Chapter 544: Exogenous branches
There is a needle on both sides of the shoulder joints and on the outside of the clavicle.
This site is where the brachial plexus nerves and blood vessels enter and exit. The anatomical structure is very complex, and the nerves and blood vessels can be damaged if you are not careful.
The operation of removing small foreign objects from deep inside the human body is actually very difficult.
Because whether it is color Doppler ultrasound or X-ray positioning, a flat image is obtained, and the needle cannot be positioned accurately. Sometimes when you see a certain position, it is impossible to cut it in, because the fine needle is hidden in any layer of tissue, and it is very difficult. Hard to find.
There is one on both hip and knee joints, as well as on both upper arms, forearms, thighs and calves.
These needles are scattered horizontally and vertically, and they look creepy.
It’s hard to imagine that a ten-month-old baby has so many needles hidden in its tiny body, and that someone deliberately inserted these needles.
Scenes from horror movies actually appeared in real life.
Everyone carefully discussed each needle and finally decided on the removal plan.
After discussion, it was decided that those who can use an endoscope should use an endoscope, and those who cannot use an endoscope should make as small an incision as possible. Color ultrasound should be used to position fine needles throughout the operation, so as to make the operation as precise as possible and reduce damage.
It was already past eight o'clock when the meeting ended, and everyone was still hungry.
Yang Ping spent his own money to treat everyone to a restaurant near the hospital.
While eating, a graduate student felt very uncomfortable and was always worried that there was a needle in the food. He moved the food around in the bowl and chewed each mouthful carefully, fearing that a needle might not be found and be swallowed by him.
He knew it was impossible, but he just couldn't suppress the thought.
The nurses in the department are very caring, and everyone spontaneously takes turns feeding Xiao Minmin milk powder and changing diapers.
Nurses with childcare experience are naturally skilled in doing these tasks, while nurses who are not married and have children seem very unfamiliar.
Under everyone's care, Xiao Minmin slowly adapted. When she no longer saw everyone, she turned around and fell into her grandma's arms, and then cried loudly.
But there was one thing that troubled the nurse.
Due to the need for surgery, a needle needs to be left on Minmin's head so that medicine can be injected at any time in case of an unexpected rescue during the surgery.
Establishing intravenous access before surgery is a routine operation, so be prepared.
Just imagine if an accident occurs during the operation, such as an allergic reaction to an anesthetic, and inserting an injection during the rescue will not only waste time, but also make mistakes easily.
If there is an indwelling needle, directly open the temporarily closed indwelling needle channel and push the medicine into the patient's body, saving time. For rescue, every second counts.
But there was no way to complete this operation. No matter how much he coaxed, as long as the nurse showed the needle, the guy would know there was a needle without looking. Li Ke's eyes were frightened, he grabbed grandma's clothes tightly, and kept kicking his limbs, as if As if trying desperately to escape, the heart-piercing cry resounded throughout the ward.
The nurse tried to control her, but she still struggled desperately, her face turned purple from holding back, and her breathing was wheezing like an asthma attack.
In this way, the nurse did not dare to restrain her forcefully, so there was no way to give her an injection.
"Go to the operating room and leave the needle after anesthesia!" Nurse Cai had no choice but to ask the nurse to give up.
It took a long time for the little guy to breathe smoothly and his face turned from purple to red.
But the crying didn't stop, and grandma had to hold her in circles in the ward. When the nurse saw this situation, she was afraid that grandma wouldn't be able to hold on, so she wanted to help. Minmin cried even louder.
There was no other way, so the doctor on duty had to sedate Minmin and put her to sleep, which solved the problem.
The old lady couldn't help sobbing. The old man sighed and said, "This is all life, all life." There were tears in his eyes.
At their age, what will happen to this child in the future?
The police contacted the allergic mother. The woman said that she was married and the child was given to her ex-husband. She no longer wanted to have anything to do with the child and should not call her in the future.
What will happen to this child in the future?
The old couple couldn't sleep when they thought about this.
In the middle of the night, the old woman suffered from severe chest pain and tightness, breathlessness, and sweating profusely, as if a huge stone was pressing tightly on her chest.
The old man hurriedly called the nurse. When the nurse saw it, she quickly called the doctor.
The doctor on duty happened to be Li Guodong. He immediately made a preliminary diagnosis of acute myocardial infarction. While calling the nurse for rescue, he did an emergency electrocardiogram, drew emergency blood to check myocardial enzyme spectrum, called the chest pain center to request support, and then reported to Yang Ping.
Dr. Yu, the doctor on duty at the chest pain center, rushed over quickly. After looking at the electrocardiogram, he found that this was acute myocardial infarction. Combined with the myocardial enzyme spectrum that had just been obtained, it was confirmed that he had acute myocardial infarction and needed emergency rescue. He performed coronary angiography and interventional coronary stent expansion. .
At this critical moment, we race against time and immediately take the green channel. Dr. Yu and Mr. Guipei push the old woman to the catheterization laboratory of the chest pain center.
Li Guodong typed out a written consent form, talked to the old man, signed it, and reported to the hospital's general duty officer.
In this kind of rescue surgery, due to humanitarianism, money is not discussed. Save people first, and then talk about money after the surgery.
Regardless of whether the money is paid or not, it does not affect the rescue.
The old man was confused and rushed to the cath lab, where his granddaughter was alone. Stay here, my wife needs to be rescued now, her life or death is uncertain.
The nurse on duty was quite experienced, and luckily Corey had a trainee nurse. The nurse on duty left one trainee nurse to help take care of the baby, and sent another trainee nurse to push the old man to the cath lab in a wheelchair, and then comforted him not to worry.
After receiving the report from the nurse on duty, head nurse Cai came to the department from home in the middle of the night to urgently dispatch additional manpower.
Yang Ping, Song Zimo, and Xu Zhiliang also rushed to the department and then went to the catheterization laboratory of the chest pain center.
Minmin's grandfather was sitting in a wheelchair, holding the wheelchair with both hands, staring at the door of the cath lab, tears streaming down his face.
How come this life is so hard, and a person who is over seventy years old and about to be buried still suffers from this?
People say that raising a son will provide for old age, but this son not only failed to provide for old age, but also tormented the two old people to the point where life would be worse than death.
Nurse Cai was afraid that the intern nurse could not take care of the old man, so she sent a nurse from home to the cath lab to take care of the old man. The old man could not have any more problems.
Yang Ping was preparing to go to the cath lab to see what was going on. He met the director of the chest pain center at the door. He had just received a call and came from home. The director lived nearby.
"Doctor Yang, let's go in and have a look!"
Director Guan doesn’t know the specific situation now.
Following the director, everyone quickly changed their clothes and put on lead clothes, and entered the cath lab. Dr. Yu was performing an interventional surgery and had just completed puncture and catheter insertion to push the contrast agent.
"Acute myocardial infarction, cardiogenic shock, loss of consciousness, left ventricular assist device to maintain blood pressure, ventilator to assist breathing -" Dr. Yu reported immediately when he saw his superior doctor, Director Guan, but the operation did not stop.
The contrast agent spreads along the blood vessels, and the image of the branches of the coronary arteries is immediately displayed on the screen. The contrast agent stops at the beginning of the left main coronary artery and no longer extends downward.
"Oh my God! The beginning of the left main trunk is completely blocked!!!"
Director Guan didn't care about brushing his hands, and immediately found a pair of sterile gloves to put on, quickly put on a surgical gown, and went on stage in person.
The left main artery refers to the proximal portion of the left coronary artery from the left coronary sinus to its branches. Together with its branch vessels, it innervates 60%-90% of the myocardium of the heart.
When the left main coronary artery is completely occluded, the risk of fatal left ventricular dysfunction and malignant ventricular arrhythmia is extremely high!
This type has the highest risk and lowest survival rate in acute myocardial infarction. The vast majority of patients die suddenly outside the hospital. Even if they have the opportunity to receive emergency coronary intervention, there are still very few successful rescue cases.
"Hold on, don't panic, look for the opening of the left main trunk - stand back, I'll come!"
Director Guan had already put on the surgical gown and asked Dr. Yu to step aside, and he stood at the position of the surgeon.
Ginger is still old and spicy. Director Guan relied on his rich experience, strong psychological quality and precise techniques to find the opening of the left main coronary artery at the first time, quickly opened the occluded main artery, and restored the blood flow of the occluded vessel. The movements were smooth and smooth.
Director Guan is a doctor recruited by Dean Xia in the early years and is the subject leader of the Chest Pain Center. Under his leadership, the Chest Pain Center actively carries out various high-risk complex cardiac interventional surgeries and implements the concept of a cardiac-multidisciplinary comprehensive treatment and monitoring unit for critical illness. Combining cardiac assist device treatment and severe multi-organ failure treatment with high-risk complex coronary technology will greatly improve the level of treatment for emergency, critical and severe cardiovascular diseases.
If Dr. Yu had not followed the treatment procedures and put on the left ventricular assist device and ventilator in time, this patient would not have had a chance to be rescued.
"What were you doing slowly just now? I usually don't pay attention when doing it, and I get panicked at critical moments. Can I hesitate in this case? Find the opening of the left main coronary artery as soon as possible, quickly open the blood vessel, and restore the blood supply to the myocardium. You hesitated just now What?”
Director Guan severely criticized Dr. Yu. Dr. Yu was a young doctor, attending physician, and Director Guan's proud disciple.
The more you value it, the stricter the requirements.
"Review the rescue just now to see if there are any loopholes? Is there anything that needs improvement? Your hesitation just now shows that you are not yet skilled in the operation. At this critical moment, the test is proficiency. There is no time for you to hesitate."
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Director Guan still criticized Dr. Yu and was very dissatisfied with his hesitation at the critical moment.
In fact, Dr. Yu was fast enough. It only took fifteen minutes from arriving at the scene to examine the patient to going to the operating table.
It's just that I really lack experience, and I'm a little timid at critical moments and don't dare to make quick judgments.
Director Guan left the finishing work to Dr. Yu: "Come on, please write something about this case and give it to me tomorrow. Remember next time, don't hesitate. This is a moment that can determine life or death in one second."
Dr. Yu took over the work from Director Guan, who stared at the screen: "Send to CCU after surgery. Pay attention to postoperative acute heart failure, lung infection, and metabolic acidosis."
"Professor Yang! This patient has been temporarily rescued. It is not yet certain whether he will survive in the future, but there is great hope."
Director Guan knew that Yang Ping was a young talent in the hospital and respected him very much, so he spoke very politely.
"Thank you, Director!"
Yang Ping said politely.
Director Guan waved his hand: "Xiao Yu moved quite quickly. It took less than half an hour from the time he came to see the patient on site to the time he opened the coronary artery. It wouldn't have been possible if it had been any later, and the left ventricular assist device and ventilator were used promptly."
Criticism should be criticized, and affirmation should be affirmed. Director Guan is very pertinent.
(End of chapter)