I can see the status bar

Chapter 247

Li Fengmin's situation has changed. Although the words "mild pulmonary embolism" are still very faint, almost only a little ghost outline, but the status bar does remind Sun Lien that there is something wrong with Li Fengmin's blood.

And this change, to be honest, did not exceed Sun Lien's expectations.In other words, if Li Fengmin did not have this symptom, Sun Lien would still feel a little strange, and at the same time feel a little fortunate that it is a miracle that this hemorrhage did not cause blood problems.

There are two possible causes of pulmonary embolism, the first being venous thrombosis.Li Fengmin's external iliac vein was torn. Although the bleeding was successfully stopped after patching the outside, because the operation was too urgent, the ruptured blood vessel was not trimmed and reconnected, and the tourniquet on the lower limbs actually hindered the venous return of the lower limbs. , these factors are likely to lead to thrombosis.After these clots travel up the veins of the lungs with the reopened blood vessels, they can block the pulmonary veins directly, causing a pulmonary embolism.

The second reason is even more troublesome. If it is not a pulmonary embolism caused by venous thrombosis, then Li Fengmin may have fallen into the symptoms of DIC (disseminated intravascular coagulation).

As the final path of various blood diseases, the pathogenesis of DIC has been studied over and over for a long time—when the human body consumes too much coagulation factors due to various reasons, the human body may spontaneously experience coagulation disorders.Coagulation occurs due to the deposition of fibrin in the blood in small blood vessels, while other parts may have a spontaneous tendency to bleed due to the lack of coagulation substances.But under what circumstances the body will appear DIC, this is still a mystery that has not been clarified.

Although there is no clear answer, scientists and doctors have summed up a set of high-risk factors for DIC. Unfortunately, Li Fengmin happened to meet two of them-massive blood loss, and after major surgery.

Speaking of it, in fact, the term major surgery is a bit wishful thinking. In the medical field, it is generally rare to say "large and small", and instead judge it by risk.The more risky the operation, the closer it is to what people generally understand as "major surgery".The external iliac veins on the left and right are the main connections of the inferior vena cava, and at the same time, they are deeply hidden in the abdominal cavity. Even if the operation is performed in a hospital with complete facilities, there are considerable risks.And the risk of urgent hemostasis in the conference room can be imagined.

Although the cause has not been determined, no matter what the cause of the embolism, it must be dealt with immediately.Otherwise, Li Fengmin would definitely not be able to get off the operating table.

"Didi, Didi!" Just as Sun Lien opened his mouth to speak, the cardiopulmonary monitor suddenly called out.Everyone in the operating room immediately stopped their preparations and looked in the direction of the anesthesiologist.

"Blood oxygen saturation has dropped to 90%!" The anesthesiologist stood up suddenly from the stool. He turned around and walked quickly to Li Fengmin's side, and checked the trachea still inserted in Li Fengmin's throat and his breathing at the fastest speed. Ventilator settings, "The ventilator settings are all right, did any of you meet a patient just now?"

"I'm disinfecting." The equipment nurse raised the iodophor cotton swab in her hand, "I just finished the first disinfection."

"It has nothing to do with this." The anesthesiologist continued to check according to the prescribed procedures, "There is no nail polish, no strong light, I will try another probe." He quickly ran to the heart and lung monitor, and took out an unopened blood tube. The oxygen saturation monitoring probe was unpacked and replaced.

"The blood oxygen saturation is 89%, it's not a malfunction." The anesthesiologist frowned and walked quickly to the operating table, "It can't be DIC, right?"

It is not the anesthesiologist's responsibility to administer heparin to the patient, but it is his responsibility to stabilize the patient's vital signs. "I'll increase the breathing flow a little bit and try breathing with pure oxygen." He looked at Lin Hua and said, "Doctor Lin, let's do a B-ultrasound to check the blood flow in the lungs."

Generally speaking, to diagnose whether a patient has pulmonary infarction, the gold standard is pulmonary angiography.However, Li Fengmin had a ruptured vein, which was a contraindication for radiography.Even if imaging is to be done, it is not practical to transfer a patient with an open belly to the intervention room.Those who can judge the situation immediately can only rely on B-ultrasound imaging.

"Lung B-ultrasound...call and invite Director Guo from the ultrasound department." Lin Hua immediately made a decision. It is not an easy job to use B-ultrasound to judge the blood flow in the lungs.Although the B-ultrasound machine in the Sanya Branch of the Army General Hospital is advanced enough, the pulmonary artery is hidden directly under the sternum, and this physiological structure determines that it is extremely difficult to detect it with an ultrasound probe.Only highly skilled doctors can accomplish this task.

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"You really found me a difficult job." Director Guo of the Ultrasound Department walked in wearing a blue disposable hair cap.He muttered to Lin Hua, "Use B-ultrasound to see the pulmonary artery? Why not enhance it?"

"The stomach is open, and the radiography cannot be done even if there is a ruptured vein." Lin Hua spread his hands, expressing that there was nothing he could do about it. "Please show it quickly, we are in a hurry to save lives."

Sun Lien watched Li Fengmin's condition on the top of his head change from "slight pulmonary embolism" to "moderate pulmonary embolism". Just a reminder—pulmonary embolism is fatal.

However, the conditions in the status bar are only a reminder after all. To obtain the real basis for medical decision-making, it is still necessary to rely on detection methods.Fortunately, the cardiopulmonary monitor has been monitoring Li Fengmin's vital signs. Although the situation is getting worse, at least he still has a little time.

"There is reflux, about one-third." In less than 2 minutes, Director Guo made a judgment by looking at the images on the B-ultrasound. "It may be at least a moderate pulmonary embolism, or it may be DIC. It's easy to judge the specific situation. Let's do five blood coagulation tests to see the results."

Lin Hua frowned, the operation seemed to have to be stopped first.Pulmonary embolism that has already occurred must be intervened to remove the embolus. If it is a thrombus, anticoagulant therapy needs to be started as soon as possible, just like DIC.But no matter what the result is, there is a great risk for Li Fengmin who needs to re-do the external iliac vein.

The operating room needs the results of the five blood coagulation items, and the testing department certainly dare not neglect.After getting the result at the fastest speed, Lin Hua's frown deepened - Li Fengmin's plasma prothrombin time was only 6 seconds, the fibrinogen level was 1.5g/L, and the D-dimer level was as high as 0.7 mg/L.The results of the three examinations all suggested the symptoms of DIC, which met the diagnostic criteria for DIC.

"Low-molecular-weight heparin calcium, intravenous injection of 7000 units, and then a bottle of 500 units of saline heparin calcium, 30 units, with a flow rate of [-] ml per hour." Lin Hua did not deal with DIC once or twice. The means can be said to be familiar.But the real difficulty is yet to come. After starting anticoagulation therapy, Li Fengmin's blood coagulation function will be inhibited.At this time, the operation of cutting off and re-anastomizing a major venous vessel is started, and the risk of bleeding during the operation is too great.

Chen Tianyang, who had been on the sidelines, also guessed what Lin Hua was worried about. He was about to speak, but suddenly turned around and asked Sun Lien, "Xiao Sun, do you think we can continue the operation now?"

Chen Tianyang reckoned that a doctor like Sun Li'en, who was inclined toward emergency medicine and diagnosis, might oppose higher-risk operations, so he planned to remind Lin Hua by refuting and educating Sun Lien.But Chen Tianyang forgot that Sun Lien was a freak who dared to suggest an emergency laparotomy in the conference room.

"Do it, and it must be done immediately." Sun Li'en finally found an opportunity to express his opinion, and he hurriedly said, "The hemostatic patch on the patient's external iliac vein itself will consume fibrin. Before the suppression becomes unacceptable, surgery should be performed immediately."

A person will die if he does not breathe, but he will also die if he does not have blood in his body.It is meaningless to discuss whether to stop Li Fengmin from breathing or to drain his blood.In cases where any one symptom is fatal, all potentially fatal symptoms must be addressed.Sun Lien has been working in the emergency department for more than a year, and he has done a lot of things to stop the bleeding of patients and at the same time unblock the airway.In Sun Li'en's view, Chen Tianyang's question did not need to be considered at all.After the low-molecular-weight heparin calcium injection takes effect, the hemostatic patch is likely to fail. If the treatment is delayed until this time, the anastomotic blood vessel may still continue to bleed even if it is sewn.

But it is obviously unrealistic to leave DIC alone.The main function of blood is to deliver oxygen to the cells in the body and remove carbon dioxide produced by metabolism.The blood vessels were sewn up, but the patient's DIC caused the blood in the lungs to become bloody tofu, so how about transporting oxygen?

"Insightful." Chen Tianyang gave a thumbs up in a very disrespectful manner, then turned and said to Lin Hua, "Did you hear that?"

"Understood." Lin Hua nodded, stopped talking, and said to the doctors of the surgery team, "Go to work, and try to finish it within half an hour."

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Stitching blood vessels sounds simple, but in fact, it is not ordinary.Especially for the external iliac vein, which has a large flow rate and high pressure, and is hidden under many organs, it is even more difficult.

"Hemostat." Since he decided to complete the operation as soon as possible, Lin Hua couldn't waste time.Fortunately, Chen Tianyang's cut was perfect, which bought Lin Hua a lot of time.Quickly using a retractor instead of a bent meat fork to separate the skin, the underlying muscle tissue, and the retroperitoneum, Lin Hua saw the patch to stop bleeding.And the moment he saw the blood vessel, he reached out and asked the equipment nurse for a hemostat.

"You have to bend your head..." Hu Jia was leaning on Sun Lien and was a little distracted. After hearing this sentence, she asked subconsciously.In the end, after asking three words, she realized that the doctor was not asking herself.Then he quickly covered his mouth.

Sun Li'en looked at Hu Jia, hugged her shoulder with some sadness in his heart, and gently patted her head with his free hand.

"Take another hemostat." Lin Hua ignored Sun Lien's voice.He concentrated on clamping the upper and lower ends of the damaged external iliac vein, and let go of the part wrapped by the hemostatic patch. After confirming that the hemostatic forceps were clamped well, he cut off the damaged vein with surgical scissors.

Lin Hua used tweezers to clamp out the damaged veins that had fallen into the abdominal cavity, and then began to trim the ends of the severed blood vessels. "The artificial blood vessels should be 11mm in diameter and two centimeters long."

Yizhu, who was deceived and praised Chen Tianyang several times, quickly brought the prepackaged artificial blood vessel, cut off a suitable section, and handed it to Lin Hua.

"Vascular stapler." Chen Tianyang didn't say a single extra word, he didn't seem to chatter in the operating room at all.He needs to concentrate to complete this operation as soon as possible, which originally took about two hours to complete.Any distraction of energy may cause his hands to slow down.

If it was slower at this time, it might directly lead to Li Fengmin's death.Although Lin Hua didn't say anything else, the pressure on his shoulders is unimaginable to outsiders.

It is not uncommon to use a vascular stapler to connect larger veins.After all, blood vessels can also be stitched with needles, and the stitching effect will not be worse.But the biggest advantage of the stapler is that it is not very suitable under the current conditions - using it to anastomose blood vessels is really fast.

It takes about 20 minutes for a veteran like Zheng Guoyou to sew a vein by ordinary hands.Lin Hua's own fastest record is 28 minutes.The 8-minute gap is a concrete manifestation of the gap between him and Zheng Guo who have more than 20 years of medical and surgical experience.

However, if a vascular stapler is used, Lin Hua can complete the suture within 5 minutes.

An 8-minute difference is roughly equal to 20 years of medical experience.However, the 23-minute improvement of the vascular stapler is impossible to make up for with personal skills.

Of course, artificial blood vessels are actually better to sew than real blood vessels, but this also means that Lin Hua needs about 10 minutes to sew the two ends of the two-centimeter-long artificial blood vessel to Li Fengmin's hip. up the external vein.

time is life.

At the third minute and 51 seconds, Lin Hua completed the anastomosis of the artificial blood vessel and the distal external iliac vein.After checking that the anastomosis was good, he loosened the hemostat clamping the distal end, blood flowed out quickly, and there was no bleeding at the interface.

At eight minutes and 12 seconds, Lin Hua completed the anastomosis of the artificial blood vessel and the external iliac vein at both ends in a time short enough to show off.He took a look at the stapler with tweezers, and looked at the connection effect below with a circular observation mirror commonly used in dentistry.After confirming that the stapler was in good fit and that the blood vessel was not twisted or wrinkled, he loosened the hemostatic clamp at the proximal end.Then there was a suffocating silence.

"The blood vessels are anastomosed well and there is no leakage." After looking at the blood vessels for almost 3 minutes, Lin Hua announced that the operation was partially successful. "Lavage the abdominal cavity and strengthen disinfection. Prepare to close the abdomen after completion."

This time, Li Fengmin finally didn't have to reveal his confidant to others.

　Still... I still owe 4000 words to update, I remember.

　　
　
(End of this chapter)