medical simulator

Chapter 61 The Birds Are Over! (PS: Ask for collection, ask for recommendation tickets, ask for follow-up reading!)

股神经阻滞适应症：1.膝关节镜检查术。2.大腿前部的浅表手术。3.股四头肌肌腱修复手术。4.髌骨骨折手术。5.髋关节和膝关节置换术的术后镇痛。

The range of anesthesia for femoral nerve block is actually at the intersection with the range of surgery for this patient.

If the strength and direction are not selected correctly during reduction, the muscles in the non-anesthetized area will be cut.

It is equivalent to operating on the patient without anesthesia.

Even if the sciatic nerve block is combined, it only temporarily paralyzes the sensation and touch below the knee joint, and the sensation and touch above the knee joint can only be said to be uncertain.

Cutaneous nerve branch block is a better supplement to sciatic nerve and femoral nerve block combined with anesthesia.

It's just that this kind of cutaneous nerve branch block is extremely difficult to control, it is a sophisticated operation, and its applicability is not strong, so not many anesthesiologists will study in this direction.

Zhou Cheng was quite surprised that Yang Yifeng could perform such an anesthesia, but considering that Yang Yifeng is a graduate student in orthopedics, he has a relatively deep understanding of basic anatomical knowledge, and if he can use bedside color Doppler ultrasound, it is not impossible. .

At least, Zhou Chengcheng would not be able to do such a nerve block. He is only an orthopedic surgeon, not an anesthesiologist.

When Zhou Cheng arrived, the block was almost over.

Yang Yifeng then lightly poked the skin near the patient's thigh with the tip of the needle, and asked, "Does it still hurt?"

"No more pain, no more feeling!"

"Ouch, it's much more comfortable."

"It doesn't hurt at all, thank you, doctor." The patient's breathing gradually calmed down.

For him, as long as it doesn't hurt, the feeling is simply wonderful.

Yang Yifeng pulled out the blocking needle and said: "When the patient's fracture end is just inserted into the muscle, the injured muscle is deformed, and there is a certain torque tension. If any force is applied at this time Lateral stress will generate greater cutting force and severe pain."

"The pain receptors in our muscles are extremely sensitive to the force of the cut."

"So if you add the respective blocks of the branches of the cutaneous nerve, you can avoid this situation to the greatest extent."

"However, this is only a short-term block. I estimate that it can only last for about 30 minutes at most. Teacher Cai, Professor Zhong, is this enough time?"

Hearing Yang Yifeng's words, the director of the anesthesiology department, Director Zeng, said with a smile: "Enough is enough, it must be enough."

"Today I have gained a lot of knowledge. I heard people talk about this kind of branch cutaneous nerve block at the academic exchange meeting before. Very few people know it. I didn't expect that Xiao Yang, you can do such a block operation. .”

"I really hope you can come to our anesthesiology department!"

Cai Dongfan probably felt that the big problem of anesthesia for patients has been solved now, so he joked: "Director Zeng, Xiao Yang is Professor Ding's precious student, if you fool him into the anesthesiology department."

"I guess Professor Ding would not mind letting you see the fists of the old professor of orthopedics."

The corner of Director Zeng's mouth twitched, remembering that he couldn't even beat Cai Dongfan in a one-on-one fight, let alone one-on-one with Professor Ding and a large group of disciples and grandchildren...

Just shook his head: "I was just joking."

After Yang Yifeng finished the anesthesia, he said, "Teacher Cai, Professor Zhong, I'm done with the anesthesia, so I'll step down first."

After speaking, Yang Yifeng was about to take off his clothes.

"Xiao Yang, don't step down. The manipulation of the femoral bone reset requires a lot of strength, and one more person will add more strength." Cai Dongfan was a little stunned.

Yang Yifeng has helped so much, it is unreasonable not to let him come during the official operation.

Yang Yifeng took two steps back, shook his head and said with a smile, "I believe that Professor Zhong and Teacher Cai will be able to complete the follow-up operations, so I'll take a look in the audience."

"I haven't touched manual reset before, so I can't help you much."

After finishing speaking, he reached out to pick up the collar, which was regarded as a violation of the principle of asepsis, and he stepped down passively.

Cai Dongfan didn't dare to pull anymore.

Zhang Zhengquan frowned, as if he couldn't understand Yang Yifeng.

It's not just Zhang Zhengquan, Zhou Cheng can't understand it either.

Zhong Hua and Cai Dongfan saw that Yang Yifeng was full of personality, so they stopped persuading him.

The manual reduction of fractures is actually similar to the manual reduction of joint dislocations.

First of all, it must be fully tracted. The prerequisite for sufficient traction is to have two back tensions. Otherwise, the patient will be pulled off the operating table directly.

Therefore, an assistant is needed to fix it, and the operator performs traction operations. This patient is special, so many helpers are needed.

But this patient can't start to reset directly, and his fracture type is also special, so you have to check the position of the fracture end first——

Zhong Hua immediately said to Cai Dongfan: "Director Cai, you may be a little faster in doing the investigation."

"Okay, Professor Zhong." Cai Dongfan also nodded, and after asking the equipment nurse for a round knife, he immediately cut two 4cm long incisions at the two broken ends, and then broke the skin and skin layer by layer inside. subcutaneous tissue.

With the number of manipulations by Cai Dongfan, he found the proximal end of the fracture about 4 minutes later.

Cai Dongfan replied: "Sure enough, it is inserted into the muscle group, but it is the bone intermediary muscle. I checked it, and there are no blood vessels around it!"

"Then look at the far end." Cai Dongfan immediately began to investigate the broken end of the far end.

Then I saw that the fracture site was only 0.5 cm away from the rear femoral artery, and the sharp bone edge was only 0.4 cm away from the femoral artery!This is because the muscles are deformed, so the fracture ends are pulled out of the way.

His complexion changed immediately!

"Professor Zhong, come and see!"

Zhong Hua is naturally also a surgeon. If a person in the department of orthopedics does not perform surgery, then he must be fine. Could it be that the patients in the surgical indications will not be cured?
When he saw this artery, the expression on his face immediately froze!

His forehead began to be covered with fine sweat.

The reset before Yang Yifeng did not apply cutaneous nerve block was simply too dangerous. If he didn't pay attention, he succeeded in 'killing' directly.

Yes, before Yang Yifeng came to supplement the anesthesia, he and Cai Dongfan had already tried a reset, but the patient suffered too much pain during the operation and the level of anesthesia was not ideal.

So the operation was called off halfway, and Yang Yifeng added cutaneous nerve block anesthesia.

"This? Can it be reset?" Cai Dongfan asked.

Zhong Hua's eyes were very tangled, he turned his head and signaled Cai Dongfan to go away with his eyes, and then the two stayed in the corner of the operating room.

Zhong Huacai said: "Director Cai, let's forget about it. In this case, there can be no deviation at all."

"And in the process of traction and reduction, no one can guarantee that the distal end of the fracture will not slip. The patient's heart function is not good. If the artery is broken, heart failure and insufficient circulating blood will basically appear soon. Happening."

"Go and talk to the patient's family." Zhong Hua wanted to stop the operation.

When Luo Yun and Du Yanjun saw this scene, their hearts sank.

It seems that this patient has really stayed in the department for a long time.

I can't move at all!

"Okay!" Cai Dongfan's face changed for a while, and he went straight out of the operating room. He wanted to talk to his family members. The current situation is the most complicated and dangerous one.

After about 5 minutes, Cai Dongfan walked in again.

Said: "Professor Zhong, I talked with my brother-in-law just now. He is quite an open-minded person. He thinks that if you take a risk and fight for it, the quality of life in the future will be greatly improved. Otherwise, the life behind his father will be completely lost. quality."

Zhong Hua asked: "Ah? Are you sure? Make up your mind!"

Cai Dongfan took a deep breath and said, "I'm sure!"

Although it is better to be alive than dead, but if you can't even move, and you are lying down, you are enduring endless pain.

That such a survival!

It really lost too much meaning, just to live and live.It is estimated that the old man talked with his children and wife after he found out about his situation.

"Alright then." Zhong Hua also took a deep breath.

"Luo Yun, Xiao Du, you two are responsible for fixing the pelvis. Let's try one last time. There is only one last chance." Zhong Hua said.

Four people took their seats one after another.

Zhong Hua squeezed his hands, and then said: "You two need to fix it firmly, the fracture of the femur will take a long time to continue traction. And we don't have much time left."

"To completely relax the muscles!"

"Just four people?" Zhong Hua frowned slightly. There were not many opportunities. To antagonize the thigh muscles, only he and Cai Dongfan took the initiative to pull them, which might not be enough.

Luo Yun understood, and immediately said: "Zhou Cheng, wash your hands and go to the stage to help."

Zhou Cheng nodded, turned around and left. Since Luo Yun had called his name, he would not retreat.

It's just that Zhang Zhengquan, who was standing next to him, was slightly taken aback: Teacher Luo, obviously I came to the operating room first?

I also have great strength.

A little bit wronged.

But Zhang Zhengquan didn't know at all that Zhou Cheng proposed the operation suggestion this time, otherwise there would be no such thing as today.

Yang Yifeng looked at Luo Yun thoughtfully, and began to wonder why Luo Yun called Zhou Cheng to the stage instead of Zhang Zhengquan, who was also Gui Pei. This was an excellent material for him to write in the novel.

The story is taken from reality and higher than reality, which will make readers more sticky...

Cai Dongfan and Zhong Hua waited for a while.

Zhou Cheng finally changed into the surgical gown.

When Zhou Cheng approached, he watched Cai Dongfan and Zhong Hua standing on the left and right sides of the ankle joint, completely grasping the ankle joint with four hands.No place was reserved for him.

I sighed in my heart.

Secret channel: I knew that Zhong Hua would choose a farther away traction position.

The heel is one of the common positions for bone traction, and it is also a good focus point for manual reduction.

But in fact, for femoral fractures, it is better to use more traction from the tibial tubercle. When doing manual reduction, the choice of focus point is the same.

Moreover, the broken end of this patient's femur was more interestingly inserted into two muscles with classic shapes.

If he didn't go on stage, Cai Dongfan and Zhong Hua would exert force from the ankle joint, it would be over, the knee joint would be used as a prying point, and the femoral artery would be in danger!

Cai Dongfan and Zhong Hua were just starting to pull in the longitudinal direction, when Luo Yun and Du Yanjun pressed the pelvis hard to fix it!
I saw Zhou Cheng put his hands behind the tibial tuberosity, and then lifted it up with a little force, just like doing a drawer test.

A force perpendicular to Luo Yun, Du Yanjun, Cai Dongfan and Zhong Hua was exerted.

Immediately, the patient's lower limbs flexed.

This?
What is Zhou Cheng doing?
Seeing this scene, the faces of everyone on the field changed drastically.

What is Zhou Cheng doing this week?
The traction is vertical, and Zhou Cheng suddenly added a vertical force in the air. According to the principle of force synthesis, Zhou Cheng's force has no antagonistic force!

Didn't it happen that Zhou Cheng bent his knees?

What will happen after the knee joint is bent is completely out of the expectations of Zhong Hua, Cai Dongfan and others!

The scalps of the two of them went numb in an instant!
Then the heart seemed to be crushed by an invisible force, followed by the high tension caused by the frightening of all the muscles in the whole body, as if every muscle was being pulled by some invisible force.

Thoughts running wildly——

The femoral artery ruptured!
Heart failure!

The sick died...

Dead bird!
Zhong Hua regretted it very much at this moment.

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(End of this chapter)