In the past, when Zhang Fan was in Fangdong Hospital, he would sometimes listen to the bragging of the sailors in the hospital during ward rounds.
"Bohai is a bathhouse!" At first, Zhang Fan felt that these people were really bragging. Is your bathhouse so big?
But this time, he realized that what the other party said was so right. Oceans and seas are really different. When China was tossing in the Bohai Sea before, it never said anything.
The navy is the navy, but when they rushed out of the Bohai Sea, they started to talk about the deep blue force. The large ships were like dumplings, one by one, and China started to talk about the deep blue.
And he also said it very carefully. We at Deep Blue are not attacking, but just to see the stars and the sea!
There's something special about tying someone up. Especially some people who are not engaged in medical care, have trauma, and are far away from the hospital. They are anxious, and then they take a thin rope and start to strangle them.
Bleeding, bleeding from small arteries and small veins. If there are no first aid items, the first thing to do is to look for a towel or other wide ones. When you can't find it, the sleeves of your clothes can also be a perfect tourniquet.
Never tie a limb with a thin rope. You won’t know whether it will die if it bleeds. If the thin rope is tied for a long time, the hospital will not need to stop the bleeding and will directly amputate the limb.
The organs of the human body are not pig's trotters. They need blood to carry oxygen, and they need to breathe.
Especially for those who have special hobbies, if they play with a weight pendant, brother, that thing is full of sponge-like blood vessels. Once it is damaged, you will not have time to cry over it.
After Zhang Fan and his assistants were tied up with wide abdominal belts, Zhang Fan could truly feel the loveliness of Mother Earth.
Damage, as there are more and more cars in today's society, there are more and more traffic accidents. Sometimes, you must not be careless.
Zhang Fan encountered a case in the hospital. A car hit an old man. The driver got out of the car and quickly checked. Hey, he was fine, and his skin was not even scratched.
The uncle was reasonable and said it was okay, and even stood up and jumped on the spot. The driver felt too guilty to give the uncle a hundred yuan as compensation.
Then the driver drove away. As a result, the old man just came home and fell to the ground in shock before he could speak.
The family members were also quick to send him to the hospital and then called the police. It turned out that his spleen had ruptured and the old man was in danger. They asked Xue Fei to rescue him. After he woke up, the traffic police confirmed and released the driver. Otherwise, it would have been a direct accident. escape.
The two wounded people, the young fisherman seemed to be quite serious, his stomach full of donated blood kept dripping down.
The person was as weak as a fish jumping onto the shore, breathing desperately with his mouth open, and he looked quite serious. Looking at the other one, there are no other symptoms except that his face is like gold foil.
For those who are inexperienced, looking at this situation, they may have difficulty choosing which one to save!
Preoperative considerations are very important in such emergencies. Sometimes, this consideration is more important than surgical technique.
Injuries caused by external mechanical energy (let alone burns) can be roughly divided into two categories: blunt injuries and penetrating injuries.
The mechanism of penetrating injury is relatively simple. During the operation, a traumatic life chain is ensured. Those who can survive will definitely not die. If they really die, they probably will not be sent to the hospital, such as a direct hit to the aorta.
The mechanism of blunt injury is more complicated than penetrating injury. Apart from other factors, the shearing moment generated by pressure is not something that ordinary doctors can easily diagnose.
This thing is like a missed cannonball. No one knows where it will hit or where it will hit.
Often blunt trauma results in systemic damage to organs connected to organs. If there was a shearing force, the left side of the abdomen was originally injured, but as a result, a hole was opened in the right kidney, which was thousands of miles away, and it was bleeding like a wronged doll.
"You take the hygienist to quickly treat the abdominal trauma, and leave the shock to me."
"Okay!" Zhang Fan's assistant director was also unambiguous.
The soldier with a face like gold foil was carried to the surgeon. The nurse took off his clothes and opened other unopened channels. The dark red blood transfusion bag had been hung up.
Even the blood transfusion bags and infusion bottles were fixed on top by circles of gauze like bandages for injuries.
While Zhang Fan was working as a nurse, he was disinfecting and thinking. When surgery is performed in the hospital, everyone seems to think that the patient goes into the hospital, is lifted onto the operating table, and then the doctor opens the stomach and cuts out the damaged organs.
In fact, this is not the case. When a patient is admitted to the hospital, the first step is to check and make a clear diagnosis. Then at the department morning meeting the day before the operation, everyone began to discuss the surgical plan.
Whether to cut it horizontally or vertically is almost always decided in advance. Some emergencies will even be taken into account.
This is why surgery patients often have many incisions made by the doctor in the area where the knife is needed. This is the scheduled incision, but be sure not to wipe it off with your hands.
But in this sudden situation with poor equipment, Zhang Fan was thinking about two things now: First, after the stomach was opened, whether the wounded person's body was strong enough to be fully explored.
Second, if after opening the stomach, the condition of the wounded person does not allow surgery under such conditions, will he be able to insist on fighting again the next day?
Within a few minutes, not even more than ten minutes, Zhang Fan had to stop thinking because everything was ready and waiting for him to perform the operation.
"Start!" Zhang Fan nodded and took a deep breath, "Knife!" A weird scene.
Just like a TV shot by a cameraman suffering from Parkinson's disease, nurse Zhang Fan and the patient lying on the operating table were shaking back and forth at the same frequency.
Zhang Fan took a knife and opened the wound in the abdomen. This operation can be broadly called an exploratory laparotomy.
The wound goes directly from the xiphoid process to the pubic bone. That's it. Maybe after exploration, another transverse cut will be needed on the left or right side.
Most people can't feel how big this kind of wound is. The feeling of incision and no incision are definitely different.
When pigs are killed during the Chinese New Year, when the pigs are hung up to remove their internal organs, the incision is particularly similar to this exploratory laparotomy.
In addition, the retractors around it were pulled so hard. Well, let me put it this way, there is no problem at all in putting a half-year-old child into this abdominal incision, let alone a human head.
Just like when you are wearing clothes, your girlfriend cannot get in. If you unbutton the clothes, not to mention one, even two can be wrapped in it. It is so wide.
Opening his stomach, blood mixed with semi-coagulated blood clots, just like some kind of duck blood being poured into a hot pot, the soup overflowed.
When the peritoneum is opened, the right side of the liver is like the mouth of a laughing child, laughing with its front teeth open.
"Sterile glass bottle!" Zhang Fan said in one sentence. If he were in an ordinary hospital, doctors and nurses might not understand what he meant.
In hospitals, as long as it is a regular hospital, few doctors encounter this situation.
But military hospitals are different. At critical moments, when there is no rear, no support, and the sky and the earth fail to respond, this kind of uncontaminated blood is the last guarantee for patients.
The assistant collected the blood congestion with a glass bottle. Although it was still unclear whether the blood was contaminated, collecting it was better than not collecting it at all.
Zhang Fan held a piece of wet salt gauze in his left hand and covered the slit in his liver, then thrust his right hand into his abdominal cavity, just like he was cooking a famous dish from the capital.
He kept pushing his right hand in and out of his intestines. Now Zhang Fan's first step is to determine whether there are other organ injuries and bleeding, and the second step is to determine whether the blood is contaminated.
There is an iron law for self-transfusion of blood. Regardless of whether it is in the chest or abdominal cavity, once the hollow organs are ruptured, the blood cannot be recovered.
What are hollow organs? The largest hollow organs are the intestines and stomach. Zhang Fan kept tumbling in his intestines.
There are rules for this tumbling. Whether the intestines are ruptured or not, the best tests are abdominal CT and X-ray, which can reveal the amount of free gas in the stomach. But there is no such condition now.
Zhang Fan's eyes were as wide as a cow's, staring at the blood in his abdomen carefully, and his ears stood up like a police dog.
Then the right hand is like a butcher washing pig intestines. Starting from the pylorus of the stomach, Zhang Fan pushed down with his right hand little by little.
What this is doing, to put it simply, is to see if there are bubbles and listen to whether the injured farts.
Older boys may have had the experience of mending bicycle tires when they were young.
A basin of water, and then turn the bicycle tire little by little through the basin. Once you see bubbles, you can determine where the tire is broken.
In layman's terms, Zhang Fan will do this again now. I squeezed the round small intestine and the large intestine bag after bag, but no air bubbles were seen, and the sound of exhaust was heard in my ears.
"It's ready to be used, ready to be filtered." Zhang Fan let out a breath. With this amount of bleeding and in this environment, he was really lucky to be able to have an autologous blood transfusion.
Being able to replenish blood from the patient's own body increases the patient's chance of survival by several levels.
"Yes!" The circulating nurse took the recovered blood and began to filter it. The six layers of gauze began to filter the blood bit by bit.
This filtering process is quite slow.
When Zhang Fan first came into contact with chemistry in the third grade of junior high school, there was an experimental class where he learned about filtration. The teacher took a liquid containing sand mixed with salt and asked Zhang Fan and others to do filtration and sedimentation.
Zhang Fan watched the turbid salt water in the flask drop by drop endlessly. At that time, he didn't know what a prostate was.
It may be estimated that men are naturally very disgusted with this kind of ticking thing. Then, without saying anything, Zhang Fan directly poked a hole in the filter paper with his little finger.
Men naturally don't like trickling water, but they like to poke holes.
Window paper, plastic foam, if you don’t believe it, take a look and give it to girls. Girls’ delicate things can be transformed into very cute things.
And boys definitely use their fingers to insert holes everywhere. This is not because boys like to destroy. This thing is innate. It is in the genes. They have been practicing and preparing for the future.
When Zhang Fan broke the filter paper with his finger, he was deeply remembered by the teacher. The chemistry teacher who was as strong as Wu Song was slapped and kicked.
While beating, I asked, do you like poking so much? Ah, do you like poking so much? Can this be stabbed? I'll let you poke me! I'll let you poke me!
Zhang Fan was beaten from the beginning to the end of the classroom. Nowadays, chemistry teachers probably won’t hit students like Zhang Fan anymore, because he has now reached the age of prostate rebellion.
The traveling nurse collects the blood while dripping anticoagulant into it. There is no need to shake it on the ship. The glass bottle has its own rhythm! Hold the bottle in your hand and it will move on its own.
After turning over the intestines, Zhang Fan still pressed his left hand on the slit of the liver, thanks to Zhang Fan's skill.
The greasy intestine is just like a fish with mucus on its body, which is quite slippery. This kind of inspection cannot be done lightly or seriously, otherwise the intestine may slip away accidentally. If it's too heavy, it may cause intestinal damage.
After touching the intestines and touching the spleen, among the abdominal closed injuries, splenic rupture ranked first. According to some data, the mortality rate of a simple splenic rupture is 10%. If there are multiple injuries, the mortality rate can soar to 50%.
So, when you get hit hard in the belly, don’t take it lightly. Go to the hospital for a check-up, it won't be too much trouble.
Why do these non-cavity organs not hurt after being broken, nor do they go into shock immediately?
Quite simply, these organs are wearing coats. These coats are just like the more expensive apples bought in the supermarket, wrapped in a layer of plastic film.
At the beginning, when the bleeding overflowed from the organ wounds, this film blocked the blood. Although the organs were ruptured, the clothes were not torn, and the brain thought that the thing was intact.
Then, like water inside a condom, it gets bigger and bigger, and then pops.
When the condom breaks, the brain and blood pressure become anxious. It feels like a roller coaster. The blood pressure can drop from 200 to undetectable.
The blood pressure dropped sharply. This was a person who was obviously fine, but he was hit, and he said with a smile that he was fine. Half an hour later, he suddenly lay on the ground, and when he touched the carotid artery, it was over, he was dead!
Blunt impact, the probability of damage to hollow organs, such as the intestines and stomach, is particularly small.
This thing is inherently buffered. The gastrointestinal tract contains a large amount of gas. Not only does it bring its own gas, but the food is mixed with various digestive juices. During the digestion process, it is directly a gas-producing tank.
Some people have such bad breath that they brush their teeth eight times a day and lose all their teeth, but their breath can still make their girlfriend vomit.
This is a problem with the digestive tract. Try taking some hawthorn pills instead of staring at the toothpaste.
The same cannot be said for actual organs. Such as spleen, kidney, liver. Among these organs, the spleen is the most vulnerable to injury.
Because this organ is not taken seriously in the human body. Just talk about the kidneys. Although there is no air buffer, people have cotton-padded jackets.
Men love to eat big kidneys. They would give two big kidneys to a bottle of beer at a barbecue stall even if they were given to the gods. In fact, what they like to eat is not the kidneys, but the cotton-padded jacket outside the kidneys.
If the fat near the kidney evolves, it may evolve into tendons. You can imagine the toughness of this fat.
The spleen is not treated so well. Not to mention the impact, sometimes the hiccups are so severe that they involve the ligaments of the stomach. The stomach is fine, and the spleen is torn open.
After turning over the intestines, Zhang Fan immediately explored the spleen. "Hey, the spleen is also ruptured!"
After exploring the spleen, Zhang Fan asked directly: "Did the urine come out?"
"Come out, come out!"
"Is there blood?"
"No! No obvious blood was seen."
"It's good to supplement potassium. Just clamp the spleen vessels!"
Before the 1980s, as long as the spleen was slightly damaged, it was usually cut off without repair. Doctors at that time realized that this thing would be useless after adulthood.
In fact, the spleen has many functions. The simplest and most useful function is to filter bacteria in the blood, which is quite awesome.
The spleen is a foodie, it also eats red blood cells, white blood cells, and bacteria! Therefore, people should not be too edible, otherwise, like the spleen, they might be abandoned one day.
"Can't you save it?"
"There is nothing we can do, the hole is too big." Zhang Fan shook his head. Cruel, really cruel, but that's what medical treatment is like. Sometimes, cruelty is to allow patients to survive longer.
"Vascular forceps!" Stuck, stuck. Like a crocodile's mouth, the vascular clamp directly clamps the spleen's inlet and outlet vascular channels.
"Repair the liver!" The organ that had already been given up was not in a hurry now.
Zhang Fan took off the gauze on his left hand and took a breath.
At first, in order to detect the surgical damage as quickly as possible, Zhang Fan did not check the liver carefully.
When he looked back at his liver at this time, Zhang Fan's face looked as uncomfortable as thousands of ants marching.
This feeling is not numbing, but goosebumps. It's trembling!
The wounded man's liver wound was not big, at most it was as big as a three-year-old child's mouth, but when Zhang Fan gently opened it with his index and middle fingers, eh! This action, well, men should understand.
Gently, quite gently, the liver, as crisp as a green apple, slowly separated.
The shadowless lamp penetrates into the wound...
