When looking at the medical industry, it is easy for outsiders to have a sense of low-key luxury and connotation. For example, when the director is making rounds, he stands in the middle of the crowd and makes some slight body movements.
Then he amiably explained the key points of the patient's treatment to the young doctors around him, occasionally popping up a foreign word that he had barely heard before, especially the middle-aged male director, whose deep and deep voice was really charming.
But for the young doctor standing next to the director, it was so easy! For doctors, this thing is definitely not low-key, luxurious and connotative, but really something that can be used once you see it, and it will be useless once you get started.
For example, those in cardiac surgery are the most obvious ones. In cardiology, everyone can explain the working principle of the heart more eloquently than the other, from electrophysiology to cell thresholds, from the entry and exit of sodium ions. Talk about the state of heart contraction.
It is easy to get started. There are only three people in the hospital who can beat their chests and say that I am the most efficient at performing cardiac puncture! The simplest is cardiac puncture among the five major puncture procedures. This is clearly required by the Ministry of Health's syllabus for intern doctors. must be mastered.
But let’s go and see, which medical school in Manchuria dares to let interns do this work? The result is that every time this class comes, the students are so excited that they are all excited, as if they can finally see each other. It is a sword manual that has been used to ward off evil spirits for a long time in the world.
As a result, during class, the teacher said lightly, I won’t explain this chapter in detail for everyone’s self-study. Real Nima is very similar to the biology class in junior high school. It was about to teach the anatomy of men and women. The beautiful teacher actually said that the students should go home after class and see for themselves.
Nima, see for yourself what I want from your teacher? Did I pay the tuition fee to study on my own?
In fact, this thing is really difficult. If you do an abdominal puncture, the worst result is to give someone a shot in the bladder, and the most is to make the person urinate blood for a few days, making the old man with an enlarged prostate suddenly feel like himself. It’s just an illusion that I’m having my period.
But if the heart is not good, if the force is not strong enough, if the needle is inserted too deep and pierces the muscle layer of the heart, this is not a joke that can be solved with a few toilet paper, it can kill people.
In the operating room of the Children's Research Institute, Zhang Fan and Old Man Jiang have separated the child's circulatory system. It's like a drum washing machine placed next to the operating table, with double barrels.
The blood entered the extracorporeal circulation machine, and the child looked like an alien, covered in wires.
Especially for infants and young children, their bodies are covered with wires and tubes, and then there is a big bloody hole in their chests. Really, the more you look at it, the more distressing it becomes.
At this time, Zhang Fan and Old Man Jiang have no time to worry. They have now reached what can be said to be the most critical moment.
"We must lower the temperature and perform smooth brain perfusion, otherwise the brain will be damaged. The child is too young. We can't even judge whether it is damaged or not. Zhang Fan, please cool down!" Old man Jiang looked at the beans on Zhang Fan's forehead. Big sweat beads said something.
To be honest, Zhang Fan, who has not opened the secondary extracardiac system, can do very well in surgery, but at present, Zhang Fan can only say that he has a pair of golden hands, but lacks a brain that is fatal to heart disease. .
His amount of extracardiac surgeries and knowledge are not enough.
Cooling, cooling on the operating table, to be honest, this thing is a double-edged sword.
The human brain tissue is extremely sensitive to ischemia and hypoxia. At normal temperature, the brain can withstand ischemia for five minutes, which is also the treatment window of cardiopulmonary resuscitation. If it exceeds five minutes, brain damage will definitely occur.
Therefore, when rescuing people who are not in the medical field, once they find that the heart of the person who needs rescuing is not beating, you should not think about taking advantage of others by opening their mouths and blowing air into them. You should first find a way to make the heart beat.
Regardless of whether it is passive or active, as long as you can make the heart beat, it is a success. First of all, you have extended the resuscitation treatment window for rescue.
In brain tissue, 40% of oxygen consumption is used to maintain cell integrity, and 60% is used for the conduction of nerve impulses. This is why people will experience some hallucinations when the concentration of carbon dioxide is too high.
Because at this time, the brain is actually like a migrant worker who is not paid enough. It looks like he is working, but in fact he is fishing.
The current surgery requires the whole body to stop circulation for ten minutes, ten minutes, not to mention other organs, but the brain is not willing.
What to do, lower the temperature. Every time the body lowers by 10°C, brain oxygen metabolism decreases linearly, just like the intersection of the two functions. When the body temperature reaches 13°C, the safe period of cutting off the supply can reach 29 minutes.
Of course, if the body temperature continues to drop, the safe oxygen consumption metabolism will continue to decrease, but the side effects will become more and more serious. First, the brain is willing, but the heart will not be willing. At this temperature, the heart may not be able to sleep at any time. Or the blood vessels may become clogged.
This is why many elderly people develop cardiovascular diseases when winter comes.
This kind of cooling is very troublesome and requires corresponding equipment, such as a special water bath. Cooling the patient is not just like buying a piece of meat and throwing it in the refrigerator. This requires a constant water bath.
And it must be done after extracorporeal circulation is started. This cooling time is very slow, and sufficient cooling is maintained for at least thirty minutes. Current experimental data clearly confirms that sufficient and uniform cooling requires at least 75 minutes.
When cooling down, an opening must be made in the large blood vessel on the other side to inject warm blood retrograde and anterograde.
What does it mean? To put it bluntly, while bleeding to cool down, a little warm blood must be injected to ensure that the neurons and internal organs in the body will not be frozen.
This kind of surgery is particularly troublesome. It requires cooling down while maintaining a small amount of body temperature and body temperature. When the temperature is high, the brain becomes active and excited. When the temperature is low, other internal organs and neurons will die again.
Really, to be honest, if nothing else is said, just cooling down and raising the temperature is enough for a doctor to study for a lifetime.
This kind of surgery, not to mention Chasu, has only been done a few times in the entire northwest.
"What should we do now?" Zhang Fan asked Old Jiang directly without any nonsense.
Old Jiang was slightly stunned, and cursed in his head: Bangchui! But he still started to say: "Do you have a constant-temperature water bath?"
"Yes!" The director of the Children's Research Institute nodded in reply, and then asked his doctor to push out the water bath. This thing is somewhat similar to an electric incubator for hatching chicks.
"Is there a bedside tester?" Old Jiang swallowed and spit!
"There should be EEG and somatosensory point detection, right?"
"Yes, if you need European standard or American standard, we have three sets!"
“It’s best to also have a jugular vein oximetry balloon catheter temperature detector.”
"Yes, a toddler version!"
The more Old Jiang talked, the more surprised he became. Finally, he wiped his sweat and asked tentatively: "Is there a non-invasive transcranial blood oxygen saturation detector?"
To test blood oxygen saturation, you usually need to puncture an artery. Generally, doctors and nurses will take off your pants and stick a thick needle tube into the root of your thigh. Under normal circumstances, nurses are not familiar with this operation, and it is often performed by doctors and nurses.
The non-invasive detection actually emits infrared rays to the outer cortex, just like an electronic thermometer. This thing is effective, but this method is relatively new, so it only appeared in some high-end laboratories.
As a result, the director of the Children's Research Institute nodded shyly, "Yes, but..."
Unexpectedly, Nima Tea Suer Research Institute also has it. When Old Jiang heard this, he quickly asked: "What's wrong? Is it broken?"
The old man thought that the thing was too advanced and he let these guys ruin it.
Unexpectedly, the director of the Children's Research Institute shook his head and said: "It's not broken, it's not broken, it's just that the doctors here are not very good at using it!"
"Hurry, push it out!" These words almost sent Old Jiang away. He had wanted this instrument for a long time!
When all the equipment is set up, the child is like a fish that has been disemboweled and put into a water basin.
The only thing missing is the green onion, ginger and garlic sprouts, otherwise it would really feel like it was marinated for flavor.
"DHCA temperature management begins!" Lao Jiangtou began to call the names one by one.
"Yes, DHCA temperature management begins!" At the same time, Yang Yong from the Pediatric Research Institute repeated the old man's words, and then clicked on the switch of the instrument.
"PH management begins!"
"Yes, PH management begins!"
"Increase the dosage of halothane and isoflurane!" The three old men outside the operating table also changed the dosage of anesthesia. When the child entered the pool and the temperature began to drop, the injection anesthesia gradually changed to inhalation anesthesia. Lord.
"Doubled the hormones! Enter the pot!"
"Boy, it's up to you now. In twenty minutes, we'll see if you can seal this hole." After the old Jiangtou finished making arrangements, he took a deep look at Zhang Fan.
"Okay, let's start!"
At this time, it was obvious that the EEG and blood oxygen data were as stable as the ticks of a prostate patient, and could not be more stable.
Under the microscope, Zhang Fan began to operate. When everything was stable, to be honest, this hole, as big as a soybean, was like a younger brother to Zhang Fan.
He's just as big as a soybean. I look down on Zhang Fan so much. If you have the ability, come up with someone as big as a broad bean.
Zhang Fan didn't need help. One hand held a needle holder with absorbable purple sutures hanging on it, and the other hand held ophthalmic tweezers, pulling directly on the edge of the hole in the heart without any prediction.
Just start sewing with your hands, it's so easy, it's all in vain.
Up, down, left and right, a cross nodule was sutured out by Zhang Fan, and it was as beautiful as a small chrysanthemum growing on a child's heart. It really followed the movement of the muscles, and the small chrysanthemum opened and closed. So beautiful.
"Rewarm, infuse!"
Blood is slowly sent to the body from the postural circulator, and the water temperature in the child's bathtub slowly begins to change from cool to warm.
The child, who was originally blue like a Smurf, slowly turned pink first on his cheeks, then on his neck, then on his whole body, and finally on his limbs and lips.
Slowly, the little doll that originally looked like a little devil turned pink, and it turned out to be the sleeping Peppa Pig.
"Heart rate, blood pressure, blood oxygen, and breathing are all normal. Zhang Yuan's child has recovered. The child's electroencephalogram is also normal. Zhang Yuan succeeded!"
The director of the Children's Research Institute was so happy that he didn't even know what to say.
Something that I didn't even hope for turned out to be a perfect success. It was really an unexpected surprise.
At this time, Old Man Jiang touched the instrument beside him and muttered secretly, "What a good thing, what a good thing!"
Zhang Fan was also excited when he looked at the child's instruments. It was true. When the child could not be operated on after extracorporeal circulation, his eyes turned black. It was true.
He looked at the data and took a moment to glance at Old Man Jiang. He originally wanted to thank the old man, but when he saw the old man looking greedy to death, he smiled slightly.
