world famous doctor

Chapter 84 Rescue
In the past, there was a child in his teens who suffered from chest and abdomen pain after falling from a height.

Abdominal CT examination revealed a ruptured spleen accompanied by peritoneal effusion.

Whole abdominal CT showed perihepatic effusion.

At that time, Xu Weiping judged that it was a closed injury of the chest and abdomen, and an emergency laparotomy was performed.

During the operation, an autologous spleen transplant was performed. After active treatment, the child later saved his life.

at the moment.

What worries Xu Weiping most is not the rupture of the liver or spleen.

What he was most afraid of was that Zhang Mo's pancreas would rupture.

Everyone who has studied medicine knows it.

The pancreas contains pancreatic juice, which is a corrosive alkaline liquid.

It generally has the function of digesting food. It is combined with food in the duodenum of the human body and then excreted from the body.

Once the pancreas is ruptured due to trauma or blunt force trauma, it is very dangerous.

Pancreatic juice will flow from the break in the pancreas into the abdominal cavity and corrode other organs and tissues.

If it flows into the stomach, it will cause gastric perforation and leak gastric juice.

If it flows to the intestine, it will cause intestinal perforation and leak feces.

If it flows to blood vessels, it will cause massive bleeding, accompanied by various infectious suppuration.

Patients with pancreatic leakage can be said to be close to death.

I hope that the patient Zhang Mo in front of me is not pancreatic leakage.

After a physical examination.

Xu Weiping also discovered that on Zhang Mo's right side, there were many fractures in his ribs.

Without hesitation, Xu Weiping immediately went outside the emergency room and called two nurses to the nurse station.

Together, Zhang Mo, who was in shock, was sent to the rescue room. At the same time, he chose tracheal intubation, established an intravenous channel of 18g under general anesthesia, 5 sets of indwelling needles, and rapid rehydration.

Infuse 500 ml of B-type erythrocyte suspension.

Etomidate 20 mg, Scolin 110 mg, Fentanyl 0.2 mg...

According to the abdominal B-ultrasound, the blood accumulation in Zhang Mo's abdominal cavity has exceeded 800 ml, and it is still increasing.

This proves that Zhang Mo's injury is still getting worse.

Blood pressure dropped to 70/40mmHg, heart rate 139/min.
Xu Weiping, director of the emergency department, immediately called several attending physicians from the general surgery department for an emergency consultation.
Zhang Mo's massive intra-abdominal hemorrhage, accompanied by hemorrhagic shock, already has indications for surgery.

The condition is critical, and an emergency laparotomy must be performed.

A nurse went out of the emergency room and looked outside.

There was only one child, Zhang Xiaoxiao, sitting in the corridor.

"Is that your father in the emergency room?"

"Well, he is my father." Zhang Xiaoxiao replied.

"Are there any other family members? Hurry up and call over to sign." The nurse held the surgery informed consent form in her hand and said hurriedly.

Zhang Xiaoxiao shook his head, looking confused.

"Where's your mother?" the nurse asked.

"Mom...she's dead..."

Helpless, the nurse had no choice but to turn around and return to the emergency room.

After Xu Weiping, director of the department, learned the news, he had no choice but to perform surgery in view of the critical condition of the patient.

Before the operation, propofol, enflurane, and ketamine were continued to maintain anesthesia.

When they opened his abdominal cavity, they found it was filled with blood.

During the operation, it was found that there was a 4.2mm*2.1mm rupture in the right lobe of Zhang Mo's liver.

The tear continued to bleed, and some of the blood clotted and blocked the tear.

The accumulation of blood in the abdominal cavity continued to increase in large quantities.

Doctors from the General Surgery Department urgently removed the blood clot from the liver tear, and performed hemostasis and sutured the tear.

Because the patient's closed cavity is opened, the already low blood pressure and hemoglobin become extremely unstable.

In addition, after Zhang Mo was injured, he didn't get treated in time, but instead ran around holding Zhang Xiaoxiao, which made his injury even worse.

The difficulty of stopping the bleeding and suturing the tear has also greatly increased.

A general surgeon packed gauze into Zhang Mo's obvious bleeding area, then raised his head and said:
"No, the patient's bleeding is too severe, and hepatic vein has ruptured and hemorrhaged. In such a severe hemorrhagic shock, we should simply close the abdominal cavity, put him intubated, and transfer him to a higher-level hospital for rescue!"

Transfer to a higher-level hospital! ?

This is the best tertiary comprehensive hospital in Jiangzhou City.

If you want to transfer to a higher level, you can only transfer to the provincial capital.

And Jiangzhou is hundreds of kilometers away from the provincial capital.

Driving at the fastest speed will take at least four or five hours.

For patients with such serious injuries and such critical conditions, Xu Weiping, director of the emergency department, believes that there is no condition and time to transfer them to higher-level hospitals.

Moreover, this will delay the rescue timing on the contrary, resulting in the possibility of death of the patient.

Another front-line general surgeon also said solemnly:
"Continuing to bleed like this will only aggravate the condition, and the heart rate of the injured has dropped drastically, which means..."

Speaking of this, he paused before continuing:

"This means that the patient will soon suffer systemic multi-organ failure, and I think the chance of successful rescue is very low!"

Xu Weiping, a front-line emergency physician, has encountered patients with liver rupture and inferior vena cava rupture before.

He believes that the key lies in rehydration!Blood!

He has also rescued the same critically ill patients before.

You can't just think about transferring him to a higher-level hospital.

As a doctor in the emergency department, he must have a strong sense of responsibility. When encountering critically ill patients, he must do his best and do everything possible to rescue the patients.

but.

Patient Zhang Mo's blood pressure continued to drop at this moment.

Heart rate also dropped from 129 beats to more than 60.

The general surgeon ordered: "Quickly replenish fluids."

"20 mg of dopamine, plus 50 mg of metahydroxylamine intravenously, half a bottle of fentanyl..."

5 minutes passed.

The blood pressure of the injured Zhang Mo could not be measured.

Department Director Xu Weiping hurriedly ordered: "Add another two milligrams of dopamine intravenously and 5 milligrams of imidazole..."

Continuous rehydration did not bring any results.

"Dexamethasone 30 mg, hydroxyethyl starch 1000 mg, balancing solution 1000 ml, epinephrine 0.1 mg..."

Xu Weiping wiped the sweat from his forehead.

The nurse called Bing, and from the moment the patient Zhang Mo was sent to the emergency room, she never stopped.

Measure blood pressure again.

50/19mmHg, heart rate 100 beats, sinus electrocardiogram.

After using a large amount of vasopressors, Zhang Mo still showed a downward trend in blood pressure.

Xu Weiping, the department director, was a little flustered.

Because of large doses of vasopressors, it is also possible to accelerate the patient's death.

"Not good, the injured person's pupils tend to be dilated." A doctor said quickly.

"Quick, add 0.1 mg of epinephrine and 1 mg of atropine, every 5 minutes." Xu Weiping said again.

Then, Zhang Mo suffered ventricular arrest, and his life repeatedly fell into extreme crisis.

Drip—drip—drip—drip—

ECG monitoring turned into a straight line.

Zhang Mo's breathing and heartbeat stopped, and multiple organs in his body failed.

No matter how hard the doctors tried to save him, in the end, a life passed away before his eyes.

After four and 10 minutes of hard work, finally, the doctors gave up.

(End of this chapter)