passing through the head may damage the mouth, ear, nose, throat and eyes. They will need to assist the neurosurgeons in dealing with their own specialized problems.

Yang Ping, Song Yun, and Kong Weiquan all stood on the side of the reading lamp and watched the film. At this time, everyone stood on both sides of the film consciously, leaving the front empty for the doctors on the stage. They might come over to watch the film at any time. Guide the next steps of your surgery.

Qiu Nuo, the equipment nurse from the orthopedic department, was also sandwiched between everyone. She had been eating with them before, and now she came with them.

Yang Ping watched the film very quickly, and he already grasped the information in the film at a glance. The two long steel bars were really difficult to handle. The longest one just passed through the abdominal aorta. It seemed that it had just passed through the side. However, the aorta was not injured, but it was already injured.

Whether you disturb it when it is separated, or when you need to saw the steel bars, it may cause the aorta to rupture and bleed.

This patient was lucky and was able to be sent to Xiehe University alive.

Professor Liang also stood with Yang Ping to look at the CT pictures. He paid more attention to the spine. Burst fractures of the thoracolumbar segment. Severe fractures involve chest 12 upwards, waist 1 and waist 2 downwards, and the burst is the most serious. The area corresponds to the conus medullaris, and it is difficult to recover from damage to this area.

If it is a single such injury, it must be emergency surgical decompression and fixation. However, this is not a single injury, but multiple injuries. As a part of multiple injuries, spinal fractures have retreated to a secondary position compared to other injuries, because spinal fractures are temporarily It does not affect life, but affects the future bowel and bladder function and the man's sexual function.

When the first principle is to save lives, these can only be put aside.

"The weather isn't very hot either. We wrap ourselves in blankets on the balcony to enjoy the coolness in the middle of the night. Adults really don't have any sense of safety."

Professor Liang was quite impressed.

"The cost of enjoying the cool air for this patient is too great. Everyone must pay attention and be aware of safety. Do not lean on the balcony railings when enjoying the cool air at night, let alone sit on the railings. It is very dangerous!" Professor Liang said as an elder Warning to everyone.

It seems that the old professor's thinking still cannot keep up with the times, the young doctor next to him couldn't help but think so.

Seeing that everyone was indifferent to his warning, Professor Liang turned around and said, "You don't have such a habit, do you? You lie down on the railing on the balcony to enjoy the shade at night."

Everyone shook their heads quickly: "No, no, how can there be such a habit."

"That's fine!" Professor Liang was relieved.

The person on duty didn't know when he appeared in the crowd. Before the family members came, he had already signed the surgery information form.

Ever since the patient entered the emergency room and the emergency department doctor reported to him, he has been involved in coordinating the rescue and was just coordinating the blood supply issue in the blood transfusion department.

This kind of rescue surgery, whether it is a blood transfusion department or a blood bank, will try their best to supply blood. Unlike elective surgeries, which are very careful about their budget, this kind of rescue surgery is the priority for blood supply.

Moreover, this kind of rescue operation takes a green channel. Even if there are no family members, the operation will still be carried out. The informed consent form for the operation is signed by the hospital leader. The largest leader on duty in the hospital at night is the general on duty. The general on duty is taken by the hospital administrative leaders in turns every day. To ensure the normal handling of major emergencies at night.

"Professor Liang!"

The chief on duty saw Professor Liang next to the reading lamp and came over immediately.

"Why did I alert you?"

The general on duty felt that the scale of today's rescue was a bit beyond imagination. Academicians from the Department of Orthopedics were dispatched in the middle of the night, and looking at the formation, there were a lot of people coming.

"I heard that spinal injuries are also serious. I came over to take a look." Professor Liang said calmly.

There are so many talented people in the Department of Orthopedics. What kind of spinal injury can make Professor Liang come over for consultation in the middle of the night? The general manager on duty can’t figure out the situation. Why is today’s emergency rescue so big?

''You should go to bed early and let these young people do their thing. "

The general officer on duty exchanged a few words with Professor Liang and then hurriedly went about his business. In such a big rescue, the general officer on duty must have been running up and down all night, and his phone calls would have been scalding hot.

Director Long and Director Wen were wearing gloves and gloves in the operating room. It was uncomfortable to sit on the bench, so they simply put down their hands and came to the reading light.

"Professor Yang has done this kind of case before?"

Director Long asked.

Yang Ping nodded: "I rescued similar cases before when I worked in the Trauma Emergency Center of our hospital."

"Xiao Yang, tell me what you think." Professor Liang asked.

"You need to be very careful here. The aorta should be wiped and then returned to its original position. Be careful when separating, otherwise it will easily cause bleeding." Yang Ping pointed out several images of the aorta on films.

"If you want to complete the operation as quickly as possible, these are the key points of bleeding and need to be ligated to stop the bleeding. These must be separated and then pulled out."

"It's best to take out these short ones first."

Yang Ping's fingers quickly pointed out dozens of well-known blood vessels on the path of two relatively long steel bars. He made it clear which ones should be processed first and which ones should be processed later.

And he divided the numerous blood vessels into different priorities so that bleeding can be minimized when treated.

Director Xu is working hard to stop the bleeding. The main task now is to stop the bleeding, but it is too busy here. There is bleeding everywhere. Director Xu calmly responds and ligates the blood vessels one by one.

The chest was not much better, it was full of bleeding spots.

The main reason is that there are too many steel bars criss-crossing inside, making the operation very inconvenient.

The treatment of head trauma is a little more calm, not as exaggerated as the thorax and abdomen. The neurosurgeon has opened the skull and is cleaning the subdural hematoma. However, with this steel bar poking out like this, it is also very difficult to deal with. You have to follow the steel bar a little bit. Separate it point by point, completely separate the steel bar from the surrounding tissue, and stop bleeding of all blood vessels along the way.

Intracranial hemostasis is very strict and needs to be performed under a microscope. If you are not careful, there will be untreated bleeding points, which will lead to intracranial hemorrhage after the operation, which can seriously cause cerebral herniation.

"Gauze! Hurry up, stuff it and compress it."

"Vascular forceps!"

"Attractor, here, look clearly!"

"No, the bleeding here won't stop. Prepare for lobectomy."

"There's bleeding in the pelvis too. Orthopedics, can we handle it together?"

The orthopedic department has installed an external fixator, but the hemostatic effect is still not good, so the treatment measures must be upgraded.

"Should we call the interventional department to prepare for embolization?" a doctor in the audience suggested.

But once the interventional department comes for embolization, all other surgeries will be suspended. How is this possible?

"No, temporarily fill it with gauze, a lot of gauze, quickly, temporarily fill the pelvic cavity."

The temporary reduction and external fixation of pelvic fractures in the emergency department are to control the volume of the pelvis, so that retroperitoneal bleeding will naturally stop when it reaches a certain level, but now it seems that this method is not effective.

The orthopedic surgeon extended the incision made by Director Xu downward to expose the pelvic cavity as thoroughly as possible, and then continuously filled the retroperitoneal space with large pieces of gauze.

Packing to stop bleeding is the fastest, safest and most reliable method, and it is also the last resort. If there are other methods, this primitive method will not be used. After packing with gauze, wait for many days, and the body's self-coagulation function will seal part of the damaged blood vessels. A second operation was performed to remove the gauze.

At this time, because most of the injured blood vessels are closed, the injured area is much cleaner, it is much easier to stop bleeding, and the gauze can be removed.

These gauze cannot be left in the body for a long time as it can easily cause infection and must be removed after surgery.

A large amount of gauze was used to pack the pelvis to control the bleeding. The abdominal and thoracic surgeries were still continuing. Everyone's hand speed had been stretched to the limit to catch various bleeding points, but there were too many bleeding places.

With the support of massive blood transfusions, the critical blood pressure kept rising and falling, as if it was a little difficult to support and could drop rapidly at any time.

"Active blocking! I want to temporarily block the aorta!"

Director Xu shouted that because there were too many bleeding points and it was far beyond his control, the aorta must be temporarily blocked to obtain a certain time buffer.

This is a big battle in emergency surgery, where almost all emergency trauma surgical techniques must be performed.