Chapter 95 Eight Hundred Milliliters of Blood
"Aortic clamp!"
The surgeon places the aortic clamp at a convenient place in advance.
The chest is opened from the midline!
As the blood gushes out, the aortic clamp takes the lead and clamps lightly and accurately at the point where the aorta branches out from the brachiocephalic trunk, blocking the blood supply from the heart to the lower body.
Several suction tubes are sucked at the same time to remove blood from the chest cavity, which is all accumulated blood.
The blood accumulation subsided, and the heart and lungs appeared in the field of vision. The warm heart beat rhythmically, and the lungs opened and closed under the drive of the ventilator.
The strong aorta originates from the heart, turns a corner, and extends downward into the thoracic aorta and abdominal aorta.
The hood of the human body is opened, the engine is displayed in front of the eyes, and it is still working. Life is intuitively displayed in front of the eyes in a physical form.
Taking the original wooden stake as the dial, it is now at the 12 o'clock position. Except for the rupture of the diaphragm, no major blood vessel damage was found, and the heart and lungs were not damaged. Due to the extrusion of the wooden stake, the position was slightly shifted, and some small blood vessels were bleeding. Quick ligation to stop bleeding.
However, this amount of bleeding must be due to the rupture of a large blood vessel. The rupture is not at this location. Continue to explore.
The surgeon was calm and unhurried, the movements of his hands were extremely fast, and the operation was advanced quickly and rhythmically, without any impatience, urgency or rush.
Director Li is engaged in thoracic surgery. He is pulling hooks on the side. During his training, he has also seen big men perform surgeries. Shouldn't this kind of rescue surgery be completed amidst anxious and noisy urging?
How could it be so quiet and calm? The surgeon's ability to control the operation is extraordinary; the team's cooperation is also impeccable.
The heart's irrigation to the lower body is blocked, and the pressure of bleeding in the surgical area is relieved; at the same time, the limited blood is concentrated to supply the brain tissue, and the brain tissue's tolerance to ischemia is far less than that of the trunk and limbs.
In a state of ischemia, the brain tissue can only survive safely for three minutes; while the abdominal organs that currently have no blood supply can tolerate it for twenty minutes.
The aorta can only be blocked for 20 minutes at this location because the patient is already in a low perfusion state, so the blocking time will be less than 20 minutes.
Is he going to complete the operation and end the battle within twenty minutes?
Tian Yuan looked at the blocking forceps that had been moved up, and understood the surgeon's intention. He had to speed up and cooperate with Yang Ping. Although the task in the back was not as dangerous and complicated as the front, it still took 20 minutes to complete the operation, which was extremely difficult.
The posterior approach is also a midline incision, and the automatic retractor is used to expand the spine. The spine is transected, and the spinal cord is damaged at the same level. It requires pedicle screws and steel plates to be fixed anteriorly and posteriorly, otherwise the entire body will lose its support.
A midline sternal approach was made at the 12 o'clock position. Now, a midline abdominal incision must be made at the 6 o'clock position, and the two approaches are retracted to both sides to fully expose the surgical area.
A midline incision was made on the abdomen, incising the skin, subcutaneous, deep fascia, and three layers of abdominal muscles, directly into the abdominal cavity. Blood stasis burst out, and the intestines poured out and were held by a cloth bag made of sterile drape.
The retractor is inserted, retracted left and right, and works together with the chest expander to expose the surgical area well.
Likewise, the abdominal cavity was full of stagnant blood. Several suction machines were working at the same time, and it took several minutes to suck them all out.
The aorta and vena cava were squeezed out by the wooden stake at the junction of the thoracoabdominal area and moved to the right side. The insertion of the wooden stake was a little skewed, just avoiding the aorta and vena cava, otherwise the ambulance would not have been able to get into the ambulance.
The 6 o'clock position was explored, the duodenum was ruptured, the pancreas was ruptured, and the bleeding blood vessels were ligated.
In fact, because the aorta was blocked, there was no bleeding. The surgeon, relying on his proficiency in anatomy, could still easily find the broken blood vessels and ligate them.
"Blood pressure 54/37mmHg-"
Fatty Liang reported that his blood pressure has been declining.
The human body's compensatory capacity is constantly weakening, and when it collapses, the spark of life is extinguished.
"Blood! Why isn't there yet?" The surgeon's voice was loud, but he didn't yell.
"It will take a few minutes! It's being delivered!" Dr. Tao said.
Although there are volunteers donating blood, there are still procedures to go through, such as checking blood types, checking for infectious diseases, and cross-matching blood, which takes time.
The exploration turned to the 9 o'clock position. There were a large number of blood clots around the aorta and vena cava, and fresh blood was flowing out. There should be a break here, and the blood remaining in the blood vessels was flowing out.
I put my fingers in to explore, and sure enough, there was a two-centimeter gap in the aorta. The aorta was torn. This was a fatal injury. The general rescue time was only 6 hours. Within 6 hours, there were excellent and experienced major vascular surgeons. Only with doctor's treatment can he be saved.
This 6 hours is just an average time. Many people with large ruptures will die instantly or within a few minutes.
The patient was able to buy some time to come to the hospital because the squeeze of the wooden stake slowed down the bleeding speed of the wound.
Use two blocking forceps and clamp up and down the gap to prevent the remaining blood from being lost. One milliliter of blood is precious now.
The vena cava was fine, and the liver was squeezed and ruptured.
There is a nail at the 9 o'clock position of the wooden pile, which is about three centimeters exposed, forming a hook. It is frightening and makes people's scalp numb when looking at it.
The hook just caught the aorta and tore a tear. It was dangerous!
Cut the nail with strong scissors and carefully remove it.
"Blood pressure 50/32mmHg-"
The door of the operating room opened, and finally, I saw two bags of blood. The circulating nurse quickly hung up the blood. It seemed that the emergency command department had already thought of a solution.
"Transfuse blood from the venous channels of the upper limbs!" Yang Ping reminded the nurse.
Director Tian is also exploring and stopping the bleeding. The exploration at 9 o'clock was completed, and the exploration at 6 o'clock started. Another nail was found. It was roughly the same shape as the previous one, but the tip was in the opposite direction. The spleen was fine, and the stomach and duodenum were torn. The nail was cut off. ,take out.
If an ignorant and fearless person tries to pull out the stake, no matter which direction it is taken, the nail will hook into the surrounding tissue, large blood vessels or organs, and the consequences will be disastrous.
Director Li and Director Zhang have worked in grassroots hospitals for many years, and have also gone to large hospitals for further study. They have seen the world and mastered anatomy so well. He has never seen anyone who has such a proficient grasp of anatomy. He admires him extremely in his heart. This patient is so lucky. Regardless of whether he can be saved or not, he is lucky.
One unit of red blood cells and four hundred milliliters of whole blood were quickly transfused under pressure. The blood pressure has not yet increased, but at least it has not dropped again. There was too much blood loss before.
"How is it?" The director of the medical department came in. Director Miao was already on the operating table to rescue the patient with a broken pelvis.
"Prepare pedicle screws and anterior plates to fix the spine. The spine is transected, and the front and back are fixed together!" Director Tian said while performing the operation.
The director of the medical department immediately called to make arrangements. There were pedicle screws and anterior plates. They were originally given to patients undergoing surgery tomorrow, but now they are brought over for emergency use.
"The blood pressure cannot rise, and there is not enough blood, so I have to lose blood," said Fatty Liang.
The director of the medical department said: "We are trying to find a way. We have already collected 400 blood, and now there is only one volunteer to donate blood."
An orthopedic surgeon is so skilled in abdominal surgery. Director Zhang is a general surgeon and feels ashamed.
Now, the top, bottom, left, and right sides of the stake have all separated, and the front and back have joined together, so the anatomical structure is clear.
"The stakes can be pulled out." Yang Ping raised his head, his neck was very sore. This position was too difficult to do, and the operating field of view was extremely poor.
"Four sterile blood-draining tapes!" Yang Ping said.
Sterile blood-draining tapes are commonly used in orthopedics. Finding a few at random is not a problem.
Sterile blood removal tape is placed on the table.
"Big straight pliers, the biggest!"
The blood-driving belt was clamped with straight pliers and passed carefully between the hole and the wooden stake. Director Tian caught it.
Four sterile blood-draining tapes were sent over, slowly opened, and pulled in reverse to pull away the surrounding tissues and create a small gap with the wooden stakes to protect the surrounding organs and blood vessels.
Director Yang Ping and Director Tian carefully moved the stakes one by one and pulled them by the other, and finally took them out safely.
Rinse, explore and debridement again, and rinse again.
Tissue scissors were used to trim the aortic tear, four non-damaging blood vessel sutures were sutured, and the tear began to be repaired. Soon, the tear was repaired.
The diaphragm, liver, pancreas, stomach, and duodenum were repaired, and the bleeding was completely tied again.
There is no fixed procedure in this kind of surgery textbook, and it depends entirely on the surgeon's rich experience and ability to apply knowledge.
The separation during the operation is like a chef removing a cow, without accidentally damaging a blood vessel, not even a small artery.
While exploring, the small bleeding blood vessels were ligated and advanced layer by layer without any pause or repetition.
The whole process was like a thrilling prison robbery, a prison robbery of Death Prison.
Director Li and Director Zhang thought that if they were allowed to perform this operation, the patient would definitely not be able to be saved.
They all came up with the idea of going to Sanbo Hospital for further studies in their forties.
"Four hundred milliliters of whole blood!" came up again.
This person has donated 800 milliliters.
This is equivalent to the amount of bleeding from a severe femoral shaft.
A blood donation generally does not exceed 400 milliliters. If it exceeds, there are risks. He donated 800 milliliters.
“With only one volunteer, the blood bank no longer dares to collect blood,” said Dr. Tao.
With these 400 milliliters, I can at least hold on. After a few more units of red blood cells, I can hold on.
"Blood pressure! 76/42mmHg——"
There is a rise! The anesthesiologist reports blood pressure dynamically.
The time is almost up. Release the blocking clamp and let the blood flow around the body.
All that's left is to stabilize the spine.
Thank you Han Ye Yue Se for the reward of 666 starting coins!
(End of chapter)