A hundred days after signing in, the first surgery shocked the world!

Because there is simply not enough time, understanding the condition can only be done inside the operating room.

The workers came in together, disinfected and asked about the situation.

"What's going on?" Zhang Yuan asked.

"Ah~~" The worker is probably also frightened and unresponsive.

"I asked, how did this injury come about." Zhang Yuan softened his tone.

"I hung a piece of glass on the construction site, and then broke, the glass fell, Lao Liu was making a video call with his daughter, saying that he had a few days off, bought gifts to go back to his daughter, and then didn't have time to run, and then the glass fell, broke, and shot to Lao Liu's neck..."

"How long has it been since then?"

"10 minutes... No, about 15 minutes..."

Lin Feng and Zhang Yuan looked at each other.

Such a distance, such a large amount of bleeding, it is simply numb to the scalp!

At this time, needless to say, from Lin Feng and Zhang Yuan touching the patient's skin, they knew that the temperature was low and out of a state of hemorrhagic shock.

Shock!

It is the most common and dangerous symptom after heavy bleeding!

Its symptoms are: a sharp decrease in effective circulating blood volume, insufficient tissue blood perfusion, microcirculation disorders, metabolic disorders, and cell damage, and if not treated in time, it can be life-threatening.

Of course, shock is also staged:

According to the batch of skin temperature and color to judge, there is a compensation period and a loss period.

Compensatory period: pale, cold and wet limbs

Loss period: cold limbs, obvious cyanosis of skin and mucous membranes all over the body, and even petechiae and ecchymosis appear.

Obviously, the worker patients at this time have reached the period of loss of compensation.

"Rehydration!"

"Create two channels, one from the internal jugular vein and one from the femoral vein (both are central meridians, the thickest kind of veins, the fastest)..."

"I'll come, I'm faster."

Lin Feng poured iodine on his hands, disinfected, and then disinfected the patient's two large veins, punctures...

The speed is very sharp!

And Zhang Yuan was ordering the nurse to dispense liquid.

It is still the textbook general principle of rehydration: crystal before gum, salt before sugar, fast before slow, alternation of liquid species, see urine potassium supplementation.

There will be little change.

First enter the crystalloid solution: normal saline, balanced saline solution, glucose solution to increase the amount of blood return and cardiac output, and control shock...

Then, colloids are transfused: whole blood, plasma, albumin, etc., to reduce the penetration of crystal blood into the blood vessels...

It took about 3 minutes for many people to join hands...

The rehydration work is all done...

"Hurry up and detect BP (blood pressure) and CVP (central venous pressure) in real time..."

"Yes!"

Soon, the testing instrument was also plugged in and the measurement began.

The test results appeared: BP and CVP are low, so rapid rehydration is required.

That's it.

It was only then that everyone began to formally prepare for the operation.

The patient's neck was still being pressed by a nurse.

Lin Feng was worried: "The speed should be fast, if you keep pressing the blood vessels, then the blood supply to the brain will be insufficient and the cerebral infarction will occur." "

"By the way, plus aspirin (anticoagulant), recombinant tissue plasminogen activator... It can reduce the probability of cerebral infarction..."

At this time,

Lin Feng's eyes saw the co-worker.

Stunned for a moment.

"What are you still doing here?"

"Huh?"

"Oh what? Get out quickly! "

"Oooh, oh, I'm going out now..." the worker went out in a panic.

"Wait... What is the sound? "

What did Lin Feng hear.

The worker quickly took out the mobile phone in his pocket: "This is Lao Liu's mobile phone, he is talking to his daughter." "

Lin Feng happened to see the picture of the mobile phone, a little girl, and an old woman with gray hair, looking nervously at this side.

"粑粑~~Woo~~粑粑~~~~~"

The little girl kept shedding tears, obviously frightened.

And the white-haired old woman is estimated to be a grandmother or grandmother, crying while comforting the little girl.

Lin Feng quickly snatched the mobile phone and prevented her from seeing the picture of the operating table.

Lin Feng squeezed out the sunshine's smile.

"Your dad is fine, don't worry, ha, it will get better soon..."

Then he handed the mobile phone to the co-worker and asked him to hurry out and comfort the little girl.

The co-workers went out and the emergency door closed.

Surgery, begin!

......

Zhang Yuan, Lin Feng, anesthesiologists, nurses wash their hands, dress, gloves...

Return to the operating table.

At this point, the patient has finished anesthesia.

Lin Feng stood on a seat of help.

Zhang Yuan said, "Come on, I'll learn something..."

Lin Feng pushed back, but Zhang Yuan refused, because he could indeed learn from Lin Feng, and his speed was not as fast as Lin Feng's.

"Then you're welcome."

Lin Feng took a deep breath.

Zhang Yuan took over the nurse's pressure to stop the bleeding, and the nurse who originally pressed to stop the bleeding withdrew, and the fingers often moved proximal and distal by two centimeters, leaving Lin Feng with a wound vision.

Lin Feng quickly disinfected the wound field with iodophor, repeatedly disinfected, and observed the glass slag, but did not find it.

After disinfection, Lin Feng began to use surgical forceps to find the location of the arterial wound.

Logically speaking, it is best to do a high-resolution MRI, but in the current situation, doing MRI will greatly delay time and cause further cerebral infarction of the patient.

You can only rely on experience to find, repair, and then go to the MRI to see the situation after the operation.

As for finding out the location of the blood...

Such a large amount of bleeding can only be arteries, or arteries + veins.

There are many arteries in the neck, the general carotid artery, the superior thyroid artery... A dozen ...

Among them, the total carotid artery and superior thyroid artery are the thickest in this position.

Open the wound and probe.

It's easy to see.

Total carotid rupture!

Broken superior thyroid artery!

Looking at the other blood vessels, luckily it was okay (after the operation, do an MRI approval)!

This is unfortunate luck, they are fine, then it can reduce Lin Feng's operation by a lot of time.

At this time, the nurse began to report quickly:

"BP is back to normal, but CVP is still low..."

Lin Feng: "This shows that the blood volume has almost recovered, reduce the infusion, control it... In addition, inject 10mg of heparin and 30mg of papaverine, and I will have surgery..."

Nurse on the circuit: "Yes!" "

......

The operation has officially begun!

"Attracting..."

Hissing ~~~~

The aspirator quickly cleans the subcutaneous blood and finally exposes the clear surgical field.

Lin Feng first made a blockade for the rupture of the total carotid artery, and the large blood vessels clamped on the blood vessels at the far and near ends.

Then block the superior thyroid artery, still clamping the far and near ends.

At this time, Zhang Yuan could finally let go.

At this time, Lin Feng began to prune, cutting the two broken ends of the two arteries by 2mm at the edge of the blood vessels... (because it is elastic)

1% lidocaine, 50ml flush blood vessels ...

Then warm salt water hot compress ...

Finally, Lin Feng picked up the 5-0 non-damage thread and first sutured the common carotid artery, the specific method is to make two-point positioning intermittent suture, and then make intermittent mattress sutures between the positioning sutures for several stitches.

5 minutes to do.

Connection complete!

"Let go of the common carotid artery vascular clip and see..."

Lin Feng is not worried about arterial problems, he is concerned about the problem of cerebral infarction, and he needs to provide blood oxygen to the brain as soon as possible, which can be one second faster, and every second can greatly reduce the risk of cerebral infarction.

First put the proximal end slowly,

The proximal vascular clip is opened and arterial blood begins to rush into the wound.

No blood leaking out!

Continue to open the distal vascular clip, and the blood gurgles towards the distal end, towards the part of the mind.

Not a drop of blood oozed out!

"It worked!"

Lin Feng was neither happy nor sad, because this was not difficult for him.

Next

It is the turn of the superior thyroid artery, almost the same technique, connection, and finally intermittent mattress suture.

This time it was 4 minutes, and the connection was completed.

Bloodletting!

Proximal first, distal later.

Open, and not a drop of blood came out of the end again!

The operation was basically successful!

Lin Feng breathed a sigh of relief and finally gave an explanation to the little girl.

But......

There was also a shadow hanging over Lin Feng's head.

In these 178 minutes of compression and blockade, did it lead to cerebral infarction of the patient?

Also, are other blood vessels still ruptured or broken?

......

Next

Lin Feng carefully probed the inside of the wound, made sure that the naked eye did not see the bleeding point of the wound, and then began to suture the wound.

Broken lymph cut off...

Disinfect, rinse...

Stitch the inside ...

Keep stitching...

Finally, the skin is sutured and the operation is completed thoroughly...

Looking at the time, it took a total of 35 minutes.

On the one hand, the operation is not difficult, on the other hand, Lin Feng tries to speed up as much as possible to provide favorable time for the brain to supply blood oxygen.

Look at the testing instrument again.

BP, CVP have returned to normal levels, and the shock has survived...

The plasma used up 1500ml~~

Everything seemed very smooth.

Lin Feng couldn't help but think again, could it be that my "luck" worked?

......

Outside the operating room.

A vice president of the construction site came, gave the formalities, money, and waited outside.

The worker clumsily held the mobile phone, and the camera was pointed at the operating room door.

The eyes of the little girl and grandmother, through the network and camera, looked at the operating room, expecting the appearance of the father inside.

Airplanes~~~~

The door of the operating room opened, and Lin Feng, Zhang Yuan, and the nurse pushed the car out.

"Dumpling~~~~"

The little girl cried out expectantly and worriedly.

The co-workers and vice presidents quickly ran over.

Look anxious!

"Doctor, how was the operation?"

"Rest assured, the operation was successful, and the life was picked up... Here I would like to thank this uncle of the co-worker, who pressed to stop the bleeding and provided us with valuable time for rescue. "

The worker scratched his head embarrassedly, very happy.

Lin Feng took the co-worker's mobile phone and said to the little girl in the mobile phone:

A sunny smile.

"Hi, little friend, your father is in good health now, you can rest assured ~~~~"

"Really!!"

When the little girl heard the news, she immediately cheered, and finally bowed to Lin Feng and the others with a serious face.

"Thank you, uncles and aunts!"

It made a group of nurses cover their mouths and laugh happily.

The little girl smiled joyfully: "Uncle and aunt, grandma said, we will take the train tonight and go to the hospital tomorrow..."

Lin Feng laughed: "Okay, when the time comes, uncle will invite you to dinner!" "

Seeing her so happy, Lin Feng felt that he had more warmth.

Being a doctor is hard, but it's good!

......

In the afternoon of the same day,

The patient woke up.

Lin Feng happened to have not left work, so he rushed over and gave him a rating.

The consciousness is still relatively clear, and the thinking is clear.

"Thank you doctor."

"This is what we should do, but generally the mortality rate of common carotid artery rupture is very high, you can pick up a life is also lucky, you have to thank your co-worker, if it is not for him to press to stop the bleeding, I am afraid we can not do anything... Also, your daughter said to wait to get off the train and come here tomorrow to see you. "

"Good." The worker's vicissitudes showed a happy smile, "My wife died prematurely, the child has been without a mother since childhood, and the relationship with my grandmother has been severed, and I am dependent on my grandmother and me... Thanks doctor! "

Three thanks in a row.

Lin Feng nodded.

"I'll give you a strength rating now... Can you move now? Hands, feet, try them all..."

According to Lin Feng, the workers began to try.

Soon, a look of panic appeared on his face.

"Doctor, I can't seem to lift my left arm."

"Don't panic, can you move?"

"Yes."

"Move horizontally and try..."

"It can... But I can't lift it..."

Lin Feng's brows furrowed.

The left upper limb score is level 2, it seems that although he has done relevant prevention, he still caused cerebral infarction.

The good news is that the right hand, left and right legs are fine, grade 5, normal state, indicating that the cerebral infarction is not serious.

(Level 0 is unresponsive, Level 1 is able to flutter, Level 2 is level, Level 3 is anti-gravity, and Level 4 is resistant to external resistance.) ）

"I'll send you for an MRI test later, and a brain CT to see how it goes..."

"Yes, Doctor."

Lin Feng prepared to send the patient to the imaging department for examination.

However, there are too many imaging patients, and it will not be time to do it until tomorrow morning.

In this regard, Lin Feng can only leave work first,

Wait until tomorrow to go for a check-up...

"Hope it's okay..."

Lin Feng thought of the cute little girl's sad and crying look, and he was very distressed, and he didn't want her to lose the pillar of the family...

——————————

ps: Many book friends say that there are fewer updates: to emphasize again, although there are 3 chapters, the word count is three or four thousand words, I must have more than 6 chapters when I take it apart, I am just lazy to score chapters.

Today: 3500+3800+4100=11400 words.

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