godfather of surgery

The bleeding in the retroperitoneal space of the pelvis is temporarily stopped by packing a large amount of gauze. Even after packing, the bleeding will not stop immediately. The retroperitoneal space will still bleed slowly, but the bleeding will gradually slow down until it stops.

The pelvic fracture is only one site of bleeding. Now there are many sites of bleeding all over the patient's body. The current situation is very critical, and there is nothing that can be done about it. The rescue team is already advancing the operation as quickly as possible.

After hard work, Director Xu finally took out a bloody short steel bar, and then continued to fight, preparing to take out the second short steel bar. Only by taking out all the short steel bars could the two long steel bars be easily separated.

On the side of the chest trauma, the pericardium has not yet been opened, and the tear in the lung is already bleeding. The thoracic surgeon has to give priority to the lung. The bleeding in the lung cannot be stopped at all, so there is no other way but to perform a lobectomy.

Lung tissue is very fragile and more difficult to suture than other tissues, so in this emergency, lobectomy is the only option.

This method of stopping bleeding is widely used in surgery. For example, if a woman has heavy intrauterine bleeding during childbirth, if the bleeding cannot be stopped, the entire uterus can only be cut off to stop the bleeding.

There are many branches of blood vessels in the uterus, and when it is difficult to stop bleeding one by one, cutting off the entire uterus is undoubtedly the most effective way, because the blood supply and return blood vessels of the uterus are fixed, and they are not large in number and are easy to find. .

This is equivalent to countless bursting water pipes in a house. There is no way to block them one by one. The best way is to turn off the main water supply switch of the entire house.

The same is true for lobectomy. The breach cannot stop the bleeding. The entire lobe is removed and its blood supply and return vessels are ligated to stop the bleeding.

The pericardium does not dare to wait too long. Since the steel bar has penetrated the pericardium, even if the heart is not damaged, there will definitely be blood vessel damage. Temporarily, because the steel bar exerts a certain pressure on the surrounding tissue, this pressure can temporarily squeeze and seal the blood vessels to a certain extent. .

However, there will definitely be blood leakage in the pericardium to some extent. Once the amount of blood leakage accumulates to a certain extent, it will cause cardiac tamponade, which will cause the heart to be unable to beat.

Director Xu continued to separate the second short steel bar. If all the short steel bars were not taken out, other operations would be difficult to carry out, and it would be impossible for firefighters to cut the two long steel bars in sections.

The neurosurgeons in charge of the head are still cleaning up the intracranial hematoma. They are moving carefully. No matter what the situation of the chest and abdominal surgery is, they only focus on their own surgery.

At this time, doctors from several teams were doing their best to carry out rescue operations, and the doctors in the audience were also extremely nervous.

Suddenly, an unknown large blood vessel in the abdominal cavity ruptured, and there was a sudden squeaking sound, and blood spurted out far away. The parabolic blood line was more than one meter away.

Several of the doctors who were watching the battle had blood splattered on them, and one doctor had a large pool of blood sprayed on his body.

"Is this patient okay with all four infectious diseases?" The doctor who was spattered with blood immediately became nervous.

The doctor who was spattered with blood felt relieved when he got the answer from the anesthesiologist that there was no problem.

gauze! gauze!

Director Xu immediately caught the gauze in the nurse's hand and pressed it to the bleeding area as quickly as possible. However, a few pieces of gauze were not enough, and there were steel bars blocking the area. It was difficult to move freely, and the filling to stop the bleeding was much slower than usual.

"gauze!"

Director Xu shouted while instructing his assistant to suck blood.

"here!"

The assistant immediately put the suction device into the blood, hoping to create a clean surgical field in a short period of time so that the surgeon could find the blood vessels that spurted blood.

But this was in vain, a straw could not clear the large amount of blood from the surgical field.

We are all experienced emergency surgeons and have prepared several suction tubes. The assistant immediately pulled out the suction tubes and directly used the thick suction head to suck blood.

In this way, with the help of a few straws, an unstable and instantaneous clean surgical field was barely created.

Director Xu relied on this instantaneous surgical field to lock the bleeding location in a small area. His hands were full of blood, and the blood flowed downwards along the gloves. Director Xu was very experienced. He couldn't control so much right now. He directly touched and pinched the upper part of the abdominal aorta with his hands to stop the bleeding.

This kind of manual hemostasis is a basic skill that almost every emergency surgeon must master, and sometimes it can have unexpected effects.

Director Xu judged based on experience that the bleeding rate was obviously from the aorta, and other blood vessels could not be so violent, so Director Xu pinched the upper part of the abdominal aorta and began to look for the bleeding point.

Searching along the aorta from top to bottom, Director Xu soon found the breach. He was very puzzled: "Why is there still a breach here?"

Just when he was about to ask a vascular surgeon to treat the breach, he found that it was difficult to do so because of the presence of steel bars.

Director Long just heard Yang Ping's prediction in advance and couldn't help but admire him very much. If Professor Yang had done this surgery, there would definitely not be the blood spurting just now.

"Aortic clamp!"

Director Xu had to block the aorta in advance. Aortic occlusion is a very good way to stop bleeding, but the blocking time is limited. Once the limit time is exceeded, various organs below the blocking plane will die due to ischemia and necrosis.

Therefore, as a first-class emergency surgeon, Director Xu placed the aortic occlusion at the most urgent moment. He did not expect that this moment would come so quickly.

After blocking the aorta, Director Xu checked the blood vessels. It was okay, but for some reason there was a tear here. It should have been small. Maybe the pressure on the blood vessels was too high, and the small mouth suddenly tore into a large longitudinal hole. The vascular surgeon saw Finally I thought it would be fine to repair it.

However, the two short steel bars must be removed before the repair can be carried out, otherwise it will be difficult for the stitches to get started, and the break is just behind one steel bar and is covered by the steel bar.

Before Director Xu could catch his breath, another large bleeding point appeared out of nowhere, gurgling out like spring water.

"Attractor, here, hurry up, give me some visibility."

Director Xu estimated that the bleeding blood vessels came from the liver or pancreas, but some of the blood vessels in the liver and pancreas were on the back side. If they were blood vessels on the back side, it would be very difficult. Director Xu could only locate the approximate location of the bleeding point for the time being.

He was an experienced emergency surgeon and responded calmly. With the help of his assistant's suction device, he finally determined that the source of the bleeding was probably the blood vessels at the third porta hepatis behind the liver.

He reached behind his liver and touched it, as if he had found something, and then pinched it. The bleeding actually decreased, which showed that his judgment was correct.

A short steel bar just passed through the liver. The liver was going to be cut anyway, so it was better to cut it now.

"Vascular forceps!"

Director Xu used a vascular forceps to stop the bleeding of the blood vessel with the feel of his hands. This is a real skill gained through many years of emergency surgery experience, and it is difficult for ordinary people to do it.

But after treating the blood vessels here, the bleeding only decreases, not stops.

Judging from the direction of the bleeding, the remaining bleeding should be on the pancreas. Director Xu tried to feel the back side of the pancreas. The pancreas was relatively troublesome because its blood vessels often mutated and its anatomy was unstable.

Moreover, the pancreas was tightly suppressed by the steel bars, and the hand could not dig too deep. No matter from above or from below, Director Xu fumbled several times, but found nothing.

This battle was fought passively and cowardly, but Director Xu had no choice. This was the emergency surgery team of Union Medical College. If it were in a general hospital, such cases would have disappeared long ago.

Several groups of doctors were very fast, but unfortunately there were too many bleeding parts, the bleeding speed was also fast, and there were a lot of steel bars.

It is impossible to treat so many places at the same time. The abdominal cavity is so big, so it can only be treated one after another.

My blood pressure was already showing signs of being unstable and started to drop.

The pancreas has not been treated yet, and the vascular surgery department is waiting to deal with the large blood vessels, but it is impossible to treat the large blood vessels with the pancreas bleeding like this. If two people handle it at the same time, there is not enough space. The anesthesiologist paid close attention to the patient's blood pressure. It was obvious that the blood pressure was now on a downward trend. He planned to increase the blood transfusion pressure, but found that it was already the maximum blood transfusion pressure and could not be increased any more.

''My blood pressure is a little unstable! "

The anesthesiologist immediately informed the surgeon of the vital signs he observed.

There is nothing we can do if we can't stabilize it. There are so many bleeding points now, it's like a fire is out of control and the fire brigade is exhausted.

The neurosurgery team is working steadily. They have cleaned up the intracranial hematoma and slowly started to separate the tissue around the steel bars to create a safe channel for removing the steel bars. The surgery on their side is not urgent, so they can only work slowly and slowly.

"The blood vessels of the pancreas are mutated. You see, this one is the bleeding blood vessel of the pancreas now. The bleeding is very violent. This is the blood vessel that must be controlled first. Not only these blood vessels, but also here, you see, these blood vessels are It must be controlled quickly.”

Yang Ping pointed out several major blood vessels on the film. These are the blood vessels that he believes must be controlled first, but they have not yet been controlled.

From the location of the injury and the rate of blood pressure drop, Yang Ping can make a rough prediction. This is some of the trauma theories in the papers he published. Judging the rate of blood loss from the injured blood vessels, and then adding the rate of blood transfusion, this can Predicting how long a patient can support it from a circulatory perspective will be even more accurate if factors such as age are added.

According to his own theoretical prediction, this patient will not be able to survive for long at this rate.

"You have to hurry up, otherwise the patient won't last long." Yang Ping was very worried.

Director Long looked at the situation on the stage and began to feel anxious.

''The blood pressure is still falling! “The anesthetist’s concerns are now even more apparent.

"Keep up the pressure!"

Director Xu ordered.

But now it is the ultimate pressure, and there is no more pressure to add.

"It's already the biggest pressure."

said the anesthesiologist.

Director Xu raised his head and looked at the bags of blood hanging on the infusion pole. No, it’s not possible. The bleeding is so fast and the injury is so complicated. Not to mention the steel bars that damaged so many blood vessels and the bleeding from so many fractures. The amount of bleeding is huge. .

At this time, Director Xu began to feel lack of confidence. This case was indeed beyond his previous experience and was very difficult to handle.

I don’t know what happened, maybe one of the blood vessels broke through the thrombus formed by the body’s self-coagulation function, and blood started to gush out again.

Where is this bleeding again?

The enemies in front of me are still too much to deal with, and now there are new enemies.

Director Xu felt a little nervous, but this was only on a technical level. Emotionally, Director Xu remained calm as usual. He was a senior emergency surgeon, not a rookie who had just picked up a knife.

Not every patient can be saved, just try your best.

The anatomy here is complicated, otherwise the combined pancreaticoduodenectomy would not be a very large operation.

The short steel bars haven't been pulled out yet, and now they have to dissect the pancreas. It's too busy, and it's all in vain even if they have three heads and six arms.

Treating a dead horse as a living horse doctor is the only way.

"Director Xu! The heaviest bleeding is behind the head of the pancreas!"

"Take a large curved forceps, open the forceps a little, and insert it from the underside of the pancreatic head. The curvature is to the right. The direction of the forceps entry is straight upward. Insert the forceps to the hinge position and clamp."

"Give me a big bend and I'll show you."

Yang Ping shouted loudly. Director Xu immediately stopped and turned to look at Yang Ping. Qiu Nuo gave Yang Ping a clean large curved blood vessel. He immediately used his hand as a pancreas to demonstrate to Director Xu.

After the demonstration, Yang Ping approached the operating table and prepared to guide Director Xu to stop the bleeding.

Director Xu hesitated for a moment and immediately followed the instructions. However, even with the demonstration, Director Xu could not have done it so accurately. He carefully inserted the blood vessel clamp.

Everyone gave up their positions. Yang Ping, regardless of the sterility principle, tried to get as close to the operating table as possible and looked inside:

"Go a little to the right, yes, go in a little further, go a little further, don't be afraid."

"The opening of the pliers is too small, please make it bigger."

"Turn the pliers a little clockwise, yes, stop!"

"Keep this position, move forward a little, and don't move!"

"folder!"

Under Yang Ping's remote control command, Director Xu finally completed the action. He clearly felt that he had clamped some tissue. After the suction device cleaned up the bleeding in this area, something magical happened. Really, there was no more bleeding here.

"Clamp on the upper teeth first!"

Yang Ping could only order Director Xu this way, because the next step of ligating the blood vessels by hand was impossible for Director Xu to do.

Director Xu followed the instructions, set the teeth on the vascular forceps, and then released the vascular forceps, feeling relieved.

If it were anyone else, even if Yang Ping controlled the operation like this, it would be impossible to complete the hemostasis action, because this requires a lot of experience.

Next, under the remote control of Yang Ping, Director Xu actually completed the hemostasis of several blood vessels, and these were all the more difficult bleeding parts.

After hemostasis of several relatively large blood vessels, the condition of the surgical area improved significantly, and Director Xu breathed a sigh of relief.

You can't always let others direct you to perform surgeries, right?

Director Xu said to Yang Ping, "How about you come on stage to help?"

Yang Ping was not polite. There was not much push and pull when rescuing people, so he immediately went out to wash his hands.

When you go out, don't forget to say: "Qiu Nuo! Wash your hands!"

The surgery he was waiting for was very fast, and the nurse on the stage couldn't handle the equipment. He needed a nurse who could adapt to his own pace.

PS: I wish everyone a happy New Year, good health, a happy mood, and all the best! Thanks for your support over the past year, salute!