When doctors have a simulated operating room

"Replacement?" "Well, I've looked around and you're the only one left." Before Zhang Yi could say anything, Zhang Shengwei pleaded again: "Hey, can I treat you to a meal when I come back? I really have something to do, just consider it a favor." "Okay, okay, remember to hand it over to me before you leave." Zhang Shengwei is also a generous person, and Zhang Yi happened to have nothing to do. He helped. "Haha, OK, I'll treat you when I get back from vacation!"

Zhang Yi smiled and waved his hand:

"Come on, no need."

...

In the afternoon, just after treating an old lady who was coughing up blood, a burst of urgent whistles sounded at the gate of the hospital again.

"Doctor Zhang, there is a serious car accident at the gate! Transferred from another hospital." The nurse walked in and said anxiously.

As soon as they heard that it was a car accident, the other two doctors in the emergency room next to them became nervous instantly.

In the emergency room, who wouldn't sweat when hearing the words "serious car accident"?

"Prepare the rescue drugs, and bring the bedside ultrasound machine and blood gas analyzer!"

After thinking for two seconds, Zhang Yi began to prepare in an orderly manner.

Serious car accident, Zhang Yi already had a picture in his mind just by hearing these words.

The first is blood loss.

Whether it is internal bleeding or external bleeding, most car accidents involve blood loss.

Therefore, a bedside blood gas analyzer is a must, which can quickly detect important values ​​such as the amount of hemoglobin, blood oxygen, pH, and carbon dioxide partial pressure in the patient's body.

B-ultrasound machine is also a must, which can immediately see whether the internal organs are damaged.

The nurse had just prepared the things when the door of the emergency room was pushed open.

"Make way! Who will take over in your emergency room?"

Zhang Yi pushed the cart to the bedside and said, "I'll take over. What's the patient's condition?"

Seeing that it was Zhang Yi on duty, the emergency doctor's nervousness was relieved a lot.

"The patient was injured in a car accident and was directly run over by a large van. The accident happened an hour ago. This is the CT and blood gas of our hospital. It is currently suspected that the pelvic fracture is suspected, and there is bleeding, but the bleeding point has not been found yet."

"The peripheral blood vessels have deflated, and liquids can hardly drip in. Our hospital probably can't save him, so we transferred him to your Union Hospital."

After the emergency doctor finished speaking, he looked at Zhang Yi with some admiration.

Finally I met Zhang Yi in person.

My male god~ You are so handsome~!

But at this moment, Zhang Yi had no time to care about others. He held the CT scan in one hand and the blood gas analysis results in the other hand while telling the nurse: "Prepare for central venous catheterization."

"Okay!"

Not to mention the blood gas test report in his hand, just looking at the patient's painful mask and pale face with cold sweat, you can tell that the patient has lost a lot of blood.

The blood gas value shows that the hemoglobin has dropped to 8.5.

The normal hemoglobin value is between 11.5-17.8.

This person has dropped by 3 points, so the amount of bleeding is about 600 ml.

But looking at the patient's condition, the amount of bleeding seems to be more than 600.

So Zhang Yi turned around and asked, "How long has this blood gas report been done? Did your hospital take any rescue measures after taking over?"

The emergency doctor shook his head: "This report is about an hour old, and it was done right after admission. As for rescue measures... there are none. As soon as the CT came out, the whole pelvis was broken, and our director immediately asked to transfer to another hospital."

Zhang Yi secretly said that it was not good and hurriedly ordered: "Quickly do another blood gas analysis for this patient!"

"Okay!"

The blood gas analysis from an hour ago is no longer of much reference value.

Just at this time, the emergency kit for central venous catheterization was also brought over.

Generally, for patients with a large amount of blood loss, peripheral blood vessels are easily deflated.

After blood loss, blood pressure drops and blood vessels cannot be filled.

During rescue, if the venous channel is established late, the needle cannot be inserted.

So Zhang Yi directly chose central venous catheterization.

Directly inserting the needle into the central vein close to the heart can quickly and massively replenish the body's blood volume in a short time.

The central vein is a section of the middle blood vessel near the superior vena cava and the inferior vena cava.

The puncture point is the jugular vein.

Zhang Yi put on gloves and looked at the female patient and shouted:

"Qi Fang?? Can you hear me? Qi Fang?"

The female patient was probably in her forties.

Her whole body was pale due to blood loss, but fortunately she was not unconscious.

She groaned in pain:

"It hurts...it hurts me

. ”

Hearing the answer, Zhang Yi felt relieved: "I'm going to give you an injection in your neck, can you bear it for a while? I'll give you anesthesia."

"Hold on, your family hasn't come to see you yet, you have to hold on, okay? "

Zhang Yi started the operation while chatting with the patient to distract her attention.

Another doctor in the emergency room was also doing a blood gas test.

The doctor in the orthopedic surgery department and the doctor in the ultrasound room were also notified.

For such a serious pelvic fracture accident, it is probably not enough to call an orthopedic surgeon.

You have to call the gynecology department!

In addition to being a link between the spine and the lower limbs, the female pelvis is also a warm room for the uterus and life.

The wheel ran directly over the pelvis, and it is estimated that several reproductive organs inside were broken.

From the limbs, the patient did not have any traumatic wounds that caused heavy bleeding.

The bleeding must be inside.

In addition to several large arteries, the blood supply to the female reproductive organs is also very rich.

So, the bleeding points of this female patient are in these reproductive organs!

"Ah... It hurts! It hurts!"

The female patient was no longer conscious at this time, but fortunately she still knew to scream in pain.

"It will stop hurting soon. "

Zhang Yi comforted her while slowly injecting lidocaine.

Then he looked up at the blood pressure value on the ECG monitor: 100/60mmhg.

But Zhang Yi felt that the blood pressure might not be that high.

"Give me the interface of the pressure sensor, and measure the blood pressure again."

After the central venous catheter is placed, the pressure sensor can be connected to the interface and then connected to the ECG monitor.

This blood pressure value is much more accurate than the one measured by tying it to the arm.

Because this is a direct measurement of the blood flow pressure of the right heart return blood volume.

"Good!"

One minute later, the blood pressure came out.

"Damn! 72/40mmhg! "

A doctor nearby exclaimed!

Just now everyone thought that the amount of bleeding was not big, after all, the blood pressure showed 100/60!

Who knew...

The actual data was actually as low as 72/40!

Zhang Yi did not delay any longer, and after fixing the indwelling needle interface in the neck, he began to give medical advice:

"18mg of norepinephrine is pumped in with a micro pump! And 1g of calcium chloride! Hurry up!"

"Okay, 18mg norepinephrine plus 1g calcium chloride, micro pump!"

"Yes, hurry up!"

At this time, the doctor in the B-ultrasound room had not come yet, but Zhang Yi could not wait and went on himself.

Although he could see the condition of the patient's internal organs with his naked eyes, others did not know.

Seeing Zhang Yi's operation, others were stunned.

"Zhang Yi... The B-ultrasound doctor has not come yet, do you want to do the B-ultrasound yourself? !"

"Yes, there is no time, I will do it myself!"