There is no need to be too normal to be a doctor.

Chapter 165 The terrifying thing about Chen Gong! (Ask for monthly ticket)

The situation of hypotension is special.

Generally speaking, there are physiological and pathological hypotension.

As for primary hypotension... Chen Gong felt that the vital signs were not very similar to the patient's.

The patient was obese and short. If it was physiological... he should have known.

Thinking of this, Chen Gong couldn't help but ask: "Do you have low blood pressure?"

The patient was lying on the bed, crying tears of pain.

Hearing Chen Gong's words, he quickly shook his head: "No, absolutely not!"

"I'm usually quite healthy."

"Except for being a little afraid of heights, I never have low blood pressure."

"We usually have physical examinations in our unit. I've only been here for less than half a month, and I don't have any low blood pressure!"

"Moreover, apart from a little fatty liver and myocardial ischemia, there are no other diseases."

When Qin Xuehai heard the sound, he frowned slightly, raised his head and couldn't help but look at Chen Gong.

When Chen Gong heard this, he fell silent again.

The pathogenesis of primary hypotension is still unclear, but most scholars believe it may be a disease related to central nervous system dystonia.

Due to the imbalance of the excitation and inhibition processes in the central nervous system, the inhibition process in the vasomotor center is strengthened, the dynamic balance of vasoconstriction and relaxation is disrupted, and vasodilation becomes dominant, ultimately leading to a decrease in arterial blood pressure.

The patient is likely to have a problem with the central nervous system!
But... there is no way to detect this thing.

The car was driving fast on the road.

"How is your blood pressure now?"

Chen Gong quickly asked the staff who was connecting to the ECG monitor.

Hearing Chen Gong's words, the staff on the side quickly looked at it.

Not long after, the values ​​appeared.

"90/55mmHg!"

Chen Gong looked at the blood pressure and suddenly frowned. He couldn't help but raise his hand and press the patient's waist.

Accompanied by a sound of ghost crying and wolf howling.

The patient's blood pressure dropped again!

The high pressure is only 85 and seems to be falling!
As a result... Chen Gong's face became more serious.

The patient is likely to have central nervous system blood pressure fluctuations.

Moreover, this fluctuation will still change along with the patient's mood.

When Qin Xuehai saw this, his eyes widened immediately.

This... weird blood pressure?
Qin Xuehai couldn't help but look at Chen Gong: "Xiao Chen, what do you think?"

Chen Gong suddenly said with a solemn expression: "The situation may be more complicated than we imagined."

"The patient's pelvic fracture was relatively serious."

"But... the most troublesome thing is how you choose the surgery."

When Qin Xuehai heard the sound, he was suddenly stunned for a moment, and then suddenly thought of something. He quickly looked at Chen Gong with wide eyes:

"You mean... the problem of surgical anesthesia?"

Chen Gong nodded!

"The cause of hypotension is difficult to detect."

"But, I have a doubt!
First, if a patient uses neuraxial anesthesia during surgery, a big problem is that he will have obvious trauma to his back.

As an invasive procedure, neuraxial anesthesia requires puncture of the back skin, and local anesthetic is injected into the subarachnoid space or epidural space through a puncture needle or catheter.

The above operations on the surface of the spinal cord have a great risk of bacterial infection, so back boils or skin infections are contraindications to spinal anesthesia. "

At this moment……

Qin Xuehai couldn't help but ask: "What if it's general anesthesia?"

Chen Gong shook his head again!

During this time, his understanding of anesthesia has reached a professional level.

Although there is still a big gap compared to those powerful anesthesiologists.

but……

He still knows a lot of anesthesia common sense and common problems.

The so-called general anesthesia actually refers to the inhalation of anesthetics through the respiratory tract, intravenous or intramuscular injection into the body, resulting in temporary reversible suppression of the central nervous system.

Clinical manifestations include loss of consciousness, loss of whole-body pain, reflex inhibition, and skeletal muscle relaxation.

This doesn't seem to be a problem.

Although the effect is accurate and reliable.

However...respiratory depression, circulatory system and central nervous system complications may occur, such as asphyxia, respiratory obstruction, pneumonia and hypoxemia, atelectasis, hypotension, etc.

General anesthesia is not recommended if the patient has severe lung disease before surgery.

Although the patient did not have obvious severe lung disease.

but……

This hypotension will become the main factor causing complications during the operation.

Many times, risk factors are not singular.

Often when a risk factor appears, it may lead to a series of reactions.

Therefore, anesthesiologists must have strict requirements on vital signs before performing surgery on patients.

Never underestimate an anesthesiologist.

It can even be said that anesthesiologists are the key to ensuring surgical safety!
Without an anesthesiologist, the surgery likely wouldn't be possible.

They play a decisive role in whether the operation can be carried out.

Chen Gong took a deep breath and said:

"General anesthesia...the risk is too great!"

“Under general anesthesia, although the patient’s muscles and nerves will relax, the body’s functions will be limited!

The patient's hypotension is central nervous system hypotension. Although this type of hypotension is very rare, it is also very dangerous.

Emotional excitement and nerve transplantation can trigger changes in blood pressure!

Perhaps... hemodynamic changes may also occur during surgery, leading to adverse reactions such as urinary retention, nausea and vomiting, or respiratory depression. The most important thing is changes in blood pressure, which may cause serious complications!
Negative impact on his recovery! "

After hearing Chen Gong's words, Qin Xuehai had no doubts.

He didn't think about where Chen Gong learned his anesthesiology knowledge.

The only thing he cares about now is the patient's condition and how to carry out the operation!
After listening to Chen Gong's words, Qin Xuehai also fell silent.

At this time, the patient was lying on the bed, becoming more and more excited, and his blood pressure began to change erratically.

"Ouch...it hurts, it really hurts!"

"Old Qin, you have to save me."

"I can't die yet, my son is only 7 years old..."

"Old Qin, you have to save me..."

"pain……"

……

The man's voice echoed in the carriage, making this moment less dull.

But Qin Xuehai's pressure has not diminished at all.

As Chen Gong said, patients are likely to encounter some problems during the current surgery.

Now we can only hope that the other party's situation is not that serious.

Elective surgery is possible!
During this time, you can also adjust your blood pressure.

Otherwise...the operation cannot be carried out at all.

And he can't make the decision in all this.

The so-called medicine, modern medicine, is actually more like a robot walking within a certain framework.

It does not have such random characteristics. Just like a diagnosis of a disease, it requires all indicators to be fully met before it can start.

Surgery can only be performed after the conditions for surgery are met.

The purpose of first aid is to save lives.

The purpose of surgery is to live a better life.

The car was driving at a high speed, leaving only a howling warrior. Perhaps... he should be thankful that the thick fat on his body gave him enough cushioning and did not cause any damage to his internal organs. Even his ribs... were stable.

However, the weight of the body also crushed the already overwhelmed pelvis.

Life is fat, failure is fat!

……

……

Soon, the car arrived at the hospital.

Qin Xuehai urgently arranged an examination in the radiology department to scan the patient's pelvis.

It turns out that a fluke is impossible.

Falling from a height of seven to eight meters, even if fat is used to cushion the landing, the huge weight base without the slightest care for the pelvis will directly cause the pelvis to be severely fractured.

even……

Qin Xuehai watched the film and said to Chen Gong:
"The situation is quite serious!"

"I still need surgery as soon as possible."

"I suspect bleeding."

"Over time, the amount of bleeding, aside from the pelvis, will become a dangerous factor."

Hearing Qin Xuehai's words, Chen Gong couldn't laugh or cry either!

"Director Qin...you are too tactful."

"Is this serious?"

“You see, the pelvis itself is a strong ring of bones connected by the sacrum, coccyx, and hip bones on both sides (ilium, ischium, and pubis).

You see on the film, the ilium and sacrum on both sides form the sacroiliac joint.

But... this fall, it can basically be said that it fell into pieces!
Even if you don’t have surgery, it won’t work!
But... I have to say that the pelvis is the bridge between the spine and the lower limbs. The gravity of the trunk is transmitted to the lower limbs through the pelvis, and the shock of the lower limbs also reaches the spine through the pelvis.The pelvis protects the important organs in the pelvic cavity. "

"This patient's pelvis was smashed like this, but his organs are really fine...it's really a miracle!"

Qin Xuehai wiped his face and sighed with a headache: "Being fat is not without its disadvantages!"

"But the pelvis was broken like this, and emergency surgery is necessary!"

"Okay, let me go find Director Zheng first and have a chat with him."

Director Zheng is the director of the anesthetist, named Zheng Chusheng, and has a good relationship with Chen Gong.

Even Zheng Chusheng admired Chen Gong very much.

Watching Chen Gong grow up day by day with his own eyes, Zheng Chusheng was also very happy.

After seeing Chen Gong and Qin Xuehai, Zheng Chusheng laughed.

"Little guy, do you come home often?"

Zheng Chusheng smiled and shook hands with Chen Gong, patted his shoulder and said with a smile.

"I heard, you did a great job at the emergency center!"

"Good job!"

"By the way, what do you want from me today?"

Qin Xuehai sighed helplessly: "Old Zheng, something really happened. Please take a look at the patient's condition and what should I do!"

"Can anesthesia and surgery be performed?"

While talking, Qin Xuehai took out the medical record book and showed the patient's condition.

Zheng Chusheng frowned while watching!

After a moment, he said with a solemn expression: "It's difficult!"

"It's a bit difficult..."

"Old Qin, you may not understand. I have seen this kind of central hypotension several times in clinical practice. It is simply my nightmare."

"I almost left on the operating table."

"Look, with the patient's pelvic condition, vertebral anesthesia is obviously unrealistic. Anesthesia here is a contraindication. The damage to the back is infected. You see... this area is seriously damaged..."

"Furthermore, even if it is vertebral anesthesia, I think the anesthesia effect on the femoral nerve and this area is not enough."

"General anesthesia is possible, but... do you know how high the risk factors of central nervous system hypotension are for central nervous system transplantation?"

"Let's put it that way!"

"There are not many people in the province who dare to give you anesthesia for this surgery."

"Even I feel nervous!"

"Although vasopressor drugs can be used,... vasopressor drugs also react to the heart, and at this time, the heart is also transplanted..."

"How should I put it? It can be understood that general anesthesia is a state with extremely high risk factor, second only to shock!"

"Let me ask you, do you dare to reduce blood pressure in a state of shock?"

"Isn't this courting death?"

"There is no doubt that being under general anesthesia at this time is courting death!"

After hearing Zheng Chusheng's words, Qin Xuehai also realized the seriousness of the situation.

If I don’t have surgery now, what can I do?
The patient's pelvic area is now severely affected. How long can the patient be treated?

"Is there really no way?"

Qin Xuehai couldn't help but sighed and asked.

Zheng Chusheng looked solemn: "Old Qin, do you think I'm kidding you?"

"As long as there is a way, I am willing to give you a try, but...Old Qin, you know better than me what the consequences will be if there is a problem with the anesthesia effect during the operation!"

"If a new anesthesia method can be found, it will be a great contribution to medicine!"

After saying this, the scene suddenly fell silent.

Zheng Chusheng said at this time: "Actually... you see that medicine is developing very fast..."

"But it's actually not as fast as you think."

"It's just an assumption brought about by technological development."

“The development of orthopedics is based on the vigorous development of modern imaging and the replacement of new instruments.”

"You are a master of orthopedics, and you also know how many innovative changes have been made in the surgical techniques we use over the years?"

"Same goes for anesthesia!"

"The discipline of anesthesia is developing rapidly, but in fact... anesthetic drugs are changing."

"However, the actual anesthesia methods, techniques, and techniques...these changes are very slow."

“We have very few new methods that can really be used clinically!”

"Of course, the operation is not completely impossible. What I'm talking about is the risks. The risks are probable."

"As long as the patient's family or himself is willing to take the risk, I won't be unable to operate!"

Hearing this, Qin Xuehai shook his head.

The silence at the scene made the atmosphere much more solemn.

At this time, Chen Gong, who was standing aside and had been silent, suddenly said:
"Teacher Zheng!"

"I actually have an idea here, but... I don't dare to try it."

Hearing this, Zheng Chusheng looked at Chen Gong with a smile: "Say it!"

At this time, Chen Gong took out a piece of paper and quickly started drawing on it.

Not long after, a gap in the fascia iliaca appeared on the paper.

Chen Gong said: "I think this is an anesthesia point." "You see, this is the iliac fascia, and two nerves come in and out from here, namely the femoral nerve and the lateral femoral cutaneous nerve.

Theoretically, it can be proven that it can block two nerves in the lumbar plexus: the femoral nerve and the lateral femoral cutaneous nerve. "

"Even the obturator nerve is affected to some extent."

"Although spinal anesthesia cannot be performed, general anesthesia carries great risks."

"Then...I think it is possible to perform anesthesia for pelvic surgery by triggering it from the iliac fascia."

"You see, the pelvic area is here. If the fascia iliaca is anesthetized... the femoral nerve is the largest branch of the lumbar plexus and originates from the L2, 3, and 4 nerves..."

"Then there's the lateral femoral cutaneous nerve..."

"When anesthesia is administered here, I think it will be very effective."

“Clinical anesthetics or opioids are used during surgery to reduce stress reactions.

Among them, ropivacaine has a definite effect in pain blockade, but it has a short time and poor effect on motor nerve blockade, so it is mostly used for local anesthesia.

Dexmedetomidine has significant analgesic, sedative, antisympathetic and hypnotic effects without the risk of respiratory depression, so it is widely used in clinical applications. "

"If in this area, the effect of caine mixed with dexmedetomidine iliaca fascial space block anesthesia."

"Maybe the effect will be very significant..."

"Of course, I don't know much about anesthesia, it's just my immature opinion."

The voice fell, and the scene was silent.

There were people in the anesthesia department room originally. After hearing what Chen Gong said, several people immediately gathered around.

Zheng Chusheng listened to Chen Gong's words, his face was solemn, and his eyes were staring at the iliac fascia area.

After listening to Chen Gong's words, Zheng Chusheng's eyes suddenly widened!

"This...did you come up with this?"

Chen Gong coughed: "As you know, I have been conducting research on interstitial medicine."

“The fascial iliaca gap is one of my research interests.”

"I didn't originally discover the role of this gap, but... I think from an anesthesiology perspective, this is an area worth studying!"

Hearing Chen Gong's words, the room immediately exploded.

Several deputy directors were already standing aside, discussing frantically.

"I think it works!"

"This completely satisfies the theoretical support of anesthesiology!"

"Yes, the most important thing here is that it is very safe. You see, the protective tissue in the fascia iliac area can perfectly avoid the bypass of blood vessels, and the absorption speed of anesthetic drugs is no less than that of spinal anesthesia!"

"Great!"

"Really amazing!"

"Are you also an anesthetist?"

"What a genius idea and creativity! This is a completely new direction in the field of anesthesiology."

"Too good!"

……

Listening to the comments of his subordinates, Zheng Chusheng's breathing became rapid at this time.

Because Chen Gong is not an immature assumption at all.

It is a new direction of anesthesia with theoretical basis and feasibility.

This is definitely an innovation in the field of anesthesia medicine!
Perhaps, there are already many anesthesia methods available at present, but... this fascia iliac anesthesia can really make up for many shortcomings.

Moreover, Chen Gong had even made the choice of medicine.

How powerful is this?
"Xiao Chen... do you know anesthesia?"

Chen Gong scratched his head and smiled: "I understand...a little bit."

"not much!"

"I hope Teacher Zheng won't laugh at my unprofessionalism."

“In order to study interstitial medicine and translational medicine recently, I had to study other fields of medicine.”

“I think these gaps can be analyzed and studied from multiple angles.”

"My class is messing up, please forgive me!"

It's not that Chen Gong is modest, but Zheng Chusheng is the vice president of the Shanhe Provincial Anesthesiologists Association.

His words are very authoritative!

Chen Gong's suggestion directly made him excited.

This made Zheng Chusheng couldn't help but stare at Chen Gong.

Good guy!
genius!

He really underestimated Chen Gong.

This is simply a jack-of-all-trades!
He knows all about anesthesia!

You know, anesthesia medicine and clinical medicine are thousands of miles apart.

The distance is obvious to all.

Clinicians also know how to perform infiltration anesthesia and use lidocaine.

And what about Chen Gong?

This is simply... awesome!

Zheng Chusheng stared at Chen Gong, feeling that this boy was so evil.

Being stared at by Zheng Chusheng, Chen Gong felt a little numb and couldn't help but ask:
"Teacher Zheng, do you think... it's feasible?"

Zheng Chusheng suddenly smiled: "Is it more than feasible?"

"If you look at it, this is simply a genius idea and creativity!"

"This iliac fascia anesthesia technique is really more powerful than you think!"

"Do you know that your seemingly casual words may cause riots in the anesthesia circle?"

Zheng Chusheng's words were supported by a group of subordinates around him.

"It's more than just a riot!"

"This is definitely a new direction in anesthesia globally."

"You are amazing!"

"I think there is no problem at all, and you can definitely try it, because there is no risk factor here at all!"

"Correct!"

Zheng Chusheng took a deep breath and said to Qin Xuehai:
"Get ready for surgery!"

"I will provide anesthesia for this operation!"

"Go quickly!"

"To be honest, my hands are a little itchy!"

"In a while, you guys, follow me to the operating room to evaluate and test the patient's vital signs and anesthesia effects!"

"I want every piece of data!"

Hearing Zheng Chusheng's words, several colleagues around him laughed: "Okay!"

"no problem!"

"Boss, can you put me in the top ten for this subject?"

"Boss, I also witnessed it!"

……

Qin Xuehai was stunned on the spot, looking at Chen Gong in disbelief.

He never expected that today would be such a situation.

It was Chen Gong who... solved the problem of anesthesiology?

Speaking of it, he even felt a little unbelievable.

However, at this time, Zheng Chusheng said quickly: "By the way, Director Yang, you go and go with Director Qin."

"Go and communicate with the patient and family."

"Explain the anesthesia situation and ask the other party to sign it. Just say that this anesthesia is our original creation and there are certain risks..."

After Zheng Chusheng finished settling in, he then looked at Chen Gong.

His eyes were full of anticipation.

"Chen Gong!"

"Three days of separation really impressed me."

"You've made great progress."

"Stay here, I want to talk to you."

"Can we do this together?"

"Of course, you can be the first person in charge of the project."

"is it okay?!"

"You must let me do it, please!"

Seeing Zheng Chusheng's excitement, Chen Gong couldn't help but say: "Director Zheng, is it really possible?"

Zheng Chusheng smiled slightly: "You really underestimate your strength!"

"Your ability is far more terrifying than you imagine!"

"I really can't imagine what your future will be like!"

"I guarantee that this topic will be at least a first-class National Science and Technology Progress Award topic!"

"Even if you are qualified, we can recommend you to become an academician!"

"It's not excessive."

"It's not an exaggeration!"

After hearing this, Chen Gong's heart was beating wildly.

He really didn't expect it to have such a big influence.

Originally, Chen Gong just thought that this was a new anesthesia point.

but……

In Zheng Chusheng's eyes, this is obviously a technical supplement in the field of anesthesia medicine.

"Don't worry, I will raise funds for this project and write the project application."

"You don't have to do anything!"

"Just wait."

“This subject has great potential.”

"I will give you three places, even if it is the third person in charge, you can invite me to cooperate with this project."

"How about it?"

Chen Gong thought about Zheng Chusheng's words, this... isn't this the rhythm of winning by lying down?

By accident, translational medicine seems to be one step closer!
……

The surgery began quickly.

Do the patient’s family members have any reasons for refusing?
Even if it is a new anesthesia method, so what?
After all, patients now have no way of surgery...

So, it didn't take long for the surgery to begin.

Chen Gong stood in the room uneasily.

Watching everyone carrying out the operation intensively.

Several anesthesiologists evaluate the patient's physical signs and anesthesia effects.

There was silence in the operating room.

As an experienced anesthesiologist, Zheng Chusheng is also cautious.

After all, it was the first time to use this kind of anesthesia.

Time passed by minute by minute.

Chen Gong's eyes were also fixed on the various indicators on the ECG monitor, breathing, heart rate... He didn't dare to breathe out.

After a long time!

As the news of the successful operation rang out, there was constant applause in the office.

Qin Xuehai was also sweating profusely, but... when he looked at the stable values ​​on the ECG monitor, he couldn't help but breathe a sigh of relief.

It worked!
Qin Xuehai quickly looked at Chen Gong and couldn't help but say: "You kid!"

"It really makes me feel unbelievable!"

Chen Gong smiled slightly and said nothing.

Looking at surgical participation.

Not low!
The surgical contribution was actually 50.00%.

This made Chen Gong feel a little more confident.

That is...contribution to surgery is not just about how much you participate.

But how much has been contributed!
This operation would never be carried out successfully without me.

Without his new ideas for anesthesia, it would never have been possible, and no one could predict the patient’s follow-up.

Chen Gong was overjoyed when he saw the diamond treasure chest he had obtained.

Today’s trip is a huge profit!

Not only the fascia iliaca space anesthesia has been verified.

And I gained a subject, and finally got a diamond treasure chest.

After coming out of the operating room, Zheng Chusheng asked an anesthesiologist to observe the patient's postoperative signs and recovery, and record them carefully!
Obviously, at this time, he had entered an experimental state.

Zheng Chusheng himself took Chen Gong to the office and talked straight to the point.

"see it?"

"This is your credit!"

"You used your methods to save a person."

"Are you ready for a new project?"

Chen Gong smiled slightly: "Happy cooperation!"

Zheng Chusheng looked excited. He really didn't expect that Chen Gong made his originally silent heart ripple again.

future……

Who knows what it looks like?

Maybe, I can still give it a try!

The more he thought about it, the more excited Zheng Chusheng became.

The look in Chen Gong's eyes was filled with excitement and joy.

While speaking, Zheng Chusheng stood up excitedly and hugged Chen Gong:
"Thank you!"

"Xiao Chen, you may have given me a new dream!"

"Too precious!"

"If you need me in the future, feel free to ask."

"any!"

After finishing speaking, Zheng Chusheng stretched his arms and hugged Chen Gong tightly.

He is so excited!
Who would have thought that he would usher in such a dawn as he was approaching retirement?
……

ps: It’s the end of the month, please give me a monthly pass, to be honest... I’m really embarrassed, this month’s update is so annoying.

However, thank you all for your support.

(End of this chapter)