Start From Emergency Doctor

Chapter 250

If you change to any other person, I am afraid you will make the same choice as Zhou Yuan.

“Take care of it?”

In the operating room, He Jianyi looked at Zhou Yuan who had finished the preoperative preparations behind him, and he sighed with relief.

Zhao Han’s situation is only better than Duan Hongwei, but it is also enough to be marked as black-endangered patient.

He Jianyi and the ocean are very nervous.

Craniotomy is not something an emergency doctor can do. It is a high-tech technique. The two of them can only wait for Zhou Yuan to come.

“Get ready to start surgery.”

Zhou Yuan sorted out his mood, put on the surgical gown with the help of the nurse, and came to the operating table.

Zhao Han closed his eyes tightly at this time and his expression was very painful. Although he was still in a coma, his heart rate and blood pressure had stabilized after He Jianyi and Haiyang rescued him.

“Heart rate is 40, blood pressure is 131/69!” The anesthesiologist reports.

The normal heart rate is 60-100 per minute, and less than 60 can be judged as bradycardia. The high blood pressure of normal people is between 120 and 139, and the low pressure is between 80 and 89. All of Zhao Han’s are in a dangerous state, but at least temporarily out of danger.

In the case of massive blood loss, skull injury, and spinal injury, it is impossible for Zhao Han to maintain a normal heart rate and blood pressure.

“We have checked the preoperative skin test and the history of allergies, and it is no problem. The family members have also completed their signatures.” Haiyang said.

Zhou Yuan nodded relievedly.

“Anesthesiologist, start anesthesia!”

For the craniotomy of the posterior fossa, the general anesthesia method is tracheal intubation.

Of course, local infiltration anesthesia can also be used during nerve root cutting and neurovascular decompression. This method can facilitate the observation of the effect during the operation.

The anesthesiologist chose general anesthesia for tracheal intubation.

Because Zhao Han not only performed the posterior fossa craniotomy, but He Jianyi also performed spinal repair.

“Side position.”

After Zhou Yuan finished speaking, he turned Zhao Han over with He Jianyi, Haiyang and others.

The movements of the three were very light, for fear that the sudden movement would cause the displaced spine to contusion other tissues and cause more serious sequelae.

After the lateral position and anesthesia were completed, Zhou Yuan and He Jian glanced at each other. Zhou Yuan said, “Start the operation!”

With that said, Zhou Yuan picked up the marker and chose to make an incision.

The volume of the posterior fossa is small, and important structures such as the brainstem, posterior cranial nerves, and vertebrobasilar arteries are all distributed here. If the opening is improper, damage or excessive traction may occur during the operation.

Therefore, the incision design during craniotomy is very important, and it must be accurately positioned before surgery, and the surgical approach must be designed to meet the needs of the surgical operation.(Read more @ wuxiax.com)

Zhou Yuan’s face was serious.

The scary thing about skull injury is not the fracture of the skull itself.

The skull is a bony shell resembling a spherical shape, which protects and contains the contents of the cranial cavity-mainly to protect the human brain.

There are very few blood vessels and nerves on the skull, just a few combined bones. However, once the skull fractures, it will often cause concurrent damage to the contents of the cranial cavity.

Depressed or comminuted skull fractures are the most serious, which can damage the meninges and brain, and can also cause rupture of cerebral blood vessels and nerves. ,

Therefore, the harm of skull injury is not in itself, the secondary injury caused by fracture is much more serious than the fracture itself!

This is why Zhou Yuan is cautious.

“Brother Haiyang, puncture into the posterior corner of the lateral ventricle to place a drainage tube!”

After speaking, Zhou Yuan picked up the scalpel and prepared for a craniotomy.

As Zhao Han suffered an intracranial injury, it is likely to be accompanied by obvious intracranial pressure increase and obstructive hydrocephalus, which will affect the exposure and operation of the surgical site, so a drainage tube needs to be placed to drain the hydrocephalus in the brain.

In order to save time, Zhou Yuan intends to puncture the craniotomy.

The ocean nodded and immediately ran over to start the puncture.

Zhou Yuan chose the midline incision. After marking the incision line with gentian violet, Zhou Yuan quickly performed routine disinfection, and then covered the single towel with the incision film to fix the single towel on the skin.

“0.25%～0.5% procaine with adrenaline added!” Zhou Yuan said solemnly.

Procaine is a local anesthetic. After adrenaline is added, procaine is used to infiltrate each layer of tissue along the incision line, and 5~10ml of procaine is injected equidistantly on both sides of the incision line to reduce Bleeding during the operation facilitates the separation of muscles.

Zhou Yuan picked up the needle tube and pierced the long needle into Zhao Han’s skull that had been given by Ricoh, and injected them on both sides of the incision until the lamina of the first and second cervical vertebrae stopped.

“The puncture is complete, and the drainage tube is placed!”

Sure enough, a little red water was drawn from the drainage tube…

Zhou Yuan nodded, took the scalpel, cut the skin and subcutaneous tissue in the middle, and then quickly ligated the bleeding spot to prevent excessive bleeding.

After incising the skin and subcutaneous tissue on the surface of the skull, Zhou Yuan cut the periosteum above the extraoccipital carina, extending it all the way down, bypassing the extraoccipital carina, leaving behind the diamond-shaped fascia at the carina— —This is to facilitate the alignment suture of the periosteum here after surgery.

“Periosteum dissector.”

A scalpel cannot be used for craniotomy, and special equipment is required, which is why Zhou Yuan emphasizes the preparation of craniotomy tools.

Zhou Yuan took the periosteal stripper and stripped the muscles and tendons attached to the occipital bone to both sides, pushing them to both sides.

“Automatic retractor.”

Zhou Yuan placed an automatic retractor at the incision, and at the same time he electrocoagulated the muscles next to him to stop bleeding.

The automatic retractor is a surgical instrument used to retract the tissue and expose the area to be operated on. It is actually a retractor. The automatic retractor can save the assistant and reduce the burden of the surgeon.

Soon, the small incision was opened by the retractor.

After completing the incision, the next step is to perform a fenestration of the skull.

A small incision cannot provide a surgical field of vision and a good operating space, and a bone window must be opened.

“Drill.” Zhou Yuan said succinctly.

Because Zhao Han was in a lateral position, the drill could not drill vertically into the surface of the skull. Zhou Yuan placed a bone pry below to prevent the drill from sliding down and causing damage to other parts of the skull. This would cause the drill to cut the scalp. No more skin or hair can grow here.

Soon, Zhou Yuan drilled a hole in the occipital squama on Zhao Han’s left side, and the finely divided skull powder fell off, especially infiltrating.

The scope of the bone window extends from the outer trochanter and the lower edge of the transverse sinus of the skull, left and right to the posterior edge of the mastoid process, and extends below to the posterior edge of the foramen magnum.

“Just drive like this?”

The ocean was a little surprised.

The bone window opened by Zhou Yuan is not large. If you switch to another brain surgeon, you can’t operate it at all!

He Jianyi raised his head, but was also shocked.

However, before he could speak, Zhao Han’s cut back suddenly heard a soft noise.

It’s the sound of bones bursting…

The expressions of Zhou Yuan, He Jianyi and others changed drastically.

“Teacher, what’s the matter?!” Zhou Yuan asked palely.

Did He Jianyi make a mistake? .