Chapter 113 Hepatic portal block (please vote for me)
Hmm!
Sixteen beds, isn’t it her? He looked at Wu Xiaofu's figure who had already run out of the observation room, and then looked at his bed number. He was not the one he was talking about.
Didn’t you just say that you can’t decide whether to leave the hospital or not? That’s enough?
Recalling that the nurse just said that there was a car accident patient, Qing Yue still didn’t know what Wu Xiaofu meant. This was to make room for himself, you bitch.
Ten minutes later, the ambulance stopped and the patient was pushed into the emergency room.
"The patient is a 40-year-old female. She was injured in a car accident for half an hour. She is in deep coma, her blood pressure cannot be measured, her abdomen is distended, and she is breathing like a nod..."
The doctor following the car quickly reported the condition, Duan Hao nodded and led Wu Xiaofu into the rescue room.
The doctors and nurses in the rescue room are all skilled in the initial procedures, including endotracheal intubation, ECG monitoring, ventilator, establishing intravenous access, and rehydration...
Such a serious patient is in the ambulance. The established intravenous access is no longer enough. Two accesses, or even more, are required.
The endotracheal intubation was inserted directly, nodding breathing was performed, and the blood pressure could not be measured. Although I don’t know if the lungs had any serious damage due to the car accident, I am afraid that non-invasive breathing can no longer keep up. Now it is life-saving, and it must be carried out. If you think about it, Duan Hao is the executive deputy of the emergency department, so he can skip the process and operate directly based on experience.
Wu Xiaofu had already picked up the stethoscope and came to the patient. After listening carefully, he breathed a sigh of relief. The breathing sounds in the chest were normal, and there should be no problems with the lungs. He checked the pupil size again and performed brain physiology. Pathological reflex examination, fortunately, the problem is not serious, and serious brain injury can be ruled out.
He nodded to Duan Hao, who knew what he was doing.
As soon as he stretched out his hand, the gloves were already handed to his hands. Unknowingly, Wu Xiaofu and the nurse in the emergency department also had some tacit understanding.
The patient's abdomen was exposed. After the nurse disinfected the patient's abdomen with iodophor, Wu Xiaofu had already taken out the syringe from the open puncture bag and pierced the patient's abdomen.
There is a visible increase in red liquid in the syringe.
The situation that needs to be dealt with now has been determined. Hemoperitoneum and liver and spleen rupture can basically be determined.
The heartbeat has soared to 150, and the blood pressure has been fluctuating. This situation is a bit critical. The blood loss situation is probably not optimistic.
Duan Hao asked the doctors in the emergency room to quickly complete the tasks by replenishing fluids, expanding volume, and conducting examinations.
Duan Hao also directly mobilized the mobile CT to quickly conduct a full-body scan.
"The left lobe of the liver was lacerated, the spleen was ruptured, hemoperitoneum, pelvic fracture, bilateral femur fractures, all ribs were broken, the left radius and radius were fractured, and the humerus was fractured."
The buffs are stacked up.
"Call the orthopedics department, general surgery department, and anesthesiology department for consultation, and contact the blood transfusion department for blood transfusion."
The orthopedics department came, and I frowned when I saw it. The operation must be performed, but it needs to be seen. What orthopedics to do first? The most troublesome thing now is the pelvic fracture. However, it seems that the condition of the pelvis is not bad. If the pelvis is seriously injured and the bleeding is severe, it will not be as serious as liver and spleen bleeding.
It is certainly unrealistic to treat so many injured areas at once. The most important thing now is to save lives. The eyes fell on Duan Hao and Lian Jingwei. The main focus was on general surgery, which solved the rupture of the liver and spleen. , maintaining vital signs, and orthopedic surgery can be postponed.
Of course, he is indispensable in the operation. He is necessary to provide protection. If someone is missing, he can be a hook.
Outside the rescue room, the patient's family members had already arrived. As soon as Wu Xiaofu came out, they were surrounded. Five or six family members, one after another, heard voices in Wu Xiaofu's ears, which made Wu Xiaofu feel a little dizzy.
The patient was riding an electric bike and was knocked down by a truck. Because it was a blind spot, the patient was riding fast and the truck was not slow either. It even knocked the patient out. Fortunately, he was wearing a helmet. , otherwise, it is unknown whether he will have the chance to go to the hospital. The moment he was knocked away, the handlebar hit his abdomen, which may be the main reason for the rupture of the liver and spleen.
"The patient is seriously injured, with ruptured liver and spleen, massive bleeding, and severe fractures all over the body. We must perform surgery as soon as possible, which may be able to save a glimmer of life. Which of you is the patient's immediate family member, come and sign the consent for the surgery with me. Book. ”
A glimmer of hope!
Several family members immediately became quiet, it was so serious.
“I am her husband, I will go.”
In the medical office, the patient’s husband could not stop shaking, and his voice was full of vibrato. Wu Xiaofu was like this. After explaining, how could he not know that this time it was really serious and he needed to fight the King of Hell for people.
Wu Xiaofu looked at the patient's husband and felt a little unbearable, but the condition was like this, and no matter how serious the condition was, it could not be exaggerated.
And I would rather give a serious explanation than avoid the important ones and take the easy ones. Otherwise, no one will know the consequences.
The consent form was quickly signed, the operating room was ready, and the patient was quickly sent to the operating room.
When I walked out of the medical office, I happened to see Qing Yue being pushed out by the assistant. After seeing Wu Xiaofu, I wanted to complain a few times, but Wu Xiaofu didn't give him a chance at all. He glanced at her and said directly Heading to the operating room, Jiang Qingyue was very angry.
"Man, I remember you."
In the operating room.
Duan Hao, chief physician of the emergency department, Lian Jingwei, chief physician of general hepatobiliary and pancreatic surgery, Gao Yang, chief physician of orthopedics, and Liu Wengui, anesthesiologist, as well as Wu Xiaofu, patrol desk, and equipment were all in place.
After the evaluation, the patient's anesthesia condition was actually not ideal. After all, the blood pressure was difficult to measure and the heart rate was difficult to control. After the blood transfusion, the situation did not improve much. In this case, the risk of anesthesia was too high.
However, at this time, the surgery is urgent.
Liu Wengui could only bite the bullet. Fortunately, Liu Wengui was also an experienced anesthetist, so he was still somewhat sure. Anesthesia is completed.
Duan Hao was the one who performed the abdominal dissection. Yes, it was Duan Hao who performed the abdominal dissection. Even Jingwei had to take half a step back in front of Duan Hao.
Wu Xiaofu was responsible for retracting the hook. As soon as the skin and muscles of his abdomen were cut open, blood clots blurred his vision.
Wu Xiaofu hurriedly performed suction to remove the blood clots and blood accumulation in the abdominal cavity.
The field of vision was slightly clearer, and everyone was shocked. There were two long large cracks in the left lobe of the liver. Compared with the damage to the spleen, the damage to the liver was the most serious at this time.
Among abdominal injuries, liver injury is undoubtedly the most terrifying. After all, liver injury causes the largest amount of bleeding.
"Vascular Blocking Band."
Wu Xiaofu stared with wide eyes. He already vaguely understood what Duan Hao was going to do.
“I’m just Wu Mengchao!”
Say the easiest words and do the greatest things.
Duan Hao worked very quickly. The blood vessel blocking tape wrapped around the freed hepatoduodenal ligament and tightened it several times before fixing it.
Hepatic portal block!
Intermittent portal blockade at normal temperature can be said to be good news for many patients with liver damage. This technology can be said to have given many fatal liver surgeries a chance and made many dangerous liver surgeries less likely to be fatal. Be relatively safe.
When performing liver surgery, the most important thing to consider is bleeding.
Just like when performing leg and arm surgery, a tourniquet must be used to stop the bleeding. The same principle applies to Duan Hao's current portal block.
But the truth is that there are not many people who can do this. Wu Xiaofu didn’t know it before, but it’s different now. After seeing it again, Wu Xiaofu felt that this technique was almost surpassed by his Once he has mastered it, next time he comes, he should be 80 to 90% sure to copy it successfully.
This operation was really not in vain. This technology alone is enough for him to use for the rest of his life.
"Xiao Fu, record the time."
Wu Xiaofu immediately took a look at the control panel in the operating room. The time for the hepatic hilar blockade must be released every fifteen minutes at most, but he did not dare to delay.
Usually double recording is done. Wu Xiaofu is facing the control screen in the operating room and looks up from time to time. The patrol station must also be recorded together to prevent anyone from forgetting.
As expected, the bleeding in the liver was temporarily controlled, and the vision became much clearer in an instant. The next step is to follow the steps.
The blood clots and inactivated liver tissue in the tear are removed, the liver tear is sutured, and the omentum is packed to stop bleeding.
After untying the blood vessel blocking band, the bleeding was under control. At this time, several people breathed a sigh of relief, and the patient's blood pressure began to rise. Lian Jingwei began to treat the spleen, and the damage to the spleen must be treated in time. Although the spleen is currently bleeding The amount is not too large. If there is no liver bleeding, you may consider bed rest and observation for a period of time.
But now that the abdominal cavity has been opened, removing the spleen and eliminating hidden dangers is the best choice.
After all, depending on the patient's condition, the possibility of major bleeding in the later stage is still high. Life-saving is the most important thing, and we still can't take chances and lose the big for the small.
Gao Yang, chief physician of the Department of Orthopedics, saw this situation and praised him. Duan Hao and the others were so fast. He could handle the pelvis and femur simultaneously.
The pelvis is directly fixed with an external fixator.
Femoral fractures require external traction, while fractures of the radius and ulna and humerus also require temporary external fixation.
Wu Xiaofu was helping Gao Yang. Seeing how neatly Wu Xiaofu cooperated, Gao Yang couldn't help but praise, "Xiaofu specializes in emergency medicine?"
Duan Hao looked at him alertly. Come here, "Lao Gao, don't make up your mind, this is an emergency."
Gao Yang was also stunned when he heard this. This is too sensitive, so he just asked. However, the more this happens, the more it shows that Wu Xiaofu What a talent. It seems that after returning home, we need to find out what is going on with Wu Xiaofu.
"Warm saline, metronidazole irrigation, double cannula and drainage tube preparation."
The abdominal cavity is flushed, double cannulas are placed at the site of liver injury, and a drainage tube is left.
The nurse checks the instruments and gauze.
Wu Xiaofu is close to his belly.
When the skin suturing was completed, Wu Xiaofu couldn't help but sigh, it was too fast and efficient. Such a serious operation could be done so easily and comfortably. As expected of a big shot.
Asking for monthly tickets and recommended votes.
(End of this chapter)