I can see the status bar

Chapter 541 One after another
Worry about gain and loss, because care leads to chaos.At least for the vast majority of family members, because they care about their loved ones, they tend to fall into an endless loop - they want their relatives to survive, and they also want their relatives to be "safe and sound".

Only by making the patient's family members realize that these two options are in conflict can they be helped to break free from this endless loop.

Only the dead don't have to worry about whether to save their limbs or save their lives.The biggest difference between the work in the emergency department and the outpatient clinic is this—save lives first, and then have room to discuss treatment.

Sun Lien's words are heavy, but the effect is really good.Zheng Xin's wife hesitated for a few seconds before making a decision, "Cut it off, life-saving is the most important thing!"

That's right? Sun Li'en nodded secretly, and handed the consent form to the young woman in front of him.Then, he sent the consent form back to the emergency room as quickly as possible.

"The family members agreed." Sun Lien said to Dr. Cao Yanhua, "Is the orthopedic department in the operating room?"

"They've arrived." Dr. Cao Yanhua glanced at the consent form, nodded, and said to the nurses beside him, "The blood transfusion should be faster—Lien, go and get two more tourniquets."

Now that the amputation has been decided, stronger methods of hemostasis can be used.Sun Li'en brought several tourniquets from the cart beside him, and tied Zheng Xin's arm tightly with a very "barbaric" technique.After the three tourniquets were tied, Sun Lien also locked the tourniquet with a hemostat, and then turned it around again.

This level of hemostasis is generally not used in the hospital setting - excessive hemostasis can lead to ischemic necrosis distal to the ligated portion.But now that it has been decided to amputate Zheng Xin, this kind of issue can be ignored.It's just that the side effects of forceful hemostasis still exist-Zheng Xin, who was unconscious, soon developed symptoms of irritability.

In addition to apathy, patients with massive blood loss are also prone to irritability.Coupled with the fact that the means to stop the bleeding is really painful, his irritability became even more obvious.

"Don't move, we are saving your life!" Head nurse Hu Jing pushed Zheng Xin back with a slap.But the opponent kept struggling, which really hindered the rescue.Zheng Xin had two infusion tubes pierced on his left arm, and two on his right foot.If his blood loss was greater, he would have to ask an anesthesiologist to insert a central venous catheter for him.

"It won't work like this." Although the head nurse Hu Jing can hold the other party immobile with a single slap, Hu Jing can't be used as a restraint belt in all the subsequent rescue processes.Sun Li'en thought about it, and tied Zheng Xin firmly with a restraint belt. "His situation can't be delayed any longer, and he has to be sent to the operating room as soon as possible."

Zheng Xin's vital signs were barely maintained through pressurized blood transfusion through four venous channels. This was a very serious bleeding situation.No matter how many tourniquets Sun Lien could use to stop the bleeding of Zheng Xin's right arm, he still couldn't completely stop the blood from flowing out of those damaged arteries.The only way to completely stop the bleeding is to ligate the bleeding arteries and veins and then cauterize to stop the bleeding after amputation.

"The operation side should be in place." Dr. Cao Yanhua seemed relatively calm, "I can't deliver it now, and another eight units of whole blood will be transfused. Let's wait until his condition is a little more stable."

It takes a while to send patients from the emergency room to the operating table.Even with the hospital process design and architectural design of the large emergency department of the Fourth Hospital, it takes at least 10 hours to transfer a patient from the emergency room to the operating room, then send him to the operating table, and start the operation after anesthesia. minutes.

During these 10 minutes, the patient cannot get the same life support as the emergency room.In this process, once the patient's condition deteriorates, it is difficult to deal with it.

In the elevators and corridors of the hospital, where will there be equipment in the emergency room!

With Zheng Xin's current situation, it is really difficult to guarantee that nothing will go wrong within these 10 minutes.But at the same time, it is not a problem to make people lie down in the emergency room for blood transfusions.

"Do you think this will work?" Sun Lien frowned and proposed his own idea, "Let's ask the doctor from the anesthesiology department to come over first and give him preoperative anesthesia. Then send him to the operating room?" Preoperative preoperative Anesthesia can save about five to eight minutes of surgery preparation time.

"That's the only way." Sun Li'en's proposal was approved by Dr. Cao Yanhua, "I'll contact the doctor in the anesthesiology department, Xiao Sun, look at the patient's condition."

There are many points that need to be paid attention to in massive blood transfusion. The first thing to pay attention to is probably acidosis.In the modern medical system, in order to prevent blood coagulation, on the one hand to store and use blood, the blood bank will use the utensils coated with sodium citrate on the wall of the tube and in the bag when collecting blood.After the sodium citrate dissolves in the blood, it can prevent the blood from clotting, thereby prolonging the storage time.But as a large amount of blood was injected into Zheng Xin's body, the sodium citrate used to prevent blood clotting also entered his body.

When the blood transfusion is greater than 1000 ml, sodium citrate will be difficult to be oxidized by the body in time, so there will be serious side effects such as bleeding tendency, hypocalcemia and acidosis.

Bleeding tendency can be counteracted by vitamin K and other drugs, and hypocalcemia can be improved by intravenous injection of calcium gluconate. As for acidosis, it is even simpler - 5% sodium bicarbonate injection diluted to 1.4% concentration and then intravenous drip Note can be.These problems are not difficult to deal with, but in the rescue process of massive bleeding, not all doctors can immediately judge whether it is a side effect or the result of disease progression based on the patient's condition.

The same bleeding tendency, how to judge whether it is caused by sodium citrate during blood transfusion, or the patient has already had the initial symptoms of DIC?The patient has ventricular fibrillation or cardiac arrest. Is this myocardial ischemia caused by hypovolemia, or is the cardiac electrical signal disorder caused by hypocalcemia?Is the acidosis shown by the patient due to blood transfusion, or is it due to carbon dioxide retention due to insufficient respiratory ventilation after coma?
The same symptoms may be caused by different reasons.Doctors must find out the correct cause of the symptoms in the race against time, and then deal with it correctly.One wrong step can cost the patient's life.

Emergency work is dirty, tiring and bitter.

"Hang up a bottle of sodium bicarbonate." With the assistance of the status bar, Sun Lien quickly discovered the symptoms of metabolic acidosis.He issued the doctor's order directly.Dr. Cao Yanhua also communicated with the anesthesiology department, "They will send someone over immediately."

Sun Li'en nodded, took two steps back, pretended to observe the monitor and continued to observe Zheng Xin's status bar.

"120 Forecast!" Just as Sun Lien squinted his eyes to look at the stall on the status bar, the duty desk reported new bad news, "Male, around 25 years old, in a production safety accident, his right leg was severed."

"I'll pick it up first." Sun Lien and Cao Yanhua exchanged glances, "After the patient is sent to the operating room, Dr. Cao will take over."

(End of this chapter)