Chapter 35 Race against time
Even if the leg is amputated on the spot, Yang Ping does not want to take the matter lightly.
Clear away the debris next to it and place a waterproof sheet under your thighs.
Xiao Wu has clear steps and fast hands. As Yang Ping's assistant, he wants to be qualified.
The sterile bag is opened, sterilized, and then covered with sterile bottom sheets and sterile towels.
"Syringe, 10% lidocaine, saline, diluted one to one!" Xiao Wu had already handed it over.
There is no anesthesiologist, so local anesthesia is the only option.
How high-level local anesthesia skills are required to perform amputation under local anesthesia? Dr. Lu from the emergency department was sweating.
Local anesthesia is generally used for minor surgeries, such as small debridement and suturing, removal of small tumors, etc. If the dosage is too small, the purpose cannot be achieved; if it is too large, it may lead to narcotic poisoning. There was once a hospital where a ganglion cyst on the back of the hand was cut and local anesthetic was overdosed. The patient was poisoned by anesthetic on the spot and died in the outpatient operating room.
Therefore, local anesthesia will not be used for slightly larger surgeries, even larger debridement and suturing. The risks are high and the results are not good.
Now Yang Ping wants to use local anesthesia for amputation? Everyone expressed surprise.
Although local anesthesia is simple, it is also a technical job. Ordinarily, injecting a few injections around the surgical area is also a local anesthesia; more precisely, selecting the innervating nerves in the surgical area to block is also a kind of local anesthesia.
The latter is called nerve block, which is actually a more advanced form of local anesthesia. If the former is compared to using artillery to shoot at enemy positions at random, then the latter is to use precision-guided missiles to clear enemy strongholds at fixed points.
To master nerve block anesthesia, one must be very familiar with anatomy, the innervation of various regions, and the course of nerves.
Yang Ping will now perform right femoral nerve and sciatic nerve block.
When an anesthesiologist performs this kind of block, he often needs to use color ultrasound to locate it, but Yang Ping now completes it with his bare hands.
Dr. Lu is waiting to see what happens, and it also opens his eyes to amputation under local anesthesia.
According to the course of the femoral nerve and the ischiofemoral nerve, Yang Ping first blocked the femoral nerve - in the upper thigh, starting from the skin, anesthetizing it layer by layer, and carefully inserting it. When it reached the nerve sheath, an electric shock was immediately felt.
"Do you feel like you're getting an electric shock?"
"Yes!" the patient said through gritted teeth.
The drug is then injected into the sheath of the nerve.
In the same way, block the ischiofemoral nerve. The skin sensation of the entire lower limb mainly comes from the branches of these two nerves.
Just as the propagation of electric current by wires is cut off, nerve impulses are successfully cut off by anesthetics.
The effect was very good. After a while, the patient could no longer feel the right lower limb, and Yang Ping began to operate.
The knife cuts a beautiful tongue-shaped skin flap, and the skin, subcutaneous, deep fascia, muscles, and blood vessels are ligated, and the nerves are cut off at a high level to expose the femur. In the middle and lower third of the area, the wire saw cuts off the femur and slightly cuts the femur. The broken ends are rounded.
Then cut out a tongue-shaped flap from the muscles, deep fascia, subcutaneous, and skin of the contralateral side.
The bleeding points were ligated one by one, leaving the surgical area clean.
The amputation was completed in less than five minutes, probably less. Wrap the broken end with a sterile drape, and take the rest to the car to continue processing.
Several first responders took action, and the patient was immediately carried on a stretcher to the ambulance. Oxygen was inhaled through a nasal cannula and ECG monitoring was continued. The nurse quickly connected various pipes and wires and then sorted them out.
The stretcher was placed in the middle, with Yang Ping and Xiao Wu sitting on one side, and Dr. Lu and the nurse sitting on the other side.
The car started and rushed towards Sanbo Hospital. In order to save time, the driver chose the fastest and smoothest road on the navigation system.
Lidocaine provides local anesthesia, which can last from one to three hours. The anesthesia is still taking effect and the patient feels no pain. Dr. Lu thought that if he mastered Yang Ping's superb nerve block technique, he would not need to use morphine for pain caused by trauma during first aid in the future. He would directly use highly selective nerve blocks to make the patient painless. Sent to hospital.
In the car, in a limited space. Yang Ping and Xiao Wu carefully rinsed the severed ends of the amputated limbs. The drapes are sterilized again, and the muscles, fascia, and skin are sutured. Amputation is not the end. This is also a matter of minutes.
"Doctor, can I survive?" The patient's voice was already very weak, his face and lips were pale, his eyes were closed, and he struggled to open them a little.
The fluid has been opened as fast as possible, with three channels simultaneously infusing colloid fluid and crystalloid fluid into the body.
Yang Ping held his hand tightly, which was cold.
"Yes! It must be possible!"
The patient gasped and wanted to speak, but could not speak several times.
"No need to talk anymore, it will be fine, hold on!" Yang Ping held his hand and put a little more force on it to show encouragement.
The patient still squeezed out a few words: "Save--me--, the child--is in--junior high school--poor--"
A few intermittent words, no more words can be squeezed out. This kind of emergency vehicle is already very advanced, but it is still just an emergency vehicle. It can only provide the most basic life support such as rehydration.
In the short term, fluids can maintain volume, but eventually blood transfusions are needed to replenish red blood cells and maintain oxygen transport. Blood transfusion can only be done at the hospital.
The heart rate has risen to 120 beats/min, the blood pressure has dropped to 80/40mmHg, and the blood oxygen level is barely maintained at 90% by inhaling oxygen.
I don’t know if the expanding splenic capsule has broken. If it has, I will definitely die. It all depends on luck. Sometimes, you have to admit that there is such a thing as luck.
Dr. Lu can no longer perform color ultrasound, as the squeeze of the ultrasound probe is also risky. Even if you see the rupture, you can do nothing for the time being.
"Hurry up!"
Yang Ping told the driver in front of him that he was holding the patient's hand and kept his fingers on the radial artery. The pulse was weak and he felt that it would dissipate at any time.
"It's already the fastest!" the driver shouted, but he still pressed the accelerator deeper.
The nurse changed another bag of liquid. Dr. Lu was anxious and his face was covered with sweat.
The ambulance sirens were blaring urgently, and the driver was weaving in and out of the traffic. Some cars in front took the initiative to get out of the way, but many more cars ignored them. The driver was a retired automobile soldier with very good skills. He turned the steering wheel calmly and kept overtaking.
The biggest uncertain factor in urban transportation is traffic jams.
Everyone prays in their hearts, never get stuck in traffic, never, never!
The patient was already in a state of confusion. He shouted loudly, but his eyelids only moved.
The ambulance got on the viaduct. Suddenly, the car in front braked, slowed down, and stopped slowly.
The ambulance followed the car in front and slowed down to stop. Because the distance between the cars was well maintained, the ambulance stopped smoothly and no patient caused too big a bump.
"What's going on?" Xiao Wu asked.
The driver shook his head: "I'll go down and take a look."
A long dragon formed immediately behind them, and looking ahead, it was also a long dragon.
The driver pulled the handbrake, pushed open the door, got out of the car, looked around, and walked a dozen meters further to inquire about the situation.
He came back and said: "I heard that the truck in front broke down and there was a traffic jam!"
Holy shit! Everyone cursed.
There was no way to do anything about the traffic jam at this time. There were cars all over the place in front, back, left, and right, and there were also cars stuck in the convoy. It was so jammed that we couldn't move forward or back.
Yang Ping's heart was filled with despair, and there was only a faint trace of pulse left in his hand, like a candle in the wind that would be extinguished at any time.
The fire of life is sometimes very tenacious, but sometimes it is extremely fragile and will be extinguished by any disturbance.
Dr. Lu opened the back door of the ambulance and put up a pergola with his hands. He looked forward and could not see the long queue at the end. Looking back, he still saw a long and winding queue.
He walked back and forth behind the car, banging the fist of his right hand on the palm of his left hand anxiously.
Time passes minute by minute.
The patient's consciousness was completely blurred, and he was asked not to move his eyelids.
The heart rate is getting faster and faster, and the pulse is as fleeting as a gossamer.
After watching the traffic several times, Dr. Lu raised his head and shouted heartbreakingly: "Help, the people in the car are waiting for help!"
Helicopters, even if it is too late to call a helicopter now, not everyone has the opportunity to use a helicopter. The hospital has two helicopters, one is under maintenance and the other is hired by a high-end insurance company to pick up patients.
The piercing sirens and flashing lights of the ambulance, as well as the hysterical shouts of the doctors, alerted the nearby car owners who got out of the car to get some air. A man wearing sunglasses moved over in the narrow gap between cars and asked: "What's going on?"
"The people in the car are waiting for help. They are dying!" Dr. Lu was helpless and wiped the sweat with his sleeves.
Yang Ping and Xiao Wu were in the car, Xiao Wu stared at the ECG monitor, and Yang Ping kept holding the patient's hand.
The eldest brother touched his head, took off his sunglasses, looked inside, and then looked at the queue of cars.
Open your Northeast accent voice:
"Quick, quick, quick! Come and help, help, it's urgent!"
(End of chapter)