Gou is practicing medicine in the clinic

The pale face is due to a problem with the blood supply.

The face is rich in capillaries and is the part that best reflects the body’s blood flow. When we are nervous or shy, our face becomes red and feels hot.

This is because the capillaries on the face dilate, causing redness.

"The patient had high blood pressure before the operation, but no other underlying diseases."

Director Shang replied.

Most patients with aortic dissection have problems such as high blood pressure or arterial sclerosis.

"Which part of the artery is being repaired?"

"This section of the aorta."

Director Shang made a gesture.

This part is very special and there is no way to block the blood flow in the blood vessels. When repairing or replacing this section of blood vessel, cardiac arrest is the only option to complete the operation.

Therefore, during the operation, there must be a race against time.

Because if cardiac arrest is selected, not only must the patient's body temperature be lowered to about 26 degrees, but the extracorporeal circulation machine must also be stopped, and the vascular clamp must be loosened.

In this case, the blood in the patient's body will be in a state of almost complete stasis.

The patient at this point is almost indistinguishable from a corpse.

Then the cardiac surgeon takes advantage of this precious opportunity to replace or repair the blood vessel.

Generally, blood vessels are replaced directly.

After changing, then start the extracorporeal circulation machine and let it run.

As the extracorporeal circulation machine operates, the blood in the patient's body will slowly begin to flow. The whole body begins to 'resurrect'.

This is a very critical step.

As the blood flows, the patient's body temperature will slowly rise. Then a temperature point is reached and the heart will restart on its own. At this time, the patient came back to life.

It sounds simple, but in fact every step is full of risks.

Right now this patient is stuck at the last hurdle.

It means that the blood vessel replacement was completed and the extracorporeal circulation machine was turned on, but the patient's heart failed to beat again.

Our human heart seems fragile, but it is actually a hundred times stronger than imagined.

When a new life is conceived, there is no fetal heart at the beginning.

In its original state, the human heart is just a blood vessel.

As the fetus develops, it will eventually form a heart.

If something goes wrong in the process of transforming a blood vessel into a heart, congenital heart disease will develop.

The proportion of children with congenital heart disease is much higher than imagined.

Although the hearts of some children suffer from errors during development, their vitality is particularly interesting and miraculous. When it makes a mistake in one place, in order to continue life, the development of the heart will choose to make another mistake again and again until the end.

This defective heart can keep the fetus alive.

After birth, it can even grow.

However, due to an error in the internal structure, the exchange of arterial and venous blood was ensured through a one-on-one error. However, venous blood will mix into arterial blood, causing some obvious symptoms in the child's body.

Such as palpitations, palpitations, fatigue, difficulty breathing, etc.

Through complex heart repair surgery, it can be restored to a correct structural state.

This patient's heart cannot restart. What is the problem?

Under normal circumstances, cells in heart tissue have the ability to automatically depolarize and repolarize.

Even in the absence of external stimulation, heart cells are still able to generate electrical activity. This is why when a patient encounters cardiac arrest, as long as cardiopulmonary resuscitation is implemented promptly, the patient can quickly resume his heartbeat and come back to life.

Li Jingsheng subconsciously touched the patient's carotid artery with his hand.

The itinerant teacher's eyes were as round as a bell, and her mouth could be seen opening through the mask, but she didn't say anything in the end.

Director Shang and Professor Wang Weiwei invited the doctor who came to help rescue the patient. If she scolded him and ran away, the patient would be asked to come to the rescue by then.

"There is a weak pulse signal, but his body temperature is not as high as expected. How long has the extracorporeal circulation machine been activated?"

He has high attainments in the fields of cardiac surgery and internal medicine, which can be regarded as one of his advantages.

In addition, it also has diagnostic capabilities in the fields of internal medicine and gastroenterology.

Now that he has a general understanding of the patient's condition, he conducts a preliminary comprehensive diagnosis and etiology analysis of the patient.

He believes that there are only a few factors that affect the heart's resumption.

Either the blood flow rate does not meet the requirements.

Or the body temperature didn't come up.

Or the repair of the heart and blood vessels is not in place.

For example, the heart blood vessel after replacement is blocked or there is a blood clot in a certain section, etc.

"It's been at least an hour."

Director Shang looked up at the clock on the wall and replied.

Li Jingsheng frowned. It has been so long since the extracorporeal circulation machine was restarted. Why is the patient's body temperature still so low?

Is the person really dead?

But what about the patient having a very subtle pulse in his neck?

Does it mean that the heart is trying hard to resume beating, but it is not strong enough and cannot beat normally?

To use a vivid metaphor, it is like a person being pushed down to the ground by a heavy object. He is trying hard to get up, but he is not strong enough to push the heavy object on his body.

At this time, what can help this person get up and get rid of the heavy object must be external force.

The heart beats again, and the same principle applies.

"Take the patient's rectal temperature!"

Li Jingsheng made a request directly to the surgical nurse.

In this case, rectal temperature and oral temperature can be used as ideal temperature references.

Body surface temperature cannot be used as a reference.

Under some specific conditions, the internal body temperature can differ from the body surface temperature by 0.5 degrees to 2 degrees.

There are even special cases that are even more different.

"30.6 degrees."

The nurse reports a temperature.

Normally, maintaining body temperature at around 32 to 35 degrees is considered a suitable temperature for resuscitation.

If the heartbeat is revived after freezing, it even needs to reach above 42 degrees before it can start beating again.

Director Shang and others were stunned when they heard the temperature reported by the nurse.

This is really a day-long hawking, but the eagle pecked my eyes out.

"Take the skin temperature again."

Director Shang signaled to the nurse.

The infrared thermometer measured the patient's forehead temperature at 32.5 degrees, and the ear temperature was similar.

"Bullshit, why can't I jump again? Try raising the air conditioner temperature by 1.5 degrees."

Hypothermia is the enemy that prevents the heart from beating again.

When re-jumping, body temperature control is extremely important. Neither too low nor too high is acceptable.

If the temperature is too high, it may even cause damage to the patient's brain and other parts.

And this damage is irreversible.

Director Shang asked the nurse to raise the indoor temperature by 1.5 degrees, taking a relatively large step.

Under normal circumstances, it can be adjusted up to one degree.

Li Jingsheng looked at the patient's condition and the data on the screen of the life monitoring instrument.

He gritted his teeth and said to Director Shang, "Is it safer to increase the temperature by one degree first? Although it is possible for the heart to re-beat up to 34 degrees, I see that this patient's basic condition is not very good. The heart has stopped beating again. For such a long time, the blood circulation in the body seems not to be ideal. I am worried that the temperature will rise too fast, which will harm the patient."

In this case, if he doesn't bring it up, others certainly won't.

When he touched the patient's neck just now, he was able to roughly sense the patient's blood vessel condition with the help of bone palpation.

The blood flow is not very fast.

This should be one of the reasons why the patient's temperature cannot rise.

And it's probably the main reason. Under normal circumstances, the patient's body temperature drops to 26 degrees before surgery. When the surgery is completed, the extracorporeal circulation machine is restarted. As the blood flows in the body, the temperature will automatically increase.

Generally no external assistance is required.

"Listen to Dr. Li, just raise the room temperature by one degree."

Director Shang is very kind.

As soon as Li Jingsheng came over, he helped him discover the reason why the patient's heart could not restart successfully. He naturally had deep trust in Li Jingsheng.

After the room temperature rose by one degree, Li Jingsheng touched the patient's neck again after a while.

Other doctors and nurses were watching.

Everyone is discussing why there is such a big difference between the patient's internal temperature and surface temperature.

It was ultimately concluded that the patient's skin temperature was affected by the room temperature.

Internal body temperature is the true body temperature.

The result of this discussion should be relatively scientific and reasonable.

"Dr. Li, did you really feel the patient's pulse before?"

"Well, I did touch it, but it was very weak. The instrument may not have detected it."

Li Jingsheng raised his head and looked at the anesthesiologist.

She was a female anesthetist with cold eyes, but her exposed forehead, eyebrows, and eyes looked quite eye-catching.

"No wonder."

The female anesthesiologist nodded as if she had a sudden realization.

"It seems that we cannot completely trust these high-tech instruments in the future. When they leave the factory, their sensitivity is set to a standard range. In this patient's case, the pulse is too weak, causing it to not be detected at all."

Hearing her tone, she would follow Li Jingsheng's example and touch the patient's neck when she encountered a patient whose heart was unsuccessful in re-starting the heart.

"Teacher, can I touch the patient's neck now?"

"Just touch it! Dr. Li has set a precedent anyway."

The itinerant teacher gave Li Jingsheng a slightly complicated look.

Her words sounded critical.

In fact, this is a bit too dogmatic.

For aseptic management, doctors generally should not place their hands below the waist in the operating room.

When you are tired, you can wipe your hands on your chest pockets.

Most of the time, the surgeon's hands need to be raised.

But when it comes to touching patients, it’s really hard to say.

As for bacteria, after opening the patient's abdomen, if it is necessary to cut the intestines. Or opening any section of the digestive tract will cause bacteria to come out.

There are also some patients who have suppuration themselves, which also contains bacteria.

Completely sterile, no operating room in any hospital can achieve this.

Includes laminar flow operating room.

Level 100.

This requirement is also not met.

At most, the bacterial content in the air is lower than a very low standard value.

The person who came up to touch the patient's neck was a male doctor in his forties, who should be the second assistant in Director Shang's team.

Under normal circumstances, Issuke's status is higher.

In terms of qualifications and abilities, the first assistant is usually higher than the second assistant.

An assistant in the surgical team may even be able to replace the surgeon in some special circumstances and complete all subsequent surgical tasks for the patient.

This is awesome.

Also, most of the surgeons are relatively old, some are even ninety years old.

They are only responsible for doing the most critical part of the operation, or standing aside to guide the doctors under them to complete it.

After all, surgery is a physical job. It would be really difficult for a surgeon in his 80s or 90s to complete a major operation that can take two to three hours or even longer.

As you get older, there is another problem that is unavoidable, and that is trembling hands.

In some large hospitals, when recruiting surgeons, if they are found to have trembling hands, they will be eliminated directly.

"Hey, why can't you feel your pulse?"

This middle-aged doctor in his forties looked at Li Jingsheng.

"Did you just touch it?"

"Yes, I felt it. The patient's pulse is very slight. You may need to feel it carefully before you can feel it."

Li Jingsheng had no idea that his bone-touching skills had surpassed those of most doctors after reaching the current level.

Other doctors couldn't find out the subtle details of the patient's blood vessels, but he could.

The bone-touching technique is the core medical technique among the osteopathic techniques taught to him by Dr. Xu.

It is not easy for other doctors to learn.

What's more, if you don't have anyone to teach you, it's almost impossible to succeed if you just rely on yourself to understand.

"Let me touch it too."

After hearing this, Isuke, who was in his early fifties, felt curious and couldn't help but step forward and touch it.

Compared with the second assistant, he is obviously higher in status.

Because he didn't even consult the traveling teacher, he just started touching it.

The operation is actually completed now.

But if the patient's heart fails to beat again, it's not over.

"There is no pulse! Doctor Li, how did you feel it?"

Isuke became interested in learning.

He wanted to learn this magical skill from Li Jingsheng.

"That's how you touch it. When you touch it, you can feel it carefully. If you can't touch it, it may be that you don't have the talent in this area, or you don't have enough practice."

Li Jingsheng could only say this.

The bone-touching technique will definitely not be passed on to others casually.

"Then let me touch it and see."

Isuke touched for a while, but still found nothing.

"Dr. Li, can you feel it again to make sure the patient really has a pulse?"

He somewhat doubted whether Li Jingsheng had made a mistake.

Li Jingsheng touched the patient's carotid artery again, with a hint of joy on his face.

Because he found that the patient's carotid artery was significantly stronger than before.

This shows that the increase in external temperature can still help the patient's heart restart.

But this process cannot be rushed, you can only let it accumulate a little bit of power, and then jump again.

"There is a pulse, but it's thin. You should be able to feel it after a while."

Li Jingsheng said to the two of them.

"Jingsheng's sense of touch is very keen, which is beyond the imagination of ordinary people like us. You don't need to question it."

Wang Weiwei spoke for Li Jingsheng from the side.

Less than twenty minutes later, the anesthesiologist suddenly stared at the screen of the life monitoring instrument.

In fact, the patient's electrocardiogram and electroencephalogram have changed at this time.

"The jump is about to resume successfully."

She said with some excitement.

Everyone looked nervously. I admire Li Jingsheng even more in my heart. (End of chapter)