My medical skills add experience

Chapter 178 Ultra-difficult clamping, sudden heart attack again
Generally speaking, choosing an incision from the intercostals, or incisions from the neck, below the sternum, and abdomen are gentler than this method.

However, when formulating a surgical plan, doctors will fully consider all aspects.

If the chest must be opened from the front, then it must be opened.

The risks and possible sequelae will be clearly explained to the family members and patients before the operation.

The diameter of this patient's cardiac aneurysm has exceeded 5.5cm, which is an extremely dangerous type.Moreover, the surrounding organs have been severely compressed, causing great physical pain to the patient.

It is the most direct and quickest way to go in from the center of the chest.

Director Xue methodically commanded three assistants to open the patient's chest. The key high-risk parts were operated by herself or guided by the first assistant.The surgical team she leads is quite strong.

Even Dr. Long can barely get the position of the third assistant.

Kazusuke seemed to be older than Director Yuki, with a lot of gray hair on his temples, and the gray hair had spread to the top of his head.There are fewer wrinkles.

Being a doctor is a very stressful and high-risk profession, and premature aging has almost become a common phenomenon.

Many people have gray hair after finishing their medical studies.

Also, the evaluation of doctors' professional titles never depends on age.As long as the working years can meet the assessment standards, and the academic, surgical volume, written examination, scientific research achievements and other aspects can meet the assessment requirements, they can apply for examination.

Some talented and hard-working doctors can really be promoted to chief physician at the age of 42.

And some people may be stuck in one aspect, or fail to meet the requirements in many aspects, and they are still staying in the attending seat at the age of nearly [-].

This first assistant is at least five or six years older than Director Xueyan.

It was quite frightening to watch him wobble a bit as he sawed through the breastbone.

"Remember, because this aneurysm is close to the back of the sternum, you must swing the sternum saw skillfully when sawing the sternum to avoid tearing the aneurysm wall and causing massive bleeding."

While Director Xue instructed the first assistant to saw the sternum, he explained the key points of the operation to other junior doctors.

After Zhou Can heard this, he suddenly realized.

I thought Kazusuke was too old and his hands were unsteady.

It turned out to be a deliberate and conscious swing of the sternum saw.

To be able to be the first assistant, and gain the high trust of Director Xue, he really has not weak strength.

These valuable experiences are all summed up by the lessons of the predecessors.

After opening the chest cavity, the huge aneurysm can already be seen.

It must be explained that an aortic aneurysm is a lesion in which the normal structure of the aortic wall is damaged due to various reasons, and locally bulges outward to form a tumor-like expansion.

rather than actual tumors.

The nature of the two is also completely different.

The greatest risk of an aneurysm is rupture, causing massive bleeding.

What's more, when it keeps growing and oppresses the surrounding organs and tissues, it will bring great pain to the patient.If it is an intracranial aneurysm, it is even more dangerous. If any important nerve, blood vessel, or brain tissue is pressed, it may cause serious problems.

No matter benign or malignant, tumors are crazily self-replicating, destroying the immune mechanism of the human body and invading normal cells and organs throughout the body.

Tumors also have the same problem of compressing surrounding organs.

The largest liver tumor can even occupy more than half of the chest and abdomen.

"Director Xue, this aneurysm is located on the brachiocephalic trunk, very close to the ascending aorta, do we need to make preparations for the establishment of extracorporeal blood circulation?"

The anesthesiologist for this operation is still the official doctor.

He has the integrity of an anesthesiologist, and usually keeps silent and does not interfere with the operation of the chief surgeon.

Only when it is considered that there is a greater risk in the operation process will it issue a reminder.

Ascending aneurysms are not suitable for interventional surgery.

Common treatment methods are excision and replacement of artificial blood vessels.

Director Xue chose to clamp the aneurysm instead of resecting it, probably because of the huge risks in the process of blood vessel replacement.

Even today, the technology for replacing the ascending artery is very mature, and the mortality rate is still as high as 10%.

If you encounter a surgeon with a technical fistula, or if some accidents occur during the operation, the mortality rate will only be higher.

Director Xue hesitated for a moment after listening to the doctor officer's reminder, and then said, "The establishment of extracorporeal blood circulation requires heparinization of the whole body first, and catheterization of the femoral artery and femoral vein, which will cause certain physical harm to the patient. Because only clamping The risk is relatively small, so let’s not make preparations for this!”

She has her own considerations.

This is not to save trouble, but to consider from the patient's point of view.

The operation cost can be saved for the patient, and the injury to the patient's body can also be avoided at the same time.

Doctor Guan didn't say anything more, and the operation continued.

Zhou Can found that the location of the aneurysm was very bad, at the junction of the brachiocephalic trunk and the ascending aorta.

How to put it, the ascending artery and the aortic arch are like a round arch, and then three important branch arteries are branched from this arch.Brachiocephalic trunk, left common carotid artery, left subclavian artery.

The three branching arteries are interesting.

Both the left common carotid artery and the left subclavian artery branch off directly from this circular arch.

But the right common carotid artery and the right subclavian artery branch out from this brachiocephalic trunk.

The right common carotid artery is slightly higher.

It can be seen from here that the brachiocephalic trunk is equivalent to the integrated trunk of the two branch arteries on the right.It has a very large blood supply.

It can be understood as half of the total pumping volume of the heart.

Not to mention the ascending artery.

Equivalent to the arterial assembly.

The location of this aneurysm is very special, and it is extremely difficult to perform clipping surgery.

Some highly skilled doctors especially like to challenge this type of operation.

Zhou Can still doesn't know Dr. Xue's specific treatment plan.

Since it is a clipping operation, even using three clips may not be able to completely clip this special aneurysm.

In addition, such a large aneurysm is usually accompanied by hardening of the blood vessel wall and spots.

The most appropriate treatment is excision and replacement of artificial blood vessels.

"Although this aneurysm is a bit special, I have successfully completed an aneurysm clipping operation at the junction of blood vessels before. Now the surgical field of view is sufficient, and the difficulty of the operation is relatively reduced. If the operation is good, two arterial clips are enough. Complete this clipping operation. Director Lu, you will use a temporary blocking clip to temporarily block this section of blood vessel later."

While arranging, she repeatedly selected the appropriate aneurysm clip.

The style and size of this clip are very rich, enough to meet the clipping needs of all aneurysms.

It can be seen that Director Xueyan is very prudent in doing things.

Not only have two most suitable aneurysm clips been selected, but three more have been prepared, which are used for rescue in case of accidents.

"let's start!"

She motioned to Kazuke.

"Doctor Guan, is it okay to block for about a minute?"

She asked the anesthetist for his opinion.

"It's absolutely possible. It's just that it's quite difficult to complete the clamping operation within one minute. And there is no extracorporeal blood circulation channel, so I feel somewhat uneasy."

Doctor Guan is still full of worries.

Experienced anesthesiologists often experience many surgical accidents.

There are many unpredictable risks, and accidents often happen in an instant.

He has seen too many surgeons who were full of confidence before the operation, but accidents occurred during the operation, which put the surgical patients in a state of extreme danger.

"It's okay, 1 minute will pass soon. Don't worry!"

Director Xue comforted him.

The chief surgeon had already said so, and the official doctor didn't say any more.

Only the eyebrows are full of worry.

"Block it!"

She gestured to Kazuke again.

She was several years older than her, and she directed the surgery, which meant that Director Lu should be the deputy chief physician.

Deputy Director Lu manipulated the temporary blocking clamp to precisely block the junction of the ascending artery and the brachiocephalic trunk.

The difficulty of this operation is quite high, and it tests the doctor's skills.

He successfully completed the proximal block.

Next, the upper end of the brachiocephalic trunk is also temporarily blocked.

At this time, it is equivalent to framing the aneurysm so that no effective blood flow can enter.

It is equivalent to completely cutting off the blood transfusion of this section of blood vessels to ensure that Director Xue's clipping of the aneurysm is safer.

The cooperation between the two sides is very tacit.

Director Xue's operation is also very precise.

It took less than ten seconds to complete the clamping task of the first clip.The placement of the second aneurysm clip did not seem to go as smoothly as she had hoped.

The site itself is rather special. If the blood supply of the entire aneurysm cannot be blocked, the therapeutic effect will not be achieved.

So, placing the second clip is the hardest part.

1 minute is very short.

She kept adjusting, but she still couldn't achieve satisfactory results.

At this moment, it is equivalent to letting the patient's whole body blood

There was no other way, seeing that the time was up, she could only place the second aneurysm clip first.

"Let's try to pass the blood first! If it doesn't work, then adjust it!"

Cutting off the blood supply for too long is very dangerous.

In any part, as long as there is ischemia, cells will die rapidly.If the time is a little longer, a large area of ​​irreversible tissue necrosis will appear.

After the bleeding, everyone stared nervously at the clamped hemangioma.

The blood pressure on the main road is very strong.

As soon as the blood was drained, the blood recirculated at a very fast speed.

Most of that aneurysm was clipped, but it was still missing.

Blood was poured in, and the aneurysm seemed to be growing.

After Director Xue saw this situation, he didn't panic, but calmly observed the gap in the clamping position, thinking about the solution.

"May need to use three clips!"

She seemed to be talking to herself, but also seemed to be discussing with other doctors.

"It is indeed safer to use three clips, and the operation will be easier. Director Xue is sometimes too kind and considers patients too much."

Kazuke agrees with her.

I admire her character even more.

From what she did in this operation, it can be seen that she is always thinking about the patient.Some risks are all borne by herself.

It is said that each other is born from the heart.

Her temperament is so good, and she is still very beautiful in her 40s, which is enough to show her kindness.

Using less hemangioma clips can save a lot of money for patients.

"The family burden of this patient is relatively heavy. He himself does food delivery for a living, and his wife is blind. He belongs to a vulnerable group, so he can help if he can," she said.

The poorer the family, the more prone to some serious diseases.

Some diseases are saved, and some diseases are caused by fatigue.

Poverty keeps them sick, and they are reluctant to go to the hospital for examination. Some food has spoiled, and they are still reluctant to throw it away.There are also various very bad working environments, as well as hard work regardless of the body, which can easily lead to some malignant diseases.

The world is not only beautiful, but also suffering.

After a short rest, block the blood vessel again, and then perform the clipping operation.

It is mentioned here that it is not necessary to block the blood vessels to perform clipping, but surgeons generally strictly follow the relevant procedures for safety reasons.

"Beep beep..."

Not long after it was blocked, the life monitor immediately issued an alarm.

The patient's heart rate plummeted, accompanied by ventricular fibrillation.

The official doctor panicked.

"It must be the continuous blockage of blood supply, which induced the occurrence of cardiac arrest during the operation. This is a big trouble."

It was the first time I saw Doctor Guan panic like this.

The problem is extremely serious.

Director Xue's face turned pale, and there were obvious palpitations and panic in the depths of his eyes.

It happened so suddenly.

Women are not suitable to be surgeons. In addition to being inferior to men in physical strength, their psychological quality is generally much worse.

When encountering emergencies, fear can easily make them lose their minds and lose their ability to think and judge.

Deputy Director Lu's brows were tightly furrowed, his expression solemn.

The other doctors and nurses all looked nervous.

The most feared thing in the operation is some sudden accidents.Because the consequences are often death.

"Doctor Zhou, hurry up and help with the intubation of the extracorporeal blood circulation."

Doctor Guan had no choice but to call Zhou Can for help again.

Cardiothoracic surgery is often accompanied by high risks, and various dangers occur almost every day.

What can be prevented can be prevented, and what cannot be prevented can only be resolved by the concerted efforts of doctors and nurses.

Therefore, a strong surgical team is very important.

They can cooperate very well in dealing with various difficult surgical parts in the operation, and help patients survive the danger together.

"Who is Doctor Zhou?"

Director Xue was at a loss, as there was not a doctor surnamed Zhou in his surgical team.

Then, she saw that Gui Peisheng, who was punished by Doctor Zhao to clean up the operating room, walked quickly onto the operating table, and quickly established extracorporeal blood circulation channels for the patient with very professional and skillful movements.

Femoral arterial and venous intubation, if Director Xue operates it himself, it is considered a very good performance if it can be completed in 10 minutes.

But Zhou Can only took less than 30 seconds.

It was so shocking.

She seemed to see the reappearance of the legendary sweeping monk.

"Doctor Guan, hurry up and perform pericardial compression! Otherwise, the patient's brain will soon be ischemic and necrotic." Zhou Can urged Doctor Guan to come instead.

In the Department of Critical Care Medicine, he followed several chief physicians to learn various rescue knowledge and techniques.

In this emergency situation, it is immediately useful.

"Row!"

Doctor Guan had actually asked the nurse to put on gloves and prepare to perform pericardial compression.

Cardiac arrest and ventricular fibrillation during thoracotomy are extremely dangerous.

If effective and accurate rescue measures cannot be implemented immediately, the patient will die soon.

Next, Zhou Can disregarded the extremely shocked expressions of the other people who seemed to be living in a daytime, and calmly began to intubate the superior and inferior vena cava.

Only Dr. Long, who had seen Zhou Can's skills, was still calm.

Because he already knew that Zhou Can's ability was extraordinary.

The most shocking one was Dr. Zhao.

He really never dreamed that this Gui Peisheng, whom he looked down upon, would actually explode.Various intubation operations completely refreshed his cognition.

"Here, who is this?"

Deputy Director Lu asked the surrounding doctors in shock.

His gaze first looked at Dr. Zhao.

Because when he came in, Dr. Zhao said that he punished Zhou Can for cleaning here.

Dr. Zhao is also a resident doctor at the bottom of the cardiothoracic surgery department, and he really doesn't know much.How does he know what Zhou Can's background is?He is also dumbfounded.

Some stammered, "He, he's a Gui Peisheng who just transferred to our cardiothoracic surgery department today."

"How can a Gui Peisheng be so powerful?"

Deputy Director Lu didn't believe it at all.

"What's his name?"

"It seems to be called...Zhou Can, yes, it's called Zhou Can!"

Dr. Zhao only remembered Zhou Can's surname as Zhou, and it took him a long time to remember Zhou Can's name.

"Ah... so it's him, no wonder he's so awesome!"

Deputy Director Lu is much more informed than Dr. Zhao.

He had heard of Gui Peisheng Zhou Can's name a long time ago.

It is said that every time this Gui Peisheng enters a new department, he will set off a huge wave. His strength and talent are so high that even Vice President Ye and other existences are alarmed.

Director Xie of the Department of Surgery heard that he wanted to poach Zhou Can several times, and offered all kinds of super high treatment, but Zhou Can refused.

In the department where Zhou Can stayed, the chief doctors were full of praise for him.

Such a powerful Gui Peisheng was fined to clean the operating room on the first day of his rotation to cardiothoracic surgery.This doctor Zhao is really ignorant.

When Director Xueyan heard Zhou Can's name, she subconsciously moved her eyes away from the patient's pericardium and looked at Zhou Can.

"Doctor Guan, should we establish extracorporeal blood circulation now?"

"Of course!"

Doctor Guan replied while pressing the pericardium.

He didn't dare to look up, didn't dare to look away.

Chest compressions during CPR are protected by the entire rib cage of the rib cage.During thoracotomy, the pericardium can only be pressed urgently.

It is equivalent to pressing directly on the heart.

The danger is self-evident.

"I think the patient should be given vasoactive drugs immediately!"

While operating, Zhou Can established extracorporeal circulation for the patient while making suggestions.

"That's right, that's right, I almost forgot about it. Director Xue, you can arrange this right away, I can't get out here."

Doctor Guan is kind and kind, and accepts Zhou Can's suggestions as they are ordered.

No matter how stupid Director Xue was, she could tell that Zhou Can held an unusual position in Doctor Guan's mind.And the strength is extremely powerful.In a very short period of time, preparations for the establishment of extracorporeal circulation have been made.

And every suggestion made is very accurate and in place.

What is reflected is Zhou Can's comprehensive rescue strength.

"Fortunately, this doctor Zhou helped me today, otherwise the patient might not be able to be rescued." Director Xue's evaluation of Zhou Can rose to an extremely high level in his heart.

It can be regarded as seeing Zhou Can's true ability.

Seeing is believing, hearing is not.

Seeing Zhou Can's series of extracorporeal circulation establishment operations with her own eyes, she felt that Zhou Can was even more powerful than the rumors.

　Thank you Brother Monk Diao for your support!I wish all readers a happy Mid-Autumn Festival!
　　
　
(End of this chapter)