godfather of surgery

Chapter 468
The AB blood of the last 8 units of the blood station is being sent to Sanbo Hospital. Follow-up, it will take some time to start emergency procedures and call family members and volunteers to donate blood on the spot. At present, only these 8 units can be used for rescue.

"This is the driver, and there is a student next door. Both of them are seriously injured. Director Han said that you need to take a look at them."

Dr. Lu briefly introduced the condition. Whether these two patients can be saved depends on Yang Ping. Others do not have such a fast speed.

At the gate at the end of the corridor of the emergency operating room, there were two policemen standing. The female driver was suspected of drunk driving and rushed directly into the crowd without any braking action. The first time she ran into the crowd until she was blocked by an obstacle, she reversed the car and went crazy Speeding up, crashing into another group of people for the second time, and choosing places with a lot of people to rush, has been suspected of committing a crime.

After understanding the situation, Yang Ping quickly browsed the CT images on the screen. The abdominal cavity and pelvic cavity were in a mess, and many large blood vessels should be ruptured. If the temporary conservative treatment is to rely on blood transfusion to resist shock, the blood volume balance cannot be maintained. The fixed frame maintains the pelvic volume, but it still cannot maintain the volume balance, and the pelvic cavity is now full of bleeding points.

If the interventional department is invited to do interventional embolization, there is no way to embolize so many places, and the time is too late.

The fastest and most effective method is the interventional aortic balloon occlusion technique.

Puncture from the femoral artery that is still intact on one side, send the balloon into the abdominal aorta, and then expand it in the abdominal aorta to block the abdominal aorta, almost all the bleeding below this level can be blocked, and the bleeding is greatly reduced.

It can even send the balloon to a higher position to control bleeding, cooperate with blood transfusion and fluid replacement, temporarily stabilize blood pressure, and buy time for surgery.

This operation can be completed in 2 minutes.

The plan quickly took shape in his mind, and Yang Ping immediately ordered:

"Prepare REBOA!"

REBOA, resuscitative balloon occlusion of the aorta!
After hearing Yang Ping's order, Dr. Lu immediately took out the resuscitative aortic balloon occlusion kit from the locker in the operating room.

These are always available in the emergency operating room, but no one can use this technique as skillfully as Yang Ping.

At this time Director Ouyang and Lao Jin had rushed over, Yang Ping handed over the wounded to them, and took Song Zimo and others to see the student next door.

"You do REBOA first!"

Yang Ping explained, and immediately came to the No. 2 operating room next door.

The emergency department now has 6 operating rooms, all of which are multifunctional operating rooms integrating inspection and surgery.

"Hemorrhagic shock, comminuted pelvic fracture, comminuted sacral vertebral fracture, bilateral femoral shaft fracture, multiple rib fractures, hemopneumothorax, mediastinal hematoma, lung rupture, severely comminuted pelvis, blood pressure cannot be maintained——"

The emergency doctor in charge of this patient reported the condition to Yang Ping.

"This female student, a high school student, and the driver just now are the most seriously injured."

Dr. Lu followed again. He was the doctor in charge of first aid at the scene, and he had to report Yang Ping's condition at any time.

The pictures on the screen were swept away, and Yang Ping immediately made a judgment that this patient's condition was very similar to the one just now, and they were both on the verge of life and death.

"REBOA!"

Without waiting for the emergency doctor to do it, Xiao Wu directly took out the REBOA kit from the cabinet and opened it. Yang Ping and Song Zimo had already put on gloves, and Song Zimo was his assistant.

Puncture, insert the cannula, and send the aortic blocking balloon in the deflated state from the cannula.

In Yang Ping's mind, based on the patient's height, the CT scan image, the proportion of the image, and the amount of bleeding in each part, he quickly judged the precise anatomical position of each segment of the injured patient's aorta and the height at which the balloon should be delivered.

The action is fast, the balloon is sent to the appropriate position, and it is opened immediately. The opened balloon instantly blocks the lumen of the aorta, just like running water closing the main valve, and most of the bleeding is controlled in time.

But this is only temporarily blocking the bleeding. If the injured are to survive, blood needs to be replenished to maintain the perfusion of vital organs in the body. Sufficient blood is needed to transport oxygen.

In this window period, we must seize the time for surgery to achieve real long-term hemostasis, so that the injured can hope to survive.

This kind of operation is nothing more than a race against bleeding.

If the hemostasis and blood transfusion are completed before the organ collapses due to massive blood loss, everything can be reversed; if the hemostasis and blood transfusion are not completed before the organ collapses, once the ischemia and hypoxia of important organs cross the critical point, an avalanche will immediately occur and failure will occur. Will be powerless.

"Continue to transfuse! Swipe your hands and go to the stage. I'll go to the next door to have a look, and I'll be here soon."

Next door, Dr. Jin and Director Ouyang were puncturing and inserting the aortic balloon, but because they were not accurate enough in judging the position, they pushed it up bit by bit, and the balloon was expanding accurately.

"Low! Go up, go up!"

Yang Ping simply went up by himself and sent the balloon up about fifteen centimeters before expanding the balloon.

"You guys make this one, I'm going to be next door."

Yang Ping came here just to help insert the balloon to complete emergency hemostasis.

When Yang Ping returned to No. 2 operating room, Song Zimo had already completed the disinfection and preparation of the thoracotomy. They all had full surgical authority and did not need the assistance of the thoracic surgery department at all.

The director of the Thoracic Surgery Department stood at the door, just glanced at it, and saw that Yang Ping and Song Zimo were performing the surgery. He didn't say anything, and changed the target of the consultation.

With these two buddies here, what kind of thoracic surgeon is needed.

"After the chest is processed, the pelvis and bilateral femoral shafts will be done later. The pelvis needs to be reconstructed with steel plates, and the bilateral femurs need interlocking intramedullary nails—"

The emergency operating room has a complete set of spare orthopedic equipment, from the spine, pelvis to limbs, several large boxes full, which are used at this time, and soon, several metal boxes wrapped in sterile sheets are pushed over.

"Right-angle vascular clamp!"

Yang Ping took the vascular clamp, found that it was a curved forceps, and immediately reminded the equipment nurse.

"Where is Su Yixuan, quickly call Su Yixuan!"

This kind of time-saving operation can determine life and death in a second.

Yang Ping needs the best assistants, the best equipment nurses, and the fastest operation speed.

At this time, there is no scruples about other people's face, and the simple and direct communication method is the most effective.

"coming!"

A familiar voice, a tall and straight figure, at the door of the operation, Su Yixuan has already walked in with her hands raised, and she has finished brushing her hands.

So timely!
Seeing this scene, the equipment nurses on the stage had to silently give up their positions and wait for dispatch.

Immediately afterwards, Zhou Can, the itinerant nurse, and Fatty Liang, the anesthesiologist, took their place to replace the original itinerant nurse and anesthesiologist.

"The muscles are not relaxed enough, and the abdominal muscles are too tense. Later, I will use the rectus abdominus approach." Yang Ping told Fatty Liang in advance.

Fatty Liang made an OK gesture, and immediately increased the dosage of muscle relaxants to relax the injured's muscles and facilitate the retraction and exposure.

"Not enough blood! Why hasn't it come yet?"

Fatty Liang glanced at the data on the monitor.

The blood that has been sent has been transfused, and the last 8 units have just arrived at the blood bank. The emergency nurse has already gone to collect it, but has not returned yet.

"Now there are only 8 units of suspended red blood cells in stock! The wounded next door is also type AB, so we can only allocate 4 units to us. We must wait for the follow-up!"

Zhou Can quickly grasped the situation, and she has been urging the nurse who took the blood.

Depend on! 4 units, Yang Ping cursed in his heart.

Not enough, far from enough, 8 units are not enough, let alone 4 units.

8 and 4, although there is only a difference of 4, but sometimes it hovers around the critical value, and if you push it, it will live, and if it is almost, it will disappear.

"Bring all 8 units, all of them!" Yang Ping ordered Zhou Can, and went into surgery again.

Fatty Liang quickly estimated the accumulated bleeding, the blood that was being lost, and the blood that needed to be replenished.

4 units definitely won't work, but 8 units can push the wounded away from the critical line. He understands why Yang Ping insists on 8 units. This is a question of the critical point of life.

"8 units! Quick!"

Now that the chief surgeon had given the order, Fatty Liang and Zhou Can were given the order to stimulate the blood.

The nurse who took the blood returned to the No. 2 operating room. The 8 bags of suspended red blood cells were piled up on the cart, and Zhou Can pulled the entire cart over.

The nurse who took the blood was very embarrassed: "Dean Sun said that the distribution is even, 4 units on each side."

In other words, only 4 units are given here, and 4 units will be sent to No. 1 operating room next door.

However, if the 8 units of red blood cells are used separately, one of the two seriously injured patients will not survive. If they are used intensively, this student still has hope.

"Let's leave it here. If there is any problem, Director Han will communicate with Dean Sun!" Fatty Liang grabbed the handle of the cart tightly.

Fatty Liang didn't dare to delay, so he withheld blood from 4 units and immediately reported to Director Han.

Director Han was nearby and soon appeared in the operating room.

"How's the situation?" he asked.

Yang Ping buried himself in the operation: "I'm pulling back. There is no blood. The 8 units are very reluctant, and the 4 units can stop now."

"I know the situation, Ouyang and Ah Jin next door are holding on, saving one is one."

Director Han circled around the operating table, but couldn't see anything.

The two of them chatted like this, chatting like this.

Perhaps the nurse who just took the blood also reported to her head nurse and the director of the emergency department, and Dean Sun ran to No. 2 operating room.

"Old Han, you are so confused. With only these 8 units of blood, isn't the average score enough?"

Dean Sun anxiously persuaded Director Han.

He is an old man in the officialdom, and he has his own considerations. Now the two wounded are both type AB, and both are seriously injured. If they are distributed equally, they will be impeccable in terms of ethics and procedures. As for whether they can be rescued, it is another matter.

But once the blood of these 8 units is separated and used by one person, who will it be collected for?

No matter who it is concentrated on, no one knows, and nothing happens; once someone pursues it, and it goes online, it will be a big trouble.

If it is given to students, some people will say that although the female driver is suspected of committing a crime for drunk driving, she is still a life. Why should students be given priority and where is humanitarianism?

If it was given to a female driver, the student is innocent, okay, he was seriously injured by this drunk driver, why should he share the life-saving blood equally with her.

"It must be divided evenly! The driver's family and the student's family are all outside. There are also a large crowd of reporters. The commissioner of the city government is also outside to supervise the rescue. The female driver's family also invited a professor from Nandu Fuyi. We are rushing over to support the rescue! We can't make any mistakes in the procedure." Dean Sun still had a persuasive tone.

The implication is that as long as the program is correct and you can't find any faults, you will be fine. As for whether these two can be saved, it depends on luck.

These days, when doctors are tired and drink a bottle of glucose, some people go online.

Director Han said slowly: "Critical is the priority! According to the unanimous evaluation of several of our experts, the wounded is the most critical and needs these 8 units of blood the most. Those people outside are not doctors. They came to the stage to perform surgery?"

"You? Old Han, what should I say about you?"

Dean Sun was furious. Dean Xia went out for a meeting. He is now the number one person in charge and must take responsibility.

Director Zhao right next to him said, "Well, Dean Sun actually meant the same thing. Now this student needs the blood the most in terms of his condition, and the limited resources are for those who need it most. There is still blood in the back. The blood station is trying to find a way Well, just wait a minute, isn’t it just 8 units of blood, what a big deal.”

Dean Sun had no choice but to acquiesce.

"I'll take a look next door, you're busy." Director Han turned around and went out again.

Fatty Liang stared at the bags of blood, for fear of being snatched away in the blink of an eye.

This is something you can't help, sometimes you have to choose.

For example, in the graded treatment of emergency patients, red patients are given priority, which is also a medical choice.

Because the red patients have unstable vital signs and will die if they are not rescued, the yellow patients can wait a while, and the green patients are fine.

Sometimes, two lives are at the forefront, and only one can be saved. Whom to save is a choice between the two!

Very cruel, but must also choose!
(End of this chapter)