In the early 2000s, let alone in border areas, even when making calls in cities, I had to shake my head and look for mobile signals from time to time.
It seems that after the Olympics, or a year before the Olympics, the country's network suddenly became powerful. The mobile phone signal is getting stronger.
Even in mountainous areas, you can have a relatively strong signal. The network has also begun to be fully rolled out to towns and villages. In this small town with few people, China Mobile, China Unicom and Telecom are still fighting each other either next door or door to door.
The development of the Internet has also been of great help to medical care. With the rise of online consultation, for diseases that cannot be diagnosed in villages and towns, people can directly contact higher-level hospitals through the health system platform, and let experts consult through the Internet. A consultation costs 30 yuan!
General chronic diseases can also be dealt with through online consultation, but there is still no good solution for this kind of emergency, especially for life-threatening diseases, if there is no medical team tonight. Tusun Hanjiang had to go to the county seat hundreds of kilometers away, and his life or death depended on his fate.
There are doctors in rural health centers, but after several years of siphoning off the medical system, township health centers have shrunk considerably in just a few years. Doctors with a little bit of skill went to the county town. Doctors in the county town, who were more capable or younger, either went to the urban area or to the south. Small towns can no longer support surgeons. The final result of development was that township health centers became pharmacies.
There is no way to stop the loss of talent. In the end, medical treatment in small places can only be solved by going to the countryside regularly. When there are no doctors in rural areas, once an emergency occurs, it is a very troublesome matter. Then, the chain reaction is that the crowds gather towards the city faster. When asked why they want to go to the city, most people will say: for the education of children and medical care for the elderly.
Maybe this is urbanization!
Once abdominal organ bleeding is considered, the bleeding organ must be quickly found and the bleeding stopped. Abdominal organs, after being hit, are particularly susceptible to bleeding, such as the liver, kidneys, and spleen.
These organs are relatively fixed first and are very brittle. The fresher they are, the softer and brittle they are. When a car accident occurs in the city, the speed of the car is not high. After hitting someone, it seems that there is no external injury, but the person is already in shock. This situation often causes damage to the abdominal organs, leading to massive bleeding.
The surgical carts in China were all fake German products in the early years. They seemed to be manufactured by a designated automobile factory. The price was extremely expensive at that time.
Later, the policy was opened up, and Yutong Motors came to the forefront. I don’t know why, but they didn’t learn from Germany, and they took over all the technology from Maruko Country. After a few years of development, they surpassed other Chinese car manufacturers in the field of medical professional vehicles in a few years. Almost all of these professional vehicles are contracted by them, except for some designated ones, of course.
The place where meatballs are big is not good at the macro level. But in this small means and small platform, I really have to admire what they do. They are quite powerful. Everything is done very smoothly and reasonably, and it is almost perfect.
The abdominal midline incision is not a straight line. Gotta avoid the navel. Because this area is a depression, which can be regarded as a place where dirt and evil practices accumulate, it is not easy to recover after the operation, and it is also prone to infection. In abdominal surgery, this area is the focus of disinfection.
Open the skin and it will look like a thin piece of kraft paper. The skin is incised, followed by the superficial fascia. What exactly is this thing? It is actually white fat and some loose connective tissue, which are mainly walking superficial blood vessels and cutaneous nerves.
This is the advancement of human evolution. As long as there are a large number of blood vessels or nerves, this soft fat and slightly harder conjunctival tissue will almost always act as a protective layer. Without this layer of organization, you might be able to slap the opponent with blood all over his face.
"Electrosurgery, gauze." After entering the superficial fascia, the bleeding began to increase, Zhang Fan said softly. Baoyin neatly passed the things Zhang Fan needed. You have to be extra careful when passing things on the operating cart, because this platform is for emergency use after all, and almost everything is single.
After the bleeding is stopped, continue to enter. "Move faster, the blood pressure won't rise." Dr. Liu Yaowen from the anesthesiology department reported to Zhang Fan while looking at the monitor.
"Okay." Zhang Fan's already fast speed improved a step further. Although he had to be fast, he had to pay attention to the layers. The abdominal structure was too complicated.
Not to mention the internal organs, first of all, the abdominal muscle layer is very complicated. The abdominal organs are so important, and the abdominal muscle layers are layered on top of each other. In layman's terms, this abdominal muscle layer is like two doors, divided into two doors starting from the navel as the midline.
Many people think that by opening the muscles, the abdominal organs can be clearly seen, but this is not the case. To put it simply, the muscles are the doors. When the door is opened, there are also door curtains and internal walls. The so-called door curtains are the omentum.
Therefore, when entering the muscle layer, only a few organs can be seen, such as the liver, a small part of the stomach, a small section of the large intestine, and a part of the small intestine. Other organs cannot be seen.
The anesthesiologist had already warned that the blood pressure could not go up, so hemostasis at the muscle layer was very simple, with gauze compression. After dealing with the internal organs, come back and deal with it again.
Open the door curtain and you will see the wall. This so-called wall is a double-layer plastic-like film derived from the abdominal wall, that is, the belly.
This thing is like a wall that separates various organs. The peritoneum is double-layered and contains a small amount of fluid. It has many functions. The most important thing is to prevent friction and buffering between abdominal organs.
Without this structure, people cannot exercise vigorously, because once the activity is intense, the abdominal organs will rub against each other strongly, and the organs as thin as cicada wings may be worn out, and then either the stomach will be filled with blood or water. Shit! Very scary.
After opening the peritoneum, a large amount of congestion appeared. Zhang Fan took a look and said: "The bleeding is on the upper left side. It's not the liver, it's the spleen." Then he opened the bottom of the stomach and started looking for the spleen.
Because the spleen is a small organ, not much research was done in the early years. It was simply considered to be an organ that produces blood during childhood and fetus. In adulthood, it becomes an organ that degenerates like the appendix.
As the research deepened, it was gradually discovered that this organ is a very important immune organ. In the past, once it was discovered that there was something wrong with the spleen, it was removed directly. However, with the development of evidence-based medicine, the medical community has defined this organ as the largest immune organ in the human body. It has many functions, such as hematopoiesis, blood storage, blood filtration, and the most important immune function.
The shape of the spleen is an enlarged broad bean, almost exactly the same, hidden under the tenth and eleventh rib arch on the left side. The upper part covers the body of the stomach, and next to it is the pancreas.
This thing is also wearing a thin coat on the surface. There are many spleen injuries. When first injured, there are no symptoms at all. It is because of this thin coat that when bleeding breaks through this layer of clothes, shock will occur.
As soon as Zhang Fan confirmed the bleeding, he said to Baoyin: "Scalpel!" Because the position of the spleen is relatively high, Zhang Fan's incision is relatively low, and the incision must be extended upward. Generally in this case, it must be opened under the xiphoid process.
"Cut it all?" Just as Zhang Fan extended the blade upward, Lu Shuyan asked.
"Take a look and say, keep it if you can. If you can't keep it all, it's best to do a partial resection." Zhang Fan said while quickly extending the incision.
"gauze!"
"Doctor Zhang, the blood pressure has dropped drastically." When Zhang Fan opened the stomach and incised the peritoneum, the pressure around the wound suddenly decreased, the amount of bleeding increased, and the patient's blood pressure dropped significantly and rapidly.
"Increase the amount of intravenous fluid. Adrenaline and dopamine are combined with intravenous infusion to prepare for blood transfusion." Zhang Fan, who originally had goosebumps all over his body, started to sweat. The operation was not difficult, but because of the delay, the patient suffered from severe bleeding.
"Dr. Zhang, the effect is not good, the blood pressure continues to drop." The anesthesiologist's tone was so fast that he could hardly speak clearly.
"Blood transfusion. Use O-type RBC directly." Zhang Fan was really doing two things at once. He was rapidly processing the tissues with his hands, entering the spleen area while still giving oral medical instructions.
Under normal circumstances, blood transfusion cannot be easily performed even in the hospital. Today's situation is even more troublesome. First of all, we don't know the patient's blood type, and there is no time to test it. We are not a technician in the laboratory department, and the speed of ordinary people is even worse.
At this life-saving moment, time is tight and there is no room for delay. It all depends on the doctor's weighing and bold weighing. If you balance it well, it can save your life; if you balance it incorrectly, it may directly kill you!
Under normal circumstances, large hospitals have stored blood and inspected blood. But during emergency rescue, there is no way to take care of it. Fortunately, the operating vehicle is equipped with type O plasma. Otherwise, the only way to do it is to draw it from the doctor or nurse on site. In a place like this, not many people know their blood type. Only doctors and nurses know their blood type. Even if others knew his blood type, Zhang Fan would not dare to use it even if he was not a soldier or a policeman!
This is why at the critical moment, when the hospital is short of blood, the army or police directly enter the hospital! And this is an order, a non-negotiable military order. Really, for these people, the country owes them and the people owe them.
Don’t think that blood transfusion is saving lives. In fact, blood transfusion is very dangerous. Even with the same type of blood, there are many problems. Therefore, under normal circumstances, try not to transfuse blood as much as possible.
"Increase hydroxyethyl starch in the left venous channel. Give me fifteen minutes, only fifteen minutes. Quick!" Zhang Fan said loudly.
"Gauze, stuff it!" Zhang Fan was the only one in the operating cart who ordered.
"Three curved forceps. Look! Did the urine come out?" What Zhang Fan said at this time was regarded as a verbal medical order. Both the nurse and the anesthesiologist must execute it unconditionally, because the person who knows the condition best at this time is Chief surgeon.
"No urine!" the circulating nurse said neatly.
"Quick! Scissors!" Whether the spleen is completely removed or partially removed, the spleen must be completely freed because the tissues here are too complex.
The stomach, pancreas, and intestines are all in this area, and the blood vessels here communicate with each other and accompany each other. They are very rich. If the dissociation is not careful, a mutated blood vessel will come out, and it will really make things worse when the scissors are removed.
Moreover, the upper pole of the spleen is the spleen-gastric ligament. This ligament is too short, and the short arteries and short veins of the stomach are deformed inside. The separation is not clear, and a slight stretch will tear these two vessels.
"Hold the spleen with gauze. Pay attention to the ligaments here. Be gentle and don't pull." After freeing the spleen and gently holding it up with gauze, Zhang Fan specifically told Lu Shuyan.
The spleen is shaped like a broad bean. It has a door, which is a curved place on the inside. This place is where the broad beans sprout. The same is true for the spleen, where the splenic hilum is located on its inner bend, where arteries and veins run.
Start clamping one by one with curved forceps. As the curved forceps are tightened, the bleeding will be significantly reduced until the bleeding stops. At this time, it was slightly better than the previous ten minutes. This can be regarded as a disguised form of hemostasis.
"Dr. Zhang, the blood pressure has risen and it's been 9 minutes!" the anesthesiologist said specifically.
"Yeah!" Zhang Fan responded, not in a hurry at this time. How much does the spleen need to be cut to preserve its immune function? There is currently no clear definition in the medical community. However, it must be at least more than two-thirds, otherwise it will be meaningless.
All solid organs and their blood vessels are like two big trees. When it is at the door, it is a thick tree trunk, and then it begins to branch and spread out after entering the interior of the organ, and then a connected capillary network is formed at the end of the arteries and veins, one entering and the other exiting.
The arteries of the spleen generally divide into two or three parts at the splenic hilum, and then divide into secondary or tertiary levels to enter the parenchyma of the spleen. The veins and arteries of the spleen are like two brothers, holding hands and walking together.
The longest spleen of a Chinese man is only about 14 centimeters, but the blood vessels and arteries inside the spleen of an average person are 15 centimeters long. You can imagine how slender and tortuous this thing is.
After the lower pole of Tusun Hanjiang's spleen was violently hit by the deer, a hole the size of a popcorn was opened. The spleen is too fragile, and the buck is very strong. There was no chance of suturing, so it had to be partially removed.
This partial resection does not mean cutting along the wound, but depends on the blood vessels. Zhang Fan carefully distinguished which was the lower pole artery and which was the lower pole vein, and then slowly ligated them one by one.
"I'll tie the knot!" In a normal surgery, after the surgeon uses a needle holder to put the thread in, the assistant grabs the thread and ties it. But Zhang Fan was worried about Lu Shuyan. This is the knotting of blood vessels. If you use less strength and use more strength, the blood vessels will be strangled. If you use less strength, the blood vessels will not be ligated.
While Lu Shuyan was soaking blood with gauze, she was helping Zhang Fan support the needle holder. At this moment, no one would object or be dissatisfied. Just do whatever the surgeon asked you to do. This is the most basic professional ethics of a surgeon.
The blood vessels to be ligated were tied one by one, and Zhang Fan breathed a sigh of relief. "Wipe the sweat for me." Zhang Fan was so nervous that he felt his eyelids were sweating!
At this time, it is time to wait for the boundary between the area with blood supply on the surface of the spleen and the area without blood supply after ligation to appear. As long as the ligation is passed, within a few minutes, the areas with and without blood in the spleen will be particularly distinct.
One side is still red or pink, while the bloodless area on the other side is obviously pale.
"Scalpel." After three or four minutes, the line was clear. In order to ensure that the vitality of the spleen is preserved, Zhang Fan used a scalpel to cut open the coat of the spleen one centimeter away from the junction line, and then used the handle of the knife to cut into the parenchyma of the spleen.
The spleen is particularly fragile, and it is easy to damage the blood vessels with the blade. Although the handle of the knife is blunt, it is safe. Slowly form a V-shaped incision on the front and rear edges of the spleen, extending inward bit by bit.
While cutting, Zhang Fan's left thumb and index finger always held and compressed the edge of the spleen in order to fix the spleen. This can effectively control and reduce bleeding in the book.
It sounds simple, but in fact this is very difficult to operate. To put it simply, you are wearing plastic gloves, and there is grease on the gloves. Then hold the round soap dipped in water or oil. The force should not be too strong, and the soap must be fixed.
This is the skill of the surgeon's hands. Without more than ten years of training, let alone surgery, he would not be able to perform a simple hold.
Step by step, there is a small amount of blood oozing on the surface of the spleen, which is the residual blood in the capillary network. "Dip!" Zhang Fan said softly to Lu Shuyan.
Although this kind of bleeding does not require special treatment, it must be removed, otherwise it will affect the surgical field. Moreover, this kind of wound cannot be wiped. It must be dipped, gently with gauze. Wiping will not only damage the organ, but also change the position of the spleen.
"Ligate, this is a small artery. Be careful not to slip the knot." Zhang Fan held the spleen in one hand and the scalpel in the other. He found a small artery. He couldn't tie the knot, so he asked Lu Shuyan to tie it. , Zhang Fan made a special confession before tying the knot.
"Yeah!" Lu Shuyan replied and started tying the knot. Zhang Fan watched with his eyes motionless, fearing that a slip knot would appear or his spleen would be torn open. The spleen is more fragile than the kidneys. If you apply a little wrong force, it will cause a hole. This is also why the spleen is prone to rupture.
Finally, the damaged part of the spleen was removed. Lu Shuyan often breathed a sigh of relief after putting the removed spleen into the tissue bag.
This operation was too tense, and Zhang Fan's tone on the operating table was too harsh, which made her frightened. At this time, if you look at the spleen from below, it looks like a V-shaped duck's mouth, with a big mouth and a small inside.
This shape is for later stitching. The spleen is very fragile, and it is shaped like this during surgery to facilitate suturing. Therefore, a good surgeon has constructed a complete surgical process in his mind before surgery.
"I'll sew, I'll tie the knots, Dr. Lu, you cut the threads." Zhang Fan said to Lu Shuyan.
"OK."
Lu Shuyan didn't dare to tie knots. This kind of very brittle tissue requires real skill to tie knots, just like pulling a thread on a piece of paper. If it is not pulled properly, it will cause a tear.
And this kind of suture cannot use small needles and thin threads. Because small needles and thin threads will prevent capillaries from crawling and lead to ischemic necrosis. Therefore, the general surgeon who performs ordinary suturing cannot guarantee that he can perform the suturing well.
"Liver needle! Thick thread!" Baoyin threaded the needle and thread neatly and handed it to Zhang Fan. It is absolutely correct to say that there are specializations in the arts. In the past, simply threading a needle and thread seemed to be a very simple matter.
Not necessarily on the operating table. First of all, wear gloves, and when quickly stopping bleeding, you must be sure to be deft under your hands, one needle and thread every three seconds, and one needle and thread every three seconds. Therefore, surgical nurses will no longer be able to work as they get older. First of all, their eyesight will no longer work.
This kind of skill is also something that nurses have become proficient in after practicing countless times under the operating table. If you don't endure hardship and endure hardship, you won't be able to do it at all.
The incision was finally closed using thick horizontal mattress sutures with liver needles combined with interrupted sutures. What was originally a broad bean became a cone. After the suturing was completed, Zhang Fan applied adhesive to the wound to stop the bleeding.
"It's finally done!" Lu Shuyan felt relieved when she saw Zhang Fan covering the spleen with the omentum. Zhang Fan on the operating table was too cruel. The more crisis he faced, the more cruel he became. But the more responsible she became, her eyes were filled with tears when she looked at Zhang Fan!
"When the arterioles were tied, if I had torn my spleen, would you have beaten me?" Lu Shuyan saw that the operation was at the end, and she could not speak without thinking.
"Where are you? I don't want any more sterile procedures!" Zhang Fan rolled his eyes at Lu Shuyan.
"If you hit the chest, that area is considered sterile!" Liu Yaowen, an old man who is an anesthesiologist, said. At this time, the atmosphere became lively. Although everyone was talking nonsense, my heart seemed to be filled with a sense of accomplishment. I didn’t want to be proud or complacent, but it was really uncomfortable not to release it, so~~, this feeling is really beautiful. Got it!
"Rogue!" Baoyin and Lu Shuyan cursed together.
"Hey!" The old man smiled obscenely.
The operation is over!
Outside the operating cart, as the operation began, people from the Tusun Khanjiang tribe and relatives of Tusun Khanjiang's wife also learned the news.
People riding horses and holding lanterns gathered outside the operating cart from all directions. There were more and more people, comforting Tusun Hanjiang’s wife and caring about the surgery.
The township chief also came, "Everyone, be quiet and don't disturb the doctors in the car who are doing the surgery. Keep the horses away."
Before the operation, Zhang Fan asked Zhang Yanfeng from the Department of Respiratory Medicine to inform Tusun Hanjiang’s family that the situation was very dangerous. So Tusun Khan Jiang's strong wife had already burst into tears and sat limply under the wheels of the operating cart.
No matter how tough she is, she is still a woman, no matter how tough she is, she is still a wife. She kept mumbling and praying.
"Is that right? Let everyone go home. What if there is an accident~~" Dr. Zhang Yanfeng said to the township head with a little worry as he looked at the growing crowd.
"It's okay, don't worry. Adasi, if it weren't for you, Tusun Khanjiang would have died a long time ago. We are all reasonable. Don't worry, it's okay. Every spring, someone is kicked to death by an animal. He is considered his fate. Big one. Hu Da bless you!"
After the mayor finished speaking, he stood in the crowd and said: "The doctors performed the operation overnight. This is a benefactor. No matter what the situation is later, if anyone behaves badly, I will be a whip! Do you understand!"
