medical simulator

Chapter 319 Life on Fingertips! (seeking subscription)
Pelvic hematomas, or retroperitoneal hematomas in the pelvis, are dangerous.

The official definition is that retroperitoneal hematoma is a common complication of abdominal and lumbar injuries, which can be caused by direct or indirect violence.The most common causes are pelvic and spinal fractures; followed by rupture of retroperitoneal organs (kidney, bladder, duodenum, pancreas, etc.) and large blood vessels and soft tissue injuries.Because it is often associated with severe compound injuries, hemorrhagic shock, etc., the mortality rate can reach 35% to 42%.

What kind of concept is a disease with a mortality rate as high as 30.00%?
Moreover, in terms of textbooks and perceptions, such retroperitoneal hematomas are mostly treated with interventional or conservative treatments. The traditional incision method has a higher mortality rate.

However, everyone also understood why Zhou Cheng wanted to use the knife.

The pelvic fracture caused the injury of the venous plexus. At present, arterial injury cannot be completely ruled out. If the blood loss continues, the patient will undoubtedly die. Conservative treatment is ineffective, and surgery can only be used for rescue!

The second choice to intervene, Jin City People's Hospital, without this equipment, naturally has no way.

The director of the general surgery department immediately cheered up, and then saw that although Zhou Cheng moved the knife, the edge of the knife he controlled was not as he thought in his heart, pulling it violently inside, and then blood spattered everywhere. .

Instead, Zhou Cheng used the blade to cut the swollen outer layer of the peritoneum with appropriate force.

The peritoneum is the largest serosa with the most complex distribution in the whole body, and its area is about equal to that of the skin!
Consisting of the mesothelium and its outer connective tissue, it is thin, smooth and translucent.It covers the inner surface of the abdominal wall and pelvic wall and the surface of the abdominal cavity and pelvic organs. The former is called parietal peritoneum or peritoneal parietal layer, which is developed from body wall mesoderm; the latter is called visceral peritoneum or visceral peritoneum, which is formed by visceral wall The mesoderm develops.The parietal and visceral layers migrate to each other to form a very irregular potential cavity called the peritoneal cavity.

What Zhou Cheng is cutting now is not the peritoneal layer...

"Aspirator, suck the blood for me." Seeing that the director of the general surgery department seemed to be a bit out of his mind, Zhou Cheng quickly reminded him.

The director of the general surgery department didn't say much. In the current situation, the patient has already been on the operating table, so what should be fought for must be fought for. He is afraid of this and that. In the end, the patient is afraid of dying on the operating table. Die on the operating table, there is no essential difference.

Pelvic fracture itself has a lot of blood seeping out, so, in fact, in the pelvic cavity, it is scarlet, and there are blood clots in some places, which have already clotted into clots.

The retroperitoneal space is very large, so it represents the amount of bleeding, and it is also very large. Before solving and exploring such a hematoma, you must not define where the blood vessels are injured. You must explore the abdomen one by one. .

Perhaps because Zhou Cheng was hesitating, Mo Youcheng said, "Doctor Zhou, do you want me to help you explore the arterial structure?"

Zhou Cheng shook his head and asked, "Director Mo, you have done an abdominal examination before, and you have closed the abdomen. It should be that there is no vascular injury in the abdomen? Right?"

If he had just stepped down, Mo Youcheng would have said that he hadn't let go of any clues, but now, seeing such a large peritoneal hematoma, he couldn't be sure.

Just kidding, how dare he say that he completely ruled out this real retroperitoneal hematoma?
"Doctor Zhou, let's investigate one by one to avoid mistakes." Mo Youcheng didn't answer directly, but he also gave Zhou Cheng the bottom line. I may not understand through investigation. At this time, we must be careful!

Zhou Cheng is a little bit pained. This is the bad thing about lower-level hospitals. If it is in Shanghai No. [-] Hospital, then the professors and doctors of general surgery can give you a clear answer and reduce your workload.

But now, it's not the time to complain and worry about these things. Zhou Cheng took a deep breath and said, "Then let's continue to investigate."

"Move the light!" Zhou Cheng ordered Xun Xun.

Do it on tour.

In fact, the best approach to explore the contents of the abdomen is the approach developed by Mo Youcheng before, but he has sewn it up, and now it is a bit difficult to probe upwards through the pelvis.

However, things have come to this point, no matter how difficult it is, they have to go, if it is not possible, just open the gap before!

Under Zhou Cheng's ingenious technique, Mo Youcheng discovered that Zhou Cheng actually completed a part of the retroperitoneal space exploration through such a narrow approach!

Moreover, Zhou Cheng detected a hematoma, which is relatively limited in comparison. That is to say, the blood vessels he detected before were correct, there were no mistakes, and there were no other arterial injuries.

Most of the broken blood vessels are still concentrated in the pelvis!

My previous surgery, yes!

Zhou Cheng also saw this, so he stopped exploring and wasting time.

Because if the upper organ oozes blood, if it is from top to bottom, there will definitely be traces left by the blood shoal. Now that the patient has not seen these traces after opening, it proves that it is from the bottom. up source.

The pelvis is located right at the bottom of the abdomen, and the source is clear.

However, this operation wastes time, but it is real.

Zhou Cheng breathed a sigh of relief, and then continued to explore the arteries and veins near the pelvis.

There are many arteries and veins near the pelvis, and they are intricate. The abdominal aorta itself has visceral wall branches, which supply various organs. The wall is divided into left and right common iliac arteries, and the common iliac arteries are divided into internal iliac and external iliac arteries.

The external iliac artery has its branches, the internal iliac artery has more branches, and finally continues into the femoral artery...

The inferior epigastric artery of the external iliac artery, and the deep circumflex iliac artery.

The internal iliac artery is further divided into visceral branches, and the mural branches include the iliolumbar artery, lateral sacral artery, superior gluteal artery, inferior gluteal artery, and obturator artery.

Visceral branches include: superior vesical artery, inferior vesical artery, uterine artery, umbilical artery, inferior rectal artery, and internal pudendal artery.

Moreover, this is just the front middle part of the pelvis, and the back part of the pelvis is adjacent to the rectum, bladder, etc...

In addition to arteries, there are accompanying meridian branches!In addition to the left, there is the right!
What does this mean? This means that there are at least dozens of blood vessels in the small pelvis, which are intricately deformed!

This is why it is so difficult to damage blood vessels after a pelvic fracture.

However, Zhou Cheng was very patient and carried out quick investigations one by one.

Moreover, Mo Youcheng also discovered that Zhou Cheng's detection speed was unbelievably fast. He almost quickly identified their specific locations from the messy pelvic blood vessels and tissues.

Then stroke it to know whether it is broken or damaged, and then move on to the next blood vessel.

Arteries and veins, all of them.

It's like a fast-working machine for spotting vascular damage.

About 4 minutes later, Mo Youcheng forgot exactly which artery or vein Zhou Cheng had detected, but Zhou Cheng was suddenly overjoyed: "I found it, silk thread!"

What Zhou Cheng said was not a response, but everyone's astonishment.

Including Mo Youcheng, including the orthopedic staff, and also including the equipment nurses.

"Silk thread, tie it up, thank you!" Seeing that no one was paying attention to him, Zhou Cheng emphasized his tone and used some polite words at the same time.

"oh oh!"

"Silk thread!" The equipment nurse, who likes to watch the excitement, handed over the silk thread belatedly.

Zhou Cheng took it and didn't start a fight, just said: "Continue to prepare for the next one, such a large hematoma should damage more than one blood vessel."

Zhou Cheng knows that he is not a member of the work unit, so he can be angry, but he should not rise to other heights, and he can urge him to solve the problem, not the person who caused the problem.

It can only be said that this nurse is a bit unprofessional, and she can't make it to the big scene at all!

Then, after Zhou Cheng ligated the two arteries and veins, he breathed a sigh of relief: "Director Mo, I need to find the exact location of the incision and sew it up!"

"But before that, we have to get rid of the retroperitoneal hematoma first. You cooperate with me to pump, and be careful of the hematoma bursting suddenly!"

Zhou Cheng reminded, but Mo Youcheng was obviously much calmer: "Doctor Zhou, I will try my best to cooperate with you."

He knew that he was just a tool man when he came here. Zhou Cheng's operation speed and blood vessel detection speed were completely beyond his own, and the gap between them was even bigger than the gap between bringing interns by himself!

No wonder the orthopedics department invited him down for consultation surgery.

Mo Youcheng glanced at the director of the orthopedics department. The director of the orthopedics department didn't say much, but continued to focus on the operation process.

Zhou Cheng chose a rather special angle. After opening the hematoma, the blood inside burst out immediately. Even though Mo Youcheng got the suction device ready to meet him in time, the suction was still not in time, resulting in A lot of blood spattered!

Fortunately, Zhou Cheng had prepared in advance and covered the incision with his hands in advance, so there was not a lot of blood coming out, but it was confined to the wound.

After the force of the pressurized jet impacted, the inside became a mess again.

Zhou Cheng then quietly waited for Mo Youcheng to suck up the blood inside, then let go of his hand again, observing the blood flow in the original hematoma.

Then I saw that the blood was still slowly bubbling out, and when there was a tendency to keep bleeding, move quickly!
It was too late for Zhou Cheng to use the hemostatic forceps, but he directly grabbed a certain artery with his hands, and the blood that spewed out slowed down!
This is the terrible thing about opening a hematoma, because you don't know where the blood vessel may be injured, and there may be multiple blood vessels injured.

"Hemostat!" Zhou Cheng reminded the instrument nurse as he handed over the silk thread.

She immediately handed over a hemostat, and Zhou Cheng took it with his own hands. After clamping the blood vessel, he continued to observe. Then, like catching a loach, he pinched a blood vessel again.

The momentum of this extravasation of blood can be stopped!
It is like this, originally there is a hematoma, and the pressure inside the hematoma is high, so the blood loss will be reduced to a certain extent, but once the hematoma is broken, the pressure will drop, and a large amount of blood will be lost in a short time.

If all damaged blood vessels cannot be found during this process, the patient will quickly lose blood and die of shock!

This is also the reason why retroperitoneal hematoma cannot be opened hastily!
Zhou Cheng clamped off five blood vessels, and now he has captured four more, which slowed down the bleeding trend. Most people, before opening the hematoma, may not be able to find the previous five blood vessels!
Under such circumstances, to open it is to open the gate of hell, and the patient will definitely come in but never come out!

"silk!"

"Teacher Tour, get ready to suture the blood vessels!" Zhou Changchang sighed, then smiled and began to apologize.

"I'm sorry, Mr. Washing Hands, the situation was urgent just now, so my tone may have been a bit harsh." Zhou Cheng comforted again.

The equipment nurse lowered her head in embarrassment.

Mo Youcheng also heaved a sigh of relief. The reason why the hematoma detection technique is dangerous is that the moment it is opened, the hematoma is violent, and the subsequent bleeding continues, making it difficult to find the bleeding blood vessel.

The most dangerous time is now in the past, and next, at least it will not make the patient's condition worse, unless it is a special case.

However, the previous scene seemed to be nothing, but in fact, every minute and every second was full of fright.

"Xuanxuan, don't blame Dr. Zhou. Even well-known experts and professors will raise their hearts in their throats about opening a retroperitoneal hematoma. Not to mention being harsh, scolding mothers is not uncommon."

"But it's all right now, this dangerous time is over."

The handwashing nurse named Xuanxuan hurriedly said: "Director Mo, I know that I didn't cooperate well. I didn't take it seriously."

Looking up at Zhou Cheng's eyes, I feel a little guilty, but also a little bit excited.

Although Zhou Cheng's stern tone just now was very fierce, it was not another kind of domineering. This is ability and skill, and Zhou Cheng's movement of grabbing blood vessels just now was crisp and neat without hesitation!

If there is a delicacy in Huaguo called Huaguo on the tip of the tongue, then what Zhou Cheng is showing now is that life is beating on the fingertips.

Maybe one wrong step could lead to eternal doom, but Zhou Cheng resolved them one by one. This kind of operation, in her eyes, was very psychedelic, and even had a kind of unimaginable acrobatics...

Zhou Cheng did not relax his mood and opened the hematoma. Although in theory, it could reduce the patient's bleeding, but the heart stimulation caused by this sudden burst, and the burden on the whole body caused by the decrease in blood volume are just too much. start.

"Mr. Anesthesiologist, it will be hard for you to take care of it next time, especially pay attention to electrolyte imbalance and acidosis." If it is in other places, it is really difficult for Zhou Cheng to give advice to the anesthesiologist.

However, the performance of Xuanxuan's equipment nurse just now made him a little scared, so even if it made the anesthetist unhappy, he could only say a few more words.

The anesthesiologist listened, smiled, did not reply, but still went to draw blood, and at the same time, asked the subordinate doctor to contact the blood bank to get blood immediately, and added a little booster drug at the same time, and slightly reduced the dose of anesthesia !

At this time, the dose of the drug may become a burden on the patient.

Seeing these details, Zhou Cheng felt relieved. This anesthesiologist is at least reliable.

Moreover, although the hematoma was temporarily resolved, this did not mean that all life-threatening risks were completely relieved for patients who were comatose during the operation.

Zhou Cheng then said: "Director Dong, you can do the stitching of the tiny blood vessels. I'll do the stitching of the femoral artery!"

Zhou Cheng's meaning is obvious. Now these blood vessels are all tied up. No matter how bad it is, it doesn't matter much if the suture is not good. question.

Mo Youcheng knew that Zhou Cheng was worried about his poor skills, but he didn't say much, just nodded: "Doctor Zhou, I will try my best."

Then, Mo Youcheng and Zhou Chengcheng switched places.

When Mo Youcheng began to suture the blood vessels in a decent manner, he took a quick glance at Zhou Cheng and found that Zhou Cheng's technique when suturing the femoral artery was also very delicate.

If it was at other times, he would definitely see and learn more shamelessly, but now, this opportunity is gone!

The people in the orthopedics department are also helping Zhou Cheng suture the femoral artery, studying hard, and are still flattering.

"Doctor Zhou, I really worked hard on you today. Otherwise, we might not have been able to discover this retroperitoneal hematoma in the first place. Under such circumstances, if the patient steps down, the consequences will be unimaginable!~"

"Furthermore, even if we find such a hematoma, there is nothing we can do. Doctor Zhou, thank you for your hard work!" Although the words were flattering, they were still sincere.

Zhou Cheng nodded, not proud: "It should be, I'm glad I didn't come here in vain, I can finally do something."

"Director Hu, should I leave it to you to do the follow-up debridement of this operation?"

"Doctor Zhou? This debridement?" Director Hu of the Orthopedics Department was stunned: "Why don't you continue to trouble Dr. Zhou? This operation is not trivial. I am afraid that after the operation, because of our limited ability, some accidents will happen. misfortune."

The same debridement, before Hu Kaihua did not believe that there is any big difference between different doctors, isn't it all debridement?
But now, Hu Kaihua felt that he was wrong, and he was wrong. In fact, there is a huge gap between debridement and debridement. It is not at the same level as Dr. Zhou Cheng.

If possible, he would rather that Zhou Cheng can solve this operation, avoid unnecessary surgical technical errors, and bring inevitable consequences!
Hu Kaihua spoke so bluntly, Zhou Cheng didn't say much.

He just smiled: "Director Hu, you're too good, let's come together. Although there are several incisions in the current femoral artery, and they are not on the same axis, but?"

While Zhou Cheng was talking, suddenly, the monitor next to the anesthesiologist blinked beeping beeps and flashing red light!

The anesthesiologist's expression changed suddenly: "The patient's blood pressure has reached a critical value!~"

"I'll call the teacher!" After finishing speaking, he was about to leave the operating room and ask his superior doctor.

"You can't go!"

"Intravenous injection of epinephrine! 1mg! Immediately!~"

Zhou Cheng immediately stopped all operations and calmly ordered.

(End of this chapter)