Chapter 141 Demon Lung
Director Kong looked anxiously at the elevator entrance. As soon as Yang Ping came out, he immediately greeted him.
"Dr. Yang, I'm sorry, I called you over this weekend!" Director Kong looked embarrassed.
Yang Ping said humbly: "Director Kong is serious. Xiao Yang is always available. Is there anything you need from me?"
During the emergency, Director Kong was unambiguous and straightforward: "Mr. Ning suddenly suffered from respiratory failure in the morning, and his blood oxygen could not rise, hovering around 70. Director Jiang from the ICU looked at it and decided to use ECMO. They punctured the device in the emergency ward. After the catheter was inserted, ECMO was connected. Although the blood oxygen went up a little, it was still low, only 78. They considered that the tumor had squeezed and invaded the right external iliac artery and vein, causing the lumen to be narrowed and the flow rate of the blood to be drawn out was not good. The unit time The amount of blood drawn out for oxygenation is too small to meet the demand. Ms. Ning offered to invite you to come.”
ECMO, nicknamed the Magic Lung, is an improved artificial heart-lung machine, also called extracorporeal membrane oxygenation, which can replace the function of the human lungs or heart to a certain extent and for a certain period of time.
It draws the body's blood from the veins, oxygenates it through the machine, turns it into oxygen-rich blood, and then injects it back into the body through the veins or arteries.
If it is infused back into the human body through veins, it can replace the function of the lungs; if it is infused back into the human body through arteries, it can replace the functions of both the heart and the lungs. Doctors call the magic lung the last straw to save lives!
However, this kind of machine is very expensive, so the cost of use is also very expensive, and it is not covered by medical insurance. It costs RMB 60,000 to start up, and RMB 10,000 to RMB 20,000 per day thereafter. For ordinary people, this is a sky-high price. For Mr. Ning, there is no need to consider this at all.
As the two walked towards the ward, Director Kong introduced the situation to Yang Ping. When they reached the emergency ward, the situation was also introduced in detail.
The emergency ward of Huaqiao Building is equivalent to a small ICU. It is equipped with all kinds of emergency equipment, including expensive magic lungs. Moreover, these equipments are not purchased by the hospital itself. Many of them are donated by patients who live here or have lived here.
Inside, Director Jiang from the ICU and his assistant were doing intubation, but they had stopped, probably waiting for Yang Ping. Next to them, there are chief physicians or deputy chief physicians of vascular surgery, general surgery, oncology surgery, and color ultrasound rooms.
"You can't go in any further. Go back a little quickly. If you go in again, the blood vessel will break!" the deputy chief physician of the vascular surgery department reminded Director Jiang.
"Keep it down! Look clearly!" Director Jiang directed the doctors in the color ultrasound room.
The color Doppler ultrasound doctor lowered the probe slightly, and the blood vessels on the ultrasound image became clearer.
Mr. Ning was lying on the bed, with a sallow complexion and some confusion. He was covered with a blue sterile drape. Director Jiang had just completed the catheterization of both femoral veins. The catheterization of the left femoral vein went smoothly, but there was a hole on the right side. Because of the stenosis, the catheter is afraid to go deeper. Now the right side is the tube that brings the blood out, and the left side is the tube that brings the blood in.
Because of the stenosis of the right external iliac vein, the blood flow failed to reach the expected flow rate. If swapped over, with the right side serving as the input pipe and the left side serving as the output pipe, there will be no difference in the result. Even if there is enough blood drawn out from the left side for oxygenation, the flow rate of the blood sent back is too slow and it still cannot achieve the expected purpose.
"Dr. Yang, I'm going to trouble you again!" Miss Ning said.
She stayed with her all the time, squatting beside the bed, grabbing her father's hand, and smiling: "Dad, don't be afraid, Doctor Yang is here, he has a way."
Mr. Ning heard his daughter's words and seemed to understand in his heart, but he couldn't speak. He nodded laboriously.
In fact, Yang Ping was helpless as to what he could do to a patient with advanced liver cancer and systemic failure.
Doctors treat patients just like the epitaph of Dr. Trudeau in New York, USA: sometimes to cure, often to help, and always to comfort.
Mr. Ning stretched out a hand with difficulty and trembling, and Yang Ping held his hand tightly, cold and thin.
His lips trembled, trying to say something. Yang Ping brought her ear to his mouth and heard a few indistinct words.
"Help me - delay it for a few more days -" Mr. Ning seemed to have exhausted all his strength after saying these words.
Yang Ping nodded heavily and clasped his hand to show that he heard what he said. Trust, how precious this kind of trust is, just a few words of dialogue on the operating table can entrust your life to yourself.
"Definitely, I will try my best to help you fight for it!" Yang Ping put down his hand. Mr. Ning was once hospitalized in the Affiliated Hospital. For his condition, the Affiliated Hospital invited all the top oncologists in the industry, and even experts from overseas, for consultation. Unfortunately, he was already in an advanced stage, his whole body was failing, and the tumor had metastasized to many places. If the opportunity for surgery is lost, tumor resection, liver transplantation, and lung transplantation cannot be performed. So after interventional treatment for liver cancer, lenvatinib was used as targeted therapy. Later, when the disease became resistant, it was changed to regorafenib. Then a famous veteran Chinese medicine practitioner from the Provincial Traditional Chinese Medicine Hospital was asked to provide traditional Chinese medicine treatment for strengthening the body.
Because the hospitalization conditions in the Overseas Chinese Building in Sanbo can be said to be the best VIP ward in G city, I transferred to Sanbo and planned to spend the last part of my life in the Overseas Chinese Building in Sanbo.
"The bilateral subclavian and internal and external jugular vascular areas are severely invaded by tumors, and I dare not puncture and place catheters, so I want to place two tubes in the femoral veins on both sides. There is no problem on the left side, but the tube on the right side cannot be put in place. Look at the film, The tumor pushes the external iliac vein open, causing squeezing. The tube cannot go in. If it is pushed up forcefully, it may break the blood vessel and cause massive bleeding. If it is left here, the replacement blood flow rate will be too low and not up to standard, and the blood oxygen will still be If you can’t go up, your blood oxygen level is only 80, this won’t work--”
Director Jiang has no regard for face at this time. He is a real person. In life-or-death situations, he will listen to whoever has the solution, whether he is a young doctor or a senior professor.
He is familiar with Yang Ping. He has also heard about the nerve root block last time. Needless to say, the fifth-stage re-implantation. The treasure that Director Han holds in his hands is not at the right level and he is not qualified to stand at this time. Here.
"You have worked hard, let me see!"
There is a reading light in the emergency ward, and the film has been hung up. Yang Ping went to the reading light to watch the film. Indeed, as Director Jiang said, the bilateral subclavian and internal and external jugular veins cannot be punctured, and only the bilateral femoral veins can be punctured. , the right femoral artery and vein have been invaded and squeezed by the tumor, and the lumen is flattened. If the puncture is forced, once the blood vessel is broken, it will cause massive bleeding.
In Mr. Ning's situation, if there was a massive abdominal bleeding, the whole body would immediately collapse and multiple organs would fail. Magic Lung would not be able to save him.
But now if you only leave the catheter of the Magic Lung in its current position, there will be a narrow opening on it, which will lead to too little blood flow and too little oxygenated blood per unit time. It will not be able to meet the needs of important organs at all. If it is supported by a stent, It needs to be able to pass through before it can be opened.
No wonder the last physical examination for him showed that the temperature of his right lower limb was lower than that of his left lower limb, and his peripheral circulation was particularly poor.
Using the knowledge gained from systematic anatomy training and Mr. Ning's CT scan, Yang Pingping began to compose a picture in the brain, superimposing sections one by one. Slowly, a three-dimensional anatomical diagram was presented in the brain.
This time it was still very difficult, and I failed to put it together several times, but it was a little easier than last time, which shows that I have made progress.
Based on the blood flow rate of the human body, Yang Ping simulated the blood flow in his mind, added the dynamic image of the blood flow, and a dynamic three-dimensional anatomical image appeared in his mind, which was quite clear.
It seems that brain mapping is very important for the improvement of medical skills. The system uses anatomy to spare no effort to train itself in this ability, which is to lay a strong foundation for future improvement of medical skills. Yang Ping understands the system's intention.
In order to successfully puncture and insert the catheter, the catheter of the magic lung must be constructed. Yang Ping kept the image in his brain and turned to Director Jiang: "Director Jiang, is there still a catheter for the magic lung? Let me take a look?"
"Xiao Li, prescribe a tube for Dr. Yang to take a look at." Director Jiang ordered an ICU doctor next to him.
The cost of a pipe is very expensive, tens of thousands, but this is not the time to care about it, and there is no need to care about it.
Xiao Li opened the sterile packaged tube, and Yang Ping observed the complete catheter, copied such a catheter in his brain, and then simulated puncture and catheter placement based on the graphics constructed in his brain, so that Yang Ping knew what was going on. .
"That's it!" Yang Ping asked Xiao Li to put away the catheter.
"Let me try!"
Yang Ping put on sterile gloves and disposable sterile clothes and stood next to the bed.
(End of chapter)