Many diseases are like deaf and mute marriages, especially some traumas. It is equivalent to a group of people carrying the bride, spreading her legs, and sending her directly into the bridal chamber. As for the next step, it depends on whether the groom has seen the world. Wrong way.
Hospitals below the third level are like a young man who can get excited for a long time when he sees a male and female donkey fighting. Such hospitals have the right to refuse this disease. After all, there is a difference between real guns and live ammunition.
As for tertiary hospitals, especially key tertiary hospitals in a province, no matter what you encounter today, you can hardly open your mouth and say, it's too big to handle.
Most trauma surgeries, life-threatening trauma surgeries, are like this. After being sent in, the doctor's ability is directly linked to the patient's life.
At this time, it is a matter of hard work, both for the patient and the doctor.
Sometimes patients don’t even have time for anesthesia, let alone various related examinations. The disease at this time is like a man showing his hairy legs, pointing at the hair on his legs and asking strangers to guess his name. It is really embarrassing.
For example, during this operation in the middle of the night, Ma Yichen could only judge the possible injured organs from the entrance of the meat skewer. But he couldn't figure out which one it was. Sometimes this kind of guess that could not be accurately judged was actually not much different from not knowing anything.
It's like guessing the father of a child through the belly. This guy only knows that the woman is pregnant, and the rest depends on God.
"Raise the indoor temperature, transfuse blood, and increase the amount of crystalloids."
Zhang Fan glanced at the anesthesia while giving oral medical orders to the tour.
The director of the anesthesiology department nodded to Zhang Fan. If there is any department in the hospital that has the most cost-effective improvement, then it must be the anesthesiology department in the operating room.
In other departments, if they want to improve a little bit, they have to spend real money on it. Some departments, such as obstetrics and gynecology, even know how to lie down and ask for money. As for the anesthesiology department, due to the increasing number of surgeries in the hospital and the cooperation with experts from all over the country, the style of surgeons from the north and south can now be handled by the Anesthesiology Department.
Lower the blood pressure and heart rate, and then Zhang Fan starts the operation.
The gauze stuffing is very simple. Make a piece of gauze into a ball, find the place where the blood bubbles are coming out, and stuff it down. It is just like a girl stuffing something into her underwear. They are all spherical objects.
When it's desirable, it's different.
This thing stuffed into underwear will be slowly taken off when someone is gentle, and it will be pulled out immediately when someone is rough. During the operation, this thing should be taken out while pressing, and the two hands should alternate with each other.
This is to prevent bleeding.
"Fishing line! Double line!" The equipment nurse quickly pulled out two silk threads, and the needle holder clicked to lock one end of the silk thread. With a snap, the needle holder was placed in Zhang Fan's hand.
The fishing line is not really a silk thread for fishing, but one end is long and the other end is engaged with the needle holder. This is to facilitate knotting inside the abdominal cavity.
Then, Zhang Fan followed the gap in the gauze, stretched out a finger, and inserted it into the warm gauze soaked in blood.
Then, use force again to let your fingers pass through the gauze layer, and then close your eyes. This time, it is not about entering the system, but relying on the feeling transmitted by the fingertips.
The sensitivity of a surgeon's fingers is generally invisible, and some doctors may never use it in their lifetime, but top doctors may often encounter surgeries that require sensitivity.
Of course, the hand care of top surgeons is not as abnormal as that of a piano player. In most cases, this can be used as an excuse not to wash the pot.
The pad of his middle finger slowly moved toward the hepatic portal vein, and Zhang Fan felt the direction of blood flow.
If it is hepatic portal vein bleeding, you can feel an oncoming blow from this direction when your fingertips are in the gauze group, like the feeling of being peed on your hand, with impact, and the temperature is slightly higher than the gauze. This kind of judgment must be accurate and cannot be specious. If you say something like hepatic portal vein rupture, the assistant on the operating table will throw down the surgical forceps and strike for you.
For this kind of surgery, the surgeon can hardly say
Suspicious statement, otherwise the assistant would not know whether he should cooperate next. If the surgeon cannot make a judgment, he will ask a superior doctor to help make a judgment.
After Zhang Fan put his fingers in, it only took about ten seconds to close and open his eyes. Men are naturally more curious about things with holes. When he was a child, he put his fingers into the cracks of the earth wall and let the earth scorpions bite him. There are many boys.
However, relying on the sensitivity of the fingertips, it is estimated that even a craftsman may not be able to do it well, and it has to be done in a short time and in a hurry. Therefore, if you want to surpass most doctors in this thing, medical treatment, you really have no talent. No.
"It's not on the hepatic portal vein!" After Zhang Fan finished speaking, he immediately added, "Inferior vena cava." Ma Yichen was stunned because this pierced a thicker blood vessel.
This method of judgment is unconventional. According to the conventional method of judgment, that is, the method of ordinary doctors is: first ligate the blood vessels around the liver portal, and then make a comparison to see if the bleeding volume is reduced, and then move it Move the liver to see if the bleeding will worsen. The only advantage of this method is that it is easy, and any general surgeon who can perform ligation can make the judgment.
Of course, there are many shortcomings. If the doctor is slower, the patient will bleed before the ligation is completed.
Moreover, rupture of large veins and arteries is extremely prone to air embolism, with a mortality rate of over 90%.
When many people go to get an intravenous drip, the nurse will take the medicine and squirt it into the ground to expel air. Of course, this amount of air does not reach the amount of embolism. A few small bubbles enter the blood vessels, and the blood can directly dissolve the air.
However, it is also to prevent accidents, so sometimes, it is okay if a few air bubbles enter the blood vessels during the intravenous drip. You don’t have to hold the nurse like an eagle catching a chicken, pinching the neck of others and insisting on giving them. You suck it out.
But the big blood vessels are different. This kind of embolism is no different from fat embolism. It enters the heart, myocardial infarction, the brain, cerebral infarction, and the lungs. Therefore, when he heard that it was the inferior vena cava, Ma Yichen felt that it was over and he was going to be on the stage today.
"Extended incision!" Zhang Fan's tone began to become more serious.
The scalpel was extended directly along the incision in the middle of the abdomen, upwards, and directly to the chest. The patient on the operating table felt like a new pig in a butcher's shop, almost being divided into two halves.
"Don't touch the liver, lots of gauze, hurry!"
The hospital gauze is actually placed in the pot before entering the operating room.
It is just like the old-fashioned large aluminum pot for steaming steamed buns at home. It is estimated that no one younger than me has ever seen this kind of pot.
Because it requires high-pressure sterilization, the gauze is put into a pot for high-pressure sterilization. If it is not used within 12 hours, or cannot be used up, regardless of whether it has been opened or not, it must be high-pressure sterilized again when it is used again. Therefore, sometimes many people think that dressing in the hospital is no different from dressing at home.
Why don't you just apply some iodophor and cover it with some gauze? A skilled person can make it more beautiful than a rough doctor. In fact, no, with only sterile conditions, it is impossible to achieve the level of a hospital at home. After all, no one is rich enough to buy a big pot of pressure-boiled gauze just for a wound.
The three circulating nurses held the pot, like waiters serving food in a restaurant, opening the lid one after another, and then poured the gauze on the instrument table.
There was no time to clamp it with oval forceps.
Zhang Fan pressed the liver with his hand while continuing to stuff it with gauze.
Pressing the liver is to prevent someone from trying to open the liver to find the bleeding point. This is quick, but if the liver is opened, a large amount of air may enter the inferior cavity muscles, and then the bleeding point will be found and the patient will be killed directly.
"Cut all blood flow?"
Ma Yichen asked. He already had the needle holder and suture in his hand.
"No, it's too late. Zhang Yuan, we need a blood transfusion. The hematology department only prepared 500 of type B blood tonight." Director Huang from the anesthesiology department directly interrupted Ma Yichen's question.
This kind of suturing must first cut off all the channels of the liver, from top to bottom, with the top coming from the lower cavity and the bottom coming from the intestine. After blocking, the liver will then be opened and sutured under direct vision.
combine.
Suturing small blood vessels and suturing large blood vessels are two different things.
Small blood vessels, especially blood vessels without names, are often ligated with a few needles. The so-called blood vessels with names are probably blood vessels that are about as thick as an oil pen refill.
In terms of thickness, this is a way to express the importance of the blood vessel system. Just like men, they are afraid of being called thin by others, especially women, because if they are too thin, they will be abandoned. The large blood vessels need to be sutured in three levels.
When Zhang Fan heard this, he didn't have enough blood.
"Go and ask the Tea Center Blood Bank."
Before the roving nurse picked up the phone, she heard Lao Chen outside the door, using the intercom to ask the roving nurse, "When you have time, please tell Zhang Yuan that Ms. Zeng has gone to the hospital with several bosses from the High-tech Zone. .
They fully support it. If they want money, they will provide money, if they want people, they will provide medicine. "
"Organize blood donation in their high-tech zone." Zhang Fan was stunned for a moment and said quickly. He was really dozing off and hit the pillow.
In big cities, central blood banks often store more blood than key hospitals, but this is not the case in small cities, especially in China. The development of Tea Su Hospital not only killed a group of certain hospitals, but also the epidemic prevention station and other tertiary hospitals were swallowed up. As for the blood bank, it was not to mention.
The people from the blood bank have no one to treat them to dinner now.
Among all medical units, in terms of leisure and reputation, the Central Blood Bank can definitely be ranked among the top three.
In particular, some directors of blood banks have almost never had a meal at home, because there are too many people using blood, and not everyone has a blood donation certificate within three days. At this time...
Ms. Zeng's words to Zhang Fan were quite polite, as if she was advancing and retreating together with Zhang Fan and the others. But outside the operating room, I almost pointed my nose at a leader who couldn't raise his hand during a gastrointestinal meeting.
"Our employees were beaten to critical condition for no reason. Do we investors still dare to invest? How did you guarantee it in the first place? Leaders, please be careful and create something good for us. Environment!」
The leader's face was livid. One side was angry, and the other side was angry. He was so bullying.
