Chapter 410: Nothing happened because not enough surgeries were done
"What's wrong, Xiao Zeng?" Wang Guohua asked.
"Old Director Guohua, the patient's PETCO2 suddenly rose to 58mmHg. It's okay. Just do your thing and give him two mouthfuls of pure oxygen."
Is this really the case?
Wang Guohua's hand gradually paused.
He tried to recall every detail from the moment the patient lay on the operating table.
From anesthesia to surgery, he went through it quickly, but Wang Guohua didn't find any problems. Everything was very standard. At least with his technical level, he didn't find anything that was not taken care of.
The patient's preoperative pulmonary function test was also normal and should not be caused by geriatric diseases.
So why?
Wang Guohua looked at the anesthesiologist, who had switched to pure oxygen inhalation and manual assisted ventilation to speed up the discharge of CO2.
A few minutes later, the anesthesiologist took an arterial blood gas analysis.
pH7.174, PaCO286mmHg, PaO2144mmHg, K+4.03mmol/L, HCO-330.9mmol/L, BE0.21mmol/L, Lac1.2mmol/L.
The operating room is really different now than before. The results of blood gas analysis can be obtained in a few minutes. Wang Guohua was worried and sighed in his heart.
How could the anesthetist when I was young have such good conditions?
Even general anesthesia at that time did not even have a ventilator. The anesthesiologist pinched the ball the whole time, which was a strenuous job.
After an operation, the anesthesiologist was so tired that he had cramps.
"Old Director Guohua, if we don't suspend the operation, the patient's carbon dioxide partial pressure is still high."
Wang Guohua did not say no, but followed the advice of anesthetist Dr. Zeng to stop pneumoperitoneum.
"Xiao Zeng, what's going on?"
"I don't know. It may be a transient reaction. I have never seen anything like this before." The anesthesiologist replied.
Wang Guohua was silent.
He had some experience with anesthesia, which was because he had seen too much, but when it came to the deeper content, Wang Guohua was a little confused and started to scratch his head.
Just wait.
Wang Guohua is good at what he does.
Anyway, it was a major operation, and there would be a pause of more than ten or twenty minutes in between.
"Xiao Zeng, have you never encountered a similar situation?" Wang Guohua asked.
"Well, I haven't encountered it before." the anesthesiologist replied.
"How long do we have to wait?"
The anesthesiologist didn't speak, just lowered his head silently.
Wang Guohua also knew that this kind of thing could only depend on the situation, and no one was completely sure about which minute or second the time would be.
The atmosphere in the operating room was a bit depressing, and Wang Guohua started to chat.
You can't just not talk face to face. Chat for a while while waiting, so as to avoid being too nervous and causing technical deformation during the operation.
After all, Wang Guohua is an experienced practitioner, and he is already very good at mastering the rules in this area.
"Xiao Zeng, how is your health now?"
"It's okay. As long as I don't do too heavy work, it'll be fine. The director also took good care of me and didn't arrange emergency room for me during the night shift." The anesthesiologist smiled.
When he was a child, he was walking on the roadside and encountered a truck pulling steel pipes in a mining area. The car stopped suddenly, and a steel pipe flew out and hit Dr. Zeng in the stomach, rupturing his liver.
At that time, Wang Guohua performed the surgery and cut off 1/3 of the liver. At that time, the mining area also organized people to donate blood.
After all, the mining area is a state-owned enterprise, and it is much easier and more open-minded to encounter such things than private individuals.
After bearing all the medical expenses, blood transfusion expenses, nutrition and other expenses, the leader gave two suggestions - one was to wait until Dr. Zeng grew up to go directly to the mining area to sit in an office, and the other was to give him a sum of money.
Dr. Zeng’s family had high expectations for him, so he chose the latter.
When Wang Guohua learned about this incident, he was a little slanderous.
But I didn’t expect that one day, when I was undergoing laparoscopic-assisted transanal total mesorectal excision under general anesthesia, I would point to my former “patient.”
This can be regarded as a kind of fate.
"Well, the emergency department is really tiring. You anesthesiologists look relaxed, but in fact you are terribly tired. In recent years, several anesthesiologists have been exhausted to death, so you should be careful."
"Oh, I'm on a pirate ship." The anesthesiologist sighed, "When I had an operation, the anesthesiologist opened and closed my eyes. You know, Mr. Guohua. I was young at that time and was deceived. Who knew the anesthesiologist? So tired.”
Wang Guohua smiled.
Tired, that is for responsible doctors. If you are a fishy doctor, you will not be too tired.
This life is a conscientious life.
The chat lasted for 10 minutes. The anesthesiologist said, "Old Director Guohua, the partial pressure of carbon dioxide has dropped. Please inflate again."
Wang Guohua's originally tense mood suddenly relaxed a lot, and he breathed a sigh of relief, but he didn't show it.
When performing surgery, especially difficult surgery, one must have Dinghaishenzhen.
I am panicking, and I am panicking from top to bottom. Even small operations that usually seem simple will become difficult.
"I just said it's okay." Wang Guohua's voice was like a bell, and he glanced at the person sitting in the medical office in the corner of the operating room from the corner of his eye.
Wang Guohua knew that he was here to watch his surgery, but he didn't say anything or do anything. He couldn't force him to leave.
Besides, people came here under the pretext of promoting general surgery, so it was hard for me to turn them away.
“Dududu~~~”
“Didi di di~~~”
Suddenly the alarm sounded like crazy.
"What's going on!" Wang Guohua was shocked, his voice thick and buzzing in the surgery room.
But his voice did not cover up the alarm sound of the monitor. The alarm sound was sharp and noisy, directly touching people's hearts.
The anesthesiologist didn't say anything. He picked up a medicine with one hand, pressed it with his thumb, and broke the medicine. He held a syringe in the other hand and began to concentrate on withdrawing the medicine.
The monitored arterial pressure dropped to 78/47mmHg, and the central venous pressure rose to 31cmH2O.
Wang Guohua's mind was buzzing when he saw it.
Bleeding?
As soon as the idea came up, Wang Guohua denied it.
This is not the case with hemorrhagic shock. It must be another problem.
Unless it encounters a large artery such as the abdominal aorta, blood pressure will drop gradually, and there is no reason for a cliff-like drop.
But what is going on? Wang Guohua was a little confused.
He boasts that he is extremely skilled in laparoscopic surgeries and can successfully perform various surgeries including severe adhesions.
That's why Wang Guohua dared to perform such a difficult operation.
But Wang Guohua has never seen this situation before. What's going on? !
The partial pressure of carbon dioxide was a little high before. After waiting for 10 minutes, it returned to normal. The anesthesiologist also confirmed this.
Why does my arterial blood pressure suddenly drop when I pump up the air?
"Xiao Zeng, what did you give me?" Wang Guohua pretended to be calm and asked the anesthesiologist.
"Ephedrine."
However, the anesthetist opened the three-way connection and administered 12 mg of ephedrine, but the blood pressure and heart rate did not change significantly.
"Director Guohua, I'm doing cardiopulmonary resuscitation." the anesthesiologist said in a deep voice.
He opened the sterile drape covering his chest, stepped on the footstool with a standard CPR hand, and immediately performed cardiopulmonary resuscitation.
"Adrenaline, 1mg!" Wang Guohua shouted loudly.
The nurse immediately administered 1 mg of epinephrine intravenously through the central venous catheter.
Wang Guohua only relied on instinct to save him. He didn't know the cause of the disease.
If you don’t know the cause, you can only treat the head when it hurts and the feet when it hurts.
Adrenaline, New Sanlian, Respiratory Sanlian, and hormones are all useful, but to what extent Wang Guohua is not sure. He only hopes that the patient will have a stronger character.
It's a bit absurd to place hope on the patient's horoscope at this time, but...who else can Wang Guohua rely on?
But the reality is completely opposite to what Wang Guohua hoped.
Within 1 minute, ventricular fibrillation appeared on the electrocardiogram.
It seems that the patient's horoscope is average.
"Prepare the defibrillator!" The anesthetist's voice trembled, and he was extremely nervous.
"How much energy?" the nurse asked as she prepared.
"Asynchronous electric defibrillation, two-way wave 200J!" came a familiar voice.
The airtight door of the operating room opened a gap, and Luo Hao walked in sideways, wearing a mask.
"Luo..."
"Continue chest compressions, I'll do it."
Luo Hao completely ignored Wang Guohua. After explaining to the anesthesiologist, he held the defibrillator in both hands, applied coupling agent and wiped each other. Luo Hao winked at the anesthesiologist.
The anesthesiologist removed his hand.
"Bang~~~"
The patient's body trembled.
Another figure squeezed the anesthesiologist out, "Brother Zeng, you push the medicine, and I'll do the compressions."
It's Chen Yong!
The anesthesiologist almost stopped crying when he saw Luo Hao and Chen Yong coming in.
A strong sense of security lingers in my heart.
"Bang~"
The second defibrillation was over and the ventricular fibrillation disappeared. Chen Yong didn't say much. As Luo Hao took away the defibrillator, he started to perform compressions.
"Nicardipine 1mg, intravenously."
"Epinephrine, 1 mg, intravenously."
"Dexamethasone, 10mg, intravenously."
Luo Hao kept giving medical orders, and the anesthesiologist pushed the medicine into the tube as quickly as possible.
Fortunately, Wang Guohua was well prepared before the operation. He even monitored the central venous pressure and pushed the medicine very quickly.
"Position, adjust to left-leaning position."
"Is there any ice cap? Hurry up and put it on the patient. Run! Hurry up!"
"Nicardipine 1mg, intravenously!"
Luo Hao held the defibrillator in both hands and stood in front of the patient, observing the various numbers on the ventilator and monitor, and constantly giving medical instructions.
7 minutes flew by in the blink of an eye.
The patient finally regained his spontaneous heart rate.
But this is only temporary, and the patient may have problems again at some point.
"Take a blood gas and give 250ml of 5% sodium bicarbonate."
"50ml syringe."
Luo Hao stretched out his hand, but it fell empty.
Oh oh oh, this is not Concorde, Luo Hao felt a little regretful. Turning around and taking a pair of No. 8 sterile gloves, Luo Hao tore them open and put on the gloves.
The anesthesiologist just tore open the outer packaging of the 50ml syringe and handed it to Luo Hao.
After connecting the central venous catheter, Luo Hao's hand paused for a moment, and then pulled the catheter out 1cm.
What is he going to do?
Wang Guohua was wearing sterile clothes, his gloves were covered in blood, and he looked at Luo Hao blankly.
Black-red blood was drawn out, along with a large number of bubbles.
bubble?
bubble!
Wang Guohua suddenly thought that the patient's financial situation might be caused by carbon dioxide.
But he has performed thousands of laparoscopic surgeries, and has never experienced an air embolism accident due to pneumoperitoneum as mentioned in the paper.
After all, it is a rare situation, and it cannot be said that it will always happen.
If air embolism often occurred during laparoscopic surgery, the procedure would have been discontinued long ago.
What a bad luck, Wang Guohua thought to himself.
It must be Lin Yuming who came to "supervise" the contact between his staff from the Medical Department, but what about Luo Hao and Chen Yong? Why do they appear together? !
Did Lin Yuming guess that something would happen today?
While Wang Guohua was in a daze, Luo Hao had already drawn out about 150ml of blood foam with a 50ml syringe.
"Record, about 150ml of blood containing a large number of bubbles was extracted through the central venous catheter, including about 100ml of gas."
There was silence in the operating room.
"Brother Zeng?" Luo Hao turned his head.
"Ah? Is this an air embolism?" the anesthesiologist asked.
"Well, establishing air embolism caused by pneumoperitoneum, remember what I just said." Luo Hao's tone was not as anxious as during the previous rescue, and became much gentler.
"Oh oh oh." The anesthesiologist quickly recorded.
Wang Guohua's face looked extremely ugly.
He believed that Luo Hao was pointing the finger at himself.
"Director Guohua, don't worry, it's just a normal complication." Luo Hao looked at Wang Guohua and explained gently, "I looked at the electronic medical record and it was written in the pre-operative instructions. The patient is fine. I will observe him for 30 minutes and then switch to surgery. ”
Although Luo Hao's tone was gentle, it was full of the majesty of a superior doctor, especially the last sentence about the operation was not a question, he did not discuss it with Wang Guohua, but... a notice.
"Ronald..." Wang Guohua felt a little embarrassed and wanted to say something, but for a moment he didn't know where to start.
"It's okay, Director Guohua, similar situations will happen as long as there are too many surgeries." Luo Hao smiled, "Observe for half an hour. If there is no problem, you can go and explain to the patient's family, and the hospital will not worry about it. .”
"..." Wang Guohua was silent.
But behind Luo Hao was Lin Yuming.
"Luo Hao, please contact your medical office. I will send you a letter and ask for an emergency consultation during the operation. Are there any other procedures?" Lin Yuming asked.
"This is enough, there are no other procedures. Then I will contact Director Feng, and you will contact Director Feng."
"Dean Lin." Wang Guohua subconsciously stood up.
"Old Director Guohua, air embolism is fatal." Lin Yuming complained a little.
"But fortunately, Director Guohua prepared carefully and prepared a central venous catheter. Otherwise, it would have been delayed for two minutes if the tube had not been removed to pump out air." Luo Hao added.
The two of them, one is a pretty guy, and the other is a pretty guy, they are both very proficient, and they have been honed in for who knows how long.
Wang Guohua had long known how Lin Yuming and Luo Hao worked. What he cared about was not red faces and white faces, but what Luo Hao said - two minutes of delay.
Just two minutes?
Wang Guohua was a little confused.
"Luo Hao, is everything okay? Are you sure?" Lin Yuming asked.
"Well, I couldn't pump out the air anymore, about 100ml. Now the vital signs are stable. Just observe for half an hour and then operate." Luo Hao said easily, "Don't worry, I see that the patient's vital signs are now stable." No. ”
"How about we observe it for a while longer?" Lin Yuming was still frightened.
Lin Yuming almost had a heart attack when he first received a call from the department staff.
It has been a long time since the mine director had experienced a patient dying on the operating table, and Lin Yuming was still an old medical director, thinking that life was the most important thing.
It is different from those hospital leaders who have never done clinical work.
"Director Lin." Luo Hao smiled. In front of others, he spoke more formally to Lin Yuming, "Normally speaking, air embolism caused by establishing pneumoperitoneum will cause bleeding. According to the surgery of the old director Guohua, I estimate that it may It's venous bleeding.
Although it is just a vein, if the bleeding lasts for a long time, there will be more troublesome things. ”
Lin Yuming nodded and left the professional matters to Luo Hao. He just asked. These words were mostly meant for Wang Guohua.
Wang Guohua was silent.
Looking at the mess, I felt inexplicably sad.
I carefully prepared an operation with the intention of creating a new technique for the Donglian mine manager, but I didn't expect that it turned out to be a mess.
"Brother Ni, the surgeon is here." Luo Hao then greeted the doctor who performed the surgery.
Dr. Ni was so frightened that he was still unconscious. When he heard Luo Hao talking to him, he forced a smile and narrowed his eyes.
"Ronald, your rescue skills are really high. Air embolism, that's an air embolism." Dr. Ni praised.
"Haha, it happened."
"I remember that when you were a department clerk, you occasionally came to the operating room and helped deal with an orthopedic accident."
"It's also a coincidence." Luo Hao said it was a coincidence for the second time.
Really?
Neither Dr. Ni nor Wang Guohua thinks so.
Once is a coincidence, twice is it?
Facts have proved that this is because of Luo Hao's high level, just like today's rescue of air embolism.
Otherwise there is no way to explain it.
Dr. Ni was silent and looked at Wang Guohua. He had something to say, but now the only voice in Corey was Wang Guohua.
"Old Director Guohua, have a rest." Luo Hao turned around and moved the big white stool nicknamed "White Dragon Horse" to Wang Guohua, just like an ordinary little doctor who flatters him.
"It's a small problem, as long as similar situations have passed. This time we have experience, and we will have experience when we encounter it in the future."
"Again?" Wang Guohua smiled bitterly. Fear had already appeared in his heart and he was absolutely unwilling to do anything more.
Just do what you can do, and if you can't do it, ask the patient to go to a higher-level hospital. You are over sixty, why should you be so nervous?
If the patient died on the operating table, wouldn't he be looking for trouble for himself?
"It's harmful. It's because we don't do enough surgeries. As long as the amount of surgery is large enough, something will happen. It can't be avoided, not even for my family, Xiehe."
Chen Yong raised his head, then turned his head away.
"Hey, I'm not used to it, and my 912 call doesn't work either." Luo Hao changed his words, but it was still awkward.
"You went to 912?" Wang Guohua was startled.
"Not yet. It will take three or four years until the bamboo project is completed."
3 or 4 years sounds like a long time, but in fact it only takes a blink of an eye.
As for what level of doctor Luo Hao would be there, Wang Guohua didn't even dare to think about it.
Professor Xie He did not return to Xie He but went to 912. The conditions given were not good. What fool would go there?
Luo Hao asked Wang Guohua to sit down and returned to the side of the patient's head, staring at the various values without blinking.
Fortunately, Wang Guohua's pre-operative supervision was in place and he was extremely well prepared. For this kind of surgery, he even monitored the central venous pressure, which was a bit excessive.
But it makes rescue easier.
It seems that Wang Guohua's level is average, but he is really lucky, Luo Hao thought to himself.
"Ronald, are you already a professor at the First Hospital of the Medical University?" Dr. Ni asked.
Luo Hao nodded.
Dr. Ni was envious, but when he saw Luo Hao didn't speak, he didn't continue to ask.
At this time last year, Luo Hao was still working as a clerk in the Mine Directorate, but this year he became an expert. It seems that he will soon be on stage to stop bleeding and perform surgery.
I don’t know what Ronaldinho’s level is.
"Ronald, you can join us later." Wang Guohua asked Dr. Ni's question.
"Well, I'll go up and have a look." Luo Hao said with a smile.
"What do you think is the problem?"
"The 100ml of air that was extracted should not be arteries. It is considered to be veins, and it is a venous plexus. There was bleeding during the stripping. For the time being, it is considered to be the venous plexus near the prostate."
Dr. Ni lowered his head, not daring to say anything nonsense.
The anal position was done by Director Wang Guohua, and the prostate venous plexus was ruptured and bleeding. It was self-evident what Luo Hao meant.
Is it true or is it deliberately nitpicking?
Dr. Ni didn't know, but he didn't want to get involved.
Wang Guohua's face turned ugly, but he didn't talk nonsense.
The rescue of the patient with air embolism just now was witnessed. If Lin Yuming hadn't planted a "nail" beside him, what he would have been thinking about now was how to explain it to the patient's family.
The best way is to "pretend" that the patient is not dead yet, perform compressions all the way, and go to the ICU for more than an hour to give the patient's family time to accept it.
The appearance of Luo Hao reversed everything.
The patient's vital signs were stable. Although the operation was suspended, it was treated as if there was some technical problem. It was not a big deal if he was delayed for an hour.
Wang Guohua was thinking wildly, and Luo Hao continued to comfort him, "Old Director Guohua, it's okay. There is always a process at the beginning. There will always be differences between the imagination and the actual situation, and they are absolutely impossible to be the same."
The operating room was quiet, and it seemed that Luo Hao's words were a bit embarrassing.
"Yes." Chen Yong's voice came, "I discovered a very nonsense thing when I went to England."
"Oh? What's the matter?" Luo Hao skillfully caught Chen Yong's words.
"There was a magician who wanted to commit suicide. He bought a Locke 17 and shot 8 times in the head, but he was still not dead."
"Ah?!" Wang Guohua was startled.
Chen Yong distorted the style of his painting, jumping directly from surgery to suicide. He is still a magician and Locke 17.
Wang Guohua didn't know what type of gun the Lock 17 was, but it was nonsense that eight shots couldn't kill a person.
"That's when I realized that in China, putting a gun to the temple is nonsense. If you look at the movies made by Americans, they all commit suicide by swallowing a gun; or they put the gun to the chin."
"Yes, according to the ballistics, it will hit the brain stem directly, and the death will be painless. If it is the temple... the gun is less powerful, and it may not be possible to die."
"That's right, our hospital received a patient the year before last and his head was penetrated by a rebar. President Lin was the director of the medical department at the time and came to preside over the rescue. Ronaldinho, you were also there." Dr. Ni added.
"Yes, I followed up the patient after he was discharged. His quality of life was guaranteed and he had no problem taking care of himself." Luo Hao said.
Wang Guohua was a little confused and had not yet come out of the shadow of air embolism.
"Before 912, people were sent to the United States every year to learn the treatment of gunshot wounds, especially complex gunshot wounds. There was really no experience in the country. So, Mr. Guohua, don't worry, just do it."
Luo Hao took the topic back and comforted Wang Guohua.
Isn't he yin and yang himself? Wang Guohua was stunned.
"If you have any complicated problems in the future, you can tell me and we will open the show on the weekend. I will come back to see my mother and my uncle." Luo Hao smiled, "There is no expert consultation fee, and I won't go. I will stand below. Watch.”
"!!!"
Wang Guohua was speechless.
(End of chapter)