Chapter 72 Sudden shock
The patient has been anesthetized and tracheal intubation is under general anesthesia. Dr. Tao prepared to position himself and waited for Director Tian to come in and give instructions.
This kind of surgical position is very important. Wrong position can make the operation impossible.
The film was hung on the reading lamp in the operating room, and Director Tian read the film again. Although Dr. Tao marked the surgical site, Director Tian still determined the left and right sides of the surgical site himself.
"Professor Tian, how many people need to come?" Director Miao asked.
Director Tian said: "Director and I, just one of you can come up. Dr. Yang will go up, and Dr. Song will take a rest."
Song Zimo was responsible for driving. If he rushed back at night, he would not be too tired and needed rest, so Song Zimo stayed as a reserve team.
Director Miao must come on stage. He is the director, and the patients are his acquaintances. Even if he does nothing, it is necessary for him to come on stage. So this arrangement is the most reasonable.
"Transfuse blood and fluids first!"
Director Tian gave medical instructions to the anesthesiologist and circulating nurse, and then led everyone to position themselves in the prone position.
First the posterior approach, then the anterior approach. This complex fracture cannot be solved by the anterior or posterior approach alone, and must be combined with the anterior and posterior approaches.
Director Tian has long been confident that the operation is really difficult. Not many hospitals can handle this type of shattered pelvis and acetabulum fracture, which represents the pinnacle level of trauma orthopedics.
For doctors in county hospitals, going out for further studies is an opportunity to learn, and asking professors from higher-level hospitals to perform surgeries is also an opportunity to learn.
Orthopedic doctors, whenever they are free, come to the operating room to observe.
Everyone was impressed by Director Tian's professionalism when they were in the ward, and now they all want to see the professor's superb surgical skills.
There were already three people on the stage. Dr. Tao didn't know whether he should go on stage. It was normal to have four fractured pelvises. He was in a dilemma.
"Xiao Tao, you push the C-arm machine in the audience." Director Miao helped him make the decision.
The body positions have been arranged, and Director Miao takes Director Tian Yang Ping to wash his hands.
Anyone who can do things is full of energy. Director Miao is fifty years old and still full of energy. He has a round waist and thick arms, and walks with great energy.
"How much blood have you prepared?" Director Tian asked.
"There are 12 units of suspended red blood cells and 1,200 ml of plasma!" Dr. Tao said.
That's enough, wash your hands and get dressed.
This kind of surgery is out of reach for Dr. Tao. He usually only performs simple surgeries, and Dr. Miao handles complex fractures.
Director Miao is currently unable to perform the surgery on this patient, not because of the patient’s special status, but because of the technical difficulties.
Surgery is not a child's play. This kind of surgery cannot be performed, and if it is performed forcefully, someone will die.
Doctors can usually brag, and bragging is bragging. No one is stupid enough to do an operation that they have no confidence in. It is just seeking death. One operation ruined his life.
As a department director, in addition to being able to support the department technically, you also need to have a certain amount of support. Like Director Miao, the operation was too difficult to complete. With just one phone call, Director Han sent a team to the countryside to provide strong support. If it were another person, he might not be able to do it.
Disinfection and draping are routine procedures, the same as in any hospital of any size. Yang Ping is the first assistant, and Director Miao is the second assistant.
The fracture of the posterior wall of the posterior column of the acetabulum is reduced and fixed through the anterior and posterior approach.
Director Tian is extremely skilled, uses standard incisions, cuts layer by layer, and advances steadily.
Director Tian performed the operation with ease. It seemed that his movements were not hurried or slow, and did not give people the feeling of being rushed. However, there were no redundant and ineffective movements, and the front and back were closely connected, so the operation time was very fast.
Normally, when Director Miao performs pelvic surgery, the big gauze is placed one after another. The white gauze goes in and is soaked with blood when it comes out.
Now only a large piece of gauze was handed over, and only a faint red flower could be seen on it. They all wondered whether they were undergoing pelvic surgery, or the surgery had not started yet.
Several doctors were walking around, looking for the best view, but they couldn't see anything no matter how hard they looked, and they didn't dare to get close.
Unlike Sanbo Hospital, which has high-definition cameras that allow you to watch videos, the operating room of Shipo People's Hospital does not have these devices.
"Steel plate, prepare the electric drill!"
It only took a few minutes, more than ten minutes, before the posterior wall of the acetabulum's posterior column was reset, and it was time to install a steel plate.
Look at him taking his time, why is he so fast?
While several doctors were discussing privately, the steel plate had been pre-bent and the screws were starting to be installed.
Director Miao is amazing, he went to the provincial capital to hire such an amazing professor.
Dr. Tao was a little disappointed. At the same age, someone could handle such a major surgery so easily, while he was still struggling with secondary surgeries.
In just half an hour, the acetabular posterior column and posterior wall fracture had been reduced, flushed, drained, and sutured. perspective!
On the screen, the posterior wall of the posterior acetabular column has been completely reset, and the plate and screws are in good position.
"Stand up and move forward!" His simple words have attracted countless admiring looks.
The technological gap is now difficult to bridge in the eyes of the observing doctors.
Re-sterilize bed sheets, wash hands and dress.
The road ahead begins.
"There will be a lot of bleeding from the front! Therefore, blood and fluids must be transfused in advance to replenish the blood and dilute the blood." Director Tian explained.
Because CT angiography showed that there were many vascular injuries in the pelvis, blood transfusion and fluid replenishment were needed to stabilize the blood pressure at the time of the injury. Now that the patient had to go directly to the fracture site, the bleeding that had stopped was bound to be awakened again.
"The death artery has been broken and retracted. You need to be quick and find the blood vessel within ten minutes." Director Tian reminded Yang Ping that the two people must cooperate well in the key step.
The death artery is the anastomotic branch of the obturator artery and the external iliac artery, also known as the death crown. Once it ruptures and bleeds, it will retract, just like a snake burrowing into the grass. It is difficult to find, and the bleeding cannot be stopped, and the patient is trapped in the trap of death. It’s dangerous, so it’s given a scary name. This is a roadblock that must be taken seriously in pelvic surgery.
Director Tian has rich experience. He transfused blood and fluids in advance, which not only replenished the blood but also diluted the blood, thus reducing the patient's own blood loss. This patient is anemic himself and cannot withstand too much loss, otherwise his blood pressure will easily plummet.
All surgeries are performed with real skills. Only with more experience can we predict the risks. Just like a captain sailing in the sea, relying on rich experience to avoid reefs and waves.
The anterior approach involves not only the acetabulum and iliac wing, but also the sacroiliac joint and sacrum. It is very difficult. Even in the entire provincial capital, the only people who can perform this surgery are those big guys who often appear at academic conferences. .
In order to take care of several fractures, Director Tian used an incision designed by himself.
Director Miao stayed aside, feeling like he was sitting next to a racing driver, holding a handful of sweat in his hands.
There are many blood vessels and nerves here, be careful! But Director Tian avoided it perfectly; if you accidentally cut off the blood vessels there, you will not be able to stop the bleeding, so slow down! Again, he was perfectly avoided by Director Tian.
Just when Director Tian wanted to expose it upwards, the retractor had changed its position to help expose it; the blood had just emerged a little, and the assistant had clamped it with a vascular forceps, and Director Tian's electric knife stopped the bleeding perfectly.
Just as he was about to draw attention to the blood vessels and nerves, the assistant's vascular forceps gently lifted up to help him separate the blood vessels and nerves.
Director Ben Tian was very skilled, and Yang Ping was so cooperative. The operation was a perfect performance.
I didn't pay much attention to the posterior surgery just now, but now it seems that this assistant is so perfect. No wonder Director Han asked me to take him. Director Tian raised his head and glanced at Yang Ping.
Director Miao was dazzled and couldn't keep up with the rhythm at all, so he had no choice but to do nothing.
The operation enters the critical step and immediately encounters the death artery! Before coming to Shipo, Director Han repeatedly reminded Director Tian to pay attention here!
"Controlled blood pressure reduction!" Director Tian ordered the anesthesiologist.
Intraoperative controlled hypotension, also called low-pressure anesthesia, can control blood pressure in a low but safe range. Low blood pressure means less natural bleeding, just like low pressure in a water pipe means the water spray will be much weaker.
"The death artery is bleeding and has retracted. I wonder if it has self-embolized?" Director Tian reminded Yang Ping.
Although it is a shame to talk about it, we must face it and solve it, otherwise the operation cannot reveal it, let alone reduce and fix the fracture.
The left and right hands work together dexterously, and the scissors can be sharply separated with skill.
The adhesions opened and blood spurted out immediately. No blood vessels were visible.
Sure enough, the death artery retracted and broke through the fragile self-coagulation clot, but Director Tian was very calm. Anyone else would have completely collapsed or lacked the courage to continue.
But he is Director Tian, and he only needs to rely on blood transfusion to buy him ten minutes before he can find the death artery and successfully stop the bleeding.
Relying on the speed of blood transfusion to obtain ten minutes was not a problem. This was something he had already considered before the operation.
The suction device in Yang Ping's hand quickly attracted the attention, keeping the surgical area clean and creating the best surgical field of view for Director Tian.
"My blood pressure has dropped, I'm in shock!" the anesthesiologist shouted, his voice a little panicked.
Shock?
Gauze, quick, gauze!
Director Tian immediately stopped the operation and temporarily filled it with gauze. He moved his hands very quickly to fill the bleeding with gauze. Yang Ping had already taken over and pressed it tightly. Let Director Tian free up his hands to do other things.
The blood pressure on the monitor screen dropped to 70/30. I was really in shock and it was still falling.
There was not much bleeding just now. Even if the death artery was bleeding, it was just bleeding. Blood transfusion and fluid replenishment had already started there. Why did you suddenly go into shock?
Did the posterior reduction just involve a large artery or vein, such as the abdominal aorta, or the internal and external iliac arteries? Causing tears?
No, the whole process was very clear, not a single movement was done blindly, and I had carefully studied the films before the operation, and found that the bone fragments were not adjacent to major blood vessels.
Several possible hypotheses quickly ran through my mind.
(End of chapter)